that of the carpenter, the mason, or any of several of the forms of day labor. And even here no account is taken of the expenses of an office, with its many accessories that still further consume the physician's already limited income. Is it any wonder, under such circumstances, that many fall into habits that are not strictly ethical, or swerve slightly to one side of the well beaten path? Is it not a wonder instead, that so few do depart from it?

While this is the condition of the medical profession as a whole, a pertinent question is whether is it equally shared by the homœopathic division. And to such a question we believe a negative answer can truly be given. The profession of medicine today is overcrowded; the homoeopathic profession has too few to fill the positions where its exponents are desired. The medical profession has one great aim: the decrease in number of medical students; the aim of the homoeopathic profession is to find sufficient to satisfy the demands for those of this school of practice.

It has been the fortune of the writer of this editorial to be connected for some years with an institution to which came these calls for help, and he can conscientiously affirm that the one great difficulty has been to obtain the persons for the positions, not the positions for the persons. He honestly believes that, aside from all sectarian ideas, there is a far better chance for success in practice at the present day for the young homoeopath than for any other. He would therefore strongly urge the prospective student to enter 'some good homoeopathic school in which the want of new recruits is great, rather than into one where there is already a great surplus. In looking over our sectarian side of the profession we cannot believe that our men are as hard pressed financially as seems to be the case with others. It is an exception in the experience of the writer to find any one, otherwise well qualified in medicine, unable to earn a suitable competence, and to hold with comparative ease his proper position in the social life of his community. Yet if we can be grateful for our present betterment over others and are enabled to offer to the prospective physician superior attractions, let us nevertheless bear in mind that a constantly shrinking income is ours also, even if less noticeably so than in the case of others.

The medical profession must come to a more common and uniform idea in the question of fees. By combination this can probably never be effected lest it be accused of introducing methods of the "trades unions." By general education it can be accomplished, by making each class, physicians and patients, realize that the consultation is actually worth the increased fee that is demanded. Of course there are, and always will be, "cut-rate" doctors to be taken into account. One of the most ingenious methods of avoiding such was that already noted in these columns, taken by a society in Indiana. This society has had printed for distribution among its members, an attractively arranged and unobtrusive card suitable for hanging in the doctor's office. On this card are the words to the effect that the society considers that the regular prices for office

calls be so and so, for residential calls a stated amount, etc., for the various professional demands that most frequently occur. It then states in a note that any member of the society who conscientiously believes his own services to be below the average can, of course, reduce the charge as he sees fit. This means that anyone who cuts the regular fees, by implication acknowledges himself to be less well qualified or less skilled than the majority of his professional associates. We do not know how well this idea worked out in actual practice, but should think that it might be worthy of more general adoption as it is certainly a unique one.

In many places the laymen, and particularly the newspapers, feel that physicians charge exorbitant fees for work performed. We have been, therefore, particularly pleased with an article in the "Detroit Free Press" which gives the subject its due amount of consideration. In this article, according to "Medical Counselor," the following will be found:

"He has great temerity who would fix the absolute price of the service that saves one's life or that of his kindred. The service of the physician is not that of the half-hour in the sick room, but the accumulative service of years of study, work, experiment, failure and mastery. We do not hire the man for the hour; we hire his whole past lifetime and experience. In order to learn how to save your eye he has probably spoiled a bushel of eyes. He is able to minister to your case by what he has learned in failing to be able to minister to another case. If you are wealthy, it is no more than your duty to reward him handsomely. If you are poor he expects only the poorest rate.

"Medical skill is beyond price. A doctor cannot buy it, neither can he sell it. He can only use it, and those who profit by it do not pay for it, but make the acknowledgment that custom prescribes or ability permits. Certainly the profession of medicine is not overpaid, nor is it recruited from the class of men whose constitutional motives are mainly mercenary. The doctor's fee is amongst the cleanest money earned or paid."

If the public at large could realize the full meaning of the ideas advanced by this writer, we feel that the question of the physician's fee could be readily settled to the satisfaction of all. And it will be largely the physician's own fault if, in future, such a truthful and sane understanding of the subject does not gain general acceptation.

ANTI-TYPHOID INOCULATION

Probably never before in medical history has the prospect of ultimate victory over many of the infectious diseases been so bright as at the present time. When the bacterial causes of this class of disturbances were first demonstrated or suspected, efforts almost innumerable were made to eradicate and destroy the minute organisms. The disease was treated as an identity without much consider

ation of the patient. Antiseptics were in great demand for all sorts of diverse conditions. They were administered by the mouth and by the rectum into the alimentary tract, by inhalations into the respiratory and by sub-cutaneous injection into the lymphatic system. Finally the extreme was reached when weak solutions of formaldehyde were introduced directly into the circulatory system by the portal of a vein.

In the great majority of cases the treatment resulted in failure. Finally it became recognized that, except in a few instances, the antiseptic to be of influence against the micro-organisms, must be so concentrated as to produce even greater injury upon the tissue cells with which it came into contact. The high water mark for antiseptics has therefore already passed, and the tide is still receding.

We are now recognizing that the best way to combat the various infectious lesions is to pay most careful attention to the individual, and to strengthen to the utmost his natural recuperative powers. In other words, we are going back to the long ago popular phrase, the vis medicatrix naturæ. The application of this idea includes in a natural manner both prophylactic and therapeutic measures. In addition to the more general procedures of hygiene, such as diet, fresh air, rest and allied means, there has gradually been introduced more specific therapy, first for one disease, then for another.

Haffkine, in the early nineties, influenced probably by the earlier successes of Pasteur with the epidemics of anthrax in sheep and cattle, described his specific prophylactic treatment for bubonic plague. At the present time a number of diseases have proven amenable to this form of treatment, while in others the hopes for ultimate success are high.

Typhoid fever is one. of this latter class where anticipations seem to be giving rise to certainty both in prophylactic and therapeutic lines. The favorable result first obtained by Wright in the South African and in the Indian campaigns of the British army, and later duplicated by the Germans, is also being obtained by the Italians and other nations. In this preventive treatment large doses of vaccine were administered with correspondingly severe reactions as of common occurrence. Such reactions, while in no way con-tra-indicating the method, were a detriment to its general adoption! on a large scale in less militant and perhaps more safe surroundings.

A study of the efficiency of smaller dosage recently made by Spooner, at the Massachusetts General Hospital, is therefore of particular interest and value. It has been reported in a recent number of the "Boston Medical and Surgical Journal." At this institution volunteers from the nurses and ward attendants were requested. A large number readily responded. Blood examinations were then made upon each in order to determine the presence or absence of the Widal reaction. Three inoculations were then given at five-day intervals. The dosage consisted usually of one hundred, two hundred, and three hundred million dead bacteria, although in some cases these amounts were reduced one-half.

In the aggregate fifty-three nurses received a primary inoculation of fifty million. This was followed in every case by some local soreness appearing within a few hours. In a few instances by pain on moving the arm, and in three cases by the appearance of small glands palpable in the axilla. Occasionally constitutional symptoms were noted, but these were of but slight severity in nearly every case. At intervals of five days one hundred million and two hundred million dead bacteria were again administered. All of these nurses, prior to the inoculation, showed a negative Widal reaction. Two weeks after inoculation over 30 per cent. of them showed a positive reaction in dillution of 1 to 100. Over 75 per cent. showed positive reactions in dilutions of 1 to 50, and all gave positive reactions in dilutions of 1 to 10. The appearance of the agglutinative power, therefore, seems to correspond relatively at least to the appearance of the other anti-bodies. The immunity thus obtained lasts probably about three or four months gradually disappearing. Concerning the nurses themselves, Spooner states that they all, without exception, affirmed that they would have undergone the inoculation even if they had known the severity of the reaction and the general inconvenience, provided that it carried with it the hope of immunity as suggested in the present instance. No cases of typhoid fever developed among those thus immunized. The writer states that the results of the work are striking, in as much as high agglutinative power has been produced with small doses of vaccine and with slight constitutional reaction.

In view of the work that has been done, therefore, it would seem wise to introduce, at least as an optional prophylactic precaution, the routine administration of typhoid vaccine in small doses to all those who repeatedly come into close contact with typhoid patients, such as nurses, orderlies, and physicians. This precautionary immunization has already been demonstrated to be effectual for persons going into localities where typhoid is frequent.

At the same time that these investigations have been in progress at the Massachusetts General Hospital and somewhat antidating. them, the treatment of the developed disease itself has been in process of investigation at the Massachusetts Homoeopathic Hospital. Here, during the past three years, there have been admitted approximately one hundred and forty patients suffering from the disease. Some of these have received occasional inoculations of vaccine late in the course of the disease, or during a remission. Excluding these and all such that have not received the routine treatment, there have been thirty-six cases treated by vaccines in accordance with the regular method. At the same time seventy-one have been treated in the ordinary way without the use of vaccines. All diagnoses have been corroborated by blood findings, as well as by clinical evidence. Those treated by vaccines have not been selected but taken as they came in certain services. A study of the comparative re

sults is of interest.

Taking an average of all cases treated and of all

Average gain by those treated, in duration of fever.10 days
Average gain by those treated, in residence in

hospital

....18 days

Average gain by those treated in percentage of re

15

lapses For purposes of this study all cases showing a temperature of 100 degrees or over, after the temperature of the original fever had reached normal, were classed as reinfections.

From these varied sources, therefore, it would seem that there is much hope for this method of treatment, both as a means of guarding against the disease, and as a distinctly therapeutic measure.

SPINAL ANESTHESIA

From time to time there occurs in some centre an attempt to revive and popularize the use of spinal anesthesia in general surgery. The latest of these attempts has been that of Dr. Jonnesco, a Roumanian physician, who has recently been traveling in America. demonstrating his method. This consists in the high injection into the spinal canal of a preparation of stovaine and strychnine. His results have been carefully watched throughout this country, as wel! as abroad. Demonstrations have been given in many of the principal cities, with a considerable degree of success. Following the inoculations the operations have been quite painless although the after effects have not been as favorable as the projector claims in regard to nausea and its comcomitant discomfort. Upon the whole the method has not been very enthusiastically received, although the feeling seems to be that in some cases it may be a suitable one to employ. Many forms of local anesthesia are now possible where this spinal anesthesia might be employed, and the former can be used with much greater safety than the latter. The death rate from the spinal method is many times larger than that from chloroform or from ether. At present therefore, the older methods seem to be the wiser and the safer ones to employ as routine.