The Mulford Laboratories, Glenolden Farms, Penna.

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H. K. Mulford Co., Philadelphia

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THE UNDERLYING CAUSE. "Tis an axiom that in the management of the sick we should always seek to determine the principal cause and, if possible, remove it. The difficulty in the practical application of this principle lies in the multiplicity of symptoms and variety of apparent exciting ⚫and predisposing factors which pertain particularly to cases of a chronic nature. While we should doubtless, whenever feasible, explain the abnormal conditions present as dependent on a single first cause, yet there is a considerable temptation to take the easiest way and jump at a conclusion, said conclusion being in line with the chief current of medical thought for the time being. For example, what dweller in the Mississippi Valley 30 years ago might not have almost any disease diagnosed as malaria and be dosed with quinin accordingly? With Koch's advocacy of tuberculin, two decades since, everybody was liable to

be found guilty of tuberculosis, unless he could prove an alibi or something just as good. Ten or fifteen years ago Haig caught the ear of the profession with his fascinating hypotheses as to uric acid being the source of about all the ills to which our human flesh is heir. Today it is syphilis which holds. the stage, to the exclusion of its rival maladies.

Even aside from the specialties, the fact of the bulk of a clinician's practice being, say, with the heart or the lungs or the stomach, will have a tendency to cause him to favor at first sight the diagnosis relating to his favorite organ. Some remarks of Richard C. Cabot are in place here: "Some years ago, when I was doing a good deal of work on the blood, I was asked to substitute as visiting physician to a convalescent home intended primarily for tired domestics and shop-girls. The matron met me with that patient and respectful expression which long ser

vice under many enthusiastic young physicians produces in some nurses. 'I hear,' she said, 'that you are specially interested in the blood. Dr. R., the gynecologist, who was visiting last autumn, found that all the patients were gynecologic. When Dr. C. visits us in summer, he finds them all nose and throat cases-that's his specialty. Now that you are to visit us, I suppose they will all turn out to be blood cases.' It must be explained that there was no election on the patients' part. They did not seek the institution because they heard that Dr. X. (a specialist in their particular trouble was on duty. They were sent there by a variety of other physicians who had no knowledge of the interests of the different attending specialists."

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Nevertheless, in spite of preposesssions and predilections, we believe in most cases it is quite within the diagnostic power of the family physician to determine what is the chief underlying cause of the patient's sickness. Especially important is it for him to detach himself from the treatment single symptoms (vomiting, headache, jaundice, glycosuria, etc.), as if they were diseases. Modern advances in diagnosis have changed our viewpoints of etiology considerably. The Mayos, for instance, have seemed to show that most stomach troubles are secondary to other abdominal conditions or to general diseases. The "uric acid diathesis" is now regarded as an effect of suboxidation, rather than as a distinct disease by itself. "Laziness" in certain southern country districts has been shown to be really a severe anemia due to the hook-worm. Insects are now known to be very largely responsible as disease carriers. "Rheumatism" is finally being divided up into recognizable entities.

As a case in point of the subject of this brief writing, consider the following: A business man of 41 had suffered nearly constantly nocturnally

from bronchial asthma for 15 years, with resulting emphysema and heart strain, and accompanied by occasional attacks of renal gravel, due to the acid. calcium phosphate crystals. The sputum was glairy and contained large numbers of the Streptococcus salivarius. An autogenous vaccine was made, and after four injections at four-day intervals (dose 10-40 millions), the asthmatic attacks practically ceased, not to return for eight months, following hay fever, when two more injections of the vaccine gave prompt relief from the dyspnea.

A SOLUTION OF THE PROBLEM.

Following the whirlwind peregrinations of the Wandering Israelite, American medical schools were cowed into the belief that, in order to fulfill the advancing requirements for a thorough medical training, medical instruction must of necessity be given in institutions subsisting on the haphazard manna of politics, or in colleges or universities supported by vast private endowments. In either event, medical teachers would be under the domination, more or less oppressive, of lay

autocrats.

Medical men (including professors, lecturers and instructors) are probably, of every class of man, by nature and training the most independent. Hence there comes a natural revolt against the cut and dried methods of over organization in their own profes sion.

Herein lies the reason why not only the American Medical Association is diminishing in numbers (34,176, May 1, 1910; 33,960, May 1, 1911), but the same may be said of a number of state societies-not to mention a certain lack of interest, as shown by small attendance at state and national meetings.

That there is a way out of the dilemma, by which independence is maintained without sacrificing efficiency, is shown by the appended letter from Kansas City. The greatly increased ex

pense of modern medical instruction lies in the primary work of the first two years, which can be done satisfactorily in any good non-medical higher institution of learning. The really practical and inspiring part of a medical education comes in the clinics and lectures of the third and fourth years, given preferably by busy men of wide practical experience. If you wish anything done promptly and well, always get a busy man to do it. Such men, each donating perhaps only one or two hours a week of his time to the college work, would rally round them enthusiastic students governed by love, not fear, and carrying with them into their professional life an eager devotion to the things that are sane and practical.

It goes without saying that the majority of independent non-medical colleges throughout the country would be inclined favorably to the plan mentioned below, and would serve as friendly feeders to the independent

medical schools.

August 31, 1911.

E. C. Hill, M.D., Editor of Denver

Medical Times, Denver, Colo.

My Dear Doctor: In all probability you have noticed in the daily press an account of the reorganization and continuance of the University Medical College, located here in Kansas City, and what our college expects to do in the future. Briefly, I would say the U. M. C. has and is making alliances with universities and colleges throughout the country whereby she will depend upon these colleges and universities for the first two years' work of a regular medical school and admit their students for the completion of their medical course, namely, the ordinary work of the junior and senior classes. In addition to this, we have arranged to give special work in bacteriology and pathology. Besides we shall have the giant magnet, radium and X-ray equipment. It is our purpose in the near future to require of our students one year of

practical work in a hospital, making our course one of five years. We will have three semesters of three months each for the undergraduate and twelve months for the post-graduate.

We have seen the officers of both the American Association of Medical Colleges and a committee of the American Medical Association, as well as the State Board of Health of the State of Missouri, who approve and indorse our plan. It is our purpose to make the school of the highest possible order and so assist in the elevation of medical sciMost respectfully,

ence.

FLAVEL B. TIFFANY. President.

VERATRIN.

The chief alkaloid of veratrum viride and cevadilla is readily soluble in hot water and in alcohol. It is irritant to mucous membranes, and large doses cause colic, vomiting and diarrhea, with general prickling of the skin. It stimulates the excretion of sweat and urine and may excite salivation. It slows the circulation and thereby lowers temperature and blood pressure. The drug is rapidly eliminated.

As a safe and certain circulatory depressant veratrin is probably unexcelled. In sthenic inflammations (except gastritis), particularly early pneumonia and rheumatism, and in cardiac hypertrophy it has proved of priceless value. Veratrum viride has long been considered a specific for the eclamptic seizures of pregnancy, but veratrin is preferable as being of uniform strength which is not lost by keeping. We have found veratrin of the greatest benefit in preventing and controlling the high tension headache and other symptoms of chronic nephritic cases. These patients get much more relief from veratrin than from aconite or coal-tar products, and with no depression or danger.

Veratrin is best given in small doses. 11⁄2 mgm. 6 to 24 times daily, as