DEAR SIR: You have disappointed me all this month and your failure to call and settle on Christmas was a very great disappointment. Now the question is, will you also disappoint me on New Year's Day? Will you begin the New Year owing this bill? I hope not-I think not. I think that you are beginning to realize your duty in the matter. I am going to trust you again; and I am going to hope

panies that breed foxes on Prince Edward Island? Big money-but not for you, unless you go up there and go into the business yourself, and then perhaps you would wish you hadn't. When you are lucky enough to have money that you do not need, don't risk losing it. Doctors are not good speculators, and those distant concerns that send alluring literature to you are speculations, and poor ones at that. Get 6% and safety, and you can do that right at home.

Tires.

Lots of money have been made in automobile tires; but you can't do it. It is not in your line of business. And the companies that have made money in this business do not send long circular letters to doctors

with this just debt hanging over your head.

5

Yours for another trial,

[NOTE. These letters will suggest what you can do this month in this way. In 1911 we had these letters printed, each one on paper of different color, and each color on a

tires at a discount or free as a bonus. This is not a good investment for doctors.

Want an Automobile?

You can get one at $5 weekly. But don't do it that way. The instalment plan is

18 of No. 3, 12 of No. 4 and 10 of No. 5, 100 in all. We sold these at $1 a set-about one-tenth what your printer would charge for printing them; they are printed in typewriter type. The plan was for each doctor to fill out with pen, sign and mail. The same thing can be done now, only the dates would need changing also with pen. We have some of these sets left over, which we will sell to subscribers at the nominal price of 25 cents.]

If you neglect your accounts all the year, you must look after them in December or you will have no turkey-and you will not deserve any turkey. "The Lord will provide" was not intended for ne'er-do-wells. In fact, the Lord does His part all the time. What could we do if the corn would not grow, nor the trees yield fruit? What could we do if our medicines would not act, nor the wounds heal? The Lord does provide when we act intelligently and industriously in harmony with His beneficence.

The people will reward us if we do our duty, and then treat them according to human nature. The reason that so many quacks succeed is that they understand human nature. And why should not a scholarly physician understand human nature as well as a quack does? Many of them do, and that is why they are successful. If you are not successful ask yourself why. Give yourself a rigid examination.

Foxes.

"Foxes have holes." Have you been invited to invest your good money in fox com

you more to buy in that way, and you run the risk of losing your machine and all you have put into it if anything happens to you, and you miss some of your payments. Buy of your local dealer. Pay spot cash if you can, and thus get the very best terms. If you must go into the credit business, do so with one whom you know and who knows you. If you have received a proposition from an instalment house, show the terms to your local dealer and he will give you better terms and treat you better. My advice has been asked, and this is it.

More Tires, etc.

to

A subscriber incloses the literature of the Industrial Securities Co., and wants know if it would be safe to buy their stocks. The circular letter "To Clients" is certainly a hummer. It is calculated to pull the money right out of your pocket if you don't stop and think and inquire. I didn't have any positive information except my general knowledge that such literature is usually misleading, so I sent it to the Financial World for information, and my suspicions. were confirmed. They size it up (the "Perfection Tire and Rubber Co.") as "a poor speculation." Further they say:

We have never known any of the high-class companies that were making good profits to advertise their stocks in this way, and it would be more to the point if they would tell something about the earnings, so that the investor could determine for him

self, whether the hope that dividends would be paid in the spring, were possible.

New Insurance Companies.

I have often warned you against taking stock in new insurance companies, however tempting they were made by their promoters-and very high and skillful talent has been used in these promotions. Now the promoters must meet the cold figures. I have been seeking the best authority on this subject, and find it in Best's Life Insurance News, which for November 1st gives the following. Read it and think, you who have fell to the blandishments of these promoters who were going to make you rich:

Results Obtained by the Stockholders of Life Insurance Companies Formed During the

Past Ten Years.

In the ten years beginning with January 1, 1905, and ending with December 31, 1914, covering the period marked by the great upheaval in life insurance affairs and the wholesale formation of new companies due to that upheaval, two hundred and six legal reserve life insurance companies were organized and began business in the United States. Of these fifty-five had reinsured or merged with other companies by the end of 1914, leaving one hundred and fifty-one actively in operation on that date, out of the total of two hundred and six organized. Ten more of these companies have gone out of business since December 31, 1914.

These figures indicate that the vitality of these young companies has been much greater than was expected by most observers of insurance conditions but, at the same time, further study of the statistics of these companies shows that their operation has been a very expensive venture for their stockholders, as is indicated by the following figures.

The capital paid in by the stockholders of these companies aggregated $41,154,006 and the surplus paid in was $31,980,719, which latter amount does not include very large sums that were retained by the promoters of some of the companies and never appeared in the accounts of the companies themselves. The fifty-five companies which retired during the period ending with December 31, 1914, had $8,240,202 paid-in capital, and $6,918,155 paid-in surplus, but at the time of their retirement their combined surplus was only $876,876, and during the whole period of their existence these fifty-five companies paid only $89,335 in dividends to their stockholders upon an investment of considerably more than fifteen millions. The one hundred and fiftyone new companies which were still in business at the end of 1914 received from their stockholders

$32,735,872 capital and $25,249,804 surplus. The

latter item at the end of 1914 had decreased to $11,230,460, and the dividends paid to stockholders up to that time aggregated only $2,593,745 on an investment of about fifty-eight million dollars-or less than one year's interest on the total investment. In considering the shrinkage of surplus-about thirteen and a half millions-and the very large amount representing loss of interest on the invested capital, the amount of business which the companies have placed upon their books must be remembered. This feature of the showing of these companies will be analyzed and made the subject of further comment hereafter in these columns.

Of

that you would not otherwise have earned, collected or saved, I am very glad. course, money should not be the chief aim of life. But he who does not succeed in making sufficient money to sustain himself and family honestly and respectably is a failure and a failure is one without the comforts, without happiness, and without standing and influence-frequently degenerates into a tramp. So while money is not the highest aim, the making of a reasonable amount of it is absolutely essential to success in life.

This is the way I have been talking to doctors for a good many years. It is not enough to write editorials on cholera infantum, and publish articles on pellagra, etc. All medical journals do such things, and they always have. Since I received the inspiration to deal with the intimate and important affairs of a doctor's life, I have not been content to limit my services to my profession to the formal and mechanical publication of impersonal medical articles, scientific and valuable tho they be. They are all right, and have their place, but a doctor wants counsel about some other things, too; and he wants to feel that his medical editor will be with him in all the walks of a doctor's life. The medical editor is a specialist, and he should prove it-prove it by rendering service wherever service is needed in a doctor's life. If he does not do this, he does not do his full duty. Hence in this department I am trying to help every doctor to make an honest living by means of his high profession, to the end that his every duty to his family and community may be fulfilled, and that he may retire to a wellearned rest of comfort and esteem when old age creeps upon him. A young man may be poor and have to scramble and economize. But necessities should not goad him when he becomes old. Youth: ambition, struggles, accomplishment. Old age: serenity, comfort, content.

Psychology and Physiology in War.

Dr. Geo. W. Crile, of Cleveland, has written a remarkable book.* The first third of it is devoted to the phenomena of war. He was in charge of a hospital in France, and was able to look at war and the results of war with a trained eye. He draws back the curtain as only a master can, and shows us

"A Mechanistic View of War and Peace." By George W. Crile. Publisht by the Macmillan Co., New York. Strikingly illustrated. 104 pages. Price, $1.25.

pictures of the great tragedy throbbing with interest. The last half or more of the book is philosophical. The following lines are taken from his remarks on "Trench Fighting":

It is as if one were contending all day and all night with a murderer in one's house. Under these conditions the personalities of the men become altered; they become fatalists and think no longer of their personal affairs, their friends, or their homes. Their intensified attention is directed solely to their hostile vis-a-vis. They look neither to the right, to the left, nor behind.

This from "Waiting Under Fire":

Lying under fire for the first time while waiting for orders to charge is perhaps the most trying ordeal for the soldier, for this instinct urges him to face the on-coming enemy. He realizes the possibility of immediate death. His kinetic system is speeded to the utmost. He is activated for fierce physical attack. He is under extreme emotion. His heart pounds loudly against his ribs, his hands tremble, his knees shake, his body is flushed with heat, he is drenched with sweat. In mechanistic terms the phenomena manifested by the soldier waiting under fire may be interpreted as follows: His brain is activated by the approach of the enemy. The activated brain in turn stimulates the adrenals, the thyroid, the liver.

In consequence

thyreoiodin, adrenalin, and glycogen are thrown into the blood in more than normal quantities. These activating substances are for the purpose of facilitating attack or escape. As the secretions thus mobilized are utilized in neither attack nor escape, heat and the muscular actions of shaking and trembling are produced. The rapid transformation of energy causes a correspondingly rapid production of acid by-products. These increased acid by-products stimulate the respiratory center to greater activity to eliminate the carbonic acid gas. The increased adrenalin output mobilizes the circulation in the limbs; withdraws blood from the abdominal area; causes increased heart action and dilatation of the pupils. In addition, the increased acidity causes increased sweating, increased thirst, and increased urinary output, all of these water phenomena being adaptations for the neutralization of acidity.

Fatigue.

Thus these men, goaded by shot and shell, and the ever-advancing army; for nine days without adequate sleep or food; in constant fear of capture, and finally wounded-thus these men, more dead than alive, came to the hospital: and thus they slept on while their wounds were dressed.

After deep sleep for two or three days, during which they wanted neither food nor drink, they began to be conscious of their surroundings; they asked questions; they experienced pain; they had discomforts and wants-they had returned from the abysmal oblivion of sleep.

Dreams.

The harmony of sleep of the exhausted soldier has but one discordant note, and that is the dream of battle. The dream is always the same, always of the enemy. It is never a pleasant pastoral dream, or a dream of home, but a dream of the charge, of the bursting shell, of the bayonet thrust! Again and again in camp and in hospital wards, in spite of the great desire to sleep, a desire so great that the dressing of a compound fracture would not be felt, men sprang up with a battle cry, and reached for their rifles, the dream outcry startling their comrades, whose thresholds were excessively low to the stimuli of attack.

In the hospital wards, battle nightmares were common, and severely wounded men would often spring out of their beds. An unexpected analogy to this

battle nightmare was found in the anesthetic dreams. Precisely the same battle nightmare that occurred in sleep, occurred when soldiers were going under or coming out of anesthesia, when they would often struggle valiantly-for the anesthetic dream like the sleep dream related not to a home scene, not to some dominating activation of peaceful days, but always to the enemy, and usually to a surprise attack.

One day a French soldier, in the first stage of anesthesia broke the stillness of the operating room, transfixing every one, while in low, beautiful tones, and with intense feeling, he sang the Marseillaise.

Pain.

The most striking phenomenon exhibited by soldiers is the absence of pain under the following conditions: (a) In the midst of a furious charge the soldier feels no pain if wounded; and sore and bleeding feet are unnoticed. In the overwhelming excitement of battle he may be shot, stabbed, or crushed without feeling pain. (b) The blow of a high velocity bullet or projectile unaccompanied by the heat of battle causes no pain or impact, tho there may be a burning sensation at the point of entrance, and the soldier may feel as if he had been jarred or struck. Frequently he first learns of his wound from a comrade. (c) In the state of complete exhaustion in which loss of sleep is the chief factor pain is quite abolished. (d) Under heavy emotion pain is greatly diminished, even prevented.

It was a dark night and the hospital train filled with the wounded was crossing the river Ourcq. The engineer failed to see that the bridge was broken, and the train plunged into the river beneath, some of the cars remaining on the bridge and some being suspended in mid-air. The patients in the suspending cars, struggling like worms in a bottle, were thrown in heaps against the ends. The engine exploded, the cars were filled with live steam, and many of the wounded were burned to Ideath. The suspended cars could not be righted and the wounded were dragged out by main force. Such intensified cruelty could not come even to trapped animals. It could come only thru the ingenuity of man-thru the machinery of civilization. And yet these men, suffering from fear, excessive marching, fighting, the loss of sleep, and the plunge into darkness, scalded, steamed, grilled, and finally shattered and bleeding-these men felt no pain.

Grief.

When a bridge has been saved, a hazardous message delivered, defeat averted, or the tide of battle turned, then grief becomes glorified and the death of the hero causes exhilarative pride. If, on the other hand, death is the unheroic result of fever, grief is unassuaged.

Belgium.

There have been many sudden deaths; many cases of insomnia; of neurasthenia; of prostration; of lost spirit and impaired efficiency; and generally a loss of hope and ambition. There has been an average loss of from six to ten pounds in weight. Many Belgians were found dead in their beds without external injuries and many died after a brief illness. (A number of cases of apoplexy were seen.) Children were prematurely born on the streets, in railway stations, or on trains. There have already been many suicides among children as well as among adults; and children as well as adults have become insane.

It is to be expected that these conditions will continue and progress, and that there will be an increasing number of cases of Bright's disease and apoplexy. The posthumous children have been robbed of their birthright of healthy bodies and stable nervous systems. The little children whose action patterns had not been formed are the only ones who may bear their rude transplantation with

out loss of mental or physical efficiency. The Belgian exiles whom I have seen show a loss in morale; they are preoccupied, absent-minded, diseased, homesick, weak, dejected, bitter and broken. They have suffered a permanent loss which is beyond compensation and beyond redemption. Thus millions of men, women, and unborn infants have been subjected to a vivisection of unparalleled cruelty unsurpassed in the history of man or of the lower animals. It is as if upon Belgium as a whole every degree of physical, mental and moral torture had been inflicted without anesthesia.

Microscopic sections of liver, adrenals, cerebellum, etc., are given, showing the normal microscopic structure, and adjoining, the same tissues are given showing the structure as altered by the extreme fatigue, fear, etc., that soldiers had passed thru.

Among the hundreds of books on the war there is not another like this one, and none of equal interest to physicians. This is the first showing of the psychology and physiology of soldiers in battle and in military hospitals that we have seen.

THE MEDICAL MONTH.

The State Pharmacy Inspectors of California captured many thousand dollars' worth of opium in their raids in that state. All but the smoking opium was turned over to eleemosynary institutions of California to be used as opium. The "smoking opium," being unfitted for medical use by the process of cooking to make it a "smoking brand," was destroyed by fire, $50,000 worth of captured smoking opium being destroyed by the police. It would be too expensive to extract the alkaloids from the cooked opium.

The American Society for the Study of Alcohol and Other Narcotics will hold its 45th annual meeting at Washington, D. C., December 15 and 16, 1915. This was the first society of medical men in the world to take up the scientific study of alcohol and other narcotics. Its papers and transactions have appeared in the Journal of Inebriety, and comprise the first scientific literature on this subject. Thirty-one papers will be presented at this meeting by specialists and distinguished medical and scientific men. These studies will be confined exclusively to the effects of alcohol and drugs on the body and mind, as seen in the laboratory and from clinical observations. The public is cordially invited. Programs can be had by addressing the secretary, Dr. T. D. Crothers, Hartford, Conn.

The United States Civil Service Commission will hold an examination for a male "assistant in metabolism" on December 8, 1915, in various cities. The duties of the assistant will be to make complete food analyses, including calorimetric determinations and determination of energy metabolism by the respiration apparatus. Salary is $1,500. Those interested should write to the commission, Washington, D. C.

Dr. L. Duncan Bulkley and staff will give the seventeenth series of clinical lectures on diseases of the skin in the Out-Patient Hall of the New York Skin and Cancer Hospital, Second Avenue,

corner 19th Street, on Wednesday afternoons, beginning November 3, 1915, at 4.15 o'clock. The Lectures will be free to the medical profession, on the presentation of their professional cards.

The Health Commission of Paterson, N. J., plans to obtain an ordinance requiring from each person applying for a license to marry, a certificate from a physician showing freedom from diseases communicable to children. Dr. Thomas A. Clay, city health physician, has gathered a mass of statistics emphasizing the fact that many of the children born in hospitals have diseases inherited from their parents. These statistics cover not only Paterson, but other hospitals and asylums.

The government of the British West Indies has been advertising in North Carolina papers for capable young medical men to serve six months or longer in medical service in the Leeward Islands. These positions offer admirable opportunities for the study of tropical diseases.

Milwaukee, Wis., is engaged in actively suppressing quack doctors, "institutes," etc.

A marble bust of the eminent Dr. Robert Battey, of Rome, Ga., has been presented to Emory University.

It is impossible in "Medical Month" to give due credit to the many-sided activities of medical men and women in the present world's war. Want of space alone forbids.

In the leper lazaretto at Tracadie, N. B., there are sixteen patients-seven males and nine females. This is the smallest number in years. This is claimed to be the result of the system of treatment now being carried out in that institution. Two former inmates discharged in

1912 remain cured.

The will of the late Henry Rutherford contains a bequest of $200,000 to the Rockefeller Institute for Medical Research.

The Virginia State Board of Health announces that it is preparing to issue its biennial register showing the name and location of all physicians, health officers and registrars of births and deaths in the state.

The Southern Medical Association holds its 1915 session in Dallas, Texas, November 8th-10th.

Steps have been taken by the Navy Department to make the Medical Reserve Corps a reserve in fact for the Medical Corps of the Navy. Under the terms of a circular just issued by the department, medical reserve officers are required to bind themselves to perform active duty in the Navy whenever they are called upon by the secretary. Officers of the Medical Reserve Corps are also required to report to the Navy Department at least once in every six months as to their location and their physical fitness for military duty. Their number is limited to 300, and they are to be honorably discharged at the age of 55 years.

Dr. Edward L. Trudeau, pioneer in America of the open-air treatment for tuberculosis, died at Saranac Lake, N. Y., on November 15th. He did herculean work in the war against that disease and carried on an extensive propaganda for open windows in offices and homes. His work was recognized everywhere and he received the Doctor of Laws degree from McGill University and the University of Pennsylvania.

ORIGINAL COMMUNICATIONS

Short articles of practical help to the profession are solicited for this department.

Articles to be accepted must be contributed to this journal only. The editors are not responsible for views exprest by contributors.

Copy must be received on or before the twelfth of the month for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.RUSKIN.

Acute Indigestion. EDITOR MEDICAL WORLD:-The best example of acute indigestion is seen in those who, on account of indiscretions in food or drink, get a condition of more or less continuous gastric distress, increased on eating or drinking, accompanied by regurgitations, the entire condition subsiding in a few days' time. This is the acute indigestion, cases of which every practician of medicine has seen a number of times. Next to this simple form are aggravations of chronic gastritis, brought on by errors in eating. A person with a chronic gastritis often has what looks like attacks of acute indigestion, which are due to an exacerbation of a catarrhal condition, which chronic state may exist without symptoms, or relatively few, in the intervals between the acute attacks. Added to these are states of acute indigestion wherein the gastric functions are at a high level, due to a greater or less degree of vagotonia, and other states in individuals who are run down in a general way for any of a number of reasons, who get attacks of about the same symptoms due to sympatheticotonic states.

A Terminal Condition of Other Disease. There is a conception abroad in the minds of some medical men, as well as most laymen, that acute indigestion is a clinical entity which may be fatal in type. It is particularly upon this that my article deals, because there are some things which apparently are not sufficiently known. In the New York Polyclinic Hospital, which covers a district in Manhattan of nearly 400,000 people, the ambulances often bring in persons who are supposed to be suffering from acute indigestion. Many of these have died, and the postmortem work has shown that

often what may look like an entity is, after all, only a terminal condition of a serious state of illness, in which there are symptoms of acute indigestion with practically no pathologic evidence of involvement of the stomach or intestines. Among the recent cases I recall is one of pericarditis, with a large amount of effusion, in a man who did not know that he had this pericarditis, but who became acutely ill on the street with what was apparently acute indigestion, and died in a few hours, the autopsy disclosing the above. Ever so many cases of perforated gastric and duodenal ulcers, in which the symptoms, local and general, are not frank enough to suggest a diagnosis of perforation quickly, have been met with; that is, cases in which the perforation apparently ensues in a masked manner. Most of the perforated gall-bladders give symptoms which are distinct enough to suggest marked mischief, but occasionally a gangrenous or perforated appendix is seen in which simple forms of gastric symptoms are present, without vomiting, sub- or supernormal temperature, acute pain, change in the pulse rate, etc. Added to those mentioned are cases of cardiorenal and vascular diseases, the entire class making up an assemblage in detailed pathology too numerous to delineate. Why it is in them that states of acute indigestion are added as a terminal feature, seen just before death, is not plain. It may be due to changes in the innervation presenting themselves in the lower end of the vagi or branches from the sympathetic plexuses in the upper abdomen, and those of the splanchnic cords that go into them, these supplying the stomach, duodenum, liver, spleen, etc. This type of acute indigestion may be specified as terminal indigestion, but cases dying, having these symptoms, are nevertheless fatalities due to the causes in back of them.

Not Connected with Disease Elsewhere.

I desire now to draw attention to some cases I have seen representing a type of acute gastritis which, according to the clinical history and the pathologic findings, are deaths caused by this condition alone. Seven cases have been met with in which there was a marked acute, diffuse, parenchymatous gastritis. These stomachs were all of them practically alike in internal appearance, in which there were seen a smoothing of the mucous membrane, due to protoplasmic and granular degeneration of the