HOME      HYGIENE LIBRARY CATALOG  

   B. PATHOGENY

      Instead of microbes being the cause of disease, they are at most only capable of joining with the culture media to develop an affection--certainly not a disease. As cause, bacteria must be classed with the elements and other influences in man's environment which are good or bad for him, depending on his health--resistance.

      Efficient cause is anything powerful enough to produce primary disease. There are chemical causes--poisoning--and animal toxins. The poison that can prostrate and kill man must be able to overcome his normal resistance. Nothing belonging to man's normal habitat can break down his normal resistance; hence the idea that germs unaided cause disease is a delusion which the medical world must outgrow, as likewise the idea that serum can antidote germ influence; for germs have no influence except as they join other auxiliary influences and break down resistance.

   C. PATHOLOGICAL PHYSIOLOGY

      This should not be recognized as differing from physiology. Biology is the same whether the process be normal or abnormal. Law is the same now and forever. Biological laws are the same in health and disease. If a given disease-producing influence is experienced, disease will be established; remove the influence, and the laws, which are always the same, continue to act ideally, and health will return. Death itself is the only way to prevent the ideal working-out of physiological law.

      It should be illuminating to those who think of disease and health as distinct entities to be assured that they are states, not entities, and that both are produced by the same laws; that it is within the power of man so to present his body to the laws that the state following will be health, not disease.

      Correcting disease must have a limit. Where a disease has been running on until enervation is profound, or until the integrity of a vital organ is far spent, coming back to the normal may be impossible.

      A patient complains of pain in the chest. On examination, congestion is found. Congestion not being a disease, on further examination a heart derangement is discovered. The pulmonary congestion is due to heart insufficiency. As there are no organic diseases proper (all organic derangements are reflex or secondary), a cause for the heart disease must be found. There may be a history of an infectious disease suffered years before--typhoid fever, rheumatism, or any of the contagious diseases. In regular medicine the primary cause--say, typhoid fever--is gone. The cause, then, is gone; so treatment is given to the heart, notwithstanding the heart lesion is not considered primary. Heart stimulants are given, which revive the organ for a time; but soon it must give out, for the treatment is stimulation, and the cause of its derangements is stimulation. In the first place, it was overworked by fever, infection, and drugs which left it impaired; then wrong eating and other habits, practiced after recovery from the disease that brought on the cardiopathy (heart weakness), prevented the organ from returning to the normal, which it would have done if it had been left for a few months or years to regain its normal tone.

      In making a diagnosis, no consideration is given to daily life by the average physician. Because a patient suffered with syphilis twenty to thirty years ago, and today he has lost his faculty of speech, he must be suffering from syphilis. The intervening years of bad habits count for nothing. If symptoms of tabes dorsalis (locomotor ataxia) present, the best doctors doctor syphilis, even if tests fail to affirm their diagnosis. The past twenty to forty years of sensuality count for nothing; the whole trouble is due to a specific germ that has been hibernating in the tissues of the body.

      Indeed, if correct living habits are practiced, no disease can remain in the body for any length of time. The body has the power to renew and purify itself, when given an opportunity; and all the opportunity needed is to receive sane care. There can be no hope of a thorough house-cleaning so long as the organism is taxed beyond a reasonable limit by an oversupply of food, by stimulants, by sensual indulgence, and, neither last nor least, by drugs that cause sclerosis.

      Morbific cause is often beyond the reach of our remedies, because we are looking beyond the daily and hourly cause or causes for a cause that will vanish as soon as its support is gone.

      In the matter of nutrition, many good and intelligent physicians often treat for the removal of an effect of malnutrition rather than for malnutrition--mistaking the effect for cause. Indeed, nearly all the work done by average physicians is on this order.

   D. PATHOLOGICAL ANATOMY

      A lesion of any structure when healed leaves a scar. Scar tissue is more liable to undergo degeneration than normal tissue, not because it carries a potentiality of the old disease, but because scar tissue is not nourished so well as other tissue and breaks down much more easily.

      An inflammation of the urethra that extend to ulceration will leave scar tissue when cured, it matters not whether the inflammation is specific, or brought on by self-abuse (onanism), or from irritation caused by urine strongly acid from chronic toxin poisoning.

      The scar tissue reduces the caliber of the urethra. This partial obstruction prevents self-cleaning. All tubes, ducts, and canals that are partially closed--strictured--fail to evacuate and cleanse themselves thoroughly. Hence, behind the strictured point, irritation and inflamation develop--a catarrhal inflammation which gradually lessens the caliber and finally develops complete obstruction. If the trouble is of the eustachian tube, noises in the head, ringing in the ears, and deafness follow; if of the urethra, slow and difficult urination from obstruction of the urethra and bladder irritation follows, and, as a result, lost coordination is liable to result from reflex irritation. In esophageal, stomach, or bowel obstructions, ulcerations and cancer are liable to follow, with all the evils accompanying partial to complete obstruction.

      Primarily there must be a chronic state of toxin poisoning and pronounced diathesis before local inflammations of mucous membranes can take on chronic irritation, inflammation, ulceration, cancer, or syphilis . If a chronic state of toxin poisoning is not developed and maintained by bad habits of life, accidental irritations and nflammations will pass away from lack of support-from a lack of daily fuel supply. The truth of this can be proved at any time by noticing how quickly and well inflammations heal in those who are free from dyscrasia. and intestinal putrefaction. And another proof may be worked out-namely, correct the chronic toxin poisoning, and a stop will be put to all silent, subacute, inflammatory hyperplasia.

      I have found no better definition for disease than the following: Disease is the morbid process considered in its entire evolution, from its initial cause to its final consequence; affecton is a morbid process considered in its actual manifestations, apart from its cause.

      The so-called diseases, such as heart diseases, rheumatism, typhoid fever, pneumonia--in fact, every disease named in medical nomenclature--are in reality only affections. Real disease is perverted nutrition, caused by toxins generated within or without the organism. It is this chronic state of toxin poisoning that breaks down resistance and allows affections to develop. Such affections as cold --catching cold in the winter time, hay fever in the summer time, and asthma in both winter and summer--are affections resting on a base of diathesis sensitized by toxemia. The more pronounced the diathesis, the less the natural resistance, hence the harder to overcome the disease, which is chronic toxin poisoning.

   All affections, commonly called diseases, are "hors de combat without a culture-medium-=a body prepared by chronic toxin poisoning--in which to develop.

   E. SYMPTOMATOLOGY

   1. The Patient

      As it is the physician's business to cure the sick (at least, that is what nearly all laymen, and perhaps ninetynine and nine-tenths per cent of the profession, believe), those who are uncomfortable or in pain place themselves under the care of a physician to be made well, and when the pain is gone a cure is supposed to have been wrought.

      The patient presents symptoms, some of which are subjective and a part of which are objective. The subjective symptoms are those about which the patient knows, while the objective symptoms are the changes of the exterior and interior about which the physician knows.

      The subjective symptoms are those that have developed in the consciousness of the patient. They may have come on rapidly, or they may have come on very slowly.

   The history of disease is that of a coming-on and a going off of discomfort; and on the revolutions--the cycles--made by diseases rests the reputation of all systems of palliation. The patients feel bad, and the doctors of high and low degree, representing schools whose scientific data--theories of cause and cure--are poles apart, and whose therapeutics range from conceit to the fanciful and on to the grotesque, gather around their victims and administer their "dope;" when, behold! as if by the touch of the lamp of Aladdin, the victims are blessed by the remedies, in spite of the fact that these are as opposite in their specific actions as it is possible for them to be. Yet the sufferers are "cured"! Of course, it matters not if the patients are sick again in a week, or a month, or a year, with the selfsame disease--another fanciful "cure" is made, which again our doctors and patients celebrate in the usual way, by telling in scientific terms just how it came about, even the wisest among them being ignorant of the fact that the natural progress of all disease is rhythmical or cyclical--better and worse--until the organism is broken down, and then the patient is better and worse, but never well, until death gives full relief.

      It is the history which the patient recites to the physician; and it is the physician's business to weigh, analyze, and criticize what the patient tells him, and, by a physical examination, to determine just what the derangement of body is.

      It should be borne in mind that the diagnosis of the exact derangement--discovering just what organ is affected, and determining whether the disease is functional or organic innocent (benign) or malignant--is very far from discovering the primary and insidious cause, without which discovery the treatment must be palliative. There is no cure short of removing the primary or initiative cause. If the initiative cause has passed away, then the secondary cause, which is doing primary work, must be discovered and removed.

      The patient may be making his first call upon the doctor. He may be having his first pain or discomfort, or he may have had many attacks of sickness and pain.

      The discomfort that caused the patient to seek relief may be a link in a chain of morbid derangements leading back to childhood, or even infancy--not on the order of heredity, for nothing is inherited except a predisposition to be sick in a given way; but if the tendency ever becomes a realization, habits that pervert nutrition must be practiced long enough to break down resistance and start the morbid tendencies to work.

      It is necessary to get all the history of the life of the patient, and, when possible, the family history, age, sex, habits, occupation, temperament, beliefs, environments, mode and manner of the care of the body.

      It is necessary to know all about the life which the patient is living, and all about the life which he has lived, if he has changed his style recently. It is not only necessary to know the physical habits of the patient, but his mental habits as well; and, in addition, the physician must have the confidence of the patient and know his secret life. The physician must enter into the relationship of "father confessor" with every important case that calls upon him. If he has not the personality to secure this confidence, and draw out the secrets that are hidden in the occult chamber of the individual's soul, he is not possessed of those qualities of character which make for healing. The doctor must have sympathy--not, however, without firmness and sternness, when necessary. The quality of selfishness in a doctor must be covered by a very large coating of politic politeness, or he will not draw patients, and certainly will not be a physician at any time. If his selfishness is pronounced, it is liable to be subconsciously interpreted by the patient, and this knowledge kills influence.

      Lost self-confidence, self-respect, and self-control are the psychical elements with which the patient contends in chronic diseases, and which make management of a cure impossible for the selfish, vain, and unsympathetic doctor; for only the sympathetic can draw confessions--and confession is necessary to cure.

      It is well, this early, to disabuse the mind of any reader of the idea which he may have that a successful curing system is, or can be, based on a set of cut-and-dried formulas. Indeed not; every case is different and a law unto itself. The only thing that is fixed and unchangeable is the natural laws within and without the patient. It is our attitude before the law that determines health or disease. If our actions agree with the law of our being, or the environment, all is well.

      Health results from an agreeable adjustment of the body and mind to natural law and order; and impaired health--a lowered health standard, called disease--comes from disagreeable adjustment of the body and mind to natural law and order.

      Diagnosis is determining the symptoms and learning just what is the cause of the morbid process, and its effect on the body.

      I practiced medicine in the orthodox manner for twenty-five years. A number of those years were spent in determining just how much my treatment had to do with the recovery of my patients, and how much it did not. Little by little my drug superstition sloughed off. Not rapidly, but little by little, I learned that the physician is a woefully deluded man.

      In the first place, it is most unscientific, not to say senseless, for medical colleges to teach clinical medicine, using as subjects men and women broken down in mind and body from years of bad habits, and to use, as a teaching force, medical men who do not consider the influences of the daily habits of mind and body as factors in producing disease. As proof of the folly of such teaching I cite the growth and prosperity of Christian Science, which has proved such a haven of rest for millions that have escaped the barbarous practice of "scientific" doctors who were struggling in a medical way to medicate, vaccinate, inoculate, extirpate, serumize, immunize and demonize patients, but succeeded only in teaching all a large sick habit. Christian Science has always builded better than it knew; but this is one of nature's compensating acts. The regular profession builds in an inferior way with what it knows. Selfishness, snobbishness, and bigotry have blinded the eyes and dulled the understanding of medical schools, as ignorant conceit and religious superstition have blinded the eyes and understanding of Christian Science.

      Each system is standing in its own light, and prefers to be wrong rather than to give up its selfish advantages. The medical schools teach without any adequate means of finding out what the habits have been and what part habits play in the evolution of disease. Of course, habits are talked and written about; but, so far as applying the knowledge in the healing of disease is concerned, the subject is a dead letter; it does not enter into consideration, except in the most casual and perfunctory way.

      There is but one way to learn of the amount of influence exerted by physical and mental habits--what part they play in a given case--and that is by inducing the patient to give them up, while the physician stands by, keeping hands off, watching nature eliminate and readjust. If the doctor cannot be satisfied to do nothing, except watch nature clean house and see to it that the work is not obstructed by the patient's bad habits or by his medical superstitions, he can never cultivate a dependable working knowledge of etiology; and without such knowledge he must remain in a mentally chaotic state concerning cause, effect, and cure.

      Our present scientific teaching leads us through a "fool's paradise" of examinations, using instruments of precision to palpate, auscultate, and percuss; chemically analyze the secretions and excretions; microscopically examine the secretions, excretions, and every fluid and solid of the body; bacteriologically examine the entire body--the exudates, the transudates, and the expectorates; aspirate from every secret chamber of the body, analyze the fluid in every way possible, and then spend weeks in bacterial culture; X-ray every suspicious location, and radiograph the same. After all this examination, the diagnosis is "hung up", and the patient is sent away on suspended judgment, to return again in a few weeks or months to go through the same ordeal. This may be somewhat overdrawn, but certainly not in a few aggravated cases of mania in diagnosis.

      What are the real causes of the bodily derangements which send professional gentlemen and their diagnostic specialists and experts through this "fool's paradise" looking for something that is not found in this glorious Eden? What is that elusive something that evades the microscope, stethoscope, test-tube, analyst, X-ray, and every other instrument of precision, and every analytical, synthetical, deductive, inductive, and seductive diagnostic procedure?

      It is life--a state that is commonly referred to as health. It is not an entity--a something to see, hear, taste, smell, or feel.

      Health is the meter by which life is measured. When health is below a certain standard, we think disease; we lose the thought that impaired life--the state we call disease--is a lowered health standard, and that there is no such thing as disease.

      The primary entities with which the physicians have to do are man and his environment. These are both good and adapted to each other, or they could not exist together. Man did not evolve until his environment evolved him. I assume that, inasmuch as nature never stultifies herself, man and his habitat are suited to each other and are potentially ideal, and that, if the unideal evolves, it is because of a maladjustment which is easy of readjustment.

      I further assume that it is the doctor's duty, if he would be a physician, to throw his whole power of intellect into the study of why an environment that produces man also destroys him--why benign and life-imparting influences become malignant and life-destroying influences; and I invite any medical man to try successfully to refute my declaration that there is not one influence in man's environment which is not for his good, if he (man) is properly adjusted to it.

      What should etiology be? Learning all about the influence of everything that affects man's body and mind. In this study we find that everything necessary to life, liberty, and the pursuit of happiness may be enjoyed to excess, and that, when it is, it enervates--lowers the standard of health; which means that functioning is impaired and self-poisoning takes place by retention of excretions. When this state is brought about, man loses his normal adjustment and every environmental influence has an exaggerated effect upon him.

      If he has lowered his resistance from overeating, overwork, worry, fear, overindulgence in any of his physical or mental pleasures, every influence to which he was once normally adjusted affects him uncomfortably. If he undertakes to eat as formerly, he suffers from indigestion; if he works or undertakes to indulge himself in previously enjoyed habits, he is made uncomfortable and to suffer. One to three cigars distress him, whereas once a dozen could be smoked without any apparent subjective symptoms. The hopelessness of this situation lies in his remembrance that he once could smoke, drink, and otherwise indulge his sensual nature without discomfort, and in his belief that if he can find a doctor to "cut out" his disease, or cure it by some scientific means, he may return to his old flesh-pots. He knows very well that he could once indulge; he is quite sure he may again, if a cure can be found; and on this fool's errand he can find doctors and healers galore to accompany him. We have "perhaps the largest surgical plants in the world" just for the purpose of cutting out disease, so that the victims will not be put to the inconvenience of cutting out their bad habits.

      The enervated man cannot indulge himself with any of his former sensual pleasures without being thrown into a state of discomfort. He and the medical expert go rummaging through the dump-pile of primary, secondary, and tertiary symptoms--a few of which are: impaired blood, functional and organic changes in various organs of the body, deranged secretions and excretions, etc.--hoping to find cause. Certainly a fool's errand, when, if they would reflect, they should notice that after every enjoyment the sick man is made worse, and after every disappointment in gratifying appetite and passion he is made better.

      In this connection it may be well to give a few of the bulletin reports of the scientific activities of the doctors in their treatment of one of the world's most distinguished patients, showing how innocent the profession is of the grotesqueness of its scientific conceits:

      "The queen is sinking. She is unable to take nourishment. Her medical attendants declare that she can last but a few hours." At the expiration of twelve to twentyfour hours: "The queen has rallied, and is able to take nourishment. The doctors declare that there is a chance for her recovery, barring complications."

      What complication or complications could spring up? What causes complications? In this case the complications were obvious enough to any mind not under the spell of medical science.

      Complications usually come from the treatment and nursing.

      "The queen is sinking. The rally of this morning was followed by a sinking spell, and she is again unable to take nourishment. Heart tonics given hypodermically keep what little life there is from ebbing away. Only the superhuman skill of the doctors prevents death from claiming the great woman as its bride."

      "Verity, every man at his best state is altogether vanity. Selah." Superhuman conceit killed the good woman before her time.

      "During the night the doctors watched at the bedside of the distinguished patient, watching with bated breath the ebb and flow of the declining energies. Once or twice the family was aroused to view the grand queen and mother of the greatest empire on earth, while there was still a little life left in her body. All efforts at keeping life in the aged queen was abandoned at midnight." Next morning: "Most extraordinary, the unexpected happened! The queen rallied, and at this cabling is taking nourishment. The doctors fear, however, on account of the queen's great age and the weakness of her heart, that the rally will only be temporary. Sir John Blatherskite, an eminent heart specialist, was called in consultation, and he favors strychnin for the heart. This heart tonic will be given in place of digitalis, which has served long and well."

      If we of the profession could see how childlike and silly much of our boasted science is, we could then see how like grandstand acting are

      The queen did die--not, however, until these disgusting medical bulletins were repeated often enough to have put the whole world "wise" to the stupidity of medical science as practiced, and the shallowness of medical thinking, if the world had been capable of cutting loose from precedent and doing a little bit of independent thinking.

      The profession is so used to looking to the unusual, the mysterious, the occult; to finding a cause for disease, instead of recognizing the fact that there is no disease per se--only a normal, supra-normal, or infra-normal state of health, and that these different states are brought about by different degrees of environmental stimulation.

      All that can be discovered by examination, be it superficial or scientifically elaborate, is the effects of influences or causes which have passed out of existence, or which are still existent, or which have caused secondary causes before passing out. Scientific medicine spends its force on effects; the real causes are left undiscovered.

      For example: A subinvoluted uterus, or a misplaced uterus, may be crowded by intra-abdominal pressure, causing a misplacement and perversion of circulation. The return circulation may be sufficiently impeded to cause a passive congestion and an enlarged hyperplastic state to develop; and the larger the growth, and the more constriction and impeding of the circulation, the larger the tumor (fibroid--for that is the character of this morbid differentiation), until restricted by the pelvic walls. This resistance to growth restricts the size and hardens the tissues. If, however, the tumor drags the uterus into the abdominal cavity, it will then, being freed from restraint, take on new and more rapid growth, sometimes filling this cavity equally to the size attained at full-termed pregnancy.

      In this case the primary cause may be a catarrhal inflammation at an old placental site; or a catarrhal inflammation of the mucous membrane of the virgin uterus, due to exposure during menstruation, may take on hyperplastic growth, causing an enlargement of one side of the walls of the uterus. This causes a flexion, and a flexion always impedes the circulation, and a fibroid growth follows. All growths are the result of impeded circulation. When the circulation becomes so mechanically obstructed as to bar the entrance of oxygen and an exit of waste matter, degeneration takes place--malignancy carries off the patient. The cure must be restoration of the return circulation by removing all pressure that causes misplacement.

   2. Appearance of Patient

      The patient's appearance will tell whether or not he is able to meet the requirements of existence. He looks able to carry on his work--his particular occupation- or he does not. If he does not, he will give the appearance of being sick with either acute or chronic disease.

      At the bedside the patient may look robust, sick, collapsed, bluish or cyanosed, thin, fat, with thick and short neck, or long and slender; he is on his back with legs extended, or with the legs drawn up; or on the side with legs drawn up against the abdomen.

      The patient may be unable to give a history or describe his symptoms.

      Decubitus (Lying Down).--The manner of lying is significant. On the back means exhaustion. This is the position when a patient has lost consciousness.

      In a faint or anemia of the brain, the head drops; in congestion of the brain, the head must be supported on several pillows; in asthma of the lungs, bronchi, or caused by the heart, the patient must have much pillow support.

      In heart disease the patient lies upon the right side. A normal person can lie on either side equally well.

      When heart disease is advancing to the fatal state, the position is sitting, with head and shoulders supported by pillows.

      Pain in the abdomen will cause the sufferer to press upon it, or lie on a pillow. Pressure gives some relief. When the pain is intense there will be twisting and writhing.

      In peritonitis, appendicitis, cystitis, gallstones, cancer of the stomach and bowels, the tendency is to draw the legs on the abdomen. In peritonitis, the patient will usually be on the back, with legs drawn up.

      In gastric ulcer, when suffering with pain, if the ulcer is in the front wall of the stomach, the patient will lie on his back; if the posterior wall is the location of the ulcer, the patient's position will be lying on the abdomen; or upon the right or left side, if the disease is of the right or left side. These positions relieve pressure on the ulcer.

      In tubercular meningitis, the child lies on the side, with legs strongly drawn up against the thighs.

      Facial Expressions.--Disease as expressed in the face and posture.

      Facies cardiac (heart): An anxious expression seen in the early stages of chronic valvular disease.

      A purple or bluish appearance of the face, especially about the eyes, temples, and ears, with veins showing on the nose and sometimes on the cheeks, intensified by lying down: Caused by high blood pressure and an approaching dangerously plethoric state of the body.

      Hepatic face: An earthy appearance; yellow tinge, jaundice.

      Hippocratic face: Indicating rapid approach of death--pinched nose; hollow temples; eyes sunken; ears leaden and cold; lips relaxed; skin livid, and if the skin is pinched it returns slowly to the plane from which it was pinched or drawn.

      Ovarian face: Features emaciated and sunken; anxious expression; forehead furrowed; eyes hollowed; nostrils open and sharply drawn; lips full and compressed; angles of mouth drawn and wrinkled, puckered but protruding"fish mouth."

      The stupid face is that of typhoid.

      Gastric face in children: A white line around the mouth, extending up by the side of the nose, shows irritation from improper feeding. Add to this sign pungent breath and vomiting, and the child has gastritis.

      Gastric face in adults: Chronic irritation of the stomach in adults is indicated by a dragging-down of the comers of the mouth. Add to this drooling or driveling of saliva, and the indication is of starch poisoning; and if there is a broad, pallid tongue, the evidence is strong for overeating on starch.

      Hysteria is marked by staring and an ecstatic expression.

      Epilepsy is marked by a stupid face after an attack.

      Protruding eyes and expressionless face in Graves' disease.

      They lypermaniac has sadness written in his face. In general paralysis the countenance is composed and satisfied. The enebriate has trembling bps and a wandering expression.

      The child with enlarged tonsils and adenoid growths has a stupid expression; the mouth is open, the lips hanging; the nose is expressionless.

      The red nose, enlarged veins, bluish lips, cyanosed cheeks, and puffiness of face of the drinking man are called the mitral face. Where the aorta is diseased there is intense pallor. In Bright's disease the face is swollen and white.

      The signs of croup are well known, but the type of disease is not so easily told. There are coughing and suffocating when a foreign body is in the air-passage.

      Expiratory disturbance is marked by flushed face, puffed and bluish; the eyes are suffused, and the veins stand out.

      In marasmus the features are drawn, the furrows deepened, the neck hollow; emaciation is marked, and, when profound, the whole appearance is that of the monkey.

   The consumptive appearance is that of emaciation; protruding, flushed cheeks; pinched nose, with flaring nostrils; short, quick, jerky breathing; halting speech, and more or less suppressed voice.

   When the face looks smaller--shrunken--and the nose is thin, long, and drawn, the bones prominent, the skin pale and covered with cold sweat, and, when drawn or pinched, the fold remains for some time, this is the facies of peritonitis, intestinal obstruction, renal and hepatic colic.

   Fainting: The heart stops; the patient turns pale and falls motionless, but there is no distortion of the face; breathing is suspended.

   Apoplexy: The patient is motionless and lies on the back; all animation is suspended; only breathing and pulse continue; the breathing is noisy, and gradually grows more stertorous. If the patient does not react and improve, the breathing and heart action gradually decline, the skin becomes drawn, the nose thinner and longer, the eyes dull, partially closed, glassy. The breathing stops, starts and continues, until it finally ends with a slight bodily convulsive movement.

   Physical appearance must be noted--all deviations from the normal mean something.

   Deformities, such as rickets, shorten the stature and cause the head to appear too large; the spine is incurved, the pelvis is deformed, the limbs are curved, the ribs project forward.

   When the muscles become atrophied they cause general deformity.

   Alterations of the heart or lungs cause deformities of the chest.

   The bowels are often too large and distended from gas, fat, or ascites; in fevers, from tympanitis and inflammations.

   Enlargement of the liver or spleen causes a large abdomen in the upper region; in the lower abdomen, enlargement may come from tumors, distended bladder, or a gravid uterus.

   A large swelling at the base of the great toe, with the toe pointing outward, indicates a bunion. This deformity usually means that there is a slight rheumatism. Deformity of the third joint of the fingers--nodes of Heberden--means arthritis deformans. The nodes of Bouchard on the second joints of the fingers indicate dilation of the stomach--a disturbed nutrition from overeating of the carbohydrate foods. Joint distortions indicate gout, rheumatism, or injury; not infrequently they mean all of these. Frequently injury is complicated by rheumatism.

   Hippocratic fingers (clubbing of finger-tips, with incurving nails) indicate heart or lung disease--scrofulous diathesis.

   Skin.--A straw-yellow hue is found in cancer cachexia.

   Paleness may be from anemia, dysemia, leukemia, amyloid degeneration, or Bright's disease.

   Articular rheumatism is marked by paleness, and profuse sweats with strong acid odor.

   Anger, fear, and jealousy cause paleness. The cause is vascular spasm. Fainting causes pallor.

   Plethoric people are too red in color. A florid complexion means the sanguinous temperament and does not mean too much blood.

   Unconsciousness may be from syncope (fainting). The face is pale; either no pulse or very light; the breathing very low and quiet. There are no signs of distress; the face is usually composed.

   Cerebral Derangements.--If unconsciousness is preceded by spasm, the cause may be kidney disease--uremic coma. Symptoms may be headache, and flushed face with veins standing out. This means congestion of the brain.

   A diagnosis--a decision as to the character of a disease and its cause--requires a close examination into the social life of the patient; the family history; the history of previous disease, and the diseases of the family as far back as possible; the history of the present disease; the history of family habits as well as the habits of the patient. It is necessary to know all about the personal habits of the patient, secret as well as open. The eating habits must be known--even to knowing exactly what is eaten at each meal daily. The sex life must be known--the early abuses, as well as those coming later in life.

   A diagnosis, so far as determining that a certain organ is affected--for example, that the kidneys are diseased, that the patient has diabetes or Bright's disease--is far from conveying to the physician's mind an idea as to the true cause of the disease. It is true that the physician sees in his mind's eye hepatic insufficiency, or a failure in the dehydration of glucose in the walls of the intestines. But as to what has caused the malnutrition, in what way the patient has brought on his enervation, and what are his habits, the physician knows nothing from the test-tube, which only tells him that there is sugar or albumin in the urine. The diagnosis, so far as naming the diseases is concerned, may be correct; but no information is conveyed to the mind of the physician as to the primary cause of these diseases. Even when germs or parasites are given as cause, this manner of diagnosis throws no light on the question of why germs and parasites do not cause disease in all whom they infest.

   Analysis of symptoms, examination of all secretions and excretions, and palpation and auscultation of all organs, amount to a scientific examination of effects; but a positive diagnosis throws no light on cause. Causes must be found and associated with effects before a curing knowledge can be possessed.

   Diagnosis may be very correct, so far as effects are concerned; but cause of effects must be known.

   It is necessary to know a healthy man. What are the signs of health?

   The eye and the skin are clear. The outlines are normal. Those whose lines are obscured by fat are not healthy. Women who weigh over two pounds to the inch in stature are too heavy. Men who weigh more than two and a half pounds to the inch of stature are too heavy and are diseased.

   Women and men who weigh much less or much more than the standards named are diseased. By diseased I mean that they give down early; they have not the resistance they should have; they age rapidly; and come to a premature grave.

   A healthy body will desire only normal, natural, and simple foods.

   Normal health is rare indeed. This being true, is it so very strange that so few live to one hundred or one hundred and twenty years of age-the normal lifetime of a human being?

A Normal Person--Hunger

   A feeling of contentment after eating, and no discomfort.

   A desire for fresh uncooked fruits, vegetables, and little, if any, seasoning, or thirst for water. Hunger is always moderate.

   Urine amber, clear, and with a pleasant bouquet. Heat and acids have no effect on it. Passed with comfort.

   Bowel movements should be brown, molded, but not hard; not offensive, and regular.

   Skin should be soft, warm, moist rather than dry, and smooth. No disagreeable odors.

   Hair is full, long, and possessed of sheen.

   Lungs do their work without discomfort and through the nose.

   Sleep is long, quiet, and refreshing.

   Work and play are pleasurable.

   When trouble comes, when disappointments and losses come, they are soon brushed aside and poise is regained with a resumption of interest in life.

   Is not envious, jealous, spiteful, nor given to irritability or temper.

   Mind is bright, alert and quick to learn. All attention.

   Is honest, truthful, generous, kind, forgiving, economical, and philanthropic.

   When sick, recovers more quickly because optimistic, and submits more gracefully to the chastening rod of correction; endeavors to get the benefit of the misfortune by reflecting on the cause, and endeavors to avoid a repetition by correcting the life.

An Abnormal Person-Appetite

   A desire for more; dissatisfaction and a feeling of discomfort; gas and belching; acid stomach.

   A desire for highly seasoned foods, alcoholics, tobacco coffee, and tea. Appetite is always driving; much thirst.

   Urine cloudy, full of sediment, bloody, dark, odorless or rank of odor. Passed too often and with discomfort.

   Bowel movements are green, gray, yellow, or white, and form into scybala (lumps). Or they are watery, bloody, wormy, and offensive to smell.

   Skin is moist to wet; hands and feet cold and clammy. Always wet under the arm. Disagreeable odors from the perspiration under arms and feet.

   Hair is thin, lusterless, and dry.

   Lungs show asthma, cough, expectoration.

   Sleep is fitful, restless, dreaming, and leaves tired on waking up.

   Work is disagreeable and tiresome; no pleasure taken in recreation.

   Worry, worry, worry, without much excuse. No interest in life. When trouble comes, the life is devoted to worrying.

   Is very irritable, spiteful, revengeful, jealous, envious, quick to lose temper.

   Mind is dull, slow, and learns with difficulty. No power of attention. Inclined to sleep, yet insomnia at night.

   Is dishonest, deceitful, stingy, selfish, unkind, wasteful of other people's property, even when selfish and miserly with his own.

   Recovers slowly because mental attitude is that of irritability and impatience. The abnormal person does not learn from experience. Everybody is to blame for his misfortunes, except himself. He is incorrigible.

   A very good standard for health is the ideally beautiful--beautiful in body and mind.

   Those who would know a sick man should study art. The artistic represents health, both of body and of mind. Then, to know the sick, contrast them with the normal--the ideal.

   Post-mortems tell nothing except how terribly the body may be abused before it dies. Yet the dead organs can tell no tale; they cannot stand up and accuse their traducers, nor tell the manner of abuse.

   The modern, popular idea of beauty and health is that the body should be incumbered with fat. Stock shows furnish a type of beauty that fits the modern sensual conception of what beauty consists of. Sensuality dominates everything in modern life. Even medical science, in catering to modem sensualism, has won the everlasting gratitude of Bacchanalians and gluttons, by offering the germ as the cause of disease, and tacitly freeing them from all restraint and giving them license to do as they like. Of course, this will be disputed, but I back my statement by referring to the patients themselves.

3. Pain

   The evidence of pain. The patient complains of pain, and directs to its location by placing his hand on the part, or as near to the part as he can.

   How much pain has the patient? He may be sensitive, imaginative, and inclined to exaggerate; or he may be frightened. On the other hand, he may be reticent and fail to tell the truth about his suffering. Again, he may be too ignorant to give a clear account of himself.

   These are a few ways of learning of pain:

    (a) Facial expression and bodily movements;

    (b) As described by a friend or nurse;

    (c) Results, such as weakness and emaciation from long suffering;

    (d) Arterial pressure.

   When a patient's face is contorted and his body writhes, doubles up, or stiffens, we have good evidence; yet he may be malingering (acting). However, the experienced physician will not be fooled long. It may take a little watching when the patient thinks he is alone. If he really suffers, he will suffer alone as well as when someone is near.

   Many are sorry for themselves and make more complaint than necessary; others complain to secure sympathy. The real physician will discriminate, while the doctor is never anything but an amateur. The former cures his patient by imparting assurance; the latter adds to the disease by first discouraging and then operating.

   When a patient who looks well declares he has been suffering for months, and he has not lost weight, and there are no objective signs, such as impaired circulation and heart action, and no tumor at the point where the pain is said to be located, it is safe to treat him as a malingerer or a self-deluded individual.

   If nervous, imaginative, and self-deluded patients, describing their suffering as "awful ... .. fearful," "I liked to died last night," "I thought I was a goner," etc., are examined for patellar reflex, this movement will be found greatly exaggerated. This proves that they are very sensitive to pain, and should be questioned regarding eating; and it will be found that they eat much starch, and use coffee and other stimulants. Many will be found to have toxin poisoning.

   Women bear pain--prolonged pain--better than men. The reason for this is that they are more self-controlled than men. Man is more self-indulged, hence less able to stand pain.

   Types of Pain.--There are many kinds of pain; namely: boring, tearing, lancinating; a feeling of pressure, of heat, of cold, of hunger; a feeling of all-goneness, fullness, emptiness.

   Colic is distinctive. It is rhythmic--the patient does not suffer all the time. It begins gradually, and increases to a climax; then subsides, to repeat again. Such pains are characteristic of canals: the intestinal, urethra, ureters, uriniferous tubules, bile-duct, eustachian tube, uterus, and fallopian tubes. An inflammation of these tubes and canals is accompanied by rhythmical pain.

   Throbbing Pain: Pain that rhythms with the heart and pulse is caused by hyperemia. Headache and toothache are types. Any inflammation that is accompanied with enough swelling will have a rhythmic pain.

   Precordial Oppression: This is a feeling of constriction. Angina pectoris is a type of this pain. This pain is of the heart. Affections of the pleura or lungs give no such pain. Asthma is a feeling of suffocation. It differs from oppression in the fact that it is difficult to draw air into the lungs, whereas in heart oppression there is no difficulty in getting air into the lungs, but it appears difficult to extract the oxygen, and the patient feels that he will die of suffocation.

   Reflex Pain: When reflex pain is from angina in the lungs or abdomen, resembling indigestion, rheumatism, neuralgia, or neurosis, it may be relieved by rest, but not with the usual palliatives.

   Shooting pains are usually neuralgic.

   Relationship of Pain to Other Facts Connected with Disease.--Time of recurrence: If regular in time-say, every day or every other day-the cause may be malaria. Pains that are worse of a morning and wear off during the day are nervous headaches and joint inflammations. Pains accompanied with fever and infections usually grow worse toward evening. Fever always runs higher in the evening.

   The position of the body: If the legs are drawn up against the abdomen, the pain may be in the bladder, the uterus, the bowels, the gall bladder, or may be due to pyloric disease, ulceration, or cancer of the stomach.

   Inflammations of the organs in the abdomen and pelvis are made worse by standing or walking. Lying down relieves.

   When the bowels are distended with gas, or there is an accumulation of fat in the abdomen, such derangements as misplacements of the womb, piles, pelvic tumors, and cystitus (inflammation of the bladder) are all made worse by being on the feet.

   The pains peculiar to chronic joint diseases and muscular rheumatism are made worse by staying in bed.

   Pain produced by taking food indicates gastralgia, gastritis, ulcer, cancer, obstruction of the pyloris, gallstones, etc.

   Enteritis, obstruction, and appendicitis are made much worse by eating. A few sips of milk will start peristalsis, and when obstruction or appendicitis exists, the patient will be thrown into great distress. Pain that is not made worse by eating is not caused by obstruction.

   Pain that is frequently mistaken for appendicitis is caused by colitis, constipation, proctitis, ovaritis, neuralgia of the spermatic cord, strictures of the urethra, and gallstone or gall bladder disease.

   Relief from drinking or taking food indicates gastric irritation caused by taking fluids too hot, eating too rapidly, overeating, the use of coffee, tea, tobacco, alcoholics, eating between meals, or gum chewing.

   Damp weather, by chilling the surface of the body, causes those who are rheumatic to have pain and stiffness of different parts of the body.

   Those who foretell storms and changes in the weather are human barometers, made so by a state of acidosis of the body. They have been using a preponderance of foods belonging to the acid producing class, and cooked foods which have had their enzymes killed by heat. Those who suffer headaches--even migraine sufferers--are made worse by meteorologic changes.

   Headaches that occur on bright, sunny days, or when the earth is covered by snow, or on train or water trips, are probably due to eye strain.

   Sea- and train-sickness is caused from abuse to the stomach by overeating, eye strain, or reflex irritation. Gas in the bowels, pressing on the ovaries, will cause sick stomach. Any neurosis is liable to be aggravated by train or sea voyages. Anything that enervates such subjects will cause them to be bad travelers.

   Vomiting that relieves does not indicate that the stomach is diseased, any more than a cough that relieves indicates that the lungs are diseased.

   The effort at vomiting shocks and produces reaction, which relieves pain in any part of the body. Pain produced by gas pressure, gallstone, or pain in the kidneys, womb, ovaries, spermatic cord, and testes, is relieved by vomiting. Heat and cold relieve pain. The patient must decide. Heat is more logical.

   The sick habit has become a reality in these piping times of great medical discoveries. The habit of thinking sickness, talking sickness, acting sickness, and being coddled and operated upon, has developed an army of people who have become expert in complaining.

   The sick habit and the drug habit are products of the medical profession. One of the principal causes is that the doctor must live, and it is to his bread-and-butter interest that every patient applying to him be very sick, or in imminent danger of dying unless operated upon at once.

   The average professional calamity howl set up when a patient calls on "the best physician" in the community is quite enough to terrify, shock, and draw the patient's attention to himself and set up a morbid introspection. Once started, the introspection habit builds mountains out of mole hills; and surgical science has developed to such a state of perfection that it can extirpate every symptom of disease, except the disease itself, which is a large sick habit.

   Pain Explained.--Every part of the body is supplied with nerves. Nerves, when pressed upon, give out a sensation of discomfort, and discomfort warns that something abnormal is taking place. The worm squirms away from it; the animal runs away from it, as did man in his early development. Man in his ratiocinative state is supposed to reason on the cause, and to remove it; but no, he runs to a mysterious individual, who administers a mysterious remedy, or cuts out an effect; and all concerned are satisfied, and the cause continues.

   Nothing but reason, however, will direct man out of the way of harm and help him to understand cause.

   When man reasons, he must know that there are two general types of causes for pain--namely, extrinsic and intrinsic. The outside causes, when understood, may be disposed of. The inside causes must be understood from inductive and deductive reasoning.

   For example, when we learn that no one will develop angina pectoris who does not use tobacco, coffee, or tea, then man will know how to avoid such an affliction. When man learns that overindulgence in eating meat, or animal proteids, will slowly but surely set up a general lymphangitis and favor the development of catarrhal diseases, from nasal catarrh to tuberculosis and syphilis, he will know how to avoid such diseases. When those suffering from stone in the kidneys, gall bladder, or urinary bladder learn that these diseases follow the neglect of eating eliminating foods, and refusing to eat mineralized foods and drink mineralized water, man can avoid these painful diseases, and become his own physician.

   Inflammations in the different organs create pain, heaviness, and fullness in the organs; pain, if the inflammation involves the surface; a dull, full, and heavy feeling, when the disease is of the body of the organ.

   A persistent pain at or near the umbilicus is an indication of obstruction, partial or complete, somewhere in the intestine.

   Radiation pain may start from an indigestion which causes gas; the gas presses upon an ovary, and the pain in the ovary causes vomiting. The nerve impulse starts in the ovary, goes to the spine, and from this center is sent to the stomach, producing vomiting. The eye strain on a railroad or sea voyage causes vomiting.

   Any theory that all pains must be radiated from the spine, or from organs to the spine and from the spine elsewhere, must be limited. The truth is that pain must be taken care of in the storehouses of the nervous system--the ganglia, which are the inhibitors and dissipators of pain, as the lymphatic glands are the repositories and suppressors of toxins.

   If it were not for the ganglia, which act as storage batteries for the distribution of surplus energy, the body would be killed from shock, which, under the system of storage batteries, is absorbed and the body is saved the shock.

   When a locality of the body is under the continuous stress of irritation, pain must be felt in quite remote parts, because of the transmission, storage, and radiation.

   When the batteries of the body become charged to full capacity, radiation or elimination takes place.

   Headache results from this overflow. Its elimination causes pain.

   The elimination of surplus energy is marked by pains of all kinds, and fevers. Colds and fevers are the unloading of pent-up energy.

   Nerves accompany arteries. When much energy is conveyed over nerves, arterial spasms are experienced. Continual overstimulation of the arterial system ends in arteriosclerosis.

   If the current of irritation is caused by envy, jealousy, or anger; or from the toxins of alcohol, tobacco, coffee, tea; or from daily decomposition of food in the intestine, with absorption of the toxins or acids or sepsin; or if the shocks come from lascivious thoughts, onanism, or excessive venery, the continual overstimulation of the arterial system must end in hardening of the arteries, loss of coordination or tabes dorsalis, apoplexy, paralysis, etc.

   It is well to remember that pain it not always located at the site of injury or lesion.

   When a nerve is compressed, pain is not always found at the point of compression, nor at the nerve's termination. Epilepsy and convulsions generally have a peripheral origin. To be exact, most cases of epilepsy primarily originate in intestinal indigestion, with toxin poisoning; then one or more organs become affected, these affections transmitting their irritations to the central nervous system.

   Affections of the spinal cord may manifest at any point other than at the cord. Infantile paralysis is a spinal affection. Its syndrome is impaired nutrition from food devoid of unorganized ferments and basic elements, and the consequent enervation. Resistance is so impaired that extraordinary thermic changes, or depressing physical changes, cause a giving-down of the nervous system, favoring central lesions--cerebral spinal, and meningeal inflammations. The gastric, darting, and girdle pains of locomotor ataxia are peripheral symptoms of a central lesion, and the lesion is caused by toxins.

   Headaches are seldom symptoms of head lesions.

   Causes of Headache: Anemia, fatigue, hunger, bad air, alcohol, morphine, lead, blood pressure, arteriosclerosis. The headache of old people frequently comes from hardening of the arteries. If examination is made, however, there will usually be found a kidney lesion; but even that and blood pressure belong to the syndrome of arteriosclerosis. Headaches come often from indigestion, constipation, eyestrain, beginning of fevers, brain tumor, and syphilis. A common headache is known as rheumatic headache. It is characterized by spots of "induration," or sensitive spots. This is without doubt the coffee and tea headache, and can be cured by stopping the use of these table beverages.

   Refrigeration is said to cause this headache, but coffee and tea make their victims susceptible to cold.

   Rachialgia (pain in the back), at the beginning of fevers, smallpox, and the backache complained of by most women are of no value with reference to the location of a lesion. Constipation and uterine disorders often cause much backache.

   A common cause of coldness--a feeling of chilliness that cannot be gotten rid of by the heaviest clothing and warmest rooms--is intestinal indigestion; in which case clothing and hot houses are only fuel added to the fire--or, rather, cold added to the chilliness.

   I have often told patients suffering in this way that if they would eat more--much more--and put on a half dozen more suits of underclothing, they would stand a good chance of freezing to death.

   Neurasthenics usually complain of heat when their hands and feet are cold.

   Those who have paralysis agitans are usually too warm.

   A pain at any point in the body may be the aura of epilepsy.

   A very sensitive state of the abdominal wall, without gas distention, or with a moderate amount of gas present in the bowels, indicates a neurosis. The real derangement may be intestinal indigestion and catarrh of the uterus,

   When deep pressure in the abdomen causes no more discomfort than a light touch, the patient is of a nervous type, and should not be subjected to an operation just to relieve her of the notion that she needs an operation.

   Hysteria is a hypersensitive state. The hysterical zones are at the top of the head, in the dorsal spine, at the nipple in man, and under the left mammary gland of woman; in the ovarian region, the spermatic cord and testes, and in the patella. It is not uncommon for the knee to be treated for rheumatism, when the disease is of the ovary.

   Many men and women are being operated upon today, in our leading "surgical plants," because of pain in the various hysterical zones.

4. Examination of the Patient

   In examining a patient, the family history should be obtained; for this gives a clue to predisposing causes and family habits which lead to specific derangements. Then the patient's personal life and habits, mental and physical, must be reveiwed. This information, with analysis of the objective and subjective symptoms, leads to a knowledge of what the patient's illness is; for diseases are the result of broken health laws.

   If the patient has pain, this directs to the part of the body affected. It must be determined if the pain is local or sympathetic.

   A patient may be sick at the stomach, and be vomiting; yet the real derangement or cause may be of the brain or uterus. If the stomach is treated, the treatment must fail.

   Spinal disease may manifest in the joints of the feet and legs. If the physician foolishly treats the pain in the legs for rheumatism, he must fail to benefit his patient. I have met with a case wherein a boy had been treated for rheumatism of the left knee, when his disease was preputial.

   Palpitation of the heart comes from stomach derangement oftener than from other causes.

   Pulmonary tuberculosis often presents symptoms of heart derangement; and mitral stenosis will cause much coughing, and even hemorrhage of the lungs, which symptoms are secondary to the heart derangement.

(a) Organs of Special Sense

   Only the general symptoms are of importance in eye derangements. The special belong to ophthalmology. Photophobia (dread of light) may be due to hysteria, a brain lesion, or an inflammatory disease of the eye.

   Ulceration of the cornea is often an index to the state of the blood--often indicates heavy meat-eating, with consequent toxins in the blood.

   Dropping of the upper eyelid may mean paralysis of the third pair.

   Protrusion of eyeballs, with heart symptoms, indicates exophthalmic goiter. If but one eye protrudes, it indicates a tumor behind the eye.

   Long vision, with lost accommodation of light, means ataxia or paralysis. This is the Argyll-Robertson sign. A bright spot before the eyes (scotoma), with loss of power to contract the pupil before a light, may indicate optic neuritis or tabes. If no other symptoms of tabes can be found, it is an eye lesion.

   If a person, deaf in one ear, can hear a watch tick, or a tuning fork, placed on top of his head, equally well with both ears, the disease is not central.

   When taste and smell are diminished, it is probably due to toxin poisoning, including tobacco, alcohol, coffee, and tea.

   A headache is rare indeed that will not get well after the patient corrects his eating and other habits.

   A crisis of tears differentiates a hysterical from an epileptic paroxysm.

   Purulent ophthalmia is often an indication of gonorrheal infection.

   Halos of light, or scintillations passing from a light, indicate indigestion in children.

   There are many eye lesions that will pass away when all stimulants are given up. Toxin poisoning must be overcome by eating in keeping with the digestive power. Venereal abuse brings on enervation of the eye and brain, and, unless corrected, no cure can be made. Adopting glasses for many eye defects caused by excesses in sensuality is the height of nonsense.

   When noises disturb and prevent concentration, in those who are trained to concentrate or give attention, the nerves are on edge, and the cause is overstimulation--overeating, coffee, tea, tobacco, alcoholics, excessive venery.

   If, by applying the ear or stethoscope to the patient's ear, the physician can hear a crackling sound when the patient swallows with his nose and mouth closed, it indicates that the tympanum is intact.

   Taste and smell are often much impaired by catarrh.

   It can be said that all the special senses are more or less impaired by a style of eating that builds toxin poisoning.

(b) Vasomotor

   Sudden redness of the cheeks indicates meningeal inflammation.

   The well-known cheek flush of tuberculosis should not be confounded with nervous flush.

   Red cheeks of teething children will be accompanied with other signs of teething.

   Red cheeks and a white line around the mouth and nose indicate irritation of the stomach; in children, gastric fever, if there is vomiting. These symptoms may precede the eruptive fevers.

   Cold, blanched feet and hands indicate vasomotor constriction and have intestinal putrefaction as their cause. When this condition becomes pronounced, it is called syncope of the limbs. The patient may have "dead finger"--a finger or fingers without feeling--and there may develop points of gangrene; or there may be the opposite state--venous congestion or cyanosis, such as occurs in asphyxia--oxygen starvation. The source of toxin poisoning must be discovered and removed, or this state cannot be overcome.

   Acute vasomotor disturbances cause hyperemia of the breasts in women. It is too common to amputate the mammary glands, the surgeon diagnosing fluxions as cancer. The careful physician will find an accompanying uterine disease, which, if cured, will do away with the periodical hyperemia of the breasts.

   In severe and advanced stages these hyperemic hemorrhages take place in the skin, mucous membrane of the bowels, urethra, ureters--bloody tears, bleeding from nose, lungs, or kidneys. There may be organic diseases, but hysteria should be suspected. Too often the physician is willing to believe the worst--that the disease is cancer.

   Dry mouth may be caused by fear, anger, or fever. Salivation (flow of saliva) may mean mercury poisoning, nervousness, neuralgia, cancer, or may be the forerunner of epilepsy.

   Sweating is suppressed in neuritis, neuralgia, and brain disease.

   Increased urination may be due to polyuria, diabetes, excessive drinking, nervousness, indigestion, hysteria. Fear, anger, and suppression from kidney disease may cut down the amount far below the normal.

   In tabes dorsalis there may be hypersecretion of digestive fluids. Hysteria should be suspected. The neurasthenic is inclined to have exaggerations and suppressions of all the secretions and excretions.

(c) Heart

   The normal apex beat is a little below and to the right of the nipple. Lying on either side may change the location slightly either way, A strong impulse should be inquired into; for the reason should be known. The apex beat may be displaced down, or to the right or left. The apex beat must vary in its location. In women the breast development prevents the nipple from being a landmark. In fullness there may be enlargement, and there may be effusion.

   By palpating, any undue dullness can be discovered. Pressure over the heart that causes pain indicates either myocarditis or pericarditis. This should not be confounded with intercostal neuralgia or rheumatism, which is strictly local, on or between the ribs.

   Percussion.--In examining the heart, there are two zones--namely, a superficial, which corresponds to a lung-dull sound, and means that portion of the heart covered by the lung; and a heart-dull sound, which is triangular- shaped and flat. The lung-dullness is bounded by a line extending along the left border of the sternum, at the lower border of the second rib, and extending by an imaginary curved line reaching the apex of the heart. Then draw a second line from the border of the second rib to meet the end of the imaginary line at the apex, curving it to the left somewhat. The two lines leading downward from the second rib may be called the right and left arms of an irregular triangle; the point where they meet at the top may be called the apex of the triangle; and the line connecting the right and left arms at the apex of the heart may be called the base of the triangle. The flat or heart-dull sound begins at the level of the fourth rib and terminates at the apex of the heart.

   The flatness (heart-dullness) of the base of the triangle may be confounded with liver-dullness; but the physician will follow the outline of the liver and make his deductions as to liver and heart sounds.

   It is to be understood that the area of dullness and flatness may vary in health, and the variation must be greater in disease.

   The principal modifications are:

   First, in hypertrophy of the left ventricle, the apex is pushed downward and outward. The flatness is slightly above the nipple.

   Second, in hypertrophy of the right ventricle, the apex is pushed outward, and the flatness is slightly above the nipple and to the right of the sternum.

   Pericardial Effusion.--If the accumulation is slight, the flatness extends below the apex beat. When the effusion is great, the flatness extends over much more of the chest wall.

   Auscultation.--The most important mode of exploration of the chest is by auscultation. It requires a good ear to be educated into reading symptoms by sound.

   Location of Sounds.--The aortic orifice is in the right second intercostal space. The pulmonary orifice is in the left third intercostal space. The mitral orifice is at the apex beat. The tricuspid orifice is at the xiphoid appendix.

   The Normal Heart Sounds.--There are two sounds: The systolic, or first, sound is caused by contraction of the ventricles. Then there might be a short silence, followed by the diastolic, or second, sound, which is caused by the closing of the semilunar valves on the arteries. These sounds may be represented graphically as follows: The first sound (venticular) may be represented by the following figure: "u" . Then there is a brief silence, followed by a second sound, which is diastolic and longer, and may be represented by -- Then silence, and the sounds are repeated.

   The attention must be educated to distinguish slight variations in these sounds. Many normal hearts must be examined to become familiar with the normal sounds. The first deviation from normal may be said to be that of emphasis on the sounds--they are more pronounced. To get the sound, have someone with a normal heart exercise vigorously for a few minutes; then, if the ear is placed to the heart, the sounds will be louder and faster. When this occurs without exercise, it must be caused by stimulation. The stimulation may be from fear or some other emotions, or from the use of stimulating foods or drugs.

   An increase of the second sound may be heard at the pulmonary orifice (left third intercostal space), indicating nothing more than a disturbed circulation in the lungs.

   A weakened sound may be caused by an accumulation of fat in the thorax, and it may be due to weakness of the heart. If so, it is the first sound that grows dull and finally disappears. This symptom is not so significant as a weakening of the second sound.

   When there is an effusion in the pericardium, the heart sounds are muffled and sometimes extinguished.

   Disturbed Rhythm.--There are two types of rhythms described by some authors; namely, intermittent rhythm and arrhythmia (irregular, lack of rhythm). Intermittent rhythm is where the pulse beat is suspended, or misses a beat occasionally. These missed strokes are usually followed by a more pronounced systol (contraction). The cause is enervation from stimulation. Perhaps, if there is one class of stimulants, more than another, inclined to produce this state of the heart, it is the coffee-and-roll or toast habit. It means a preponderance of food of acid potentiality.

   Arrhythmia is marked by irregularity in the succession of pulses. Then there is a type presenting a prolongation of one of the heart beats or of one of the silent periods. Arrhythmia is also marked by cardiac bigeminate (double), and trigeminous (treble); which means the production of two or three beats, one after another, followed by a natural pause. Then there is the alternating pulse--one strong beat followed by a weak beat; then there are two short strong strokes followed by two weak strokes. The weak ones are not perceptible at the wrist.

   There is the fetal rhythm, in which the two beats become similar, and the frequency is augmented so as to convey to the ear the sound given out by the heart of the unborn child.

   The fetal rhythm is of unfavorable prognostic significance. lt develops in some cases of arteriosclerosis. Murmur of recall is a modified second sound which is divided into two short sounds. This occurs in a disturbed pulmonary circulation, which modifies the action of the valves, and is found in mitral stenosis.

   Galloping murmur is found in two places. One place is at the left heart, a little above the apex beat, and means myocarditis or rheumatism of the heart. A second location, less frequent, is found in the right heart; this can be heard at the end of the sternum, and accompanies gastric and hepatic derangements, especially gallstone.

   A murmur that accompanies normal heart sounds is of less gravity than one that replaces them.

   Friction murmurs mean friction of the pericardium. They sound like the creaking of leather.

   A blowing murmur is a sound like that of bellows. When accompanying the first heart sound, it is called systolic blowing; when with the second sound, it is called diastolic blowing; mesosystolic, when it occurs in the silence between the regular sounds of the heart; presystolic, when occurring before systole; in this case it may be called auricular systolic.

   Heart murmurs that disappear on holding the breath are cardio-pulmonary, not endocardial.

   Murmurs accompanying the radial pulsations are systolic; those that precede the pulse are presystolic; those following are mesosystolic. The diastolic murmurs accompany the second sound and are more quiet.

   During the systole the ventricles contract. If the murmur is at one of the auriculo-ventricular orifices, it indicates that the blood flows backward from ventricle to auricle. This means insufficiency or incompetency of the auriculoventricular valves. When the sound is at the arterial orifices, it means stenosis of the aortic.

   When the murmur is diastolic, it Corresponds with the second sound, and means that the blood flows back- ward from the arteries to the ventricle. This is aortic insufficiency. The rolling murmur heard at the apex means stricture or stenosis of the auriculo-ventricular orifice, usually the mitral.

   Reduplication of sounds indicates that valve action is not simultaneous and that there is heart strain present, or high arterial tension, as in stenosis or kidney diseases.

   Mitral insufficiency often gives out a whistling, musical piping sound. Aortic insufficiency is a mild, soft, and blowing sound. Mitral stenosis is a rolling sound.

   When the murmur is heard outward or inward from the apex, or at the left border of the heart, it may be said that it is functional; when in the aortic area to the right border of the sternum, it is organic. Murmurs along the left border of the sternum are organic.

Before it is safe to say that a given murmur is organic, an apex murmur must be heard in the axilla and in the back, and basic murmurs must be heard through the vessels originating from the affected orifice or along the sternum. When aortic incompetency is suspected, the stethoscope may be applied to the femoral artery, and in these subjects to the abdominal aorta.

Ile following are graphic sounds of the heart:

TABLE OF HEART SOUNDS, LOCATION, AND SIGNIFICANCE

First Sound	Short Silence	Second Sound	Long Silence
Ventricular systole. Heard at apex--apex beat. Felt at radial pulse. Systolic blowing murmer heard at this point.	Mesosystolic. Blowing murmur.	Closure of the semilunar valves between heart and arteries.	Diastole, or auricular systole. Presystolic murmur.

   At the first sound, the ventricles close (systole). If there is a murmur at one of the auriculo-ventricular orifices, it is because blood flows back to the auricle. This means insufficient closure of one of the valves.

   When the murmur is heard at one of the arterial orifices, it indicates that the blood does not flow through so easily as it should. This means a diminution of caliber. Stenosis is the cause.

   Diastolic murmur coincides with the second sound, and means that the blood regurgitates or flows back from the arteries to the ventricles. This means aortic insufficiency--occasionally pulmonary insufficiency. This murmur is heard at the apex and has a peculiar character--namely, a rolling, rather than a blowing or purring, sound. It means stricture of one of the auriculo-ventricular orifices, more often the mitral. Presystolic murmur means the same.

   The following table describes the location of the murmurs:

   Mitral insufficiency is often a whistling, musical, or piping sound.

   Aortic insufficiency is mild, soft, and blowing.

   Mitral stenosis is like a rolling sound.

   Congenital malformation is marked by a systolic, forcible, vibrating murmur, heard at times in the center of the chest, not accompanied by purring, and heard best over the fourth dorsal vertebra.

   Mitral murmur should be looked for in the left axilla; also behind, under the angle of the scapula.

   Murmurs of the pulmonary orifice are conducted toward the left clavicle; they stop before reaching the bone.

   Aortic murmurs extend toward the right clavicle, and often reach beyond even in the neck.

   The diastolic murmur of the aorta passes along the sternum to its end, the xiphoid appendix. The murmur is a soft, blowing sound. There is accompanying this murmur a jerking pulse--a throbbing or dancing pulse.

   To sum up: In a weak heart, when both sides are affected, there is observed venous stasis, with functional disturbance of lungs, liver, kidneys, stomach, and brain, with their various symptoms: dyspepsia, dyspnea, local pain, vertigo, palpitation, etc.; with, as termination, dilation and collapse of the heart.

   A valvular defect is important as regards accommodation, whereas a dilation has a very serious importance.

   Venous stasis from dilation presents cyanosis, turgid veins, with and without pulsation of the jugular and other veins, cardiac asthma, hyperemia of the liver and lungs, catarrh, hemorrhage and edema of the dependent parts and cavities. Cardiac asthma may be due to swelling and stiffness of lung substance from congestion.

   Heart weakness may be due to muscular or valvular insufficiency, or both. It may be primary or secondary to other derangements which obstruct the circulation. The liver and kidneys must receive attention.

Congenital Heart Defects.--Potency of the foramen ovale, ductus arteriosus, defects of the ventricular system, and lesions of the pulmonary orifice. Prematurity is the usual cause of these defects.

   Symptoms: Cyanosis (blue child-not always present), dyspnea, cough, convulsions, edema, and restlessness.

   The larynx must be examined with special instruments. The bronchi and lungs present pain in the side, chest cough, difficult breathing, and expectoration. Difficult breathing and dyspnea may be due to either lung or heart affection. It may be reflex; if so, any of the organs may cause it.

   Cough may be lung cough, or it may be reflex.

   Respiration and pulse normally have a ratio of about one to five.

   Cheyne-Stokes respiration belongs to cerebral or meningeal lesions, At first it is rapid and superficial, and gradually becomes more profound. This is followed by a diminution, with a final arrest; then a short period, followed by short, shallow breathing, gradually becoming faster, with a repetition of the former sounds.

   Diabetic coma is characterized by abrupt and deep inspiration, followed by a pause; then a quick expiration, and a pause. These types of breathing are due to medullary derangement-possibly toxin poisoning.

   Rales are of three types:

   Dry or sonorous rales are called rattling when they have a grave pitch; sibilant when acute. They indicate bronchial inflammation or catarrh.

   Crepitant rale is like rubbing a lock of hair between the thumb and finger close to the ear. It means pneumonia.

   Moist rale has a bubbling sound. When high, it indicates tuberculosis, when of fine bubbles, capillary involvement.

   A blowing sound, when heard between the shoulders, indicates bronchitis. It is tubal when it has a slightly metallic or whistling character. The pleuritic murmur has the sound of "i" spoken in a whisper through the closed fist as an ear trumpet. The sound will be modified in keeping with the amount of effusion.

   In empyema (pus in the pleura) the percussion dullness will be flat like the liver sound. If the patient will count "one, two, three," while the ear is placed on the chest, the sound conveyed will be far distant-removed; whereas the voice will come to the ear when there is no accumulation.

   Egophony.--While the patient is speaking, if the voice comes to the ear with a tremulous murmur, this is called egophony, and is indicative of pleurisy or splenopneumonia.

   The teeth should be inspected--the entire mouth, lips. tongue, and throat. Many stomach derangements are cured by keeping the mouth and teeth clean. Pyorrhea begins with neglect of cleanliness, and starch and sugar poisoning. Scurvy and mercury are leading causes.

   "In diabetes the second lower molars are affected, and their alteration serves as guide to diagnosis."

   Premature loss of teeth indicates failing nutrition from wrong eating (too much starch and sugar, and not enough raw fruit and vegetables).

   The tongue is somewhat of an index, but altogether too much is made of it, as likewise of the temperature of the body, by most physicians.

   A broad, pallid, thick tongue indicates too much starch eating. A long, pointed tongue denotes irritation of nerve centers. A small tongue indicates insufficient nourishment. A red tongue, with enlarged papillae ("strawberry tongue"), means great irritation of the stomach. This is the scarlet fever tongue.

   Ulcerations on the tongue often mean injuries from teeth. Continual tongue irritation and ulceration should be investigated by a dentist; if not corrected, nocturnal epilepsy should be suspected.

   The throat, when abnormally red, indicates irritation of the stomach, tobacco or alcohol poisoning. The throat is an index of the stomach. Treatment of the throat is very far-fetched. The throat will not go wrong unless the stomach or bowels go wrong--no, not even the tonsils. Tonsillitis is symptomatic of wrong eating--wrong combinations.

   Many derangements start with an angina; but I insist that all diseases--yes, the eruptive and so-called contagious diseases--get their infective agent in gastro-intestinal putrefaction, and that without this cause they can have no existence. Hence, to cure any and all of these diseases, correct the generation of toxins. To do so is not only curative, but preventive. All so-called contagious diseases are autogenerated. This truth may require years to become popular--be accepted by the profession--but it will come.

   Stomach derangements are brought on by abuse at the table. Heartburn means overeating, or too much starch or sugar eating, or all three causes.

   A fullness after eating means overeating, or wrong combinations, or too rapid eating, or too much fluid with meals.

   Flatulency.--Gas means overeating, or waterlogging with too much fluid intake. Navy beans, peas, sweet potatoes, apples, and other foods cause gas. Apples and other fresh fruits cause gas in those who are starch-poisoned. The habit is built by much water drinking between meals. Constipation is built by gas distention and too large fluid intake, forcing the kidneys to do the eliminating for the bowels. The present universal habit of water drinking to overcome constipation is another medical fallacy.

   The tired feeling of a morning means food poisoning--toxemia. The physician should know the influence of food taken in excess, the influence of wrong combinations, and the influence of all mental and physical habits; then he can prescribe intelligently.

   Vomiting.--In case of indigestion the vomitus is usually acid. It is alkaline in cases of catarrh and cholera.

   Vomiting may be watery, alimentary, bilious, fecal. hemorrhagic, or purulent.

   Aqueous vomiting is often viscid and soapy because of the presence of mucous. It is seen in alcoholic gastritis, ulcer, cancer, sick stomach, and cholera.

   Alimentary vomiting is of food recently swallowed. Bilious vomiting shows the bile in the ejected matter.

   Fecal vomiting is of the contents of the bowels, and means obstruction.

   Blood vomiting may be hemorrhage of the stomach. If bright red, it means ulcer; when dark and like coffee grounds, it indicates cancer.

   False membranes, and long casts of mucous, are sometimes passed. These indicate muco-entero-colitis.

   White, jointed, tapelike appearances may be tapeworms. If found, watch should be kept for a few weeks. If there is really a tapeworm, portions of it will pass almost weekly.

   Deformities are often produced by corsets. The organs are pushed down; then there is compression from the liver being forced against it. Indeed, the stomach may be pushed in all directions by corset pressure, causing difficult breathing, palpitation, etc. A high stomach means hearty eating; a pendulous abdomen means debility and visceroptosis (falling or prolapsus of the viscera). Medium enlargement in the upper part indicates enlargement or dilation; and dilation means overeating, fermentation, and gas distention.

   Depression at the pit of the stomach, when the patient is turned on the side, indicates inanition--great weakness. A bulging at this point means distention of the stomach. Flattening below the navel, with protrusion below, means visceroptosis.

   Palpation discovers sensitiveness. A general sensitiveness to touch, without fever, indicate a general toxin infection from gastro-intestinal decomposition of food. In these cases there are usually constipation, colitis, catarrh of the womb, piles, etc.

   To palpate the abdomen successfully, the patient should lie on the back, with legs flexed on thighs and thighs flexed to a right angle to the abdomen. The hands of the examiner must be warm; otherwise contractions will occur.

   The sloshing sound or clapotage (a sound like that obtained by shaking a bladder half filled with water) should not be heard six hours after eating. When it is, it indicates dilation, ptosis, slow digestion, cancer of the stomach, etc.

   Pyloric thickening, or cancer of the pylorus, is felt as a hard lump or tumor at the right of, and two or three inches above, the navel. If this lump is found, and there is vomiting, every two or three days, of ingesta (previously eaten food) that were eaten, one, two, or three days before. and there is clapotage six or more hours after eating, and this sound can be elicited at all times, except immediately after lavages, or until heavy vomiting takes place in advanced cases, the ejecta will present blood of a grumous character. This symptom, with cachexia, means cancer. All cases can be cured by lavage and restricted diet before this stage is reached. Surgery will not cure after this stage, and it is not necessary before. If performed, it will handicap and inconvenience the patient for the remainder of his life. These cases are non-cancerous at the start, and, if properly treated, should recover.

   No case should be pronounced cancer until everything has been done that can be. The surgeon is an advocate of his calling, and will declare that surgery is the only cure. Indeed, it is never a cure, except when it fortunately removes a cause.

   The stomach should be washed out daily, and the patient properly dieted. If attended to carefully, many cases pronounced cancer can be saved.

   A dilated transverse colon may give out the peculiar clapotage sound; but there is always more tympanitis with the colonic affection, and the sound is farther below and at the points marked by the ascending and descending colon.

   A tumorous state of the pylorus and the great curve of the stomach--the left of the stomach--can usually be palpated, while it is more difficult to discover tumifactions of the cardia or esophageal orifice.

   Many mistakes are made in examining the intestine. Constipation with accumulation is often diagnosed as floating kidney (a very rare affection), appendiceal abscess, ovarian enlargement, uterus tumor, pregnancy, tumor or cancer of the intestine. It is true that such mistakes are ridiculous and do not occur often with skilled diagnosticians, but first class professional men do make these mistakes often enough to cause laymen to seek confirmation of a diagnosis before submitting to an operation. It is not proper to seek confirmation by calling upon a physician selected by the physician in charge; for he will pick one who will agree with him. Either call a physician, and do not allow him to know that a diagnosis has been made, or call a rival of the one making the diagnosis. At all costs, try to eliminate the subterfuges of medical ethics, which means all things to doctors, even if it spells ruin to patients.

   Professional ethics is a medical Potter's Field where the mistakes of doctors are interred without publicity. Consultation is where two or more professional men gather together to enjoy a private smoke and to discuss the mistakes of Moses or anyone else who haplessly is not present.

   A painful point in the intestine may be caused by inflammation, impaction, gas, tumor, or cancer.

   If inflammation, there will be mucous with the stools, and an accumulation of fecal matter will cause pain from pressure, and gas will cause pain from distention. A pain at McBerney's point indicates inflammation, gas, or constipation. Colitic pain is peri-umbilical, or in the right or left iliac fossa. In dysentery the pain is in the left flank and extends to the anus.

   Fecal Matter.--When dry and covered with mucous, it indicates constipation and colitis. When of rank odor (putrid-smelling), it means overeating of animal proteids. When sulphureted in odor, it may be due to sulphur or sulphate of magnesia taken to relieve sluggish bowels.

   The consistency may be hard, soft, liquid, mucoid, or bloody. If watery and mucoid, it indicates diarrhea and catarrhal inflammation of the mucous membrane.

   When the stools are small, and largely mucous, with much bearing-down pain, the disease is probably flux or dysentery.

   When the stools are of peculiar form--small and round, ribbon-like or pencil-like--there may be stricture.

   Dark color may be from food or drugs; green, from spinach or other vegetables; or, in infants on milk, it means acidity and indigestion from overfeeding. Green, mucoid stools, studded with white curds, indicate overfeeding. and unless a fast is given, followed with a cutting-down in quantity, the child may be very sick.

   Light color, if not from an exclusive milk diet, means lack of bile secretion and sluggish liver.

   Blood in the stools may be from piles, ulcer, or cancer. When red, it indicates that it comes from the lower bowels. A local examination should discover whether the bleeding is of the nature of piles or local fissure, ulcer or polypus.

   Black blood from the bowels must be considered in connection with other symptoms. Give the patient the benefit of the doubt as to the disease being malignant.

   Bismuth may color the stools dark for some time after its administration has ceased.

   Typhoid discharge, when the patient is fed, is yellowish and nauseous in odor.

   Whitish stools indicate fat; fatty stools indicate that the pancreatic juice is unable to emulsify, or that the juices are cut off.

   Sand or gravel in stools indicates that stones in the gall bladder have disintegrated and passed out--a natural form of elimination.

   Abdominal Pain and What It Signifies.--Sudden abdominal pain diffused, or in the umbilical region, will in a few hours become localized in the region of the affected organ. Deadening drugs should not be given, for they will mask the affection and obscure diagnosis, Sudden abdominal pain, with vomiting, is indicative of peritonitis. The cause may be volvulus, invagination, internal or external hernia, extension of septicemia, rupture of ectopic pregnancy, or rupture of an abscess into the peritoneum. The abscess may be typhlitic, perityphlitic, appendicular, tubal, pelvic, subperitoneal, cellulitis, perforations of ulcers, ulceration caused by biliary or renal calculus, etc. An operation at once, with drainage, should save most cases. Delay means death. Unfortunately, advantage is taken of this truth to urge people with intestinal indigestion, gas pains, uterine and other pains, to have an operation at once.

   Absolute quiet, frequent copious enemas, and abstinence from food, is a safe "watchful waiting." To use cathartics is unnecessary under all circumstances, but to give them where any of these symptoms exist is positively criminal ignorance.

   In peritonitis the pulse is of more value than the temperature. The pulse is rapid and small (120 to 150); the temperature may be normal, subnormal, or high; the breathing is costal and rapid (30 to 40); the urine is usually highly charged with indican. Collapse threatens early. The face is anxious, the skin cold, and the mind clear. Often the intoxication is so great that the patient talks and acts as if there were little the matter. This, however, depends on the cause. Puerperal cases are liable to act in this way. I have seen cases dying; yet they were hopeful and believed in an early recovery. When the organ involved in causation is the liver, pessimism is present.

   Pain that precedes or follows bowel movement indicates rectal disease, hemorrhoids, fissure, ulceration, cancer.

   If pain recurs with menstruation, the reproductive organs should be examined.

   Sudden pain experienced for the first time should be analyzed carefully. If the same character of pain has been experienced before, time may be taken, if necessary, to find the cause. If pain follows exertion, it may be from hernia, rupture of tubal pregnancy, rupture of peritoneal adhesions with hemorrhage, volvulus, rupture of cystic tumor, or twist of tumor on its pedicle. Pain following trauma may be from rupture of the bladder, stomach, intestines, or other viscera.

   Pregnancy, with threatening abortion, may be the cause of pain. Horseback, or rough riding, of any kind, followed with pain, is suggestive of calculus. Repeated abdominal pain due to painful peristalsis in the uterine, fallopian, biliary, ureteral, urethral, intestinal, spermatic, and other ducts, is not often recognized. If it could be, many mistakes would be overcome.

   I have seen neuralgia of the spermatic vessels diagnosed appendicitis, and, after the appendix was removed, the pain that came back was diagnosed adhesions. It is no uncommon thing to have the appendix removed, then the right ovary, then operations for adhesions, then operation on the gall bladder, because of genital affections; namely, spermatorrhea, ovarian irritation, endometritis with stenosis of the neck of the womb (a very common cause of abdominal pain in nulliparous women), or urethral tenesmus.

   There are many gall bladder operations because of painful peristalsis caused by gastro-intestinal indigestion, and irritation and inflammation of the viscera. After hernial operations, pain may continue because of adhesive bands. I know of one death caused by obstruction from adhesions at the internal ring of partial hernia.

   Women of menstrual age should be examined for affections of the genito-reproductive organs.

   Sudden abdominal pain in anemic young women should cause the physician to suspect perforating ulcer of the stomach or duodenum. In children, abdominal pain usually means gastro-intestinal derangement, such as gastritis, enteritis, twist, invagination, colitis, appendicitis.

   In those past middle life, particularly in old age, cancer is the common cause of abdominal pain

   The character of pain should be noticed. In perforation the character of the pain is the same in all viscera.

   In invagination the pain is paroxysmal and periodic, due to peristalsis. Strangulation is generally intense and periodic, due to peristalsis; later there is aching and dragging. In appendicitis the pain comes on suddenly, and is intense in fulminating cases. There is a type which comes on slowly, and is easily controlled by fasting and quiet. A sharp, lancinating pain, continuous in character, is possibly due to perforation. A continuous, agonizing pain spells diffuse peritonitis, and means death unless immediately relieved by operation and drainage.

   Pain caused by obstructed peristalsis is periodic, and will subside if no food or drink be given. In appendicitis the patient will remain comfortable, but in obstruction from a twist or invagination, discomfort and pain will not leave, the pulse will run high, and the face becomes anxious.

   When a stone is passing, the pain will be periodic. When it comes on, it will be excruciating. Between agonies (which means between the rhythms of peristalsis) there remains a feeling of soreness--a tolerable aching, which, contrasted with the greater pain, is insignificant, but which would in time become intolerable, if full relief could not be found.

   Pain from stone lodged in any canal--appendix, enteron (intestine), colon, biliary, pelvis of the kidney, ureter, urethra, etc.--is very excruciating, and food increases the pain,

   Gastric ulcer is inclined to give out pain when chilled with cold drinks or ice cream. When it is fully developed, pain may be caused by the ingestion of solid foods.

   In coming to conclusions regarding an affection, pain is a guide; hence it should never be suppressed by drugs, nor ignored or disputed.

   Pain on palpation may be caused from radiation; hence the hands of the physician should be warm, and the temperature of the room should be warm. It should not be forgotten that the personality of a physician may be such as to cause pain. Such surgeons find much excuse for operating.

   Facial expression, position of body, tension of muscles, all may manifest pain.

   On account of the number of organs and the complexity of the nerve supply, the great variety of functions, etc., the abdomen sends out the greatest variety of pains.

   The gastric crisis of locomotor ataxia presents paroxysmal vomitings and severe gastric pain, lasting several hours or several days, which may recur after days or weeks. Other symptoms of tabes dorsalis will clear up the diagnosis, and save a foolish and unnecessary operation for some abdominal affection which happens to fit the particular insanity of the surgeon called. If there were not such senseless operations performed, I should not make such disagreeable statements.

   Nephritic crisis (kidney crisis) is caused by a dislocated kidney. The nerves and blood vessels are twisted more or less, and the ureter is flexed. This axial rotation may cause serious strangulation. Where the right kidney is misplaced, the symptoms are nausea, vomiting, pain in the back and thigh; excessive or defective secretion in the bowels, causing indigestion and similar disorders in the renal secretions.

   Gas in the bowels frequently causes pain. The gas produces the pain by stretching the peritoneal covering.

   Pain at a given point does not always signify that the cause of the pain is located in that region. Absence of pain in regions is often significant,

   Pain at the navel is not diagnostic; yet it often signifies appendicular, fallopian-tube, or invagination affections, cancer of the stomach, etc.

   If, when pressing the abdominal wall, there is one spot that gives out pain or discomfort, and no other point is sensitive, it is reasonable to believe that the disease is located. When the whole abdomen is sensitive, the pulse is quick, and there is an anxious expression of the face, the disease is peritonitis. If the patient is bright and all attention, and the symptoms appear within a week after confinement, the disease is puerperal peritonitis. When there is no fever, and the pulse does not vary very far from the normal, yet the patient complains at every touch. and the bowels are disturbed with gas, the case is that of trauma, or stretching of the peritoneal sheet, which is made sensitive by toxin poisoning from gastro-intestinal decomposition. This is an affection that is turned aside by a class of physicians as hysteria. Because the patient complains of pressure on one part as much as on another, the doctor decides that there is nothing the matter--just hysteria. Another class will diagnose the case according to the delusion that happens to possess them at the time of examination. It may be fibroid tumor (such cases are liable to have a fibroid); and, of course, the tumor is the cause, and it must be removed. If the doctor's delusion runs to the appendix, gall bladder, floating kidney, enteroptosis, displacement or prolapsus of the womb, etc., etc., the operation selected will be in keeping with his delusion. Is this statement of mine a delusion? I wish it were. These delusions are created and propagated at medical societies. Two or three leading men force their delusions on the rank and file. Medical societies should be suppressed; for they are a menace to society. For a few months after the A. M. A. meetings there is an epidemic of operations, ninety to ninety-five per cent of which are inexcusable, except for the delusions inoculated at the last meeting of the association. Of course, this statement will be pooh-poohed by those whom it fits; but if proof of insanity is desired, surely the inmates of an insane asylum should not be consulted regarding their delusion.

   An accumulation of fluid in the abdomen will, on palpation, show flatness at the most dependent point, and resonance at the highest points; whereas an ovarian tumor will show the reverse. In a vaginal examination, with a finger on the vaginal roof and the hand upon the abdomen, the transmitted movements will be felt if there is a tumor; if dropsy, there will be no sensation transmitted. Advanced pregnancy should not be mistaken for tumor or dropsy; yet this mistake has been made by "first class" surgeons.

   Arterial pulsations in the epigastric (stomach) region are seldom due to aneurism. To keep from making such an awkward mistake, patients with tension and severe throbbing of the abdominal aorta should be examined daily, and kept on a fast for a few days. If the condition is high blood pressure, the throbbing will soon pass away, and will not return unless overeating or improper eating be indulged in, or sensuality in some form be practiced. The symptom is often found in habitual coffee drinkers.

   Obscurity of Abdominal Symptoms.--Reflex pains often get physicians into trouble. Operations on the abdomen have been performed by wise physicians for reflex pains in pneumonia; the symptoms being pain, tenderness, gas distention, temperature, frequent respiration, but lacking the pulse of peritonitis. Extensive intercostal neuralgia may be mistaken for abdominal affection; also for lung disease. The intercostal nerves end in the abdominal wall.

   Abscess in the wall of the abdomen may be mistaken for peritoneal disease. More than forty years ago a case of abscess of the abdominal wall came into my hands, after several good physicians had named the disease peritonitis and given an unfavorable prognosis.

   Volvulus (Twist in the Bowels).--This is a rare obstruction, constituting about one-fortieth of an intestinal obstructions. Men are said to have this affection oftener than women. The cause is probably an extra-wide mesentery. Invagination is probably made possible from the same cause.

   Volvulus symptoms are tympanitis; great peristatic pain; inability to have an action from the bowels after the segment below the obstruction is emptied with enemas.

   At first the pain is periodic. It gradually increases and becomes more constant. If no food is given from the start, pain will not be so marked. Vomiting will be a more or less constant symptom. Symptoms must vary to agree with the temperament and excitability of the patient.

   The disease is so rare that a diagnosis will be made after an operation. Any case presenting symptoms of obstruction with symptoms of profound prostration--giving the appearance of being on the verge of collapse--should be opened up, and whatever is found should be righted as quickly as possible. Such cases do not stand the shock of prolonged operations well.

   Robinson declared that the chief etiology of volvulus sigmoid (this furnishes about sixty per cent of the locations) is elongated sigmoid, possessing a narrow foot, accompanied by inflammation caused by vigorous action of the left psoas muscle, which injures the sigmoid, inducing migration of germs or their products through the coats of the bowels, inciting plastic peritonitis. Adhesions follow, favoring the development of this mechanical obstruction. The cause back of all causes is intestinal decomposition, with infection by toxins. Man pays and pays for lack of control in eating--for food drunkenness.

   Volvulus occurs in subjects over forty years of age. Marked tympanitis, or meteorism, or gas distention, is first located in the left iliac fossa. This may be remembered as a small, but not dependable, diagnostic point.

   Hypertrophy of the Liver.--A fullness is observed under the ribs on the right side. Tumefaction of the spleen co-exists. When it does, there is tumefaction of the upper half of the abdomen. This is especially noticeable when the patient stands. The liver is more developed in children than in adults.

   To determine the amount of enlargement, place the patient on his back with legs flexed, and begin the palpation and percussion on the lower abdomen, gradually going up toward the ribs. In enlargement the dull, flat sound will be found anywhere below the ribs, depending upon the amount of enlargement. Under normal conditions the flat sound begins two fingers' breadth below the nipple, and terminates at the costal border (border of the ribs).

   The liver is prolapsed when the flatness is below the points mentioned.

   The border of the upper line of the liver is on a line drawn from the right border of the sternum at the level of the sixth costal cartilage. It then follows the sixth rib to the right mammary line, and reaches the seventh rib on the axillary line, the ninth on the scapular line, and ends, at the spine, at the eleventh rib. Strong percussion is needed above to bring out the dullness, but light percussion is sufficient below.

   Normally the lower limit of the liver may be confounded with kidney flatness at the axillary or the scapular line. The liver extends from the eleventh rib, following the costal border midway between the ensiform cartilage and the umbilicus, and terminates in the left side at the level of the apex of the heart. Liver flatness is diminished when there is emphysema of the lungs, gas distention of the stomach or bowels, or distention from ascitic effusion.

   Atrophy of the liver occurs in cirrhosis and yellow atrophy.

   General hypertrophy occurs in alcoholism, and the enlargements occasioned by liver and heart derangement brought on from excessive eating of starch and sweets,

   Lumbar pain is an accompaniment of all derangements of the pelvic viscera. The lay mind associates backache with kidney disease; but backache may mean rheumatism, constipation, piles, fissure, prolapsus of the womb, endometritis or endocervicitis, enlarged prostate, stricture of the urethra, etc. Too much attention is given to lumbar pain or backache in connection with kidney affections. Indeed, severe kidney disease may be developed without much discomfort in the back.

   In nervous diseases, pain in the bladder is felt in urinating, especially at the expulsion of the last few drops. In urethral irritation it is the first urine that causes discomfort. Hysterical women are very prone to have urethral irritation. Hysterio-cysto-neurotics are usually subjected to so many operations that they are ruined, but never cured.

   In this connection I wish to chronicle an observation that I have made: In all cases of tabes dorsalis I have found granular inflammation and great sensitiveness of the urethral mucous membrane, and almost invariably stricture. I have made a practice of using the olive-tipped sound and rubbing away the granulations, and at the same time dilating any stricture that may be present. I have found this treatment a valuable adjunct to the general treatment.

   Of all influences leading to the development of tabes, venery stands first. Hence a successful treatment of tabes dorsalis must keep in view the need of remedying the sexual neurosis.

   In locomotor ataxia, and in some cases of arteriosclerosis, desire for urinating is lost. The subject must use his reason and attend to this function at stated interval. The urine is sometimes voided without consciousness, and unless the subject sees it pass he will not know it.

   Frequent desire to urinate may be wholly due to nervousness; or it may be due to stricture, granular inflammation of the urethra, irritation and inflammation of the bladder, gravel or stone in the bladder, polyuria (hypersecretion of urine) due to drinking overmuch, or eating sloppy foods--soups.

   In urethral stricture the stream is often divided, the length and volume of the stream is diminished, and a few drops will be passed after leaving the urinal. This is also true of prostatic enlargement. When the urine stops suddenly, it indicates stone in the bladder. Pain at the end of the penis is another sign of stone in the bladder.

   Retention of urine is where the urine is held in the bladder without power to empty it. This demands catheterization. Partial retention is the habit of carrying residual urine--a small or large amount may be retained after all is passed that can be passed. This in time causes a filthy bladder, and consequently bladder disease. Catheterization and washing out the bladder with tepid water will give great relief. Enlarged prostate, stone, and partial paralysis are the causes of this affection.

   Anuria is suppression of secretion, and the bladder is found empty.

   Examination of Urine (see tests in medical dictionary).--Urine varies in quantity. When below 1,200 grams (38 ounces), oliguria (scanty urine) is said to exist; when above 1,500 grams (46 ounces), polyuria exists.

   It is necessary to note the amount of urine voided in twenty-four hours. Make a note of the time of urinating, and throw the first urine away. Then save all voided, including that which is passed at the close of the last hour in twenty-four. If there are about thirty-eight to forty ounces, with no symptoms of kidney derangement, such as sugar or albumin, all is well.

   Note the color, transparency, consistency, odor, filaments (threadlike appearances), substances in suspension, sediments, and always the reaction and density.

   When the urine is turbid, its cause must be known. This condition is due to the presence in it of mucous, pus, uric acid, urates, phosphates, etc. Mucous precipitates by adding acid; pus forms a curdle by adding ammonia. Uric acid and urates are dissolved by heat; phosphates become soluble by adding acetic acid.

   The cause for change in color should be determined. A reddish or brown appearance is caused by the presence of blood. However, certain drugs cause this appearance (coal-tar remedies in certain subjects). The microscope reveals the red corpuscles. Hemoglobinuria, requires the spectroscope; also urobilinuria. An intense color indicates bile pigment. (See test table in medical dictionary.)

   The most important tests are for albumin and sugar. A simple test for laymen to determine the presence of albumin is to boil urine in a test tube, or a spoon if a tube cannot be procured. If the urine becomes milky or cloudy, add a few drops of lemon juice. If the urine clears up at once, there is no albumin. When suspicious of albumin, the patient should consult his physician and have the urine thoroughly examined.

   Normal urine has a peculiar, well-known odor. When urine gives out an ammoniacal odor (smells of ammonia), it indicates bladder derangement, retention of urine, or possibly it may come from eating raw vegetables. Fecal odor indicates a vesico-rectal fistula--an opening from the bladder into the bowels.

   In diabetes the urine, like the breath, may have a sharp, pungent, metallic, or ether smell. This odor is an unfavorable prognostic sign. It indicates a threatening diacetemic coma (diacetic acid in the blood). When this odor is present, the urine should be tested with ferric chloride, which gives off a burgundy-red color.

   In dyspeptic coma, related to diaceturia (diabetes), diacetic poisoning, the principal symptoms are: a sharp epigastric plain (stomach pain); an increasing wandering or beclouded state of the mind, which gradually terminates in coma; then comes the final state, which is marked by a characteristic breathing, described by Kussmaul as follows: "The breathing is divided into four stages; namely, a brisk inspiration, a pause, a brisk expiration, and a pause," This syndrome (aggregate symptoms) is liable to be precipitated by anything that will produce fatigue. A journey is liable to precipitate the symptoms. I have noted that diabetic subjects, on coming to Denver from low altitudes, are liable to do themselves harm through their desire for sight-seeing--they are inclined to walk overmuch and overdo in many ways.

   Before the ending referred to develops, there may be detected a peculiar odor of the breath and urine; namely, a strong ether odor, in some cases very pungent. This odor from the breath of diabetics is not characteristic; for I have met with it in children suffering an attack of gastritis, also in fasting to overcome various morbid affections. This peculiar breath develops in those suffering great anger, and from other excessive emotions.

   It is said this odor is caused by the development of acetone in the blood. Rheumatism--the arthritis-deformans type--is especially marked by the development of acetone (vinegar) in the blood.

   It is thought that diabetes is more probably caused by the development in the blood of a ptomain. I have found that gastro-intestinal decomposition is invariably a precursor of diabetes. When digestion is reduced by dietetic abuse, and the nerve energy is broken because of enervating habits, power to digest the carbohydrate foods is lost, when they are ingested, acetous fermentation must take place. Just what syndrome is set up will depend upon the physical state and the personality of the patient. A diabetes may develop; some form of rheumatism may be the manifestation; insanity or crime may be the ultimate result of the morbid process.

   Where this state of the blood or urine is suspected, the following test should be made: Place urine in a test tube. Allow a drop or two of perchloride of iron to trickle down one side of the test tube. The iron, being heavier than the urine, falls to the bottom of the tube. If there is sugar present--if there is ethyl-diacetic acid present--the perchlorid turns the urine brownish. This coloring is not characteristic, for the same color can be obtained if the patient has taken antipyrin. The use of the drug should be suspended until the sugar test is made, and then the drug should be abandoned by those who would like to get well. Anything that depresses the body will prevent recovery.

   Turpentine, onions, and asparagus impart a disagreeable odor to normal urine.

   The consistency of urine varies. Sometimes it is thick, and viscid. It may froth easily. This should lead to examination for albumin. If a spot of urine on the clothes attracts flies, sugar should be suspected--which, of course, suggests diabetes.

   The color of urine varies. It may be very light-colored in diabetes, inflammation of the kidneys (interstitial nephritis), nervous polyuria, and at crises--which latter means at the time when symptoms of disease decline.

   The color is deep when disease is intense; for the excretions are scanty. The urine then is a reddish or brown color, due to bile. When the urine is very red, blood should be suspected. If in women, menstrual discharge may account for it. If the blood is from the urethra, it will pass when not voiding urine. When from the kidneys, the blood is more uniformly mixed with the urine. Carbolic acid imparts to urine a blackish-brown color; rhubarb, logwood, and senna color the urine red; santonin gives it a greenish yellow appearance.

   Chyluria.--Instead of urine being clear, it becomes turbid when containing chyle (emulsified fat) or pus.

   An excessive flow of urine--a temporary polyuria--may be caused by eating freely of vegetables, soup, fruit, and salads. Besides, there may be a slight urethral and bladder irritation, produced by the excessive alkaline intake. Coffee and oranges, or other fresh fruit eaten for breakfast, exclusive of other food, will often cause an excessive flow of urine. Watermelon causes an extra secretion of urine, and should not be eaten by those of a constipated habit, because it diverts fluid elimination by the kidneys. Any foods inclined to stimulate the kidneys to extra action should not be eaten by those with an established constipation habit. Thirst should be endured; for it is a demand for fluid in the gastro-intestinal canal, and unless supplied by drinking or using an excess of fluid furnishing foods, the eliminatng organs will yield to severe demand (thirst), and the necessary amount of fluid to supply the thirst will be forthcoming from the blood for normal secretion, and excretion will be established by the bowels; which means that the vicarious work of the kidneys will be given up when elimination by the bowels has been reestablished.

   Scanty secretion of urine--anuria--may be caused by diarrhea or obesity. In the former case the bowels have taken up vicarious work for the kidneys. In the latter case the tissues of the body take the place of a lavatory. In unmasked language, the victim of this physical state urinates into his own tissues.

   One of the very necessary states of the body for maintaining health is the proper disposition of water in the system. When constipation exists as an established habit, swilling the stomach with water fails of accomplishing the desired end--causing the bowels to act. On the contrary, it waterlogs digestion, causing fermentation, diluting the enzymes, and flushing them out of the body by way of the kidneys, leaving the bowels as dry as Sahara.

   Bladder.--When the bladder is distended, a hand laid over it will feet a globular swelling, which gives out a dull sound on percussion.

   Sex power should be examined into. At the beginning of nervous diseases the power is often increased, but it diminishes as the disease advances. Anaphrodisia is viewed as unfavorable in diabetes, Abuse of this function hastens old age and old-age diseases. A natural lack of this power indicates inefficiency, lack of ambition, and low resistance.

   Masculinity is necessary to accomplish work. Sex neurosis must not be mistaken for power. Lasciviousness means mental weakness and lack of discipline. Drunkenness canno