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quently physicians can use means and measures here most effectively. There are possibilities of home treatment that we do not realize at present, and they are equal possibilities in sanatorium and hospital treatment of permanent restoration and cure, beyond any present conceptions. The stupid. theories of vice, depravity and moral weakness as explanations of why men drink has prevented any recognition or study, until these theories were obviously absurd. The man who drinks wine at the table, or beer and spirits, or the man who drinks at intervals to intoxication are all moral defectives, or if not that, are well within the range of rational control and free will, hence have a medical significance. The prevalence of such theories has built up an enormous army of neurotics, and degenerate psychosis, who only come for help and treatment when they have reached terminal stages and are in the incurable classes.

We sit around and observe this army being recruited, developed and trained and grown to the neurotic stage where their disabilities are so evident as not to be mistaken. Then we make great efforts to use medical means, always reserving the theory that it was vice at the beginning.

A large class of inebriates and alcoholics are beyond the province of practical, remedial measures, yet notwithstanding this fact, there are degrees of curability and examples that are startling in the possibilities that they reveal.

We ought to recognize the gravity, not only of the neuroses and toxemias in the later stages, but these conditions at the beginning and the possible means of prevention and correction. No physician in general practice can fail to realize the increasing neuroses and degenerations which follow from the use of spirits and no physician can fail to understand the actual condition both physical and mental which presents itself.

How to remedy it, how to advise, prescribe and plan means of restoration and cure is largely unknown, and yet every physician can do this and can find a field for practice with results as positive as from the treatment of any other disease. Home and office treatment of this class will be a prominent feature of the practice of the future physician. I repeat the same plea and claims which I urged long ago, that this neglected army of degenerates should be recognized, studied and treated, above all theories and sen

timents, and that they can be cured and restored to an extent not at present dreamed of.

The American Civic Society in a publication on the national fly campaign says: "Cleanliness is the only solution for the fly problem."

The society is right. Cleanliness is not merely the only solution for the fly problem, but for the whole problem of public health.

Cleanliness is the keystone in the arch of life.

An interesting experiment for the purpose of creating immunity against tuberculosis is being tried in Pittsburgh under the direction of the Tuberculosis League of that city. Dr. William Charles White, Medical Director of the League, says it will probably take ten years before definite results of the work will be appreciated. The experiment is being conducted on the theory that much, if not all, tuberculous infection begins in childhood. In view of this fact, the League is aiming to supervise the growth of every baby born for the next ten years in the South Side district of Pittsburgh. The babies and their mothers will be taken in charge at the birth of the infant, and everything possible will be done to increase the resisting power of the child to disease and to make it thereby immune to tuberculous infection. The theory is that by fortifying the body in the earliest period of a child's life, the infant will, in most cases, become immune to the disease with which heredity and environment may threaten it.

TUBERCULOSIS
Undermines the family,
Brings trouble and sorrow,
Empties the family purse,
Reduces many to poverty,
Comes to the careless,
Unfits for life's work,
Limits life to months,
Orphans many little children,
Scoffs at drugs,

Isolates from friends,

Scores 4,000 deaths each year in Chicago.

Six weeks ago the Health Department gave as full publicity as possible to the fact that it was prepared to give free vaccination against typhoid fever. The public press boosted vigorously and apparently some interest was aroused.

Result: Only two hundred people took advantage of our offer.

We are not discouraged. The public will learn in time. This week we at we are sending to every hospital and similar institution in the city a circular letter urging that all nurses and attendants take the vaccination, we offering to do the work.

Later it will be interesting to record the institutions that have shown a disposition to move actively for the protection of their and attendants.-From Bulletin Chicago Dept. of Health.

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READ OUR AUTO ADS-THEY HAVE THE RIGHT DOPE

ILLINOIS MEDICAL JOURNAL "Warden Specials"; they have always encoun

Published monthly by The Illinois State Medical Society, under the direction of the Publication Committee of the Council.

PRESIDENT..

GENERAL OFFICERS 1913-14

CHARLES J. WHALEN

15 E. Washington St., Chicago

PRESIDENT-ELECT...

FIRST VICE-PRESIDENT.
SECOND VICE-PRESIDENT.
TREASURER.

SECRETARY.

.A. L. BRITTIN, Athens
.S. M. MILLER, Peoria
..D. G. SMITH, Elizabeth
A. J. MARKLEY, Belvidere
W. H. GILMORE, Mt. Vernon

(Ex-officio Clerk of the Council)

THE COUNCIL

District 1.-J. H. STEALY, Freeport.
District 2.-J. A. MARSHALL, Pontiac.
District 3.-CLYDE D. PENCE, Chicago.
District 4.-AUGUST H. ARP, Moline.

District 5.-C. S. NELSON, Springfield.

District 6.-C. D. CENTER, Quincy.
District 7.-C. F. BURKHARDT, Effingham.
District 8.-E. B. COOLEY, Danville.

District 9.-FRANK C. SIBLEY, Carmi.
CLYDE D. PENCE, Chairman, 3338 Ogden Avenue.

Send all Communications relating to Advertisements and mailing list to Dr. Clyde D. Pence, 3338 Ogden Avenue. Membership correspondence to Dr. W. H. Gilmore, Mt. Vernon, Ill.

tered them through all administrations, both grafter and reformer; yea, even through the present year of grace, 1913, under the present angelic reformers' administration. People come to the receiving ward of the hospital bearing cards from this and that commissioner recommending and even ordering their admission to the hospital. In passing let us remember that all any indigent person has to do to get admitted is to come to the hospital and to be suffering from some physical trouble which needs hospital care. Therefore no legitimate case ever requires a card or a recommendation from anybody. A great many people however think that, even if really ill, the word of a commissioner or other politician is a necessary prerequisite to admission. The commissioner does not tell them otherwise because his supposed ability to get people into the hospital enhances his

Copy for publication to Dr. Henry G. Ohls, Managing Editor, political fortunes. Up to very lately the order

927 Lawrence Avenue, Chicago.

OCTOBER, 1913

Editorials

THE ABUSED MEDICAL CHARITY. It is to laugh! When rogues fall out honest men get their dues-sometimes. Without any invidious classifications or distinctions we might mention that some of the honorable commissioners of Cook county have been having a little family spat. It has long been familiar to those who know, that the County Hospital has always harbored patients in its wards-and especially in its private rooms-who were abundantly able to pay for hospital care as well as medical attention. In the language of the internes such persons have been and still are known as "Warden Specials." Warden specials are usually assigned to the small rooms off the large wards, rooms supposed to be reserved for patients who are extremely ill. attending men and the internes are tactfully informed that So-and-so is a particular friend of Commissioner What's-his-name, who will hold it as a special favor if the doctor will give the patient his especial care and "do his best for him"; as if doing his best for the patients in the hospital were not always the doctor's custom and his pride.

The

The medical men and women at the County Hospital have been quite accustomed to these

of a commissioner has always had great weight in the front office even in the cases of persons who were not ill or who were able to pay.

An amusing little story is told among the attending physicians and the internes. It seems that a short time ago (during these present reform times, by the way) a man came to the examining room and was carefully gone over by the examining interne. Nothing physically abnormal was found. There came, however, strong representations from higher up that the man must be admitted and that it was up to the interne to find some diagnosis to write on the admission card as an ostensible reason for the patient's (?) admission. Now it often comes to pass that a mother is admitted for legitimate reasons and she is forced to bring her baby with her. The baby has an admission card having the diagnosis blank filled out with the word "feeder." So our bright young interne admits this particular "Warden Special" as a "feeder," probably as correct a diagnosis as he will ever make. History does not state whether this young Aesculapius has yet been hanged, drawn and quartered or has been banished to Siberia.

But the little private graft of the commissioners has been rudely disturbed within the last few weeks. There is a breach in the Honorable Board of Commissioners of Cook county. The reformer lambs arrayed on the right hand of the reformer president and the political goats on his left hand

are making faces at each other. Word went out to the hospital and to the county agent's office that the hospital was for the sick poor of the county and not for the well or for those sick able to pay. It was intimated that at least certain commissioners were not to be allowed to have "Warden Specials" in the hospital any more. Among some commissioners who had sent people to the hospital with cards demanding their admission and who had been "turned down" was a certain belligerent one who immediately went over to see about it. Finding the employe who had refused one of his clients and had thus "incurred the patron's ire," he promptly knocked him down and slapped him on the wrist. Later, in the board meeting, his righteous indignation so overcame him that, his own lurid words failing him, he threw a large collection of the words of another at a certain reform lamb. The heavy volume containing the words hit the lamb on the nose. Things were somewhat mussed up, the president of the board, the reform lambs and the Chicago Tribune were terribly shocked and the whole story got to the public.

The result will be that, at least for a time, the Cook County Hospital will be reserved for its legitimate beneficiaries, namely, the sick and injured poor of the county, and the members of the attending staff will not be compelled to treat free well-to-do friends of influential politicians or able-bodied "bums." It is a sad commentary upon the condition of things in the medical profession that the abuse of medical charity in the County Hospital should receive this body blow not from the organized profession itself but because of an especially nasty squabble among the county commissioners.

The Committee on Abuse of Medical Charity of the Chicago Medical Society has elaborated a plan for lessening the abuse in the hospitals of the city, including the County Hospital, by means of publication in the Bulletin of the names of free ward patients admitted to the various hospitals of the city. Most of the larger hospitals so far have failed to reply to requests for lists of such names. The plan has met with little support among the better advertised members of the local profession. Indeed our peerless leaders have seemed to have little love for any scheme aiming to lessen the abuse of medical charity in the large dispensaries and hospitals. It remains for the rank and file of

the organized profession of the city and state to strike while the iron is hot and to create such a public opinion against all forms of abuse of the charity of the profession that a reform in that line will be forced.

HOSPITAL LEGISLATION.

The influence of the county medical societies working in connection or alliance with civic organizations and women's clubs to arouse public interest in health questions has been exemplified in the recent history of the campaign to secure laws for the establishment of hospitals by cooperation between the cities and counties of Texas. The last legislature passed such a bill requiring counties in which there are cities of 10,000 inhabitants or more to hold a hospital bond election whether so petitioned or not. In all other counties it is necessary for 10 per cent. of the voters to petition for such election. Mr. R. J. Newton, executive secretary of the Texas AntiTuberculosis Association has been especially active in the campaign for hospitals. His reports indicate that several counties are now actively engaged in taking the necessary steps to secure hospitals under the new law and a much larger number are becoming interested in the proposition. Mr. Newton has made free use in his literature of the excellent cuts of the Chicago Department of Health Bulletin.

The climate of Texas has always had a special attraction for the tubercular and so many patients from the East and North have gone to that state with limited funds that they have become a serious embarrassment to the various communities. The Texas State Medical Association adopted two resolutions on this subject. One called upon the U. S. Public Health Service to investigate the situation, and the other called upon congress to set aside abandoned military posts for the care of the indigent stranger consumptives and to maintain them at federal expense. The Texas State Journal of Medicine, commenting on these resolutions says: "It is extremely doubtful whether anything will come of the effort."

Now that tuberculosis is generally known to be curable in any climate there is small excuse or reason for sending the tubercular away from home, unless to a sanatorium, and that does not imply a change of climate for sanatoria are to be found in practically every state in the Union.

The new Indiana law (Act of March 10, 1913), provides that the board of county commissioners of any county shall have power to establish a county hospital for the care and treatment of persons suffering with tuberculosis. The board has the power "to borrow money for the erection of such hospital and for the purchase of a site therefor, on the credit of the county and issue county obligations therefor, in such manner as it may do for other county purposes." Provision is made for the free treatment of indigent patients of the county, and for payment from those who can pay or whose relatives can pay an amount not exceeding the average per capita cost of maintenance. Patients from counties not having a hospital can be admitted on the same terms when the capacity of the hospital is not fully taken by residents. In such case the "home" township trustees provide transportation and the maintenance fees.

TRAUMATIC HYSTERIA AND FREUD'S

CONCEPTION OF HYSTERIA.

The discussion of Freud's ideas concerning the etiology of hysteria and the other psychoneuroses has been universal. There are many ardent supporters and just as many confirmed opponents.

The essence of the Freudian theory of hysteria may be briefly stated as follows: There is in hysteria a dissociation or disintegration of the personal consciousness, with the release of certain buried, hidden, repressed complexes or constellations of ideas which have been forgotten but continued to exist dynamically in the region of the unconscious, unknown to the individual. The cause of this dissociation is some (psychic) trauma or injury, of a sexual nature, which occurred originally in infancy or early childhood. Sexual, as used by the Freudian school, has a very broad meaning. It is by no means synonymous with sensuous. It includes all possible sexually pleasurable feelings or tendencies, physical or psychical, including incestuous, bisexual and polymorphous perverse sexual tendencies. The Freudians have made much of these latter sexual tendencies of the child and the psychoneurotic, especially of the hysteric. Their idea is that the polymorphous perverse sexual activities are quite decided in the infant and the child. With advance toward puberity the genital zone gradually assumes the ascendency, and is made the center of the sexual

excitation and activity. However, the so-called erogenous zones (such as the rectum, bladder, mucous membrane of the mouth and tongue), which up to this time have been capable of independent excitation with the production of sexual pleasure, may still continue to be active or their activity may be resumed after a period of suppression. Definite bisexual and incestuous tendencies also exist, the Freudians believe. These activities are gradually suppressed and are replaced by fancies of this nature-psychical instead of physical. These fancies and thoughts are disagreeable to and incompatible with the better thoughts and tendencies of the individual and opposed to the social and ethical standards and inhibitions. Consequently efforts are made to repress them and hide them from the personal consciousness. They are forced into the unconsciousness and are apparently forgotten, but, unknown to the individual, continue to exist, to accumulate energy and grow dynamically until they become

powerful that they make their appearance in disguised form. Thus the thoughts appear transformed and symbolically expressed in the dreams and fancies of hysteries, in their psychic symptoms, and in their somatic symptoms, which latter, according to Freud, are nothing more than the manifestations of the sexual activity of the individual. It is unnecessary at this time to discuss the extensions of the Freudian theory. An extensive psychology has been elaborated.

The battle-cry of the Freudian school in the case of hysteria (and also other psychoneuroses and neuroses), is that it is primarily dependent upon a disturbance in the sexual life of the individual. The sexual disturbance may be of any nature but frequently or generally partakes of the nature of a sexual perversion which is really at the bottom of the condition.

The immediate experience producing the dissociation may be of any nature-but essentially and fundamentally the underlying cause is the sexual trauma of ancient origin which is the subsoil permitting the hysteria to be developed.

The question which should come to mind at once is: How will Freud explain the so-called traumatic neuroses and psychoneuroses, included amongst which is traumatic hysteria? The essential symptoms are in no way different. The etiology here seems to be definite. The individual has reacted biologically to a situation in which

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