owned nor controlled by private individuals. All the civilized countries of the world conduct the telegraph as a part of the postal system except Bolivia, Honduras, Cyprus, Cuba, Hawaii and the United States.

As is seen by the reports of Post Masters General Vilas, Wanamaker and others, we pay an annual rental for the postal cars equal to the value of the cars. As the average life of a car is twenty years, why should we pay for them twenty times, and then not own them? Besides the rental we pay an extortionate rate (8c. per pound for an average haul of 448 miles) for the hauling of mail matter in the cars.

For the information of our readers, particularly those in your State, please answer plainly the following questions:

1. Do you favor Postal Savings Banks, and will you vote for them in Congress if opportunity presents? If not, why not?

2. Do you favor Government ownership and operation of the Telegraph as a part of the Postal System, and will you vote for the same in Congress if opportunity presents? If not, why not?

3. Do you favor Government ownership of the postal cars, and a requirement that the railroads haul them for the Government at as low a rate as they grant to other parties for a similar service? and will you vote for the same in Congress if opportunity presents? If not, why not?

A stamped and addressed envelope is enclosed for reply. Definite "yes" or "no" replies are desired to the three questions. The doctors of the country want to know how you stand on these questions. If you wish to add any remarks, they will be published if not too long, particularly if they are on the negative side. I think I can safely say that the members of the medical profession of this country are generally in favor of these questions, but they are not only willing, but eager, to consider arguments on the negative side, if there are any.

Very respectfully,

C. F. TAYLOR. On May 26th, I followed with the following postal card:

MY DEAR SIR.-On May 13th I sent you a letter inquiring your position on Postal Savings Banks, Government Telegraph, and Government ownership of the Postal Cars. I requested "yes" or "no" replies and enclosed an addressed and stamped envelope for reply. Not having heard from you, I beg to again ask your attention to these questions. I know that you are a very busy man, and I dislike to ask for even a moment of your time; but it will take you only a moment to answer either "yes" or "no" to the three questions. The doctors would like to know how you stand on them.

Very sincerely,

C. F. TAYLor.

When the replies began to slacken, I sent the following postal card :

PHILADELPHIA, June 16, 1898. DEAR SIR.-On May 13th I sent to every United States Senator and member of the House of Representatives a letter asking the position of

each on Postal Savings Banks, Government Telegraph and Government Ownership of the Postal Cars. I received a great many replies immediately. On May 26th, I sent a postal card to the delinquents. This brought many more replies. but still there are many delinquents. I do not ask because of idle curiosity, but on behalf of over 25,000 physicians in all parts of the country. I hope that you will send a reply immediately, so that we can publish same.

We will have to construe failure to reply as unfavorable to these measures, and publish a list of delinquents in our next issue. Do you wish to be announced to the country as opposed to these measures? THE MEDICAL WORLD, per C. F. Taylor.

Replies have been published in the June and July WORLDS, and a few replies received too late for July WORLD will appear below. A few have objected to the last paragraph of my communication of June 16. Below is a list of those who have failed to state their position upon these questions. Our readers can construe this failure in any way they wish. I think that if a man favors a certain measure, he will not neglect a good opportunity to let the fact be known. Hence I am inclined to regard failure to reply to the above questions as indicating that those who failed to reply are not in favor of these measures. Any who are not opposed to them can yet easily say so. Remember that we are ready to publish any arguments that those in the following list wish to give against these measures. Also our columns are still open for any late comers to declare themselves in favor of the measures mentioned above. We have taken every pains to be perfectly fair to all. Below is the list of those who have failed to reply, tho written to three times, and hence are presumably opposed to Postal Savings Banks, Government Telegraph and Government ownership of postal cars. At any rate, they are not in favor of these measures, for if they were, they would take this opportunity to push the cause along. What a pity Postal Savings Banks were not established instead of issuing bonds. Postal Savings Banks would bring to the Government perhaps enough money to conduct the war with Spain, and it will be a proud day for us when we can prosecute a war without issuing bonds. Why don't our law makers see this? Why don't the people make them see it?

Here is the list of those who have failed to reply. Names of Republicans in italic; Democrats in roman; Populists in SMALL CAPS.

America the El Dorado of the Foreign Drug Manufacturer.

Anyone who has followed the course of the recent discussion anent the patenting of antitoxin in this country, cannot fail to be struck with the manifest injustice done to home products under the specious guise of extending equal rights to all comers, irrespective of nation, creed or race. The patent laws have a manifest beneficent intent, and are mainly to encourage the development of the inventive faculty by the granting of monopolies for a time, after which the idea that is patented becomes the property of all. The copyright laws

are adjunctive to the patent laws, but grant a perpetual privilege, tho upon a differing basis. To patent an article, a description of its processes, parts, etc., must be filed at the patent office; to copyright, the process may be kept secret, but a perpetual right may be obtained to use some word or sign by which the product may be identified. Instances where this has been done in the medical profession will readily be called to mind with the names of some well-known preparations, secret in some phase or other, whether as to ingredients or process of manufacture

matters not.

Still another phase of the application of these laws has been the field it has opened to foreign drug manufacturers, who have not been slow to seize the advantage, and have for years systematically robbed the profession under the protection of our own laws. This constitutes, in the phrase of the courts, a "legal hardship," meaning a condition sanctioned and upheld by law, by and thru which certain parties may

suffer while others benefit. The manufacturers of certain synthetic drugs have been the chief offenders against the American doctor under these laws, and many dollars of "blood money," made from the necessities of the suffering, have gone to swell the coffers of some German or French chemist without a cent of benefit to any American industry or workman. These preparations have their processes of manufacture patented and their names copyrighted here, gaining every possible advantage. As they are not manufactured in this country, but entirely abroad, no American industry is developed or American labor employed. On the other hand,

secure in the protection of the law, these manufacturers do not hesitate to rob the very nation that offers them such exceptional privileges by placing most excessive prices upon their products, in some cases double and even triple what they can be bought for abroad. It can readily be seen that the dispensing of such high-priced drugs will be a serious drain upon the physician using them, while it reacts also to his disadvantage to prescribe them, as he will soon get the name of being "too high priced." Still many of these drugs are excellent, once in a while the best possible for certain conditions, seldom ineffectual; and thus the physician feels a moral obligation to use them, irrespective of any ill result to himself individually.

The latest example of the rapacity of the foreign manufacturers and investigators as displayed especially toward America, which they regard as a sort of private El Dorado, is the announced intention of Professor Behring to prosecute any and all manufacturers, purchasers and users of antitoxin other than that produced by himself or his agents, as infringers upon the patent he has finally secured at Washington after numerous rejections. The antitoxin is not patented in any other country than the United States, nor has there even been an attempt to secure one elsewhere.

Since the principle of immunization by antitoxic serum was demonstrated by Pasteur, and since Aronson and Roux have also made the same investigations as Behring, and with practically the same results, prior in time if not in announcement, it would seem that the distinguished professor might have some difficulty in legally establishing the exclusive discovery necessary to a valid patent. If the patenting can be done legally, however, without such proof, the conclusion is unavoidably forced that there must be in our patent laws some weak point, some grave defect, which should be remedied without delay.

Two points of interest in connection with the matter are the claim of leading therapeutists that the diphtheria antitoxin man

ufactured by American firms is far superior to the imported serums, and also the fact that the extension of the charity work of free supplying of the antitoxin to the poor, by the Boards of Health in various large cities, must be abrogated, or else a heavy tax paid.

In this connection, two leading American manufacturers of antitoxin have advised their patrons and the profession generally that they purpose contesting the patent, and will protect all who purchase or use their serum, since they admit neither the justice nor legality of the issuance of the patent under the conditions existent.

Medicine and its auxiliary professions should be above the line of conduct outlined as the course of our foreign confreres. That such is the opinion of not only the rank and file of practitioners of all schools in this country, but of the general public as well, is shown by the history of the discovery of anesthesia, with the train of results following the patenting of ether by Dr. Morton.

The Heart of the Doctor.

Casual examination of a recent work upon occupational mortality discloses, among other facts of interest to the profession, the fact that a fair proportion of the deaths among medical men are reported as due to some form of heart disease. The anxieties of a doctor's life, its responsibilities, hard work and enforced irregularity of habits, are all of a nature calculated to favor the development of cardiac weakness, especially those of a degenerative nature, and the usually insufficient remuneration prevents the gaining of sufficient rest to overbalance the results of the hardships. Thus the doctor wears out faster than he himself realizes, while an acquired personal indifference leads him to often ignore symptoms which in a patient would make him enjoin absolute and immediate rest.

Personally, those things do not seem to one's self of the grave import they would

appear when occurring in another, and the busy doctor is apt to think that byand-by, when things are more likely to become serious, he will call a stop. He depends on his professional knowledge to warn him, but often the danger signal is overlooked when it does come in the procrastinating feeling that by-and-by will do, and hence so often we read of the cutting off of a useful life in the midst of its duties. Keeping up the high pressure, the physician leaves the overworked heart to take care of itself, and struggles on, thinking the warnings cannot be so urgent to him as to another, doing his utmost to conceal the extreme disability under which he executes his work. At last inexorable Nature presents her account with a call for immediate settlement, and rest, enforced and unending, comes at last to the too willing worker.

A case in point is the recent death of Dr. William Pepper, of this city, a man of extraordinary capacity for work at high pressure, upon whom were resting an exceptionally large number of responsibilities and who lived at "concert pitch." Tho he died a young man, as years go (54), he yet had compressed within those years the life and activities of four-score. There is no doubt his was a useful life, but yet it might have been even more so had it been lived slower, less intensely, with conservation of vitality, as exemplified in the life of Gladstone. It may excite wonder and admiration to live at express speed, but does it pay?

Every physician should realize that the following applies to him personally: Where diagnosis of cardiac insufficiency is made, no dependence should be placed upon the patient's knowledge as a guide for him to know when to stop, since the general condition obtains that the doctor heeds his own condition less than the layman, and often continues beyond his strength for fear of being thought afraid of disease and death-the fear of a fear.

Cramps or Tetany.

Occasionally the minor troubles of humanity present more difficulty in treatment than the graver states that are dis

cussed at length in every text-book. There are certain conditions that are productive of most acute suffering, yet which, because they are not directly fatal in their effects, receive no more than a cursory notice at the hands of the medical author or lecturer. Yet these are more than likely to form the very cases upon which the young practitioner is called to make his debut; and, according to the way in which he acquits himself in these, may opportunity be afforded for the exercise of skill in more serious conditions.

Local cramp or tetany is seldom brought to a physican for treatment save as it occurs in connection with more serious manifestations. It is generally treated at home with friction or hot applications, and unless there are almost continuous spasms, the condition is not regarded as indicative of need of medical attention. It generally affects the limbs, occasionally is localized in one limb, sometimes is generalized.

It is a safe conclusion that it is associated commonly with some form of sepsis, either of peripheral or intestinal origin, and is in all probability due to the presence of some toxic product. Sometimes its occurrence can be traced directly to the presence of pregnancy, and in this case it is probably due to the effect of pressure upon an artery or a nerve trunk. This it is claimed can be proved by producing the spasm at will by pressure on the larger arteries so as to impede the circulation. It is occasionally one of the manifestations of a rheumatic diathesis. It is of grave import when occurring in women shortly after confinement, and in such case search must be made for uterine or vaginal infection, and local antiseptic treatment instituted.

The most recent treatment of the condition is by the use of thyroid extract, and this method is receiving all the enthusiastic encomiums usually accorded to the latest new thing. Still, so great an authority as Osler advocates this method, and cites a number of cases to prove his views.

It is of prime importance in all cases of tetany to pay especial attention to the general health, remedying any condition

of indigestion or correcting any diathesis that may be found. The keynote is to remove if possible any source of sepsis. With this view the bowels should be freely opened, preferably by a dose of salts or castor oil. A non-fermentable diet should be enjoined, and sodium salicylate given in liberal doses. Gowers claims that the best effect in nocturnal cramps may be obtained by giving a dose of digitalis at bedtime. This probably is on the principle that the attack may be caused by the circulation being impeded in some way, and digitalis gives an impetus to the circulation while lowering the reflex activity.

The nervous phenomena should be promptly relieved, and for this purpose in the severe cases, or where there is manifest great nervousness on the part of the sufferer, chloroform should be inhaled, or chloral given in sedative doses. Sometimes a hypodermic of morphin will relax the spasm and give ease. Locally one may apply laudanum, morphin oleate or chloroform liniment. Hot baths have been also very efficacious.

After-measures must in all cases be directed to the up-building of the system, and the use of cod-liver oil, the hypophosphites, iron, quinin and strychnin should be directed.

Malarial Hemoglobinuria.

The literature of this, one of the most serious of the forms of malarial infection, is comparatively meager, there having been but little scientific notice of its symptomatology and morbid anatomy taken before 1830, at which time it was described as a purely local affection and peculiar to the Southern States of this country. It is generally spoken of as ma

larial hematuria, a term scarcely correct, since it is claimed that in very few instances is blood, as such, found in the urine, the color of the secretion being due to the disintegrated blood corpuscles and free hemoglobin.

The general line of the symptoms closely resembles that of the algid type of malaria,

both in the physical manifestations and the gravity of prognosis. Still there are sufficient variant points to mark the distinct type. From the initial chill there is observable the most distressing nausea and vomiting. The pulse is small and feeble and as a rule quite frequent. Great prostration is present, and the patient passes considerable quantities of dark, bloody-looking urine, leading to the lay diagnosis of hemorrhage from the bladder or kidneys.

Micro

Even to the naked eye the secretion will present a broken-down and decomposed aspect. It will seem loaded with small black granular bodies and mucus. scopic examination will show disintegrated red blood corpuscles, tube casts and the presence of free hemoglobin. It is very seldom that any entire cells are visible in this condition, and when they are found they are generally adherent to the casts.

As a rule the jaundiced appearance of the patient is more intense in this than in any other type of malaria, altho it becomes modified between the paroxysms, sometimes disappearing entirely. This leads to the conclusion that the color is in

no wise due to bile pigment, but to hematin, this in turn being due to the action of the parasite upon the blood corpuscles. This view is strengthened by the fact that the yellow look appears whether the liver is active or sluggish, and seems very little if any affected by the secretion of bile. The liver is really seldom inactive, the secretion being more often redundant, and there is no bile present in the urine. discoloration of the skin so peculiar to malaria fades in the intermission of the paroxysms, and does not appear first in the eyes. It also appears with great rapid

The

ity over the entire body and disappears when pressure is made. These are all points differing from jaundice which is generally first seen in the eyes, remains during pressure, and is gradual in its development. In addition, the color of janndice is a clear yellow, of malaria a grayish yellow.

The patient generally complains of se vere pain over the kidneys and the liver,