WBA E26h 1884 63570250R NLH D51bM3fl2 7 NATIONAL LIBRARY OF MEDICINE MI3I03W JO AHVH8I1 IVNOUVN LIBRARY OF MEDICINE ■** ^ V'ijSfc NATIONAL LIBRAR /V2 -3 ATIONAL LIBRARY OF MEDICINE 3NI3I03W JO AKVaSH IVNOUVN NATIONAL LIBRARY OF MEDICINE 3NOIQ3W JO A*> moiosw jo Anvaan ivnouvn ATIONAL LIBRARY OF MEDICINE NI3I03W JO A»V8fln IVNOUVN ^7 "> NATIONAL LIBRARY OF MEDICINE '\,-a( is V-v/^1 o ' 3NIDI03W JO A»V89n IVNOUVN 3NIDI03W JO AX IATIONAL LIBRARY OF MEDICINE NIDia3W JO ABVUflM IVNOUVN -i7 %f : ,^t,, NATIONAL LIBRARY OF MEDICINE V NATIONAL LIBRAS jKJi-iinswt jn iNvuflti iwuaiiw NLM051643827 / \^ 4 I r<*r ^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE S < Jot* 8 £3^ NATH OUVN 3Kii->inavu Jo divhoii wwni i SNOiasw jo AMvaan ivnouvn EDWARDS' HEALTH BOOKS CONTAINING Constipation: Plainly Treated. Bright's Disease : How to Live with it. Malaria : What it Means. Vaccination : Pro and Con. BY JOSEPH F. EDWARDS, M.D. Assistant Editor of the Medical and Surgical Repoktek. PHILADELPHIA: P. BLAKISTON, SON & CO., 1012 Walnut Street. 1884. ffl4- CONSTIPATION: Plainly Treated. Copyright, iSSl. -A CONTENTS. PAGE Introductory,........g Part I.—The Functions of the Stomach and Bowels,.........15 Part II.—Necessity for Daily Evacuations, 23 Part III.—How to Procure Daily Evacua- tions Without the Use of Drugs, 36 CONSTIPATION, PLAINLY TREATED. INTRODUCTORY. "How are your bowels; are they regular?" "Oh, yes, Doctor, they are pretty fair." "Are they opened daily?" "Oh, no!" "How often are they moved?" "Well, sometimes every two or three days, and sometimes not for a week." The foregoing conversation, which I venture to say has repeatedly taken place between every phy- sician in active practice and many of his patients, is the author's excuse for giving the following pages to the public. It is astonishing, and I may say, incomprehen- sible, but nevertheless it is a dismal fact, that even among intelligent persons, little or no at- tention is paid to this all important matter of regular and free evacuations from the bowels. I recall to mind one striking case of^-p^ceftJiiTgly B 9 ■-.■■■-:. A'v.w .'/,-/* 1 v; 10 CONSTIPATION, intelligent lady of sixty, who told me that she had never, throughout her long life, given a second thought to her bowels; when she had the inclina- tion to have them moved, she generally, but not always, would seek the water closet; if the desire did not manifest itself, well, no matter, she did not care; and sometimes, she told me, a week or more would elapse without one single evacuation. This is not an isolated case. I venture to say, without fear of contradiction, that there are more persons in the world' who are costive (generally through their own fault, or, at least, through want of information on the subject), by a large majority, than are regular. I have now under my care a woman who tells me that she frequently passes three weeks without a single evacuation. I set myself to work to induce regular daily pas- sages, and, although well advanced in years, with her stomach and liver much disordered from this costive habit, the improvement in her appearance and in her general health has been marvelous. The Hon. Eli K. Price once told me of a gentle- plainly treated. 11 man, eighty years of age, who, possessed of an elegant constitution, seemed to bid fair to become a centenarian, but who, in course of conversation, said that his only trouble was that his bowels were not regular. Why do you not make them so, asked Mr. Price. "Why, how can I?" was the answer; " they will not act; how can I make them do what they will not do?" Eat bran bread, fruit, and so on, was the advice given. And in commenting on this case, Mr. Price said to me: "just think of it; there was a man who had lived in this world for over eighty years, and in all that time had failed to learn how to properly care for his bowels.'' I have been led to regard regularity of evacua- tions from the bowels as one of the most import- ant elements in the preservation of health and the promotion of longevity; and on the other hand, costiveness or constipation as one of the most active agents in the production of many of the diseases not dependent upon the presence of a special poison for their origin, and of producing 12 constipation, such a vitiated and disordered condition of the system, as to nurture and favor the development of diseases even which do require these special poisons. Therefore, I have become firmly con- vinced that if human nature thoroughly understood and appreciated the great necessity of regular evacuations, and would practice such simple rules as would secure them, much disease and discom- fort would be avoided, and a better state of gene- ral health and longer life would result. Therefore, it is my purpose in this book, to en- deavor to demonstrate, in easily understood lan- guage, using the plainest and simplest words only, the great importance, I might even say the abso- lute necessity of this regularity, and to point out certain hygienic rules which will insure it, leaving the medicinal side of the question to the intelligent physician; I emphasize intelligent, because there is no malady (I use the word advisedly) so diffi- cult to overcome and so trying to fhe patience both of the physician and his patient as an obstin- ate case of constipation; while at the same time, plainly treated. 13 the indiscriminate and unintelligent use of medi- cine, instead of relieving the constipation, only serves to confirm the costive habit and render the cure more tedious and difficult. Therefore, let me tell you now (and I will tell you again further on, and give you my reasons then) that you will enjoy better health if you never take a single dose of medicine to relieve constipation, without the advice of your physician. Ever since the days of the apostle St. Thomas (I think it was) and I dare say even before his time, human nature has been skeptical, more especially the intelligent side of it, and hence has generally refused to believe any statement implicitly for which it did not have a good and satisfactory reason. Therefore, I am going to give you the why and the wherefore of every fact which I enunciate, and will not ask you to take my word for anything, but to intelligently understand and thoroughly appreciate all the ins and outs 'of this question of constipation. In order that I may do this, I will divide this little book into three parts:— 14 constipation, Part First will tell you about the functions, the duties of the stomach and bowels. Part Second will demonstrate the great necessity for daily full and free evacuations from the bowels. While Part Third will give you such rules of life as will tend to produce them. I trust these few pages may prove of benefit to some one. I am sure the melancholy, despond- ent and almost crazy dyspeptic will derive some benefit from their perusal, while the suffering vic- tim of hemorrhoids or piles will find in them great relief from his agony. The bilious person will find a means of relieving the engorgement of his liver, if this organ be not absolutely diseased in its structure, while those tortured with splitting headaches will experience much relief by following the directions contained herein. With the hope that the poor sufferers from the various ills pro- duced and maintained by this hydra-headed monster, constipation, may experience relief from the perusal of this little book, I sympathetically dedicate its pages to them. plainly treated. 15 PART FIRST. the functions of the stomach and bowels. Many of my readers have no doubt seen the little wagon belonging to an establishment for dyeing articles of clothing, etc., which used to go about our city a few years ago, bearing the curious inscription on its sides: "We live to dye, and we dye to live." Well, let me here suggest a similar curious motto: "We live to eat, and we eat to live." This is a self-evident proposition. You all know that it would be utterly impossible to live unless you eat. Just as it is necessary to sup- ply an engine with coal in order that you may generate steam, so it is an essential of life that you should supply a sufficiency of wholesome food to your digestive organs, in order that they may generate the so-called vital power, which enables your various organs to perform their different functions, the sum total of whose actions consti- 16 constipation, tutes life. The organs mainly interested in the. reception of food and its preparation and trans- formation into a condition which renders it capa- ble of supplying nourishment to and repairing the waste of the various organs and tissues of the body are known to the physician under the comprehen- sive term of the gastro-intestinal tract. Com- mencing at the mouth, this tract or canal termi- nates at the anus. For the sake of familiar illustration, let me compare this canal to a rubber hose. Suppose you take an ordinary hose or rubber tube, about one and a half inches in diam- eter, and about thirty feet long. Imagine one end of this hose to be attached to the back part of your mouth, and you have the commencement of the passage way into the stomach. The food received into your mouth passes back into this tube, and, after descending it for about one foot, it reaches a point at which the tube has become very much distended, so as to form a bag, so to speak, about ten inches long and four or five inches wide, and capable of holding from one to PLAINLY TREATED. 17 Uvo quarts; this bag is your stomach. At the right end of this bag the tube narrows down again to near its original size in the throat, and for a length of twenty-five feet lies coiled up in your abdomen, constituting the small intestine or bowel; now, it again becomes slightly enlarged (not nearly so much as when it formed your stomach), and in this enlarged condition con- tinues for a distance of about four or five feet, to terminate in your fundament at the anus. It is the function of your stomach to receive into it your food, and to commence to digest it. Some articles of food are completely digested in the stomach, and are absorbed directly from it into the blood and carried by this fluid to nourish the system. Other articles are only partly digested by the gastric fluid in the stomach, and after undergoing this partial disintegration and trans- formation, they are carried out of the stomach into the small intestines, that portion of the rubber tube where it has become narrowed, and meeting here with new juices, their complete digestion is 18 CONSTIPATION. effected, and, transformed into a milky fluid, they are taken up by small vessels provided for the purpose, and carried to the blood, prepared to become part of that fluid and to repair the wear and tear of tissue. The stomach and bowels seem to have the peculiar property of selecting from the food taken in only that which is suitable and appropriate to nourish the body, and of rejecting the rest. Just as in coal you will often find cer- tain impurities, not fit to generate heat, so in food there are certain elements not suitable to produce vital force, and these elements, refused by the digestive and absorbing organs, are carried on by the bowels, further and further along this tube, until they are finally expelled from the body in the act of defecation. Again, there are certain vessels distributed all over the body, whose duty it is to gather up the dead and useless particles of tissue, whose work has been performed, arid whose continued presence in the system would be not only unnecessary, but absolutely injurious. You probably know that every act of life, even the PLAINLY TREATED. 19 most unconscious, is performed at the expense of some particles of the tissue of your body. Each act causes the destruction of those particles which have been engaged in the performance of that act, just as the generation of heat in a stove causes the destruction of the coal which has been instru- mental in its production. I use the word de- struction here in its liberal sense for the sake of illustration. You all know, of course, that matter is indestructible, and that what seems to be de- struction is in reality only a change of condition. So that these particles of your body are not in reality destroyed, but are so altered in their com- position by the different vital acts to whose per- formance they have given their power, that they are no longer fit to constitute a part of your body, and by one of those beautiful laws of nature, they must be removed, to furnish in turn nourishment to the various articles of vegetable life, during which process their composition is again so changed that they are once more rendered fit to nourish the human body. So that, wonderful as 20 CONSTIPATION, it may seem, some of the particles of your brain which will be used up in reading and understand- ing this little book, and which will be removed from your body in a disgusting state of decompo- sition, foul and unclean, and not fit to be touched, may, in the course of years, again find their way into your brain, through the agency of the food you eat, and may again be used up in reading a book, of which I may, perchance, happen to be the author. These particles being unfit to longer remain in the body, must be gotten rid of. The vessels of which I have spoken, distributed over the body, take them up and carry them to the various eliminatory organs, whose duty it is to remove them from the body, among which I may mention the lungs, kidneys, etc. Prominent among them stands the bowels; the narrow por- tion of the rubber tube. These vessels constantly acting, bring the dead and decayed matter to the bowels and empty it into them. They are the drain pipes, so to speak, coming from the different rooms in the different houses, and carrying the PLAINLY TREATED. 21 waste into the common sewer, with which the bowels might be not inaptly compared. This matter is received and stored up in the bowels as waste matter is in your privy wells, until the proper time comes for discharging it from the body; and let me here anticipate myself by tell- ing you that the proper time is once a day. The bowels not only play a vital part in the drama of life, but, if I may be allowed a literary liberty, they have also a mechanical function, so to speak. Your kidneys are constantly removing from the blood the elements whose combination forms urine. Now, if this urine trickled constantly from your body, it would be very annoying. Your clothing would be soiled, you would smell bad, and the surface of your body would be ex- coriated and made sore by the acid in your urine. So your all-wise Creator furnished you with a bladder, which is simply a reservoir, a receptacle, as it were, for the urine. Here it accumulates, drop by drop, until, the bladder being distended to a certain extent, an impression is made on the 22 CONSTIPATION, nerves ramifying over its surface, and this im- pression conveyed to the brain, the desire to urinate is there originated; and so, in obedience to this desire, your bladder is emptied, and thus so much dead and decayed matter is removed from your bodies. The same thing occurs with your bowels. The dead matter accumulates therein, as in the bladder, and finally, after reach- ing a certain amount, the desire to evacuate it arises, and so the refuse is removed. But let me tell you that, differing from the case of your bladder, if this desire to evacuate the bowels be neglected, the nerves will become so blunted, and the muscular wall of the intestine or rubber tube so torpid, that eventually, not only will the desire not arise of itself, that is to say, naturally, but it will be almost an impossibility for you to force an evacuation. You now understand enough of the functions of the gastro-intestinal tract or rubber tube to enable you to understand the remarks I will have to make on the necessity of daily evacu- ations from it, and how you can procure them. PLAINLY TREATED. 23 PART SECOND. NECESSITY FOR DAILY EVACUATIONS. Every good housekeeper knows and appreciates the necessity of semi-annual house cleanings. If she does not scrub the floors before laying the carpets in the fall, and wash the paint, she does not consider that she has a pure and clean house. Every maid of all work has a certain day on which she must sweep the parlor, another for the dining room, and so on, and every day she must dust all the rooms. Windows must be washed and rooms aired. And all this work for what! In order that the house may be cleaned of its impurities. All large cities vie with each other in perfect- ing their systems of drainage; and for what ? In order that this very dead and decayed animal tis- sue of which I have been telling you may be re- moved and- prevented from contaminating the air which wf breathe, the water we drink, and the 24 CONSTIPATION, food we eat. New cities are considered unhealthy, and why? Because, their drainage being imperfect, much of this refuse matter remains, to poison the inhabitants. An intelligent person going to live in the country will seek sloping ground ; and high locations are generally considered the healthiest; why? Because, according to natural laws, drain- age will be better, and the sloping ground will carry away from the vicinity of the houses that dead and decayed matter which your bodies are continually giving off. Now, does it not seem strange to you, when you stop to reflect on it, that intelligent men and women will go to all this trouble and expense to remove deleterious matter from their company, when it has once left their bodies, and yet so many of them will go on from day to day, unconcernedly performing their various duties of life, seemingly ignorant of the fact that an enormous quantity of foul, rotten and unclean matter is within their bodies, poisoning the very foundation of their lives, and sowing the seeds of disease and premature death? Does it not PLAINLY TREATED. 25 seem incredible? Oh ! it is a terrible thing, this ignorance of our own bodies. Was it not Pope who said, "the noblest study of mankind is man." I do sincerely hope the day is not far distant when the study of physiology, in its elementary form, at least, will constitute, as it ought, one of the main points in the education of our boys and girls. Ignorance of the functions of our bodies consti- tutes a most prolific source of disease and misery. How can a person be expected to treat his various organs properly, if he is utterly ignorant of the way in which he should treat them. This trouble of constipation is very frequently contracted by children when growing up. Their parents before them have not been taught to value the necessity of regular evacuations, hence they have not impressed it on their children, and so these boys and girls, when, in the midst of play and amusement, the desire to defecate comes upon them, resist it by all the means in their power, rather than have their recreation interfered with, and only yield obedience to it when its commands c 26 CONSTIPATION, become irresistible. Constantly and repeatedly refusing to listen to this voice of nature demand- ing a purification, a removal of poisonous matter, the bowels finally become exhausted, as I have told you, and a costive habit is established. Not being taught differently in childhood, they do not consider it injurious, when they grow to maturity, to allow their bowels to remain unopened for days at a time, and they, in turn, neglect this all-import- ant matter in their children. Dr. Lionel S. Beale, of England, says, in his valuable and practical work on "Slight Ail- ments," "You will find that people who suffer from habitual constipation, and those who have a regular but quantitatively deficient action, com- plain of certain unpleasant sensations. Although there is no organic disease, and if you examined every part of such person you would not find the least indication of the slightest structural change, the almost constant discomfort many of these people have to endure is really great; and not only so, but various more or less serious conditions PLAINLY TREATED. 27 may result from habitual constipation. In this way that unpleasant condition known as hypo- chondriasis in the male and as a form of hysteria in the female, very often commences. There is even the possibility that a condition bordering * upon insanity may be brought about by long con- tinued improper action of the bowels.'' Even your servant who attends to your furnace fire understands that he must clean out the ashes if he desires a good fire. If he allows the ashes to remain he may pile on the coal, but he will get no heat; the coal cannot burn, it cannot do its work, because the furnace is choked up with dead and useless coal, in the shape of ashes. The contents of the bowels are the human ashes. If you do not remove them, you may eat, but your food will not properly nourish you, for the evident reason that the vital functions necessary for the transfor- mation of this food into nourishment suitable for the body are so interfered with by this mass of decaying animal matter within you that they can- not be properly performed. Any one who has 28 CONSTIPATION, been constipated for some days, and then has an evacuation, cannot help but be struck by the ter- ribly offensive odor of the passage, showing to what an extent decomposition has taken place. Do you know that the most prolific cause of • typhoid fever is emanations, in the shape of foul gases, from privies and water-closets, these gases being generated by the decomposition of the mat- ter you have passed from your bowels? Do you also know that typhoid fever is characterized by the presence of small ulcers or running sores in small glands, which are situated in your intestines or bowels ? Now, does it seem out of place to im- agine that the retention of a large mass of this same rotten matter in your bowels, and its under- going decomposition there, and liberating these same poisonous gases, acting on these same little glands, might produce this same typhoid fever, or, at least, a condition very similar to it ? Do you know what hemorrhoids or piles are ? They are an enlargement, an engorgement with blood, of the small veins in the vicinity of the anus. PLAINLY TREATED. 29 Now, can you not understand that the presence of a large amount of this poisonous matter in the lower part of the bowels—matter which ought not to be there, and which, consequently, is a foreign body—will so irritate the delicate lining of your bowels—a lining as delicate as that which coats the inside of your mouth and cheeks, with which it is both continuous and identical—as to cause an extra amount of blood to flow into its vessels, and this costive habit continuing, will eventually pro- duce a chronic engorgement or congestion of these vessels, and you have all the sufferings and tortures of piles, as a result of this constipation ? In women the womb occupies a position directly in front of the bowels, from which it is separated only by a thin membrane. Now, can you not easily perceive how this congestion of the bowels will also have a tendency to cause too much blood to flow into the womb, and to produce an en- gorgement of it, with all its attendant suffering ? Again, the womb is movable; it is suspended in the cavity of the abdomen by ligaments or cords, 30 CONSTIPATION, sufficiently stout and strong to keep it in its pro- per position when the organ is healthy; but sup- pose this costive habit so irritates the womb as to cause a great, an excessive flow of blood into it; of course it will be heavier than natural, the in- crease in weight being directly in proportion to the increased flow of blood. Being so much heavier than usual, the cords are unable to hold it in position, it drops down, from its own weight, and we have constipation, producing all the mis- fortunes of falling of the womb. Still more; this constant irritation in the bowels keeps up a con- stant excess of blood in the lining membrane of the bowels, and you ultimately have a chronic inflammation of this tube set up, which, besides causing much pain and uneasiness in the abdo- men, interferes with the proper digestion and ab- sorption of your food, and hence all the phenom- ena of nutrition are impeded. This mass of dead tissue remaining in the bowels undergoes decomposition, and being un- able to escape in the natural way, some portion PLAINLY TREATED. 31 of it is re-absorbed by the vessels ramifying over the surface of the bowels, and is carried into the blood, so that this fluid, when going its rounds to nourish the various tissues and organs, carries with it some of this poisonous material, and so poisoned blood gives poisoned nourishment to your various organs and parts. A prominent physician of our city once com- pared the brain and stomach to the two balls or ends of a dumb-bell, while the nervous com- munication between them was likened to the shaft of a dumb-bell. This illustration he used to demonstrate the intimate connection which exists between the brain and the stomach, through the agency of the nervous system. The bowels, as you now understand, are simply a prolongation of the stomach; they are most intimately connected with the brain by a large number of-nerves. In children one of the commonest causes of convul- sions is constipation, and the presence of worms in the bowels; the worms acting as an irritant, a foreign body, precisely the same as a collection 32 CONSTIPATION, of dead and decomposed matter does, will cause an irritation in the bowels, and this irritation, acting through the nerves by what is known to physicians as reflex action, will so irritate the brain as to give rise to many disordered phenom- ena on its part. Can you not, therefore, under- stand how easy it will be for constipation to pro- duce those violent headaches to which costive people are so subject ? The liver is one of the largest and one of the most important organs in your body. How many hundred times have you heard your friends say, " I have a bilious attack ? " These bilious attacks are caused by the incomplete removal from, and consequently a partial retention of the bile in, the blood, where it does not belong. When the liver removes this bile from the blood it stores it up in a small sac in that organ, from which it ultimately passes through a small duct or canal into the bowels, into which it empties at a short distance beyond the point where the narrowing of the bowel after its dilatation to form the stomach takes place. PLAINLY TREATED. 33 The membrane which lines this duct is continuous and identical with that which lines the bowels. Now, can you not clearly understand how, when this undue retention of dead matter has caused an inflammation, an excess of blood in the lining of the bowels, this inflammation will extend up the bowels, through this duct or tube, and ultimately involve the liver itself? And let me tell you that neither the liver nor any other organ can properly do its duty if it is in a state of inflammation, if it has too much blood in it. This temporary en- gorgement, caused by a temporary constipation, if frequently repeated, will, by degrees, abnormally distend the vessels of the liver; you will have a condition of chronic inflammation or engorge- ment, or too much blood produced, which, in turn, will cause degeneration and disease of the structure of the liver itself. So you have many cases of serious liver disease, induced by consti- pation. Of course, I need not tell you that the poisoned blood which I have said must result from constipation will carry some of this poison to all 34 CONSTIPATION, the various parts of the body, and will produce injurious effects on them, thus interfering with the whole function of life. Let me close the list of ills produced by constipation, by telling you that death even may be caused by simple costiveness, when it has existed for a long time, and has be- come firmly established. To support this rather startling statement, let me quote the following remarkable case from Dr. Beale's work, already referred to. He says : " Constipation has caused death. I have myself seen such a case. I recol- lect an old lady who had been bed-ridden for years, and was, in fact, dying when she came under my observation, whose abdomen had in- creased to an enormous size. To my great aston- ishment, when I came to examine it, I found the swelling due to an enormous accumulation of hard fecal matter. There was no fluid, and very little gas; but the whole abdomen (or belly) seemed occupied by a huge mass of hardened faeces, I should think, amounting in weight to thirty or forty pounds. Unfortunately, I only saw the PLAINLY TREATED. 35 patient a few hours before death, when she was reduced to the last state of exhaustion, and when it was impossible to interfere. In this case, fasces had probably been gradually accumulating in the intestines without attracting notice. The patient being bed-ridden, the circumstance seems to have escaped observation. Probably if a medical prac- titioner had been allowed to interfere some six months before, the patient might have been saved. Injections might have been given, and the con- tents of the bowel thus removed, before any harm to it had resulted. I have now told you enough, I think, to make you fully realize the absolute necessity of free and daily evacuations from the bowels. You will now know, if you did not before, that the evil results of constipation are not confined to the bowels, but ramify throughout the whole organism. Indeed, they have no boundary. Their field of operation is only limited by the limits of the body itself. Let us now see how you can procure these much desired daily evacuations without the use of drugs. 36 CONSTIPATION, PART THIRD. how to procure daily evacuations without the use of drugs. In the above title I emphasize the word Drugs, because I wish you to understand that the words drugs and medicines do not necessarily mean one and the same thing, though to the non-profes- sional mind these terms convey the same idea, and the ordinary individual regards both drugs and medicines as articles which must come from the druggist's shelf. All drugs are medicines, but all medicines are not necessarily drugs. To point this difference, let me quote from the standard and exhaustive work on "Therapeutics and Ma- teria Medica," by one of the greatest authorities now living, Professor Alfred Stilly, of Philadel- phia. In the very first line of his introductory chapter, he says, "Medicines are substances used for the cure of diseases." Further on, he says, "In some sense, even, all food is medicinal, for it PLAINLY TREATED. 37 counteracts hunger, the first symptom of a disease which tends directly to death." The word drug is less comprehensive in its meaning, and ought to be confined to those articles which the general public understand by the term medicine. Its use should be restricted to those articles whose sole use in the human system is to cure disease, while many articles comprised under the head of medi- cines (as Professor Stille has told us) may be used not only to cure disease, but also simply as food. To illustrate this, in what I am sorry to say will probably be the most familiar manner to the ma- jority of men, let me remind you that when you take a drink of brandy to relieve a stomach-ache, the brandy might here be considered a medicine, but you would hardly be willing to call it a drug, though, indeed, I must confess, it takes rank among the poisons. Again, many a severe case of dyspepsia will be cured by strict adherence to a milk diet. Milk is here a medicine, but no one will venture to call it a drug. I draw this dis- tinction between medicines and drugs, because I 38 CONSTIPATION, am now going to tell you that while much benefit will be derived by the person of costive habit from the use of certain medicines, about which I will inform you, nothing but injury and a further confirmation of the constipation can result from the indiscriminate use of drugs; a habit which I exceedingly regret to say is so common among our people, that the manufacturers of the various patent cure-all, anti-bilious and anti-costive pills have been enabled to build up enormous fortunes founded upon the gullibility (if I may be allowed the word) and ignorance of the laws of physiology of their victims. I use the word victims advis- edly. I pity from the bottom of my heart the poor, well-meaning person, who, as a result of ignorance of the functions of his own body, will pay his money for and consume large quantities ' of these medicines, whose chief merits lie in the cunning minds of their manufacturers, and in the expensive and flaming advertisements of proper- ties which they do not possess, and by which means many intelligent persons are duped into PLAINLY TREATED. 39 buying them, and do not discover their mistake until very serious and sometimes irreparable in- jury has been done. Many of these medicines will open the bowels, it is true; I do not deny this; but you must not be satisfied with this super- ficial action; look deeper, and see what they do. They open the bowels because they contain cer- tain drugs which possess the property of stimu- lating the muscular tissue in the bowels or rubber tube to increased action, and so they force the contents of this tube further and further along, until they finally reach the anus and are expelled. Stimulation is an artificial process. In order that our functions may be properly carried on, and that we may have healthy life, there must be nothing artificial about us. All our actions, voluntary and involuntary, must conform to na- ture and be natural. You all know that stimula- tion is always followed by a corresponding de- pression. A certain quantity of alcohol taken into the system will stimulate every part of it; all your organs will act more rapidly, you will live 40 CONSTIPATION, faster, as it were. When this stimulating action has passed away you suffer from depression, evi- denced in numerous ways. You are morose, melancholy and low-spirited, evidencing mental depression. You experience chilly sensations, showing depression of the func- tion which generates heat. You have no appetite, showing depression of the general system. Your stomach cannot properly digest what you take into it, showing depression of the digestive function. And so on indefinitely, all your varied functions will clearly make known to you the inevitable de- pression that always follows stimulation. When the habitual drinker of alcohol has taken a glass or two too much at night, he knows full well the general depression which he experiences in the morning, and unfortunately he finds it necessary to consume more alcohol, in order to again stimu- late his varied functions, so as to once more bring them up to that standard which, in the ordinary healthy, temperate person would constitute only natural action. Ultimately his system becomes so PLAINLY TREATED. 41 accustomed to this stimulating action of alcohol that his organs cannot act properly without it, and so, in order to live with any degree of comfort, he is obliged to daily saturate his tissues with this poison ; or if he has sufficient manly resolution to discard this baneful habit, he must suffer terrible depression and many physical ills before his sys- tem can be brought to that healthy and natural condition by which it may be enabled to act simply as a result of the natural causes furnished to it by the Founder of Nature. So it is with this indiscriminate use" of opening medicine. The bowels become ultimately so accustomed to the ar- tificial stimulating action of powerful drugs, that they absolutely refuse to move without their aid ; they are dependent on them for sufficient power to expel their contents; and as with alcohol, so with these drugs, long continued use breeds such toler- ance of their effects that each successive dose must needs be larger than the preceding one, until, finally, enormous doses are required to procure a single evacuation from the bowels, which should D 42 CONSTIPATION, have occurred naturally and spontaneously if this pernicious habit had not been cultivated. I could tell you of one case where from twenty to thirty powerful pills are required to move the unnaturally torpid bowels. Do you not now think it wrong and very injurious to use these medicines, about which you know absolutely nothing, without first obtaining the advice of a competent physician, who has made the action of these medicines the study of his life ? If any lawyer reads this book, let me ask him if he would not consider a man very foolish, and very much to be criticised for want of good judgment, if, throwing aside the services of the legal profession, he were to under- take the management of his own law business, without having had any previous training in that line ? And so on, I might draw the comparison in every profession. But when we come to medi- cine, this question assumes much more import- ance; it then really becomes a vital question. When a man meets with financial misfortunes, his friends all say, to console him for his loss, "Oh, PLAINLY TREATED. 43 well, you have good health." Those of a reli- gious turn of mind daily pray for ? -preservation of health. Parents are anxiously solicitous about the health of their children. And yet, in spite of all this desire for health, these very persons will deliberately undertake to doctor themselves, and, as invariably happens when a man undertakes anything about which he knows nothing, they make many errors, and, instead of doing them- selves good, only make matters worse; and this in the face of the fact that their Creator has placed at their service the science of medicine and its practitioners, in order that all curable ills may be intelligently treated. This is not a plea for physicians; far from it. Were I selfishly to consider the doctor, to the exclusion of the wel- fare of his patient, I would advise you all to freely use these proprietary medicines and wonderful specifics for everything; because by so doing you would ultimately bring about such a state of ill health that you would of necessity fall into the hands of the physician, and then your system 44 CONSTIPATION, would be so deranged that it would cost you much more time and many more dollars to secure a restoration to health than if you had sought intel- ligent counsel and advice in the beginning of your trouble. The venerable lawyer of our city, the Hon. Eli K. Price, tells me one of the most important secrets of his great age (nearly eighty- four years) and splendid health, when he says, "I am as watchful as to my food as is the smelter of iron that his furnace shall not chill and choke; and regulate my food to prevent constipation or laxity, rather than resort to medicine, which I avoid using until necessary; and in illness, act in strict obedience to my chosen physician of regular gradu- ation." And he tells me that though he has been sick at times, from overwork, when he would be compelled to pay attention to hygienic laws, that " my recuperations have been to a higher point of health, even to the present year, when eighty-three years old." Have I not, now, said enough to convince you that the unintelligent use of drugs can only be productive of ultimate harm? PLAINLY TREATED. 45 It is like playing with fire; if you trifle with it long enough, you will surely be burned. So let me beg you, if you desire good health—and show me the man or woman who really and sincerely does not, and I am prepared to attach my name to a certificate of insanity—never to take a single dose of opening medicine after you have read these pages, without the advice of your physician. Sometimes it is necessary to use them, but let your doctor be the judge. If the hygienic direc- tions I will give you, when fairly and patiently tried, do not suffice to establish a regular habit of evacuations, make up your mind that the consti- pation from which you are suffering is in reality a disease, as much so as pleurisy or pneumonia, and go to your doctor at once and follow his di- rections implicitly. I might here say that some persons seem to be so constituted that an evacuation only every sec- ond day constitutes in them the natural action of the bowels, and they do not seem to suffer the slightest inconvenience from it; and again, some 46 CONSTIPATION, persons in good health will have two and may be three passages daily. In these cases such persons may rest easy and satisfied; they need not endeav- or to procure daily evacuations. Still, however, these are only exceptional instances, every rule has exceptions; and so I can, without fear, enun- ciate the fundamental principle, that " without a daily free evacuation from the bowels perfect health is impossible. Just here I will tell you of a remarkable case. The first edition of this little work brought me many letters, and among them the following remarkable one, detailing a case so unique that I feel sure it will be of interest to you. This case illustrates in a most marked way the fact that no universal panaceas exist for any trouble. What will do for one man will be utterly useless with another. It contains also some very instructive information. Some of my costive readers may try, as my correspondent did, all the means I will recommend, and yet may fail to procure regular evacuations, as he failed. Such persons PLAINLY TREATED. 47 may try the expedient to which he finally re- sorted, and succeed with it. Therefore, with his permission, I will give you his letter in full: " My dear Doctor, I thank you for the two books; the one on Constipation I have just finished reading, and having inherited costive- ness on* the maternal side for over one hundred and fifty years, I can appreciate all your sensible suggestions on the subject; yet from personal experience, I know them all to be ineffectual to cure, at least in my case. After trying everything, as food, of a laxative nature, including fine, large wheat, ground in an ordinary coffee mill, and then boiled down to a jelly, and eaten with molasses or cream, I finally abandoned all and fell back on the daily use of a syringe. For over twelve years past I have never even attempted an evacuation without its use. If I go from home for a day or a month I take one with me. My case is doubtless a peculiar one, as everything gets through the hose (or bowel), without pain or even inconvenience, but when in the rectum 48 CONSTIPATION, (lower bowel), a drying process commences, as fierce, hungry and quick, as if the faces had fallen into a kiln. A little water, say a pint, put into the rectum and held there a few minutes, will lubricate the dry, hard accumulations of a day, and, without straining, I am saved the horrors of prolapse, have a pleasant peristaltic movement, and go about my daily work, a cheer- ful and happy man. Friends whom I meet in the streets of Philadelphia often inquire what it is that gives such health and complexion at sixty- five. To the ladies we say, on our farm in Delaware County we have the spring that Ponce de Leon spent so much time in searching for, the rejuvenating water that gave renovated youth to all who drank or bathed in it. To my male friends I sing the wonders and blessings of the syringe." A few days after the receipt of this letter I met my correspondent, and he gave me more of the particulars of his interesting and remarkable case. All of his family, with but one single exception, are equally as costive as PLAINLY TREATED. 49 he is, and all are prepared to glorify the syringe. For years he suffered tortures, really agony. Several days would elapse without an evacuation. He would be miserable, low spirited, gloomy and despondent. Appetite and sleep would be im- paired. His food would not taste right. Finally, after several days, he would seek the closet and attempt to force an evacuation. The hard, dry, large and irritating masses of fecal matter would be slowly forced along the bowel, producing a stretching, a distending of this canal, and caus- ing such pain, such suffering, such agony, that I can readily believe the description given to me by many female patients, that the terrible suffering experienced from an evacuation of this nature is similar to, in kind, and only a little less severe than the tearing, distending and heart-rending pains of childbirth. When finally the fecal matter would leave the bowel, this terrible strain- ing would cause some of the bowel to protrude after it, and he would have prolapse. Then he tells me this suffering, this annoyance, this nervous 50 constipation, and uncomfortable condition, into which his terrible ordeal had thrown his whole system, would last nearly all day. In a few days this awful procedure would have to be repeated, and his life in the meantime be rendered miserable by unhappy anticipations of his inevitable suffer- ing. I will ask any of my female readers who may happen to be mothers, whether they would have any peace, happiness or quietude, if they felt sure that, regularly once a week, they would be compelled to undergo the sufferings of labor. My unfortunate correspondent was for many years compelled every few days to undergo a process very nearly as painful. His physique was wonder- ful, otherwise such strain and wear and tear would have killed him. He informed me that his mother, who was afflicted with this costive habit, died when about fifty years of age, and he added, "I firmly believe that had she been acquainted with the use of the syringe and its merits, she would, in the natural course of events, have lived to be eighty." My friend was treated PLAINLY TREATED. 51 by nearly all the prominent physicians of Phila- delphia ; he tried every hygienic means to over- come his trouble, but derived only temporary benefit. His life was in reality a burden to him He could see pleasure in nothing. Finally he became acquainted with the syringe. A magical change came over him. With its use, daily, free, copious and painless evacuations became the rule. His sleep and appetite became good. His dis- position became joyous, he looked on the bright side of life. Should I point him out to you, and ask you to guess his age, I am sure you would say about fifty. He is sixty-five, and hale, hearty, vigorous, possessing an even and equable tem- perament, leading a regular and comfortable life ; he should, according to all natural laws, live for very many years. Let us begin where this costive habit usually commences, that is to say, in childhood. Most babies suffer from constipation. If your baby's bowels are not moved daily, I will tell you a sim- ple procedure which will generally secure a 52 CONSTIPATION, passage. Take a piece of ordinary note paper, not too stiff, and roll it into an old-fashioned lamp lighter; insert the sharp end carefully, gently and gradually into the bowels, for a distance of about two inches; let it remain for a few minutes. The presence of this paper will slightly irritate the bowels, not enough to do harm, but just enough to bring on sufficient action of their muscular coat to expel the contents. Smear the point with Castile soap before introducing, so that it may more easi- ly slip in. If this fails, procure a small, hard- rubber syringe, and daily inject into the bowel one or two syringefuls of warm (not hot) water; this will aid the contraction of the bowel, and will, at the same time, soften and dilute its con- tents, so that they may the more easily be carried out. If this warm water fails, use a little Castile soap in the water. If the bowels still remain un- opened, substitute plain olive oil for the soap and water. If your baby is naturally costive, that is to say, if he does not have a regular daily evacuation, you should practice this injection daily, and I PLAINLY TREATED. 53 would recommend bedtime, after baby is un- dressed and just before being put into bed, because a full and free evacuation from the bowels will insure to him a full night of sound and refreshing sleep. Attention to the bowels becomes of para- mount importance after baby has commenced to cut his teeth. All mothers know that when teething babies are particularly liable to convulsions. This is due to the fact that the teeth, in forcing their way through the gums, irritate and inflame them, and this irritation of the gums is conveyed, by the reflex action about which I have told you, to the brain, and irritating this delicate organ, will cause convulsions. Now, if, in addition to the irritation from teething, baby's bowels are also irritated by the retention in them of a foul mass of decayed matter, the liability to convul- sions is doubled. This irritation of the gums will produce a feverish state of the blood ; now, if the bowels are costive, this feverishness will be in- creased. If you are nursing your baby, it will be well for you to eat freely of such food as I shall 54 CONSTIPATION, tell you, further on, has a tendency to open the bowels; baby receiving this through the medium of your milk, will be made regular. Be careful, however, to avoid such articles as experience tells you will give baby colic. If these simple means fail, do not resort to castor oil or any other drug, but ask your doctor what to do. In this connection a word for what are gener- ally termed '' cross children." It is not natural for a child who is well to be cross. Of course, there are exceptions to this, as to every rule. But in the majority of cases, a child whose organs are all working properly, who has plenty to eat, and who is not in any way irritated, will be good; it will not cry and worry. Therefore, if your child is fretful and peevish, and at the same time is in good health, examine as to whether the clothing is irritating or fits badly, or whether a pin may be sticking him. If you can find no cause, then you may suspect worms. The pres- ence of these parasites in the bowels, I doubt not, has earned for many a little girl or boy the unjust PLAINLY TREATED. 55 soubriquet of " cross." When you suspect these worms to be present, having excluded all other causes for the crossness, you may purchase some good worm syrup from a reliable druggist, and use it. lam not an advocate of "home doctoring/" I heartily condemn the practice ; my books are not meant to supplant, but merely to aid the advice of the doctor; still, in this trifling and excessively common trouble of worms, I do not think you will do your child any harm by using some simple worm syrup, according to the printed directions of some reliable, mind you, I say reliable, apothe- cary. When your baby becomes a little girl or boy, and is able to toddle about and eat table food, you can, in addition to the means I have already indicated, use certain articles of food. A very good practice is to give your children oatmeal mush for breakfast. This oatmeal, after all the nourishment is removed from it by digestion in the stomach and bowels, still leaves a large indi- gestible residue, which is somewhat irritating to 56 CONSTIPATION, the lining membrane of the bowels; not enough here, again, to do harm, but just enough to remove the torpidity which may exist and excite the tube to healthy action. Bran bread, unbolted flour, grits, cracked wheat, and the like, may also be used at breakfast for the same purpose. One of the most important elements in establishing and maintaining a habit of daily evacuations is regularity. When I am requested to prescribe for a case of constipation, my first instruction to the patient is to determine what time of the day is the most convenient for them to devote to this important function, and when they have settled on this hour, I insist upon their seeking the water closet precisely at the same hour each day. I tell them to remain there for a few minutes, and to strain gently; if they strain very much they will be liable to do themselves a great deal of harm. If they fail at first, I tell them to go the next day at the same time, and so on, day after day, until, ultimately, this process of coaxing will have the desired effect on the lazy and torpid bowels, and PLAINLY TREATED. 57 a regular daily habit will be established, and the desire will manifest itself each day at precisely the same hour. Then I caution them that, having once established, tKey must never neglect this de- sire. Every one has experienced the fact that if you resist a desire to have the bowels moved, after a little while this desire will disappear, and no effort of the will can bring it back; well, one day's neglect of this desire, in a person who has been for some time constipated, will, in many cases, derange the bowels for several days. So, as soon as your baby is large enough, put him regularly every day, at the same hour, on his chair, and giving him toys to amuse himself, let him remain there until his bowels have been moved. Do not fret and worry if your baby is costive; nearly all babies and young children are so. I once heard a prominent physician, the father of a large family, say that his different children came to him daily for an injection, with as much regularity as they would eat their dinners. He would give them the injection, E 58 CONSTIPATION, but at the same time would use the means I have given you to produce a regular habit, and ultimately, as his children grew older, the injec- tions became unnecessary. Keep up this super- vision until your children have grown to be young men and women, and they will not forget the training they have had, but will continue through life to understand and appreciate the necessity of regularity in this respect, and will, in turn, im- press it upon their children, and so I warrant you not a small share of disease and bad health will be averted. You know how necessary it some- times is to coax an obstinate child to do as you may desire, and every one is familiar with the coaxing requisite to move a balky horse. Well, this process which I have just described to you is one of coaxing: by offering the opportunity at regular and stated intervals, you coax, you beg, as it were, the obstinate and lazy bowels to healthy action, to do as you desire, and as in the cases of the obstinate child and the balky horse, your efforts will ultimately be crowned with success, PLAINLY TREATED. 59 and the bowels, like the child and the horse, will eventually yield to your repeated pleadings, and a regular habit will be established. If you do not at first succeed in establishing this habit of regu- larity, do not fret and worry; if you do, you will make yourself feverish, fretful and irritable, prob- ably cause a headache and make matters worse. Take the refusal of your bowels to act coolly and philosophically; wait until the next day and try again. I need hardly tell you that should the de- sire to evacuate arise before the next day comes, do not refuse obedience to its commands. I have known many obstinate cases of constipa- tion to be ultimately overcome by the following simple method ; Pare an apple and eat it before breakfast, chewing it thoroughly, until it becomes pulpy, before swallowing; on top of this drink a glass of cold water, then eat your breakfast. In many cases a desire to have the bowels moved will be experienced immediately after breakfast, when this habit is persevered in. I have known some persons who never experienced the desire 60 CONSTIPATION, immediately after breakfast, but who, after a short walk, would have a copious movement. These persons would always walk to their place of busi- ness and seek the water-closet immediately after reaching there. Muscular exercise is a most pow- erful agent in promoting regularity of bowel ac- tion. I have known persons who were subject to attacks of constipation and biliousness, foul mouth and disordered stomach, who would take a brisk five-mile walk in the pure, bracing and invigora- ting air, and upon returning home would have a copious discharge from the bowels, followed by immediate relief from all their distressing symp- toms. You all know that a brisk walk in the country, where the air is pure and uncontaminated, has a tendency to quicken the circulation and to elevate the spirits and remove the general depres- sion, physical and mental, to which the residents of our large and crowded cities are so liable; well, in this general elevation or natural stimulation of all our muscles and organs, the muscular coat of the bowels comes in for its share, and, stimulated PLAINLY TREATED. 61 to a certain extent, its unnatural torpidity is removed, and it obtains sufficient strength and vigor to expel its contents. Also, this muscular exercise causes a change, a transformation of the muscular elements concerned in its performance into so much dead and decayed matter, seeking removal from the body, wherein it has performed its duty, and is no longer of any use; so that this additional bulk of matter, being superadded to that already stored up in the bowels, makes a stronger impression on them, the demand for removal becomes greater, and hence the torpid bowels are finally compelled, in spite of their laziness, to act. So I would recommend to the costive man a brisk, daily walk of five miles in the country, and to the woman half that distance. If you can secure pleasant and cheerful company in this walk, so much the better; if you cannot, em- ploy your mind with pleasant thoughts, to the exclusion of business. Select a beautiful country, in which the aspect of nature is varied, so that the eye may not become tired and the mind exhausted 62 CONSTIPATION, by monotony. Make this walk a pleasure, and not a duty. Do not tell me that you cannot find time for this daily walk; that you are too busy, and so on. Charles Dickens, who probably per- formed as much and as satisfactory work in his lifetime as any man who ever lived, was able to make time for an almost daily /3 1872 . . 208 . 47 1877 - 288 . 21 1873 . . 211 . 39 1878 • 342 . ■ J3 18 how to live The apparent exception in 1876 may be ex- plained by the presence in the city of so many strangers, many of whom, no doubt, died very soon after coming under the charge of a physician, before he had a chance to make a diagnosis, and a post-mortem examination being impracticable, the case had to be returned as due to an unknown cause. You will understand this when you read further on and see what my experience was in the Philadelphia Hospital, with this disease. This same relative increase and decrease I find to hold good, with the recorded cases of convulsions in persons over five years of age and of dropsy. The above table contains another very instruct- ive point. You will notice that the mortality from Bright's Disease in 1869 was 140, while in 1878 it was 342, nearly two and a half times greater, while the total mortality in 1869 was 13,428, and in 1878, 15,743, an increase of only 2315, less than one-sixth. This is really the most instructive and most in- controvertible point I have given you. There is no theory or speculation about this statement, but stubborn and undeniable facts and figures here show an enormous increase in the proportion with bright's disease. 19 of deaths from this disease, even in the last ten years. I could go on multiplying statistics indefin- itely, but I feel sure I have already given you enough to satisfy you beyond any question of doubt that this formidable disease has become much more frequent of late years, and is steadily and rapidly on the increase. I desire to show you this fact and to explain to you the cause of this increase, in order that you may understand the means and realize the necessity of reducing its terrible frequency. When you have read this little work through, if you think over it for a few minutes, you will realize that all the instructions and advice which it contains can be resolved into the single short precept, "Live properly;" live so that every organ in your body will have its own proper amount and kind of work to perform. Now the most powerful cause of this disease is the neglect of this maxim. It is not a so-called inev- itable disease, such as some of the fevers, but is much under our control. Exposure, over-work, abuse of our various organs, by over-eating and drinking, and, in a word, neglect of hygienic rules, 20 HOW TO LIVE will cause it. While, on the other hand, a strictly proper life in every respect will do much to re- tard its increase. Suppose it is an hereditary affection, and may be transmitted from parents to their offspring; we all know that consumption, that most particularly hereditary disease, may, in many cases, be rendered torpid and quiescent, and its development be stayed, by a proper and careful life. To point this, let me tell you that Bright's Disease is much more frequent and more fatal among men than among women ; and I need not tell you that men are more exposed to mental worry, over-work, disordered digestion, from ir- regular eating, excessive drinking, late hours, the use of tobacco and almost all injurious agents, than women. Again, it is much oftener observed among adults than among children, for the same reasons. I will tell you, further on, that a weak kidney is like a weak boiler; if you do not put too much strain on it it will bear the pressure, but if.the strain be too great, it will explode; and I will tell you that a neglect of the laws of health will have the same effect on a weak kidney, pre- disposed to disease, that a steam pressure of two hundred pounds will have on a boiler capable of with bright's disease. 21 withstanding only a pressure of one hundred pounds, namely, neither one of them can properly perform their duty, and must, beyond question, give out. No doubt many of the sudden deaths which occurred prior to the time of Bright, and were attributed to apoplexy, heart disease or unknown causes, were in reality due to the unsuspected presence of this disease. Because, so insidious is its course in many cases that its existence is not even suspected ; sometimes for many years. Let me illustrate this insidious nature of Bright's Dis- ease by relating to you a few actual cases. Case .1.—A lady, in apparently good health, who rarely complained, and then only occasion- ally, of some slight and transient ill-feeling, as nearly every one does at some time or other, took a long walk one day with her hasband, and upon returning home (feeling particularly well), went to her room to remove her bonnet, and while standing in front of the bureau, fell to the floor in a convulsion, followed by twenty-four hours of unconsciousness and death without a return to consciousness. A post-mortem examination re- vealed Bright's Disease. 22 how to live Case II.—A young married man for years suffered from dyspepsia; he consulted many physicians, who prescribed for his indigestion; dissatisfied with the non-success of their treatment, he would consult a second doctor before the first had time to suspect any organic disease as the cause of dyspepsia. After suffering in this way, and having had no other symptoms of disease, for several years, he awoke one morning to find a very slight swelling, scarcely more than a puffi- ness, under one eye. On his way to the city he consulted a country physician, in the small village in which he lived. The doctor asked him if he had any kidney trouble. He scouted the idea. Well, said the doctor, you had better see your physician when you reach the city, and direct his attention to your kidneys. An examination re- vealed an advanced case of Bright's Disease, and in less than a month he was dead. Case III.^-A lady of over sixty, previously in apparently very good health for one of her age, had an attack of rheumatism. For many years she had been afflicted with similar attacks. After the rheumatism left her she seemed exhausted; she did not regain her usual vigor, but had no with bright's disease. 23 well defined symptoms of any disease. An ex- amination revealed Bright's Disease, and she died in three days. Case IV.—A man of thirty years of age, in apparently good health, complaining of. no dis- ease, said, one evening, in conversation with a physician, "Is excessive sleepiness indicative of any disease?" An examination revealed a pro- nounced case of Bright's Disease. Case V.—A married man of thirty-five com- plained of nothing, yet his wife thought he did not look well; he had a pale, tired look, though he was actively engaged in professional pursuits. She persuaded him to consult a physician, and Bright's Disease was the verdict. Case VI.—A young man of eighteen, in appa- rently fair health, complained of indigestion and general weakness, but no definite symptoms of any form of disease. A visit to his physician resulted in another case of Bright's Disease. Let me give you one more case. A young man of twenty-two, in previously good health, to all appearances, was taken suddenly sick, and disease of the liver was the diagnosis. He was treated for this for two weeks, and not getting better, I 24 HOW TO LIVE was called to see him. The only symptoms of disease were great weakness, cramps and loss of appetite. His peculiar appearance made me sus- pect Bright's Disease, and an examination revealed a pronounced case. Careful inquiry from his family failed to elicit any previous symptoms of disease, except a very pale complexion, though the disease must have existed for some years. During my term as resident physician in the medical wards of the Philadelphia Hospital, it was a common occurrence for an ambulance call to be received from one of the down-town station houses. Upon reaching the place designated, we would be shown a man or woman who had been found unconscious on the street, and supposed to be intoxicated. He would be removed to the Hospital, where he would linger unconscious for twenty-four or thirty-six hours and then die. In the majority of these cases a post-mortem exami- nation would reveal Bright's Disease. I have given you these instances because I wish to show you that very often this disease may exist and yet the symptoms which it presents to the person so afflicted may be so slight as to cause him to neglect professional advice. with bright's disease. 25 Let me here, in the beginning of this little book, enunciate a very valuable rule. If you ever ex- perience a departure from perfect health, no matter how slight this departure may be, and if your symptoms do not indicate disease of any organ, but seem merely to be the temporary result of some excess in eating or drinking, work or exercise, or some slight exposure; if these symp- toms continue for any time after the removal of the cause, ask your physician to make an examina- tion of the condition of your kidneys. If they are not diseased, so much the better; if they are, it is well for you to know it at once, because I will tell you now (and tell you why later), that a per- son with weak or diseased kidneys can, by leading a careful life, enjoy very fair health, perform a reasonable amount of work, and attain a respect- able degree of longevity; while on the other hand (as I told you in my preface), very few diseases are so strongly influenced for the worse by a reckless and careless life as the one under consideration. c 26 HOW TO LIVE PART SECOND. THE FUNCTIONS OF THE KIDNEYS AND THEIR DERANGEMENTS. In order that you may understand and be induced to follow the mode of life here recom- mended, I will now tell you, in plain language, divested of all technicalities, some little about the kidneys and the duties which they ought to perform. The kidneys, two in number, are situated in the small of the back, on either side of the back- bone. They are small, but most exceedingly important organs. If they were removed from the body it would be utterly impossible to support life. They are among the principal scavengers of the human body. You all know that particles of our bodies are continually dying, their places being supplied by new particles, resembling the old ones, and derived from the nourishment which we take. JMow, these dead particles undergo a process of decomposition in the blood, just as our WITH BRIGHT'S DISEASE. 27 bodies in mass will do after the final death, and are then removed from the blood through the agency of aertain organs, which act as purifiers, so to speak, removing all dead and decomposed particles from, and thus purifying, the blood. Prominent among the products of this death and decay of tissue stands a substance called urea. The chief duty of the kidney is to eliminate this urea from the blood and carry it out of the body as the principal ingredient of urine. This is the only function of the kidney with which we have to do, as all the trouble in Bright's disease may be principally attributed to the non-elimination of this urea and to mechanical interference with the circulation of blood in the kidneys. Now, if disease so interferes with and cripples these organs as to prevent them from removing the urea, what becomes of it ? The death and decay of tissue continue, whether the kidneys be weak or strong; it must go on as long as life, for it *is this very destruction and renewal that constitutes life. When the renewal ceases and the destruction pre- dominates, decay of life and death result. So, with the continued destruction of tissue, there is continual formation of urea, and if it cannot be 2'S HOW TO LIVE removed from it must accumulate in the blood. Now, everybody knows that the blood circulates throughout the entire body, and if contaminated with urea it must carry this poison to every tissue which it nourishes, and so impress them unfavor- ably by its presence. That is just exactly what it does do. Then, no doubt, you will wonder why such general poisoning does not produce more marked symptoms, and why the existence of a disease which causes such general evil is not made more manifest. This is due to the law of toler- ance. A perfectly temperate man will be affected by one drink of liquor; by degrees, he can drink more and more without feeling it, until eventually he can consume enormous quantities without apparent effect. So it is with everything else. A continued use of any poisonous agent, commenced in small doses and gradually and slowly increased day by day, will eventually breed such a tolerance that enormous quantities, a fraction of which would prove fatal to the novice, can be taken with impunity. I once had a patient under my charge (who, by the way, was suffering with Bright's Disease) who could and had taken daily sixty grains of morphia, with but little effect, when WITH BRIGHT'S DISEASE. 29 I should hesitate to order half a grain for one unaccustomed to its use. So with the accumula- tion of the urea. When the disease in the kidney commences the integrity of the organ is so little affected that it performs its duty almost perfectly, and only a very small quantity of urea remains in the blood. Day by day, as the disease advances, the quantity of this poison that is retained slowly increases, the system becoming, in the meantime, accustomed to its presence, and presenting no marked symptoms of revolt against its unwelcome tenant. Finally, the point of forbearance is reached and passed. The large accumulation of urea in the blood explodes, as it were, to use a familiar word, and we have convulsions and death. You can now understand why I call Bright's Dis- ease an insidious affection. You can also appre- ciate how apt a person would be not to consult a physician, imagining his bad feelings to be merely the result of fatigue. You can, at the same time, see how a course of life which would throw as little work as possible on the kidneys would tend to longevity. I once heard an eminent physician compare the situation of a man whose kidneys are diseased to a ship at sea which has sprung a-leak. 30 HOW TO LIVE As long as she encounters fair winds and weather she is all right, and will probably reach port in safety, if her pumps hold out. But let her meet a severe storm, or let her crew become too much exhausted to man the pumps, and she will surely founder. So it is with a man whose kidneys are diseased. So long as he leads a careful life, putting but little strain upon these weakened organs, so long may he live in very fair health and comfort; but let him be imprudent and reck- less, let him pour a tempest of abuse and neglect upon his poor kidneys, and they will surely succumb to the strain. with bright's disease. 31 PART THIRD. ABOUT BRIGHT'S DISEASE (WHAT IT IS.) Bright's Disease, in all its forms, is essentially an inflammation of the kidneys. They contain more blood than in health. In some forms the kidney, at first enlarged, afterward becomes con- tracted. Its tissue, pressing on the numerous blood vessels which pass through the organ, inter- feres with the free passage of the blood through them. This backward pressure on the current of blood being met and opposed by the onward pressure of the powerfully acting heart, the watery constituents of the blood are forced through the porous walls of the blood vessels, usually of the feet and legs, and so we have the dropsy produced which is frequently present in the advanced stage of this form of the disease. Again, this backward pressure causes so much strain on the heart in its efforts to overcome it, that we sometimes have enlargement of the heart as a secondary effect of Bright's Disease. This pressure will sometimes 32 HOW to live cause the watery parts of the blood to ooze out into the small cavities in the lungs, usually filled with air, and death will ensue, from a gradual suffocation. Let me here digress, to tell you that this mode of death is not attended with great suffering-, as many would suppose; on the con- trary, it is painless and even pleasant. I will tell you why. In the first place, let me tell you that all pain is felt in the brain. If you cut your finger, the nerves of sense, immediately and with the rapidity of lightning, convey the news to the brain, and the pain is there experienced, though the sensation of pain is referred to the seat of the injury. To make this still clearer, if you had no brain your body might be cut in two and you would not feel the slightest pain, even though you had life, for it has been demonstrated by experi- ment that life is possible even after the removal of certain portions of the brain in which sensation resides. Secondly, in order that the brain may be able to receive sensations of pain, or of any kind, it must be in a state of activity, and to be so it must receive good nourishment, from pure blood, containing a sufficient proportion of the life-giving oxygen. Now, when this water oozes with bright's disease. 33 out into the cavities in the lungs in which the air usually is, you can understand that the oxygen cannot get into the lungs, and so cannot enter the blood. Now, as the particles of our body die and decay, some of them assume the form of car- bon, and as such are carried in the blood to the lungs, where they meet and unite with the oxygen to form carbonic acid, in which shape they are carried out of the body in expiration. If oxygen cannot get in, of course, carbon cannot get out, and must remain in the blood, to poison it. Nearly every one is familiar with the effects pro- duced by inhaling the fumes of charcoal. Well, here we have the same thing. At first, when the water commences to ooze into the lungs, a very small amount of carbon only is compelled to remain in the blood, and being carried to the brain by the blood, it serves to stupefy it, as it were, to render it incapable of feeling pain, only, however, to a slight degree. As more water oozes out and less room is left for the oxygen, of course more carbon remains in the blood, and the brain is rendered more torpid, less sensible of suffering, until finally, when the difficulty in breathing has reached that point which would 34 how to live prove very painful to a person in health, the brain is so overcome and clouded by the carbon that the patient fails to feel any suffering, though to those standing around he may seem to be suffering most intensely. The urea retained in the blood may accumulate in such enormous quantity as to finally poison the brain and cause convul- sions, or acting more gradually on the brain, may produce unconsciousness, blunting one sense after another, as it travels from the upper portion of this organ downwards, until it finally reaches and contaminates that portion of the brain from which arise the nerves that convey the power to the heart to move, and to the lungs to breathe, and the unconscious and insensible patient quietly ceases to breathe, his heart stops pulsating and the curtain noiselessly drops on his drama of life. I have now hastily given you the functions of the kidneys; how they are affected in Bright's Disease ; the result of these irregularities in action, and the usual modes of death. I now come to the kernel of this little work. I will now tell you how a person threatened with this disease may postpone its development, and how one in whom it has already appeared may retard its pro- with bright's disease. 35 gress. First, let me again repeat what I have already said:- that this disease is greatly influ- enced for better or for worse by our own actions. We have, to a certain extent, in our own hands the power to shorten or prolong our lives. The person with Bright's Disease may, by pursuing a correct life, outlive thousands of those around him at present in vigorous health. He may live many years and ultimately die of some other disease. Neither is it necessary that he should live the life of a confirmed invalid. He can work and can enjoy life, within certain bounds, as well as any one else. But he must always be careful. The object of his life must be to put as little strain as possible upon his kidneys. Further than what I have already said of the symptoms of this disease I will not go. The diagnosis comes within the province of the physician, and it is not my inten- tion to supplement him. A good physician is a great gift bestowed upon man by an all wise and benevolent God; and let me here strongly advise you to immediately consult some good doctor upon the first intimation of the approach of this disease, and to follow his advice implicitly. So, if any of my readers have felt unwell, low-spirited and 36 HOW TO LIVE weak, for some time, without any definite symp- toms, let them find out whether or not they have Bright's Disease. This disease may be divided into the acute or rapid, and the chronic or slow forms. The acute type we have nothing to do with here, because its symptoms are usually so marked and well devel- oped as to require the calling of the physician. It rapidly runs its course and terminates either in death, complete recovery, or by degenerating into the chronic form, the special subject of this little book. WITH BRIGHT'S DISEASE. 37 PART FOURTH. RULES OF LIFE. I hear some people asking me what I mean by a predisposition to Bright's Disease. It has not yet been set down in medical works as an heredit- ary affection; though I believe the day is not far distant when it will be so considered, just as consumption and scrofula are at present. I will illustrate my meaning by an example. I know a family in which both parents and two sons have died of this disease ; of four surviving sons, three, and of two daughters, one, are now afflicted with it. Two young children of one of the sons who died have it. Now, I would say that, in all human probability, those members of this family who have not the disease already have a predisposition to it; their kidneys are their weak points, so to speak, and any deleterious causes acting on their systems would probably produce kidney disease. Hence, these members should so live as to protect their kidneys as much as it lies in their power. 38 HOW TO LIVE They should avoid a sedentary life as far as possible, as well as mental worry,and should indulge in mental work or brain effort only to a moderate degree, preferring an out-door, active life, and plenty of exercise and motion in the pure, fresh air, to an occupation confining them to the foul atmosphere of a city house. They should, how- ever, carefully avoid overtaxing their physical strength, for while excessive mental action is very injurious, excessive physical labor is only a little less so. Many intelligent people unconsciously fall into the very natural error that great physical exercise is beneficial to health, and that ihe more they take of it the better. While this is true, within bounds, as far as a person in vigorous health is concerned, it is not so for one whose kidneys are diseased, for the following reasons: It is one of the functions of the kidneys to remove the results of the death and decay of that certain class of tissue whose predominant constituent is nitrogen. Now, jnuscular tissue is very rich in this element. Every motion of a muscle causes the death and decay of some of its component parts ; hence, you can understand how excessive muscular action will result in an excessive produc- with bright's disease. 39 tion of dead and decayed elements, rich in nitro- gen, which must be removed by the kidneys. So you will see that the work to be performed by these organs will be in proportion to the use which we make of our muscles. At the same time, a moderate amount of muscular exercise will give tone to and improve the general system, will ex- hilarate the circulation and keep the skin in proper action, the importance of which you will see further on, and will thus redound to the benefit of the weak kidneys. Hence, I would enunciate, as a general rule, applicable to the great majority of cases of Bright's Disease, where the strength has not been too much reduced, that while a walk of three or four miles will be of positive benefit to the kidneys, one of ten miles will be injurious, as it will throw too much labor on them in removing from the body the decayed products of this amount of muscular exertion. Excessive mental work is forbidden in this disease, not so much because it is injurious in itself to the weak kidney, as on account of the sedentary, in-door life, its usual accompaniment, which, by depressing the general system, reacts unfavorably on the kidneys. A considerable amount of brain work, performed in 40 HOW TO LIVE the open air, varied with a proper amount of phy- sical exercise, can be borne with impunity. Per- sons afflicted with this disease should endeavor to select a healthy medium in both. Let me suggest a daily routine, which will probably come .as near being correct as possible for the average man or woman fond of mental work. Suppose he should arise at seven o'clock: let him breakfast and leisurely read his morning paper. Then let him devote himself, say from nine until twelve o'clock, to his mental work; at the end of each hour in- termitting his labor for five minutes' light exercise. Then, for two hours, until dinner time, let him amuse himself with some out-of-door occupation. After dinner and a short period passed in pleasant conversation or light reading, so as to allow diges- tion to fairly commence in peace and quietude, let him drive, ride, or walk, or engage in some out- door congenial exercise, from half-past three until five or half-past; then to his mental work for an hour, until supper, at half-past six. The evening to be passed in conversation or light reading. Go to bed as near ten o'clock as possible. Be sure to secure eight hours of sleep out of the twenty- four. To the earnest and ambitious brain worker four hours' labor daily with bright's disease. 41 will seem very inadequate to accomplish what he desires; but to such a person let me say, for his comfort and peace of mind, that, leaving all con- siderations of preservation of health out of the question, which really is the point we are discuss- ing, the man who works earnestly four hours a day, with his mind vigorous and free from mental cobwebs, will accomplish more satisfactory work in the aggregate, than he who labors twelve or fifteen, with his mind weak and exhausted and his ideas confused, from over strain. The rest and exercise will refresh and rejuvenate his mind, and he will, each day, go to his work with a relish for it; his perception will be keen, his mental appe- tite will be good and the assimilative powers of his brain will be vigorous and capable of receiving and storing away in its proper place, without con- fusion of ideas, all that his mental stomach may take in. For one reason or another, it would be next to impossible to induce a man to live by rule, and particularly by the rule of another, but for the sake of that health which we all prize so highly (when we do not possess it), let me beg my fellow creatures to catch my idea of leading a regular, moderate, temperate life in everything. 42 how to live The whole secret of longevity (whether you are sick or well) lies in this moderation, t " Gives excellent advice."—Chicago Journal. " To teachers particularly the book is of interest and importance."— Educational Weekly. Select List of Books. 7 HEALTH AND HEALTHY HOMES. A Guide to Personal a?TTDom5stlS,SyS,ilnev fiy George Wilson, m.a., m.d., Medical Officer of Health. Edited by Jos. G. Richardson, Professor of Hygiene at the University of Pennsylvania. 12mo. Cloth. 314 pp. Price $1.50. WHAT IT TELLS ABOUT. How your Body is Made. The Hereditary Influences, as well as the self-Induced and Social causes of Dis- ease. The Value and Choice of Food, its Preparation, and Sensible Hints on Diet. Proper and well Adapted Clothing. How to take Exercise, and the best Method of Training. Useful Hints about your Home. How to Prevent taking the Infectious Diseases which are always at certain seasons so prevalent in cities. All sorts of Important Suggestions in Regard to the Everyday Life. WHAT IS THOUGHT OF IT. " A most useful and, in every way, acceptable book."— N. York Herald. "Marked throughout by a sound, scientific spirit, and an absence of all hasty generalizations, sweeping assertions, and abuse of statistics in sup- Eort of the writer's particular views. . . . We cannot speak too ighly of a work which we have read with entire satisfaction."—Medical Times and Gazette. " We warmly commend it to the public."—Boston Herald. " We have read few books of more interest and value than this."—South- ern Practitioner. " The book will take a permanent position. It is a sound work by a com- petent writer."—London Lancet. " Full of good sense and sound advice."—Educational Weekly. " The book aims at the prevention of Disease. It abounds In sensible suggestions, and will prove a reliable guide."— Churchman. " Deserves wide and general circulation."— Chicago Tribune. WHAT EVERY MOTHER SHOULD KNOW. By Edward Ellis, m.d., Author of a Practical Manual on the Diseases of Children. 16mo. Cloth. Price 75 cents. " As it is only too true that our children have to dodge through the early part of life as through a sort of pathological labyrinth, we must be thank- ful to meet with such a sensible guide for them as Dr. Ellis. He is emi- nently a practitioner among doctors, and a doctor among practitioners; that is to say, he is learned and well knows what is known, can do what should be done, and can put what he has to say in plain and comprehensive language."—Pall Mall Gazette. " The author has a faculty of sketching out the characteristics of dis- eases and their treatment in striking outlines, and of making his points very clear and impressive."— N. Y. Medical Record. 8 Presley Blakiston's Select List. DRUGS THAT ENSLAVE. The Opium, Morphine, Chloral, and Hashisch Habits. By H. H. Kane, m.d., of New York City. One volume. 12mo. With Illustrations. Price $1.50. A curse that is daily spreading, that is daily rejoicing in an inoreased number of victims, that entangles in its hideous meshes such great men as Coleridge, De Quincey, William Blair, Robert Hall, John Randolph, and William Wilberforce, besides thousands of others whose vice is unknown, should demand a searching and scientific examination. " A vivid and startling expose of the increase of this form of intemper- anoe, and the terrible sufferings endured by those trying to free them- selves from this habit."—Pittsburg Telegraph. " It is well that such a warning as is contained In this book should be sounded."—Albany Evening Journal. "The volume seems to be a summary of the results of the most approved practice, both in Europe and this country."—New York World. " A work of more than ordinary ability and careful research. . . . For the first time, reliable statistics on the use of chloral are classified and published. . . . And it is shown that the use of chloral causes a more complete and rapid ruin of mind and body than either opium or morphine." —Druggists' Circular and Gazette. " The effects of the habits described are set forth boldly and clearly, and the book must have a beneficial effect. It will do still better service in de. terring persons from experimenting 'to see what it is like.'"— Charleston (S. C.) Newt and Courier. " The subject of the chloral habit has not been investigated by any one, we believe, so thoroughly as by Dr. Kane."—Medical Record. "There is ground tor a nuw temperance movement here. The book is a valuable one. It is written in a practical manner, and has nothing of a sensational character."—Philadelphia Ledger. THE OCEAN AS A HEALTH RESORT. A handbook of Practical Information as to Sea Voyages, for the use of Tourists and Invalids. By Wm. S. Wilson, l.r.o.p.. Lond , m.r.c.s.e. With a Chart showing the Ocean Routes, and Illustrating the Ph-sical Geo, graphy of the Sea. Crown 8vo. Price $2.50. Curative Effects of the Ocean Climate; The Various Health Voyages ; Time of Starting; Choosing a Ship; Preliminary Arrangements; Life at Sea; Climate and Weather; Management of the Health at Sea; Occupa- tions and Amusements at Sea; Objects of Interest at Sea ; End of the Voyage; Future Plans; The Homeward Voyage; Australia—Its Climate, Cities and Health Resorts; South Africa and its Climate; The Meteorol- ogy of theOoean. Appendix A.—Outfit Required for a Voyage to Austra- lia. Appendix B.—Names and Addresses of some of the Principal Ship- ping Firms. "All the information is supplied by, or based upon, the actual experience of the author; and the book may be confidently recommended to all who have to undertake, without previous experience, a sea voyage of any length. Medical men may consult it with advantage, and commend it to those patients whom they may advise to try the effect of a long voyage at sea "—Med. Times and Gazette. " We have read every page of this book, and have derived both instruc- tion and amusement."— Lancet. VACCINATION: Pro and Con. Copyright 1882. CONTENTS. PART FIRST. VACCINATION—WHAT IT IS—HOW DISCOVERED—WHAT IT DOES,.........9 PART SECOND. ARGUMENTS IN FAVOR OF VACCINATION—HOW TO VACCI- NATE, .........23 PART THIRD. ARGUMENTS AGAINST VACCINATION, . . . . 50 PART FOURTH. HOW TO OVERCOME THESE OBJECTIONS, . . . DO PART FIFTH. HYGIENE OF SMALLPOX,......68 PREFACE. In a few simple words will be given the reasons why this little book has been written. The fact that certain persons, more particularly in the Old World, have recently attempted to cast vaccination into disrepute, and have, by numerous devices, sought to prevent persons from resorting to it as a preventive against smallpox, has induced the author to make an impartial study of the question. Information has been gathered from all available sources, and the question has been viewed carefully and from an impartial standpoint, with the result of convincing the author that in vaccination properly performed, and in this measure alone, can we find immunity from this terrible disease. The reasons that have led him to this belief will be given, so that the reader may form his own con- clusions. vii viii PREFACE. It has seemed wise to '' take the bull by the horns, as it were," and to anticipate the opposition which is as yet only in its incipiency in this country, but which, if not checked in the bud, may blossom into dangerous fruit. After discussing the question of vaccination, a short chapter will be found on the hygiene of small- pox. It is sincerely hoped and confidently trusted that the questions herein discussed and the facts stated may result in convincing all who read of the efficacy of vaccination. VACCINATION. PART FIRST. VACCINATION—WHAT IT IS—HOW DISCOVERED—WHAT IT DOES. Most persons have only a hereditary and very illy-defined notion of vaccination. They regard it as a something, as a mysterious operation, which if successful, if it takes, confers upon them immunity from smallpox; but what it really means, how it originated, why it protects or how it acts, they know not; no one has ever told them. Their parents before them have been vaccinated, and so when an epidemic of smallpox comes around, off they run to the doctor and are vaccinated, because they have the idea, gained in some vague way from parents or friends, that this little operation has some mysterious power to protect them from the disease. But they know not how to reason for themselves concerning it, and how to determine whether or not they are receiving a benefit from it. Therefore they are ready to receive the conclusions u 9 10 VACCINATION. of anti-vaccinators, if perchance they happen to know of a single instance of unfortunate results from vaccin- ation among their friends, without being able to intelligently reason for or against the operation. If they know all about it they are better prepared to use their intelligence so as to determine for them- selves whether or not the operation should be per- formed upon them. In this belief, I deem it wise to place the whole question before the thinking public. I will now, for a brief space, in plain words, tell you what vaccination means. Vaccination consists in an operation by which the system of man is so impressed by the introduction of a foreign substance, and the blood so altered by changes which this matter produces therein, that even though the successfully vaccinated person may there- after be exposed to the influence of the smallpox poison, yet it will not find in his system the con- ditions necessary for the development of the disease. This is, in a small compass, a comprehensive defini- tion of vaccination, and it is my purpose in this little book to be brief; I do not intend to waste any words, but to give you, in as short a space and as con- cisely as possible, the principal points of the subject HOW DISCOVERED. 11 under consideration. By doing so, I feel that you will read it, while, were I to be tiresomely verbose, you would cast it aside, and my purpose in preparing it would be defeated. The interesting points touching the discovery of vaccination next claim our attention. Some of the most wonderful and important discoveries of the world have been, as it were, the result of accident, of chance; that is to say, chance has brought to the notice of some master mind capable of utilizing and develop- ing them, the phenomena or material from which great discoveries have been made. Vaccination is a re- markable illustration of this proposition. Towards the close of the last century, a young man named Jenner was studying medicine in the house of Mr. Ludlow, a surgeon of Sodbury, near-Bristol. It was customary for the young student to be present when his master was treating patients, in order that he might become practically familiar with the means of detecting and curing disease. One day, a young country woman came to the office of Mr. Ludlow for treatment, and while there, the question of small- pox coming up, she innocently and thoughtlessly made the remark, '' / cannot take that disease, because 12 VACCINATION. / have had cowpox.'' She little thought that by this simple remark she was laying the foundation for a discovery that would electrify the world. The active, penetrating mind of Jenner was struck by the remark. He treasured it in his memory, and never missed an opportunity of verifying the truth of this carelessly uttered statement. He found it to be a common belief among dairy- maids, that those who had once had cowpox en- joyed an immunity from smallpox. Observation convinced him that this belief was more than a superstitious notion ; he soon saw that there was much truth in it, and he commenced to reason something after this fashion. If cowpox naturally produced does give immunity from smallpox, why will not the same disease artificially developed confer the same protection. He was laughed at and ridiculed, as all great dis- coverers ever have been. He was, however, firm in his belief of the truth of his idea, and, nothing daunted, pushed forward in his good work, that was destined to make his name immortal. For more than twenty-five years Jenner and his theory were sneered at. The public paid no attention HOW DISCOVERED. 13 to it or him, while physicians pooh-poohed the idea as preposterous. Finally, Jenner's triumphal day came. The day that should be forever celebrated, throughout the civilized world, as the one on which was made public and demonstrated as potent the greatest discovery in preventive medicine that has ever occurred in the history of the world. On the fourteenth day of May, i/p6, Jenner vac- cinated James Phipps, and with all the nervous anxiety of Fulton waiting to see his little boat move when the steam was turned on, he waited and watched. To his unspeakable joy, he saw all the different stages of vaccinia or cowpox occur regularly and perfectly, when, with an exultant shout, he cried out to his hitherto sneering confreres, " Behold the con- summation of my dream." Still he had many trials yet to endure before his newly discovered and demonstrated fact became a generally accepted one. Just as we declared our independence from Great Britain in 1776, and then passed through eight years of doubt and uncertainty before this declaration became an accomplishment, so poor Jenner was doomed to undergo many tribu- 14 VACCINATION. lations before his ridiculed announcement of 1796 became an enthusiastically accepted fact in 1799. In 1798 he wrote and published a work containing the evidence he had accumulated concerning vac- cination, which, though very convincing, still left many in doubt, so conservative were the physicians of Great Britain and so indisposed to believe in his wonderful discovery. The truth must always prevail, however, and finally, in 1799, about seventy of the most distinguished physicians and surgeons in London signed a declaration of their entire confidence in the benefits and advantages of his discovery. When once accepted, it was but a short time before this dis- covery became known everywhere, and the name of Jenner was enrolled prominently among the great men of the world. Honors were now heaped upon him; he was made an honorary member of all the principal learned societies of the world, while the English Parliament voted him grants aggregating one hundred and fifty thousand dollars. It will now be in order to examine into the manner of action of vaccination, and to ask how it affords protection. In this connection, it will be possible only for us WHAT IT DOES. 15 to understand the facts; the minute questions and reasons why these facts are facts, will, I fear, ever remain an impenetrable mystery. Smallpox belongs to a class of diseases known to the physicians as '' Zymotic diseases.'' This means a disease that is produced by a species of fermentation in the blood. The active poisonous agent is intro- duced into the body, and meeting in the blood with some necessary elements (the nature of which we know not) a sort of fermentative change takes place, and the resultant product of this process is the particular disease under consideration. For this change to be produced it is necessary that the poison introduced from without should find some suitable elements, a favorable condition of the blood, for its development into the disease. If this con- dition is not present the disease cannot be produced, no matter how much of the poison may be intro- duced. It falls upon barren ground, as it were, and its power for evil becomes absolutely nil. This will explain to you the apparently mysterious fact that while a given number of persons may be exposed to contagion, yet only a limited number are afflicted with the disease, since the blood of the rest 16 VACCINATION. happens to be in such a condition that it will not furnish the necessary elements for development of the poison. Thus, then, you will be prepared to understand that for the development of smallpox in an individual, two conditions are absolutely essential, and without them the disease cannot exist, First, the poison must enter the system, and sec- ondly, having gained access to the blood it must find therein conditions for its growth and development. It must be planted in good soil, suitable to produce a crop of smallpox, as it were, else, like vegetables planted in unsuitable ground, you will never see any more of it. What these conditions are, of course, we do not know j science has not yet been able to pene- trate this mystery, and we can only determine the presence of this state of the blood in one of two ways, either by exposing ourselves to smallpox, when, if they exist, we will take the disease—a very bad and not to be desired test—or by vaccination. You will now be almost prepared to anticipate me when I say that vaccination confers immunity from smallpox by so altering the condition of the blood that when the poison of the disease is introduced sub- WHAT IT DOES. 17 sequently, it falls upon uncongenial soil; it does not find the necessary conditions, and the disease is not developed. So thought Jenner, and such has sub- sequent experience proven to be the case. When a person is vaccinated successfully, the matter placed on the abraded surface is absorbed into the blood and produces a constitutional disease known as vaccinia. It circulates throughout every portion of the body, and hunting up the various elements necessary for the development of smallpox, alters or destroys them. It is at the present time a mooted question whether vaccinia is a distinct disease or is a modified form of smallpox. This, however, is of no practical moment, since we do know that it possesses the alterative or destructive power de- scribed, and this is what we desire. It may be a matter of scientific interest or curiosity to determine the identity or non-identity of the two diseases, but for all practical purposes we know now as much as we require. So, then, vaccination affords protection from small- pox, by producing in the body a constitutional dis- ease, which runs a regular course, that is similar to and possibly identical with smallpox itself, but of a 18 VACCINATION. character so mild as to be utterly and entirely harm- less, but which so alters the condition of the blood as to render the development of the disease itself in its more virulent form almost an impossibility and certainly a very great rarity. For many years previous to Jenner's great dis- covery an operation for protection against smallpox was resorted to, which was known as inoculation. It consisted of inserting beneath the skin some of the matter from a smallpox sore, which produced in the person so inoculated true smallpox, but of a type so mild as to prove but very rarely dangerous, while at the same time, it afforded, in the large majority of cases, protection against a subsequent and more severe attack of the disease. This practice of in- oculation was in vogue in very early days. The Chinese had resorted to it more than twelve hundred years ago, and according to Collinson * it was in use in Persia, Armenia and Georgia many centuries since. But since inoculation really produced smallpox, it proved to be more of an evil than a benefit, because when one man, say, was inoculated and * Smallpox and Vaccination Historically and Medically Considered. WHAT IT DOES. 19 received smallpox, he might be the means of com- municating the disease, in an aggravated and fatal form, to many who had not been inoculated ; because, as you can understand, the man who had been in- oculated successfully had smallpox as truly and com- pletely as any one could have it, only it developed less dangerous symptoms, and was much less likely to prove fatal than when contracted in the ordinary way. Still it was and is a fact, that a man with a walking case of smallpox can communicate a fatal attack of the disease to some neighbor. Hence these inoculated persons were deadly enemies going about among their fellows, and carrying disease and death to all who had not been inoculated. Had every person been inoculated, then indeed would this pro- cedure have been a blessing, and surely would it have prevented the ravages of smallpox. But such not being the case, inoculation became more of an evil than a blessing, since it tended to perpetuate and even to increase the afflictions of smallpox. Hence inoculation was unsatisfactory, and being pronounced injurious, fell into disuse :— Soon after the true danger of inoculation was recognized, Jenner made his great discovery, which 20 VACCINATION. in substance is as follows, as stated by Jenner him- self in his '' Inquiry into the causes and effects of the Vatioioz Vaccina," published in 1798 : — 1st. This disease (vaccinia) communicated to man has the power of rendering him insusceptible to small- pox. 2d. That the cowpox or vaccinia might and can be communicated from the cow to man. 3d. That the cowpox once ingrafted on the hu- man subject might be continued from individual to individual by successive transmissions, conferring on • each the same immunity from smallpox as was en- joyed by the one first infected direct from the cow. In other words, it was and is believed that the artificial production of cowpox in the individual so alters some of the constituents of the blood, that even though the poison of true smallpox may be introduced therein, it will not find the elements and conditions there necessary for the development of the disease, since the poison of cowpox has destroyed or altered these elements or conditions. So, then, vaccination confers immunity from smallpox by alter- ing the condition of the blood from that favorable to its development to a state in which its production is WHAT IT DOES. 21 impossible. In this belief the world was happy for many years, believing, as it had good reasons to, that at last had been discovered a means by which this terrible disease could be driven out of existence. They were undoubtedly right in this belief, if subse- quent experience is to be relied upon. Human nature is ever restless and uneasy, how- ever, and some one must always be agitating and dis- cussing every question that exists,while,unfortunately, there are and ever have been many narrow-minded men, who, viewing a subject only from their own standpoint, and neglecting to go around and inspect the other side of the question, have judged partially and unjustly, when, I am sorry to say it, they find all too many men ready to blindly follow the erroneous and pernicious doctrines that they promulgate. For many years vaccination was accepted by the universal world as an almost absolute protection against smallpox. Lately, within a very short time, some German physicians have raised a hue and cry against this beneficent and divine discovery, and have attempted to cast it into disrepute. The agitation has been taken up in England and has gained many adherents, while in this country the anti-vaccination fever has but just commenced, 22 VACCINATION. and will require heroic treatment to throttle it in its infancy, ere it gains strength and vigor. The anti-vaccinators have undoubtedly some good reasons for their course, but they fail to make a dis- tinction between the end to be acquired and the means by which this end is accomplished. Because vaccination does in some cases, and, unfortunately, in a good many, produce worse evils than smallpox itself would or could, therefore they reason that vac- cination is wrong and should be abolished. They condemn the entirety without considering or en- deavoring to correct the particulars that make this entirety dangerous. That there are certain dangers to be dreaded, that certain evil results can and do occur from vaccina- tion as practiced to-day, no reasonable man will or can deny. Whosoever has had experience with vac- cination must oft and again have found this to be too true. The fault, however, does not lie with vaccina- tion, but is to be found in the vaccinators, who per- form their work incorrectly and with improper ma- terial. Many good things have fallen into disrepute and disuse through the fault of man, and not through any inherent short-coming in the thing itself. Vac- cination is a remarkable illustration of this truth. DOES IT PROTECT ? PART SECOND. ARGUMENTS IN FAVOR OF VACCINATION—HOW TO VACCINATE. " To vaccinate or not, that is the question! Whether 'tis better for a man to suffer The painful pangs and lasting scars of smallpox, Or to bare arms before the surgeon's lancet, And, by being vaccinated, end them. Yes ! To feel the tiny point, and say we end The chance of many a thousand awful scars That flesh is heir to—'tis a consummation Devoutly to be wished. Ah ! soft, you, now, The Vaccinator! Sir, upon thy rounds Be my poor arm remembered." —Punch. Our humorous friend, Punch, concisely puts the question that is to-day agitating medical minds, when he says "To vaccinate or not." We will now see whether vaccination does really afford protection against smallpox. In order to form a correct estimate of the subject, we will select from current medical literature the opinions and experiences relating to the question, and allow you to draw your own deductions from them. The British Medical Journal says: '' The wicked- 24 VACCINATION. ness of encouraging the anti-vaccination agitation could not, it is opportunely pointed out by the Globe, • be more strikingly proved than by an account it printed of an outbreak of smallpox at Rotherhite. ' A leading anti-vaccinator, Escott by name, who had none of his children vaccinated, has lost his wife and two children by smallpox, and four others have had the disease. Escott borrowed a suit of mourn - ing from a friend, named Angus, to attend his wife's funeral, and returned the clothes without disinfection, with the result, that the lender caught smallpox and died. Since then, nearly every house in the neigh- borhood has been attacked, and sixteen patients have been removed to the hospital.' " This is a striking case, but I will give you so many more, that I imag- ine I will make out a conclusive and convincing case in favor of vaccination. Dr. E. S. Snow, of Providence, commenting, in the Medical and Surgical Reporter, of Philadelphia, on the prevalence of smallpox in our city during 1881 says : " No principle of sanitary science is more positively established than this, that there is an absolutely certain individual preventive of smallpox, which is easily obtainable and easily applied. The DOES IT PROTECT ? 25 whole question of the arrest of this disease, at any time and in any place, is simply the question of the faithful application of this preventive, with other suitable well-known sanitary measures." This indi- vidual preventive is none other than vaccination with suitable virus. Dr. Schuyler reports the careful records of one hundred and ninety-nine cases of smallpox treated by him in the Troy Hospital. Of this number, only seventeen had been vaccinated, and of this seventeen only two died. While of one hundred and five who had not been vaccinated, thirty-three died. He notes that not a single case, having a recent vaccination, was admitted during his service, and concludes by expressing his belief in the absolute protective power of vaccination. I will now produce a strong argument from the home of anti-vaccination. In consequence of the aggressive action of the Belgian Anti-vaccination League, the Belgian Academy of Medicine appointed a committee of three members for the purpose of undertaking an exhaustive examination of the whole subject. At the conclusion of their labors, M. Warlomont summed up the results as follows :— c 26 VACCINATION. i. Without vaccination, hygienic measures and means, whether public or private, are powerless in preserving mankind from smallpox. 2. The belief in the danger of vaccinating and re- vaccinating during the presence of a variolous epi- demic, is not justified. We can no more cultivate variola by sowing vaccinia, than we can barley by sowing wheat. 3. Vaccination is always an inoffensive operation when practiced with proper care on healthy subjects. It gives rise to fewer and less serious accidents than simple piercing of the ears. 4. It is highly desirable, in the interests of the health and lives of our countrymen, that vaccination should be rendered compulsory. You will notice that this report does not claim that vaccination never does harm, but it is careful to say that " when properly performed, it gives rise to fewer and less serious accidents," etc. No just man will claim that this operation never does harm, because some- times it unquestionably does, but we can claim that the instances in which it is injurious are so infinitely few, compared with the large number in which it does good, that they cannot constitute a valid objection DOES IT PROTECT? 27 to its use. Railroads often cause serious acci- dents, yet they are so clearly to the benefit of the large mass of mankind, that they are encouraged. So, although vaccination may, even when properly performed, very occasionally prove . disastrous, yet in such a very large majority of instances does it do good that it ought to be en- couraged. From far-off India comes a most convincing argu- ment, which I quote from a medical journal. "Although the epidemic of smallpox voited the northwestern provinces of India in a fearful manner, causing 58,800 deaths in the single year of 1878, all attempts at introducing vaccination as a protective measure were resisted by the superstitious natives. They looked upon smallpox as a visitation from a Deity, called by them Sitta, whose anger had to be appeased with special sacrifices and plagues. The faithful Hindoos considered it an act of impiety to still further incite the wrath of this deity by the administration of unholy medicines or vaccination. In spite of all this, however, vaccination, although under peculiar circumstances, was gradually intro- duced among the natives. The Thakers, a tribe that 28 VACCINATION. still practices infanticide to a horrible extent, first allowed their female children to be vaccinated, being convinced of its fatal termination, and hoping thereby to get rid of this superfluous progeny. All the sons, however, were carefully guarded against vaccination. Smallpox broke out in four of their villages a short time afterwards, which carried off nearly all the boys, whilst the girls escaped the disease. This unlooked- for termination induced the natives to resort to the opposite practice, compelling the boys to be vac- cinated,whilst the girlswere left unprotected. Besides this, a large number of cases were observed where children were concealed by their families from the vaccinators; in almost all instances these died, whilst those vaccinated escaped smallpox." Even one such remarkable and unanswerable illustration as this should convince every one of the utility of vac- cination, but I have only commenced my arguments, and will continue to give you many more interesting ones. Dr. Welch, physician-in-charge of the Municipal (smallpox) Hospital of Philadelphia, in the course of an address on vaccination says: "In Sweden, during the pre-vaccinal period, from 1774 to 1801, DOES IT PROTECT? 29 the annual average of deaths per million of inhabitants, from smallpox, was 1973; after vaccination was in- troduced, but was not obligatory, 1802-1816, the annual average per million inhabitants was 479; and after vaccination was made compulsory, during the period from 1817 to 1879, tne annual average of deaths from smallpox per million of inhabitants was only 181. This shows an annual saving of life of 1792 persons out of every million of the population by vaccination, and fully justifies the law making it compulsory.'' Statistics, collected by Mr. Marson during a service of thirty years in the Smallpox Hospital of London, show that out of 15,000 cases the unvaccinated died at the rate of thirty-five per cent., while among those who had been vaccinated the death rate was only six and one half per cent. Again, in Dr. Welch's experience of four thousand cases, the unvaccinated died at the rate of sixty per cent., while among those who had been protected by vaccination the death rate was only ten per cent. Still further, he says: " During the last twelve months I have had under my care at the hospital twelve hundred cases of smallpox, and of this number only 30 VACCINATION. one had been recently vaccinated, and this case termi- nated in recovery." In Germany vaccination is regulated by law, and when a man enters the army he is re-vaccinated. During the Franco-Prussian war, when the German army was double the strength of the French, there were only two hundred and sixty-three deaths from smallpox among the Germans, while among the French (with whom vaccination was not compulsory) the loss from this disease aggregated the enormous total of twenty three thousand three hundred and sixty- eight. A very striking example of the value of re- vaccination is furnished in the British Medical Journal. Some years ago, when smallpox was very prevalent, the surgeon of a large sailing vessel dis- covered, when a few days out at sea, that the captain had secretly conveyed on board the vessel his son, who was suffering from confluent smallpox. The surgeon at once procured all the vaccine lymph that he could, and re-vaccinated as many of the crew as possible. One-third or one-fourth of the crew remained unvaccinated. Of the re-vaccinated not a single one caught the disease, while among those who were not vaccinated all, or all but one or two, caught the disease, and three died. DOES IT PROTECT? 31 Dr. John L. Atlee, of Lancaster, bears testimony to the wonderful power of vaccination in the following statement, conveyed in a letter to his son, Dr. Walter F. Atlee, of this city. He says: "I have tested the efficacy" (of vaccina- tion) " by inoculating for smallpox after vaccination ; have taken patients after vaccination to cases of malignant smallpox in small and hot stove rooms, and exposed them to the foul atmosphere for fifteen or twenty minutes, secure from danger. In one case of a mother, with six unvaccinated children, one at the breast, who had a severe attack of smallpox, as soon as I discovered the nature of the case, I vaccinated all the children and they all took the vaccine disease. The room—it was in February—was a small ten by twelve feet room, with a hot ten-plate stove, and but one bed, on which they all slept, and which was saturated with smallpox contagion; yet these children picked off the scabs from their mother's body and the baby nursed at her breast, and no one took the smallpox.'' Owing to the violent opposition displayed by the anti-vaccinators in London, the National Health Society has issued and distributed twenty thousand 32 VACCINATION. pamphlets, and are'sending out more, in which con- clusive evidence is furnished of the following points: i. That vaccination is the only available means of protection against smallpox. 2. That with due care in the performance of the operation, no risk of injurious effects from it need be run. 3. That before its discovery the mortality from smallpox was forty times greater than it is now. 4. That in the London Smallpox Hospital the records show a rate of mortality of less than one per cent, for well vaccinated persons, against a rate of thirty-five per cent, for the unvaccinated. Sir John Pope Hennessey, Governor of Hong Kong, says that while no port is more liable to the introduction of smallpox, yet it never spreads there ; and this blessing he attributes to the fact that the Chinese so firmly believe in and so faithfully practice vaccination. The native doctors of the Tung-wa Hospital not only vaccinate their countrymen in the colony itself, but actually send traveling vaccinators over the adjoining provinces of China, so firm is their belief in its protective power. The North Carolina Medical Journal for June, 1881, DOES IT PROTECT? o3 furnishes a striking illustration of the protective power of vaccination, and although you may consider that I am furnishing too many illustrations, yet I desire to give all the important information I can gather on the subject, in order that the question may be completely and thoroughly put before you. It says: " Few commercial towns for a long time escape visitations of smallpox, notwithstanding that it is the most preventable of all diseases, and small- pox having once made its appearance, is seldom limited to the introduced case. "An example of complete success in limiting small- pox to the original case (or cases, we should say) came under our observation recently. A vessel from New York, loaded with guano, had a case of small- pox on board. The disease made its appearance at sea, in the person of a son of the captain. The young man was taken into the cabin and nursed there by his brother, who was a mate, and by the steward. Arriving at the Cape Fear quarantine station, the vessel was made to set the signal for the quarantine officer, for the steward, who had acute rheumatism. In the meantime, the case of smallpox was convalescent, and the eruption on the face and 34 VACCINATION. hands was accounted for by the action of the guano fumes. The vessel was permitted to come to Wil- mington, and the steward was admitted to the Marine Hospital with rheumatism. The convalescent smallpox patient did not come under the observation of any medical man. For, as the friends of the patient afterwards declared, having passed the quar- antine physician at Smithville, they assumed that the case was not smallpox but chickenpox, and con- sequently the young man attended church and enjoyed unrestricted intercourse. About the tenth day after the admission of the Steward,for rheumatism, he was seized with fever and pain in the back, followed by eruption on the forehead. The Super- intendent of Health was notified within an hour after the eruption was noticed, and deciding that it was smallpox, preparation was made for the removal of the patient to the smallpox hospital, four miles below the city. In the ward where the disease made its appearance there were eleven other patients, of Scandinavian and German nationality, except one elderly negro. It is well known that vaccination among the Germans and Norwegians is most thoroughly done, and so the vaccine cicatrices DOE'S IT PROTECT? 35 indicated in these cases. Nevertheless, it was con- sidered necessary to revaccinate all of them with Animal Virus, this being designated by the law of the State. All the vaccinations took, with but one exception. In the Seaman's Home, a building connected with the hospital by an entrance-way, there is a boarding house. Every one there was carefully vaccinated. To provide against the risk of an outbreak resulting from the intercourse of the convalescent case of smallpox with his friends on shore, the Superintendent of Health vaccinated un- sparingly. The case at the smallpox hospital resulted favorably, and the whole affair terminated without the occurrence of another case." An editorial in th-j Chicago Medical Review of November 5, 1881, thus bears testimony to the effi- cacy of vaccination : " It is almost unnecessary to say that cleanliness in person or surroundings has no influence on smallpox infection. The doctrine that cleanliness is more important than vaccination has been expounded by some of the medical lights of this neighborhood. They, however, forget, or never have been acquainted with, the history of mod- ern epidemics. The experience of Andersonville 36 VACCINATION. prison, where something like sixty thousand prison- ers were confined in a filth appalling in character and extent, demonstrates this position. Smallpox was twice introduced into that pen, but extensive and thorough vaccination at the date of enlistment prevented the spread of the disease. Not more than a dozen deaths occurred. In modern Euro- pean armies the same facts have been observed. In successful vaccination, and in vaccination alone, their safety lies." While this editorial rather belittles the influence which filth exerts indirectly on smallpox production and perpetuation, yet it is, in the main, correct, since no matter how clean and pure a person or locality may be,yet without vaccination, smallpox is more than a possibility; it is indeed a probability. The Louis- ville Medical News of March 19, 1881, tells us that " Dr. Turner Anderson delivered a child while the neck and face of the mother were covered by the eruption of smallpox. He vaccinated it immedi- ately, on both arms. The result was most favor- able." Among other conclusions on this subject arrived at by the Acad6mie de Medecine of France is the DOES IT PROTECT ? 37 important one, that "without vaccination, hygienic measures (isolation, disinfection, etc.) are of them- selves insufficient for preservation from smallpox." From another source I learn the> astounding but satisfactory and comforting fact that Dr. Buchanan, the medical officer of the London Government Board, has issued his statistics, which show that the smallpox death rate among adult persons vaccinated is ninety to a million; whereas among those unvac- cinated it is 3350 to a million. Among vaccinated children under five years of age forty and one-half per million ; whereas among unvaccina! ed children of the same age it is 5950 per million. The lower classes in the Island of Madeira are exceedingly hostile to the practice of vaccination, and the Pacific Medical and Surgical Journal tells us that six years ago smallpox prevailed there and car- ried off one thousand persons out of a population of one hundred and thirty thousand. Macaulay thus graphically describes the rav- ages of this disease, at the close of the seventeenth century : " The smallpox was always present, filling the churchyards with corpses, leaving on those whose lives it spared the hideous traces of its power, 38 VACCINATION. turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.'' How vaccination has changed this picture every one knows full well. Still, the Public Ledger recently said, editorially, " The world is getting on pretty near the close of the nineteenth century, and yet it appears to be neces- sary for skilled physicians and sanitarians to make formal argument before a committee of our city Councils to convince Councils that vaccination is a safeguard against the fatal ravages of smallpox! A hundred years of accumulated experience seems to have gone for nothing.'' One of the foremost physicians of America, Dr. N. S. Davis, of Chicago, believes that an immediate re-vaccination is the surest test of a successful vac- cination, since if it does not take the second time it is sufficient proof that the first has been successful, and he considers that if this precaution were ob- served " not one in a million would take smallpox." He adds that if compulsory re-vaccination were enforced it would stamp out the disease. Have I not adduced sufficient evidence to con- DOES IT PROTECT ? 39 clusively prove that when properly and successfully performed vaccination does afford immunity from smallpox? If I have, how, then, can any one have the hardihood to deny himself this immense protection, to be procured from so trivial an opera- tion. Is it that we do not thoroughly realize the dangers and the horrors of the disease, or is it that we are careless about means of preserving our health until that valuable health becomes impaired ? I am in- clined to think that both of these elements conspire to produce the comparative apathy existing among the public in connection with this protective opera- tion. The general mass of the people see so little of the ravages of the disease, unless it happens to enter their own household, that they do not realize its horrors. They are so little acquainted with the infinite number of avenues of contagion that they do not fear, half as much as they ought to, that they may themselves take the disease, and until it is brought very near home to them they fail to avail themselves of the immunity which vaccination con- fers. I will relate three instances, which, kept before 40 VACCINATION. your minds, will assist you to realize the horrors and the dangers of the disease. i. A man in Jersey City recently died of small- pox. When the Health Officer went to examine the house he found the widow lying on a bundle of rags on the floor, and she, too, was dying from the same disease. On her right hand lay a boy of seven, dead, while on her left was the dead body of a girl of five. In the corner were two more children sick with smallpox. Can you conceive a more horrible sight ? None of this family had been vaccinated. Now, contrast this case with that alluded to as re- ported by Dr. Atlee, in which six successfully vac- cinated children slept in the same bed with their mother, when she was suffering from confluent small- pox, and none of them ever took the disease. This illustrates the horrors of smallpox. The next cases will illustrate its contagion. 2. Two ladies in Philadelphia kept a boarding house; one of them was taken sick with smallpox; she died. Ten days subsequently the servant who nursed her was taken sick and died. 3. Recently, at the town of Gratz, near Harrisburg, a prominent citizen died of smallpox; the nature of DOES IT PROTECT? 41 the malady having been kept secret, the funeral was largely attended ; in a few days three children were taken with the disease, and in a very short time seventeen of those who attended the funeral were down with the disease and new cases were being reported. Of all diseases, smallpox is, probably, the most violently contagious, and, unlike other terrible diseases, it is not content with killing many persons and destroying many happy homes, but upon those whose lives it spares it forever leaves its ineffacable warning to others ; a warning that speaks louder than words, a caution so strong that it ought to do more in favor of vaccination than the greatest eloquence of the most wonderful orators, or the written accumulations of the most facile and con- vincing pens. It would really seem as though men valued their live stock at a higher rate than they do their own flesh and blood. Recently M. Pasteur, a distinguished scientist, has discovered a method of vaccination by which sheep, hogs, horses and other live stock can be given immunity against a very fatal disease that is oftentimes very prevalent among them. When his D 42 VACCINATION. discovery was made known, farmers from all about came flocking to him in large numbers, to have their animals vaccinated, so that in a short time more than fifty thousand were thus given protection in the suburbs and near vicinity of Paris alone. And yet, these very men, who feared lest they might lose some money by the death of their sheep, and who so hastily and greedily availed themselves of protective vaccination for their stock, are evidently so careless about the welfare of their human stock, of their own children, that in this very country, where such a prodigious number of the lower animals have been protected, it has been found necessary to compel human vaccination by legislative enactments. What a commentary on human nature, when a civilized and enlightened nation like France, though verbally denying the indictment, yet by action admits that to them, money, and live stock, as representing money, are of more value, are in reality nearer and dearer to their hearts, than their own offspring. Does it not seem almost incredible and beyond the possibility of belief, that in this enlightened age of mental and material progress it should become neces- <•* a- DOES IT PROTECT? 43 sary to compel persons to avail themselves of the pro- tection which my arguments must tend to show vac- cination does confer. I doubt not that if you were to ask any man if he would not consider it a great bless- ing if some means could be devised by which smallpox could be eradicated, he would answer, indeed I do, most emphatically, and without the slightest hesita- tion. Yet, when such a means has been devised, does exist and is to be so easily procured, they keep putting off until it is too late. I feel confident that if the most devout and per- sistent anti-vaccinator in the world were laid up on his back with a virulent case of confluent smallpox, if he told the truth, he would cry out, from the very innermost recesses of his soul, his regret for having neglected the protection he could so easily have pro- cured. You all know the old saying, " When the devil was sick, etc." This is applicable to the anti- vaccinators in a marked degree. While they have some arguments for their side, (which I will fairly present) yet I cannot bring my- self to believe that any one of them, who is sincere, really does not believe in the protective power of vaccination. If they would confine their agitation 44 VACCINATION. to the endeavor to reform the evils of the present system of vaccination, they would receive the hearty support and co-operation of the respectable medical profession and of every honest, thinking man. But when they endeavor to create an absolute disbelief in this protective power, or when they endeavor to maintain that vaccination does more harm than good, they assume the relation that Don Quixote once held to a windmill; they are battering against an im- pregnable barrier in their endeavor to reach their goal; they are fighting an invulnerable and invin- cible foe, since they will ever find arrayed between them and the consummation of their iconoclastic campaign a solid and impassable phalanx, composed of nearly the universal medical profession of the world, supported by the mass of intelligent, think- ing laymen, who will keep vaccination alive and afloat till this storm of prejudice and misrepresenta- tion shall have expended its fury, when they will guide it into port, to be welcomed once again by the hosannahs and the hallelujahs of a grateful and eager world. I doubt not that some persons may say that they thought that vaccination was very universally re- DOES IT PROTECT? 45 sorted to, and that they do not understand why I should take such a position. A few words will disabuse them of this erroneous idea, and may perhaps enlist their co-operation in making it universal. It is true that the anti-vaccina- tion storm has not yet reached our country in its full force, but its advance agents are already among us, and unless we show them by a very determined stand that such ideas are obnoxious and will not be entertained, we will soon have the anti-vaccination agitation in full force among us. The present epidemic of smallpox, taken in con- nection with the arguments adduced in favor of the protective power of vaccination, is one proof that it is not universally resorted to, else, if it were, we would not have this epidemic. Still more, I recently received a pamphlet, written by a physician, in which he endeavors to show that vaccination not only does not afford protection from smallpox, but he even goes so far as to say that this operation is productive of more evil even than small- pox itself. This is one of the forerunners of the anti-vaccination storm. Some of his arguments are good as far as they go, but they do not go far enough. He and those who agree with him fall into 46 VACCINATION. the error of universally condemning an entirety, without looking into and endeavoring to correct the faulty particulars that make this entirety seem dan- gerous. Some of his objections will be noted and explained away in the next part of this book. It will seem strange, no doubt, to many of my readers who already firmly believe in vaccination, that so much skepticism should exist concerning it; but the fact is that such doubt does obtain, and we might as well stare it in the face, admit its existence and endeavor to stifle it in its infancy. How to do this I will suggest further on. A few words on how to vaccinate will now be in order, but only a very few, since, entering upon this question, I am encroaching upon the territory of the physician, which I have neither the right nor the inclination to do in a popular treatise. The essential principle of the vaccine virus gains entrance to the system in the operation by being absorbed from the abraded surface of the skin. Grossly speaking, the skin consists of two layers. In the operation for vaccination the outer layer is scraped off, leaving exposed a raw surface or space on the lower layer or true skin, which possesses the power of absorption. The vaccine HOW PERFORMED. 47 material mixed with water is then placed on this raw surface, from which it is absorbed into the system. It matters not how this abrasion is secured, the point being to remove the outer skin. It is not necessary to bring blood, indeed, it would be better not, since it is possible that the blood may clot on the surface and offer a mechanical impediment to the absorption of the vaccine matter, though this latter is not likely. But to repeat and impress on you, the essential consideration in the operation is to secure the removal of the outer skin. It matters not what portion of the body is selected for the operation ; one is as good as another, so far as the efficacy is concerned. The left arm above the elbow is usually selected, but simply as a matter of convenience, since that portion can be more easily given the rest and quiet so essential to an inflamed and sore spot. It must be remembered that a successful vaccina- tion will sometimes produce very marked constitu- tional symptoms, and will oftentimes make a person so sick as to compel him to go to bed. It will also produce a very painful local sore, with much inflam- mation, that will require absolute rest of the part and the application of soothing lotions. Some parts of 48 VACCINATION. the body can, of course, be moreTeadily placed at rest than others, hence they should be chosen, since a disregard of this precept may give rise, in some cases, to very troublesome and painful complications. A prominent operatic singer was recently vaccinated in the West. She objected to having the operation performed on her arm, on account of the disfigure- ment which the subsequent scar would entail; the thigh was decided upon and the operation was there performed. She was cautioned to be very careful of the limb and to exercise it as little as possible. The vaccination took. For some days the lady was very careful ; but one night, receiving an enthusiastic reception from a very large audience, she was carried away, and forgetting her caution, endeavored to act her best, with the result that she was laid up in bed for two days with a very sore limb. Therefore I would advise all to follow these few simple directions. Select that portion of the body which you are sure you can keep most at rest, and when the vaccination commences to take, if the arm or part is very sore, keep applied to it a rag smeared with some greasy substance; you may use for this purpose cosmoline, vaseline or even plain lard, which will do as well as anything. HOW PERFORMED. 49 It will be well, before concluding these remarks in favor of vaccination, to summarize the points we have given, so that you may, if you so desire, com- mit the digest of them to memory, and have ever ready, at your tongue's end, the conclusions of the majority of physicians, with which you may answer the arguments of anti-vaccinators, or confirm the wavering of any friends who may have a tendency to take up with their views. These, then, are the con- clusions of the advocates of vaccination. That in the large majority of cases, when successfully per- formed with proper virus, it does afford protection from smallpox. That in those few cases, compara- tively speaking, in which it does not afford absolute immunity, it so modifies the intensity of the disease that it rarely proves fatal. That pure bovine virus is to be preferred to that from the human subject, since it absolutely prevents the passage of extraneous diseases from one to another. That the proportion of cases in which this operation proves a benefit is so greatly in excess of those in which it is injurious, that it becomes, not only justifiable, but greatly to be desired. 50 VACCINATION. PART THIRD. ARGUMENTS AGAINST VACCINATION. After presenting such overwhelmingly strong argu- ments in its favor, it will now be in order to ask, why does any one attempt to cast disrepute and obloquy upon such a self-evident benefit to mankind, and upon what ground can anti-vaccinators stand ? They have, indeed, very strong arguments, and so far as they go, very sensible ones; but, as I have already intimated, the validity of their objections can be upheld only when they condemn the usual methods of vaccinating, and are valueless when they attack the protective power of properly performed vaccination. The platform upon which anti-vaccina- tors stand has, in reality, only two props or supports, and I hope to be able to demolish them and drop the platform, with its occupants, into a belief in vac- cination. These two points are— i. The fact that, in some instances, vaccination does not confer immunity from smallpox. 2. That various diseases can be transmitted from ARGUMENTS AGAINST IT. 51 unhealthy persons, through the medium of vaccination, to those previously healthy. These two objections undoubtedly do exist, and are strong points as far as they go; but when viewed impartially, and in connection with the favorable evidence I have furnished, they only tend to prove that the fault lies not with vaccination itself, but with the vaccinator. We will take them up in turn and see the correct- ness of this proposition. i. Undoubtedly, vaccination does, in many cases, fail to afford immunity from smallpox; for two reasons. (0) There is no universal rule in nature. There is no law without its exception. Every sensible man knows, realizes and daily experiences this fact. Neither Jenner nor his most ardent disciples ever claimed that vaccination would, in every case, protect from smallpox. There must and ever will be excep- tions to this, as to every other natural law. But they do claim, and experience substantiates this claim, that in the vast majority of cases, when properly performed, with good material, and it is suc- cessful, it does afford protection. 52 VACCINATION. (b) Great carelessness and even criminal fraud exists, to an inexcusable extent, in the production and selection of vaccine virus, and in the performance of the operation. The story is told of a physician, who, when visited in his office by a stranger, to be vaccinated, not hav- ing any virus on hand, and fearing to lose his fee, mixed up some gum arabic, and vaccinated his unsuspecting victim with it, telling him that if it did not take in a week, to return, and he would do it over again. No doubt similar cases have repeatedly occurred, and since, in some persons, the mere scratch- ing of the arm might make a sore with a subsequent scab, and since the general public does not know how to recognize a successful vaccination, believing that a mere sore arm is sufficient proof that it has taken, they consider themselves protected, do not return to the doctor, and subsequently taking small- pox, another case is added to the list of unsuccessful vaccinations. This same insufficiency in the protective power of the material used, from various causes, unnecessary to mention here, has tended to cast distrust upon vacci- nation, when the fault really lies with the physician. ARGUMENTS AGAINST IT. 53 It is unnecessary, and would be tiresome, to here de- tail the numerous reasons why some virus possesses no protective power. Suffice it to say that such is an unquestioned fact, and to suggest a remedy, which I will do further on. 2d. That various diseases have been and can be transmitted from one to another, through the medium of the vaccine virus, is a pretty generally accepted proposition. But here again the fault lies with the material and the carelessness or criminality in its propagation and supply, and not with the operation itself. When a conscientious physician desires to procure a supply of vaccine virus, he goes to some druggist, in whom he has confidence, and buys some ivory points coated with bovine virus, of he procures from some brother physician (also conscientious) a scab taken from a child who was believed by this doctor to be perfectly healthy. In many instances, indeed in nearly all, the material thus procured will be pure and efficient, will confer immunity from small- pox, and will not contain the seeds of any foreign disease. But it is impossible for the most careful druggist to avoid occasionally receiving some impure 54 VACCINATION. points. The desire for money and to make it easily, to derive unnaturally large profits from all business operations, is so inherent in human nature, that adulteration, in order that expense may be lessened and profit increased, has even entered into the busi- ness of supplying vaccine virus. In order not to be too personal I will make no mention of locality or names in the story I am now going to tell, but will assure you that it is true. I have been informed by reliable authority that a physician of this city is in the habit of collecting all the scabs from vaccinated persons that he can get and forwarding them to a neighboring city, near which are several vaccine farms. Of course, I do not know what is there done with them, but it would not require a very great stretch of the imagination to suppose that they are mixed with water, and ivory points, coated with the mixture, dried and shipped over the country as "genuine bovine virus direct from the cow." Still worse, I have been in- formed on good authority that an extensive and generally-considered reliable drug firm in this city buy scabs directly from physicians, and in their own establishment mix them with water, coat ivory points ARGUMENTS AGAINST IT. 55 with the mixture, and sell the same to unsuspecting physicians (upon whom they fawn and into whose good graces they insinuate themselves, by a miser- able, cringing sycophancy) as, pure bovine virus, di- rect from the vaccine farm. This firm, by a num- ber of years of plausible catering to physicians, have worked into their confidence and built up an exten- sive trade, so that any material coming from their store is generally considered irreproachable. Is it any wonder, when such outrageous practices are resorted to, that vaccination meets with opposi- tion. It is enough to make the blood of an honest man fairly boil with indignation when he hears that a firm making more than fifty thousand dollars a year will resort to such a contemptible device to add a few dollars to their profits. Neither is it a harmless device, since, as we will see further on, this firm and such other mean, contemptible puppies as they are, may be the means of spreading abroad the most loathsome diseases among their unsuspecting fellow citizens. We will be charitable enough to trust that they do not realize the true nature of their nefarious traffic, else how could they sleep of nights. Again, it is a fact, that many persons contain in 56 VACCINATION. their systems the seeds of some disease, when to all outward appearances they are perfectly healthy. A scab derived from such a person, and honestly believed to be perfectly harmless and efficient, may, unfortu- nately, in the person vaccinated with it, develop some terrible disease. Again, in the medical profession, as in every other calling, the majority of men are not hampered with any too much conscience. They want to make money, and are not overly particular how they get it; the end, in their imagination, justifies the means. Hence, any scab or any virus is good enough for them. They are not very particular as to its purity or effi- ciency. In this way, no doubt, much misery is caused and very much undeserved censure and con- demnation is heaped upon vaccination. Here, then, we have concisely and illustratively stated the two arguments upon which anti-vaccina- tors base their case. To sum up: The facts that, in some cases, because of carelessness in selection of material, vaccination fails to confer protection, and in other cases produces disease nearly or quite as bad as smallpox itself. These two arguments, as far as they go, we must ARGUMENTS AGAINST IT. 57 and do cheerfully concede to the anti-vaccinators. But they are very weak, and prove nothing for their case. The fact is sufficiently answered by the admis- sion made, that no law is so absolute and universal as to be without an exception—unless, may be, as is popularly said, in the cases of taxes and death, and we might add the law that a note will be protested if you fail to pay it. The second argument constitutes one of the abuses of vaccination, and has no weight to prove anything more than the corrupt and mer- cenary nature of that portion of mankind who are depraved enough to resort to such base and villainous practices. The fact that the instances in which vaccination fails to afford protection are the exceptions, has been sufficiently demonstrated by the arguments already adduced. Therefore, at the risk of repetition, we must regard the arguments of those who oppose vaccination as being based upon wrong premises, since they use the exceptional cases and the abuses of the practice to point their arguments. One other argument, which probably ought to be mentioned, upon which our opponents base their case, E 58 VACCINATION. is that vaccination is prone to produce erysipelas. In answer, we might admit that erysipelas is produced in every successful vaccination. The disease means an inflammation of what we call connective tissue, that is, the tissue beneath the skin. Now, since successful vaccination does produce a violent inflammation of the skin about the seat of the operation, it is but fair to infer that this inflammation may extend to the tissue beneath and produce a local inflammation of it, or a localized erysipelas, which is trivial and perfectly harmless. As for its ever producing a genuine and dangerous attack of the disease, I can quote the statement of a New York physician, who had vaccinated two thousand persons and had never seen a resultant attack of erysipelas ; and can also say that, after a careful examination of all the medical literature of the past year, I have found but one re- ported case of erysipelas following vaccination, and in this single instance the disease could not be clearly traced to the operation, since other causes for its development existed. Here, then, I have concisely, honestly, and con- scientiously, stated the arguments advanced by anti- vaccinators, and have endeavored to refute them. I ARGUMENTS AGAINST IT. 59 have carefully scanned all the most recent literature, and these have been the only arguments worthy of notice that I could find. Since there are strong objections, and since they do qualify and modify the benefits to be expected, and that can be derived from vaccination, we will go on to our next subject and endeavor to suggest a means by which these defects may be remedied, and the full, free, and unalloyed protection that vaccina- tion is capable of conferring be vouchsafed to all. 60 VACCINATION. PART FOURTH. HOW TO OVERCOME THESE OBJECTIONS. It seems conclusively established that were vaccina- tion and revaccination to become absolutely universal, smallpox could in time be exterminated. This is truly a consummation most devoutly to be wished for. But how can it be brought about ? Only in one way, namely, by legislation. I will suggest a form of legislation, which, if- carried into effect, would demolish the platform of anti-vaccinators, and would, beyond doubt, if perse- vered .in, eventually eradicate smallpox. And this suggestion I will make in the form of some points or hints for a bill to be presented to, and acted upon, by the legislatures of our various States. I would suggest the establishment of a " State Board of Vaccination," who should be given the authority to compel, under penalty of fine and imprisonment, the vaccination of every man, woman and child, in the State. The members of this Board should be elected for life, or good behavior, by the PROPOSED LEGISLATION FOR. 61 State Medical Society, and any vacancies that might occur by resignation, death or removal, be filled by the same Society in annual session. By this method of organizing the Board, the damning influence of politics would be kept as remote as possible from the groundwork of our plan. An annual appropriation should be made, sufficiently large to enable this Board to thoroughly carry on its good work. This Board should commence its work by the establishment of a State vaccine farm; the Superin- tendent of which should be a physician, and be elected by the Board. The State should be divided into vaccine districts, and an inspector appointed for each, whose duty it should be to constantly watch over the persons in his district, and to report all who had not been vaccinated within the prescribed time to the vaccine physician, who should forthwith cause a notice to be served on such person to call at his office at once, and be vaccinated. A vaccine physician for each district should be elected by the State Board, whose duty it should be to vaccinate every man, woman and child, in his district. These physicians should be supplied with virus direct from the State farm, free of cost, under the following 62 VACCINATION. conditions : Once a week, they should each make requisition upon the Superintendent of the farm for as many points as they may require, and should at this time return all unused points in their possession. Each lot of points sent out should have a distinctive mark on each point, and a careful record kept of the destination of each lot, as well as the source from which the virus has been derived. When a person is vaccinated, the point used should be given to him with its distinctive mark. Thus, if any accidents occurred, if any disease was communicated by vac- cination, it would be a very simple matter to place the responsibility, through the physician using the virus which has proved disastrous, to the Superin- tendent of the farm, and if negligence or carelessness on his part could be substantiated, he should be severely punished, besides being removed from office. It should be made a penitentiary offence for any physician, other than the duly elected and authorized vaccine physician of the district, to perform vaccination. No charge should be made for his services. The vaccine phy- sician should be required to keep careful and complete records of all cases vaccinated, and should make monthly reports to the superintendent of the farm, PROPOSED LEGISLATION FOR. 63 who should in turn make an ^annual statistical report to the State Board. * It should be made compulsory for every man, woman and child to be vaccinated every five years. When vaccinated, each person should receive a card like the following: — This certifies that John Blank has been vaccinated by me, on February ist, 1882. James Brown, m. d., Vaccine Physician, ist Vaccine District, State of Pennsylvania. February 8, 1882.—John Blank has been seen by me, and his vaccination, performed February ist, 1882, has been suc- cessful. James Brown, m. d., Vaccine Physician, 1st Vaccine District, State of Pennsylvania. The District Inspectors should be allowed the authority to inspect this card at any time, and any person not possessing one should be compelled to call on the district J physician and be vaccinated. It should be made an offence as great as counter- feiting United States bank notes for any one to frau- dulently print one of these cards, and as criminal as forgery for him to>rriteJiimself, or get any one else to write, the name of the duly authorized vaccine physician to it. As much care should be exercised 64 VACCINATION. in the prevention of counterfeiting these cards as is used to prevent the counterfeiting of money. It should be compulsory on all to be vaccinated every five years, and a severe penalty should be visited upon all who neglected this provision. This system of vaccination, when once fairly in- augurated, would work smoothly, and ought not to meet with any opposition. The intelligent classes would have no reason to object to it, since they would have the assurance that they were being vacci- nated with pure virus and by competent physicians, while such opposition as might be encountered from the ignorant ought to be neutralized by the strong arm of the law, since, when people are so foolish as to object to that which would be undoubtedly for their good, then indeed does it become necessary to force these foolish people to take care of them- selves. In addition to these measures by the different State governments the National Government would have to do something. I would suggest that Con- gress empower the National Board of Health to ap- point a vaccine physician for every Port of entry, whose imperative duty it would be to vaccinate every PROPOSED LEGISLATION FOR. 65 emigrant arriving in the country and every native returning from a foreign trip, unless he could pro- duce evidence (in the shape of the vaccine card already referred to) that he had been vaccinated successfully within five years. A card, similar to the one referred to, should be furnished to each emi- grant, and it should be a part of the police duty of every city and town to note the arrival of every new person, to notify the vaccine inspectors of such ar- rival, and they in turn should take the precaution to ascertain whether or not the new arrival had been successfully vaccinated, and so report to the vaccine physician. All these officers should be liberally paid, and no charge should be made for vaccination, so that no one could have the excuse " of want of means " to offer in extenuation of non-compliance with the law. Such is, in a crude form, the only method by which smallpox can be eradicated. It really means universal vaccination, and by this universality, and by it alone, can this disease be stamped out of exist- ence, and by it, if faithfully and persistently carried out, can this disease be rendered a thing of the past. 66 VACCINATION. Does it not seem strange and almost incredible that human nature can be so blind to its own inter- ests as to neglect securing the wonderful immunity from a terrible disease that is conferred by so trivial an operation? Still, it is true that many persons do neglect to be vaccinated, and since they are so careless, it becomes the paramount duty of our law- makers to force them to protect themselves. Let me urge all classes to seriously consider and act on these suggestions. Let me beg you all to invoke the mighty power of legislation to drive from the haunts of men forever this ghastly spectre that makes desolate so many homes and ruins so many faces. I will ask the father as he gazes on his innocent and beautiful children, the young man admiring his sweetheart's beautiful skin, the wife her husband's manly beauty, and the brother who takes pride in his sister's comeliness, to agitate this question. Go and see your representatives in the legislature ; it is your votes that send them there; they must do as you desire, else you can send some others who will do your bidding in their places; insist with them that they must so legislate that you and your neighbors PROPOSED LEGISLATION FOR. 67 can be protected from this terrible disease, when protection is so easily attainable. Do not rest satisfied until you have accomplished this purpose. As surely as the sun rises, smallpox can be exterminated, but it can only be done by universal vaccination with pure material. When the Almighty has allowed the mind of man to furnish to us such a wonderful and yet such a simple means of preserving health and beauty, does it not seem terribly negligent in us that we do not all avail ourselves of it. Let us hope that the day is not far distant when from the legislative halls of every commonwealth in this great country shall go forth the glad tidings, 11 vaccination is compulsory" Then can we con- fidently trust that the medical historians of the future will refer to smallpox as one of the ancient and extinct diseases, as we of to-day are wont to speak of leprosy, and then can we hope that the one disease will be as rarely met with as the other. 68 VACCINATION. PART FIFTH. HYGIENE OF SMALLPOX. Under this heading I propose to give a few hints concerning the means of prevention (besides vacci- nation) as well as the hygienic treatment of one sick with the disease, and the best means of controlling and preventing its spread. The subject will be divided into two parts. The first will give some hints as to what might be called public hygiene, or the duties that devolve upon city and state officials, while the second will sketch the part that the indi- vidual must take in preventing the spread of smallpox. i. Public hygiene. The College and Clinical Record of August 15, 1881, contained an editorial from which I will make some selections as pertinent to the subject under consideration. It says: '' Should any of our readers or correspondents be in need of a good illustration of the way in which a large, wealthy and comparatively enlightened community, in a position, as regards social and material advantages other than sanitary, second to none in this country, HYGIENE OF SMALLPOX. 69 can mismanage an epidemic of smallpox, we invite their attention to the history of the present epidemic in Philadelphia, which, commencing in 1879, st^ drags its length along, with every prospect, during the coming fall and winter, of being as virulent as at any time in the history of the city.'' This prediction we all know has been verified. "Not a month has passed for nearly two years without furnishing its quota of cases, with a large aggregate of deaths. No one doubts that smallpox is a preventable disease, and that epidemics cease under proper sanitary pre- cautions. Some of the causes of a want of efficient management of the epidemic have been, first, the want of sufficient appropriations for the purpose; second, the want of a proper sanitary organization, clothed with necessary power, and finally, a want of moral support from the community, who have been kept in ignorance of the true condition of affairs, by the secular press, lest the publication of the facts might cause the mercantile interests of the city to suffer. Free vaccination is very good, when actively carried on, and proper precautions are taken to insure the use of true vaccine virus. But vaccination is not all. Systematic and rigorous isolation of all 70 VACCINATION. cases of smallpox, as well as convalescents and attendants upon the sick until they are free from infection. Under the present administration of affairs smallpox patients, with the eruption still out upon them, are to be met with at public dispensa- ries, in doctors' offices, in stores, in public schools, in the street cars; in short, anywhere where people congregate. Even the visitors to the Smallpox Hos- pital go and return in the public conveyances. Not long ago a smallpox bed was deposited on a vacant lot down town, in front of a row of new and clean dwellings; no less than twenty-five cases of small- pox occurred in the local outbreak which followed. In New York a corps of physicians has been or- ganized for systematic house to house visitation, prompt isolation of the sick, disinfection of prem- ises and the reporting of sanitary defects in dwelling houses.'' These are all just accusations and crying shames. If, as the Board of Health claims, they are prevented from carrying out proper sanitary meas- ures, by the refusal of Councils to appropriate suf- ficient money, the people have it in their power to force them to do so, by refusing to send to Councils any representatives until they have clearly and thor- HYGIENE OF SMALLPOX. 71 oughly pledged themselves to support liberally all measures looking to the public health. Again, the Public Health Organization of Phila- delphia at least, and of any other cities where it is similarly organized, is faulty. The Health Officer, whose supposed duty it is to carry out the directions of the Board of Health, is entirely independent of them, being a politician, appointed to office by the Governor. He may do what the Board tells him or he may not, as he pleases, and they can do nothing with him. A recent striking illustration of the faulty organization of our Health Department will be interesting. A prominent physician was called on a Friday evening, to a sick lady. On Sunday smallpox was developed. As the Health Office was closed, it was the obvious duty which this physician owed to society, to visit the Health Officer at his residence and report the case. Instead of doing so, he claims that he sent him an informal notice by mail, which could not have been delivered until Monday morning. In the absence of the physician the Health Board passed a vote of censure and fined him the paltry sum of fifty dollars. The doctor, learning of this action, asked for a hearing, which 72 VACCINATION. was granted. He then, in addition to what has been already said, stated that on Sunday morning he received, by mail, a formal blank, to be filled in; he filled it in and returned it by mail, and it reached the Health Office Wednesday morning, three days af- ter the nature of the disease had become known to him. The, Health Officer was asked whether he had re- ceived the communication of Sunday night, when he nonchalantly replied that he did not recollect. Whereupon the Board remitted the fine, but re tained the vote of censure, and the culpable doctor departed, happy. In the meantime the patient died, and her dead and poisonous body was allowed to re- main in a room in a crowded boarding house for three days. This in the enlightened city of Philadelphia, with a Board of Health counting several prominent physicians among its members. Such carelessness on the part of physicians and health authorities, when viewed in the light of probable evil it entails, is most censurable, if not criminal, and ought not to be toler- ated. If Councils cannot be forced to appropriate enough money to prevent the ravages of a disease that we know how to control, surely there are enough rich and public-spirited citizens, who annually give HYGIENE OF SMALLPOX. 73 away large sums of money, who, by uniting, could give, and hardly miss, more than enough to stay the worst epidemic of smallpox. The public duty in this matter of prevention can be summed up under three heads : Universal vaccin- ation, complete isolation, and thorough disinfection. It will be unnecessary to discuss these points in de- tail, since, if the requisite amount of money is forth- coming, there are many gentlemen thoroughly con- versant with the subject and amply competent to sat- isfactorily carry them into effect. I have heard it said that "smallpox attacks the poorer classes, and that the rich care but little about vaccination and have but little fear of the disease." If this is so, it is a most fatal error. Smallpox makes no distinction ; it would as soon enter the palace of the King as the house of the pauper. In support of the belief that the rich are careless about protecting themselves from smallpox, and to demon- strate that they are suffering from this carelessness, the conclusions derived from an elaborate statistical table which I have compiled from our Health Re- ports will be of value. On one hand I have selected the three most aristo- F 74 VACCINATION. cratic wards of our city, into which, owing to the presumed intelligence of the inhabitants, the health authorities but rarely penetrate, leaving preventive measures, in a large degree, to the individual action of the citizens. On the other hand will be found the three plebeian wards, into which, owing to their crowded condition, and the filth, carelessness and disregard of sanitary laws of the inhabitants, the chief energies of the Health Board are expended. What do we find ? In 1861 the three aristocratic wards contributed only two and a half per cent, to the total deaths from smallpox. While during six subsequent years, during which I made my investigations, they con- tributed more than four per cent., a loss of over one and one-half per cent. In 1861 the three plebeian wards contributed twenty-seven per cent, of the total deaths, while dur- ing the six subsequent years their proportion was only fourteen per cent., a clear gain of thirteen per cent., which, added to the loss in the aristocratic wards would give a comparative gain of over four- teen and one-half per cent, in favor of the plebeians. This clearly demonstrates that it will not do to HYGIENE OF SMALLPOX. 75 trust to individual efforts. It shows plainly the effi- cacy of well-directed public efforts, and it forces us to conclude that the rich as well as the poor must be subjected to them, if we would hope to eradicate smallpox. So much, then, for public hygiene. 2. Private or personal hygiene. The same cardinal points are here to be observed. Vaccination, isola- tion and disinfection. Vaccination has been already sufficiently discussed. Isolation and disinfection now claim our attention. The ignorant classes must be isolated by law, since argument and persuasion have very little influence on them. There are two classes of intelligent per- sons to whom some advice concerning this question ought to be addressed. The first class consists of those who are keeping house, and the second of those who are boarding. When a case of smallpox occurs among the first class, if it is desired that the patient shall remain at home, the physician in charge should notify the Health Officer, who ought to send an inspector to examine into the conditions and surroundings of the patient, and to decide whether or not it would be dangerous to others to 76 VACCINATION. allow the sufferer to remain where he is. If he de- cides in the affirmative, then all members of the fam- ily should be vaccinated and sent away, save, per- haps, one, who may insist, even after being acquainted with the peril of doing so, on remaining to nurse the sick one, as in the case of husband and wife or mother and child. The patient should be removed to an upper room, and absolutely no one should have access to him or her, save the physician and nurse. Every article that is removed from the room should be disinfected beforehand. Sheets should be hung in the door and window ways, which should be kept constantly saturated with some disinfecting solution, the nature of which I will leave to the in- telligent physician, since there are so many to choose from. Thus would be reduced to the minimum the dan- ger of any of the poisonous emanations being wafted by the wind to other portions of the house or to the out- side world. It would be well to keep the air of the room constantly saturated with disinfectant vapors, which can be accomplished with the aid of a small portable steam atomizer. All clothing removed from the patient or the bed should be thoroughly washed in a disinfecting solution before being removed from the HYGIENE OF SMALLPOX. 77 room, while any scabs that may fall from the body should be immediately placed in the same liquid. Absolutely no intercourse should be had by the nurse with the outside world, until the physician has declared all danger of contagion to have passed. When this period has arrived, and before any of the family are allowed to return, the sick room must be thoroughly disinfected, and for this purpose you should employ only persons who have been thoroughly protected from smallpox by a recent attack of the disease, or by a recent successful vaccination. The floor should be scrubbed,over and over again,with the strongest possible disinfectant solution. The paper should be torn from the walls, and they should be washed, as the floor, and repapered. The wood-work should all be repainted ; and in the case of very rich persons, this process should be extended to the whole house. Every article, including even the bedstead, should be burned; indeed, were it possible, it would be the safest course to burn the whole house, and I am almost tempted to say, to cremate the patient himself. In this holocaust must be included all wearing apparel used by the nurse. The second class, those who live in boarding-houses 78 VACCINATION. or hotels, can be settled in a few words. They should be at once removed, either to some private house, whose inmates are willing to have them, subject to the terms and conditions already laid down for private houses, or they should be taken to the Small- pox Hospital. They have no right to remain in a house full of people who do not care for them, and to endanger the lives of their fellow-boarders. If they do not, of themselves, realize this, they must be made to do so. They need not fear the Municipal Hospital. It should be so ruled that they would there be allowed the nurse and doctor of their own choosing, and when they once have the disease, their chances of recovery will not be lessened by removal to the Smallpox Hospital (providing they are allowed their own nurse and doctor), while the danger of infecting others will be very much reduced. The necessity for this very great caution will be understood, when you learn that the scabs from a convalescing smallpox patient may retain their con- tagious or infectious powers for a long time. Some years ago, a patient recovering from an attack of smallpox wrote a letter to a friend in a city HYGIENE OF SMALLPOX. 79 three hundred and fifty miles distant. When lean- ing over the paper, writing, a small piece of scab from his face fell, unnoticed on the paper ; the letter was folded, sealed, directed and forwarded. When re- ceived, the friend noticed this spec in one of the folds of the letter, but supposing it to be merely some dirt or imperfection in the paper, or perhaps not consid- ering it at all, put the letter in his pocket with this scab still in it. Result: in a short time this man was taken with smallpox and died, and his death was followed by a local epidemic of the disease. Does not this one case, which is a true one, drawn from life and not imaginative, sufficiently demon- strate the property which smallpox scabs may possess and retain for along time, of transmitting the disease to great distances, and may it not serve to explain the sometimes apparently mysterious origin of an outbreak where no case of the disease has previously existed ? I have now reviewed the question of vaccination as comprehensively as is possible in so small a book. The main points in each question involved have been concisely stated, the arguments for and against vac- cination have been impartially and fairly stated ; and 80 VACCINATION. the decision of the question has been left to the judg- ment of the intelligent portion of my readers. I commenced the study of this subject as a believer in vaccination, and I have concluded it a much firmer believer than before. I fully recognize and admit the dangers that may arise from the abuses of vaccination, but I find suffi- cient evidence to convince me that these abuses can be remedied. From the. evidence, I have been led to conclude that smallpox can be entirely eradicated by the universal and faithful practice of the three require- ments, Vaccination—Isolation—Disinfection. Should my suggestions in this brochure meet with favor I will at some future time furnish conclusive and unquestioned proof that the money necessary to procure these desired conditions would be a most excellent national or state investment, since the increase in the national wealth from the number of lives saved by them would be so enormous that the expense incurred would be but as a drop in the bucket. In the meantime, I will be very glad to hear from my readers any undoubted instances either favorable or opposed to vaccination. " Mr. Blakiston deserves the thanks of the public for the remarkably interesting and valuable series of works on Hygiene which he has recently issued. They are all written in a popular style, and contain information of great value to every reader. They are cheap, and can scarely fail to save their cost many times over in any family, if the directions given in them are carried out."—From a Leading Canada Journal. Catalogue No. 5. Select List oe Books FOR GENERAL AND SCIENTIFIC READERS, INCLUDING WORKS ON THE CAEE AND MANAGEMENT OF OUR HEALTH; nursing; THE PROPER CARE OF CHILDREN; PERSONAL AND DOMESTIC CLEANLINESS; HOW TO PREVENT DISEASES; DRAIN- AGE OF HOUSES AND LANDS, ETC., AND CHEMISTRY, MICROSCOPY, AND POPULAR SCIENCE. PUBLISHED BY P. BLAKISTOX, SON & CO., SCIENTIFIC, MEDICAL AND CHEMICAL BOOKS, 1012 Walnut Street, Philadelphia. *S~Anv of the boohs in this Catalogue trill be sent, postpaid, upon receipt of the price or th%cZ be procured of most bookseller, throughout the UnUed State* and Canada. See page, H and 15 for SPECIAL OFFER. 2 P. Blakiston, Son & Co.'s NEW BOOKS BY DR. J. F. EDWARDS. " Plain and straightforward."—Baltimore Sun. VACCINATION AND SMALLPOX. Showing the reasons why we should be Vaccinated and the fallacy of the arguments ad- vanced against it, with hints as to the management and oare of smallpox patients. 32mo. Cloth. Prloe 60 oente. MALARIA: Where Found; Its Symptoms and How to Avoid It. Cloth. Price 76 cents. "A foroible, logical, and sensible little book."—Philadelphia Times. DYSPEPSIA. How to Avoid It. By Joseph F. Edwards, m.d. Discusses food and digestion. States how food should be cooked, and plainly shows how and what we ought to eat. Second Edition. 16mo. Cloth. Price 75 cents. "Among the admirable publications of Presley Blakiston, there Is none that will be more weloome than Dr. Joseph F. Edwards' little treatise on ' Dyspepsia.' It is, In fact, a handbook of cooking and eating, practical and excellent In every way."—Boston Globe. CONSTIPATION, Plainly Treated and Relieved without thf Use of Drugs. By Joseph F. Edwards. 16mo. Cloth. Price 76 cents. " It is one of those useful little books which every one ought to read."— Philadelphia Inquirer. BRIGHT'S DISEASE. How Persons Threatened or Afflicted with this Disease Ought to Live. By J. F. Edwards, m.d. Second Edition. 16mo. 96 pages. Cloth. Price 75 cents. " It encourages the sufferer as well as instructs him."— Congregationali4. " Dr. Edwards is doing a good work in these volumes, and their wide dis- tribution among the people can but be productive of the best results; he neither employs nor advocates any quack methodsor treatment, but plainly tells how to avoid and how to cure or alleviate suffering from disease."— New Haven Palladium. Any of the above sent by mail, postpaid, upon receipt of price. Select List oj Books. 3 THE MANAGEMENT OF CHILDREN in Health and Disease. By Mrs. Amie M. Hale, m.d. A book for Mothers. Second Edition. 12mo. Cloth. Price 75 cents. THE PRttSS COMMEND IT AS FOLLOWS: " Altogether, it is a book which ought to be put into every baby basket, even if some lace-trimmed finery i9 left out, and should certainly stand on every nursery bureau."—Philadelphia Public Ledger. "Admirable common-sense ad vice,which mothers would do well to have." —Southern Churchman. " Contains invaluable instruction."—Evening News, Detroit. "The importance of this book cannot be over estimated."—.W. E. Journal of Education. " A work for mothers, full of wisdom."— Congregationalism "Ought to be the means of saving many a young life."—Phila Inquirer. - Abounds in valuable information."— Therapeutic Gazette. " Emphatically a book for mothers, and cannot fail to be useful to all who read it."—Indiana Farmer. " Admirably simple, clear, sensible, and safe In its teachings."— Friends' Review. " It should be upon every household table."—Nashville Jour. Med. and Sur. BIBLE HYGIENE ; or, Health Hints. By a Physician. This book has been written, first, to impart in a popular and condensed form the elements of Hygiene. Second, to show how varied and important are the Health Hints contained in the Bible, and third, to prove that the secondary trendings of modern philosophy run in a parallel direction with the primary light of the Bible. 12mo. Cloth. Price $1.00. Paper covers 50 cents NOTICES OF THE PRESS. " The anonymous English author of this volume has written a decidedly readable and wholesome book."—Philadelphia Press. "The scientific treatment of the subject is quite abreast of the present day, and is so clear and free from unnecessary technicalities that readers of all classes may peruse it with satisfaction and advantage. —Edinburgh Medical Journal.' DRAINAGE FOR HEALTH ; Or, Easy L^ons in Sanitary Science, with numerous Illustrations. By Joseph Wilson, m. p.. Late Medical Director, United States Navy. One vjl. Octavo. Fnce $l.o». "Dr. Wilson is favorably known as one of the leading American writers on hyidene and public health. The book deserves popularity. —Medical and Surgical Reporter. NAVAL HYGIENE and Human Health : the Means of Pre- ventine Disease. By Joseph Wilson, M.r... Late Medical Director, U. S Navy Illustrated. 8vo. Cloth. Price *3.00. 4 P. Blakiston, Son & Co.'s THE AMERICAN HEALTH PRIMERS. Edited by W. W. Keen, m.d. Bound in Cloth. Price 50 cents each. Paper covers 3^ cents each. The Twelve Volumes, in Handsome Cloth Box, $6.00. I. Hearing and How to Keep It. With illustrations. By Chas. H. Burnett, m.d., of Philadelphia, Aurist to the Presby- terian Hospital, etc. II. Long Lire, and How to Reach It. By J. G. Richardson, M.D.,-of Philadelphia, Professor of Hygiene in the University of Pennsylvania. III. The Summer and Its Diseases. By James C. Wilson, m.d., of Philadelphia, Lecturer on Physical Diagnosis in Jefferson Medical College. IV. Eyesight, and How to Care for It. With Illustrations. By G-eorge C. Harlan, m.d., of Philadelphia, Surgeon to the Wills (Eye) Hospital. V. The Throat and the Voice. With illustrations. By J. Solis Cohen, m.d., of Philadelphia, Lecturer on Diseases of the Throat in Jefferson Medical College, etc. VI. The Winter and Its Dangers. By Hamilton Osgood, m.d., of Boston, Editorial Staff Boston Medical and Surgical Journal. VII. The Mouth and the Teeth. With illustrations. By J. W. White, m.d., d.d.b., of Philadelphia, Editor of the Dental Cosmos. VIII. Brain Work and Overwork. By H. C. Wood, Jr., m.d., ol Philadelphia, Clinical Professor of Nervous Diseases in the University of Pennsylvania, etc. IX. Our Homes. With illustrations. By Henry Hartshorne, m.d., of Philadelphia, formerly Professor of Hygiene in the University of Pennsylvania. X. The Skin in Health and Disease. By L. D. Bulkley, m.d., of New York, Physician to the Skm Department of the Deinilt Dispensary and of the New York Hospital. XI. Sea Air »nd Sea Bathing. By John H. Packard, m.d., of Philadelphia, Surgeon to the Episcopal Hospital. XII. School and Industrial Hygiene. By D. F. Lincoln, m.d., of Boston, Mass., Chairman Department of Health, American Social Science Association. This series of American Health Primers is prepared to diffuse as widely and cheaply as possible, among all classes, a knowledge of the elementary facts of Preventive Medicine, and the bearings and applications of the latest and best researches in every branch of Medical and Hygienic Sci- ence. They are intended incidentally to assist in curing disease, and to teach people how to take care of themselves, their children, pupils, em- plov6s, etc. They are written from an Amnrican standpoint, with especial referenco to our Climate, Sanitary Legislation and Modes of Life. Select List of Books. ) 5 NOTICES OF THE PBESS. " As each little volume of this series has reached our hands we have found each in turn practical and well-written."—New York School Journal. " Each volume of the 'American Health Primers' The Inter- Ocean has had the pleasure to commend. In their practical teachings, learning, and Bound sense, these volumes are worthy of all the compliments they have received. They teach what every man and woman should know, and yet what nine-tenths of the intelligent class are ignorant of, or at best, have but a, smattering knowledge of."—Chicago Inter-Ocean. "The series of American Health Primers deserves hearty commenda- tion. These handbooks of practical suggestion are prepared by men whose professional competence is beyond question, and, for the most part, by those who have made the subject treated the specifics study of their lives. Such was the little manual on 'Hearing,' compiled by a well-known aurist, and we now have a companion treatise, in Eyesight and How to Care for It, by Dr. George C. Harlan, surgeon to the Wills Eye Hospital. The author has contrived to make his theme intelligible and even interesting to the young by a judicious avoidance of technical language, and the occasional introduction of historical allusion. His simple and felicitous method of handling a difficult subject is conspicuous in the discussion of the diverse optical defects, both congenital and acquired, and of those injuries anddiseases by which the eyesightmaybe impaired or lost. We are of the opinion that this little work will prove of special utility to parents and all persons intrusted with thecare of the eyes."—New York Sun. "The series of American Health Primers (now entirely completed) is presenting a large body of sound advice on various subjects, in a form which is at once attractive and serviceable. The several writers seem to hit the happy mean between the too technical and the too popular. They advise in a general way, without talking in such a manner as to make their readers begin to feel their own pulses, or to tinker their bodies without medical advice."—Sunday-school Times. "Brain Work and Overwork, by Dr. H. C. Wood, Clinical Professor of Nervous Diseases in the University of Pennsylvania, to city people, will prove the most valuable work of the series. It gives, in a condensed and practical form, just that Information which is of such vital importance to sedentary men. It treats the whole subject of brain work and overwork, of rest, and recreation, and exercise in a plain and practical way, and yet with the authority of thorough and scientific knowledge. No man who values his health and his working power should fail to supply himself with this valuable little book."—State Gazette, Trenton, N.J. " An unexceptional household library."—Boston Journal of Chemistry. " Every family should have the entire series; and every man, woman, and child should carefully read each book."—Alabama Baptist. "Everybodyknows that it Is uncomfortable to be cold, but few know that undue exposure to cold shortens life, and still fewer the nature of the safe- puarrts that ought to be taken against it. . . . This little book, Winter and Its Dangers, contains a mass of well digested and practical informa- tion."—Sf. Louis Globe Democrat, In a two^jolumn review, Nov. 24th, 1881. "The whole series Is a particularly useful one, and should be added to the reference books of Academies and High Schools."—Zion'i Herald, Boston. 6 P. Blakiston, Bon & Co.'s WHAT TO DO FIRST in Accidents and Poisoning. By Charles W. Dulles, m.d. Illustrated. 18mo. Cloth. Price 50 cents. PREFACE. Whoever has seen how invaluable, in the presence of an accidentals the man or woman with a cool head, a steady hand, and some knowledge of what is best to be done, will not fail to appreciate the desirability of possess- ing these qualifications. To have them in an emergency one must acquire them before it arises, and it is with the hope of aiding any who wish to prepare themselves for such demands upon their own resources that the following suggestions have been put together. OPINIONS. " Of special praotical value, and we commend it to all."—Lutheran Ob. server. " Ought to be in everybody's hands."— Times, Philadelphia. WATER ANALYSIS For Sanitary Purposes; With Hints for the Interpretation of Results. By E. Frankland, ph.d., D.o.l. With Illustrations, Tables, etc., etc. 12mo. Cloth. $1.00. " The name of the author, who is a distinguished Chemist, and has had great experience in sanitary matters, is a sufficient testimonial to its ac- curacy and its great practioal value."— Boston Journal of Chemistry. EYESIGHT, GOOD AND BAD. The Preservation of Vision. By Robert Brndenel Carter, m.d., f.r.o.s. Second Edition. With many explanatory Hlustrations. 12mo. Price: papir covers, 75c; cloth, $1.26. PREFACE. A large portion of the time of every ophthalmic surgeon is ocoupied, day after day, in repeating to successive patients precepts and injunctions which ought to be universally known and understood. The following pages contain an endeavor to make these precepts and injunctions, and the reasons for them, plainly intelligible to those who are most concerned in their observance. WHAT 18 THOUGHT OF IT. "A very valuable book, and should be in everybody's hands."— North American. " A valuable book for all who are interested in the best use and preser- vation of the vision."— N. E. Journal of Education. " A compact volume, full of information to all classes of people."—Book- seller and Stationer. "A comprehensive treatise, well calculated to educate the public."— Kansas City Review. " Gives excellent advice."—Chicago Journal. " To teachers particularly the book is of interest and importance."— Educational Weekly. Select List of Books. i ON SLIGHT AILMENTS. Their Nature and Treatment. By Lionel S. Beale, m.d. Large 12mo. Cloth. Price Among civilized nations a perfectly healthy individual seems to be the exception rather than the rule ; almost every one has experienced very fre- quent departures, of one kind or another, from the healthy state; in most instances these derangements are slight, though perhaps showing very grave symptoms, needing a plain but quick remedy. CONDENSATION OF CONTENTS. The Tongue in Health and Slight Ailments, Appetite, Nausea, Thirst, Hunger, Indigestion, its Nature and Treatment, Dyspepsia, Constipation,1 and its Treatment, Diarrhoea, Vertigo, Giddiness, Biliousness, Sick Head- ache, Neuralgia, Rheumatism, on the Feverish and Inflammatory State, the Changes in Fever and Inflammation, Common Forms of Slight Inflam- mation, Nervousness, Wakefulness, Restlessness, etc., etc. OPINIONS. "It abounds in information and advice, and is written for popular use."— Philadelphia Bulletin. " Singularly clear and felicitous."—Sanitarian. "A valuable work for the family library."—Boston Transcript. " A thoroughly practical work for non-professional as well as medical readers."—Cincinnati Gazette. "A scholarly book, singularly free from all technicalities, and almost as valuable to general readers as to the profession."—Chicago Inter-Ocean. "Clear, practical, and a valuable instructor and guide."—Baltimore Ga- zette. "The advice given as to treatment is so excellent, that no student or young practitioner should neglect to read it."—Med. and Surgical Reporter. " In a very important sense, a popular book."— Chicago Advance. "An admirable treatise upon the minor Ills which flesh is heir to."__ Springfield Republican. WHAT EVERY MOTHER SHOULD KNOW. By Edward Ellis, m.d., Author of a Practical Manual on the Diseases of Children. 16mo. Cloth. Price 75 cents. "As it is only too true that our children have to dodge through the early part of life as through a sort of pathological labyrinth, we must be thank- ful to meet with such a sensible guide for them as Dr. Ellis. He is emi- nently a practitioner among doctors, and a doctor among practitioners; that is to say, he is learned and well knows what is known, can do what should be done, and can put what he has to say in plain and comprehensive language."—Pall Mall Gazette. " The author has a faculty of sketching out the characteristics of dis- eases and their treatment in striking outlines, and of making his points very clear and impressive."— N. Y. Medical Record. 8 P. Blakiston, Son & Co.'s DRUGS THAT ENSLAVE. The Opium, Morphine, Chloral, and Hashisch Habits. By H. H. Kane, m.d., of New York City. One volume. 12mo. With Illustrations. Price $1.50. A curse that is daily spreading, that is daily rejoicing in an Increased number of victims, that entangles in its hideous meshes such great men aa Coleridge, De Quincey, William Blair, Robert Hall, John Randolph, and William Wilberforce, besides thousands of others whose vice is unknown, should demand a searching and scientific examination. " A vivid and startling expose of the increase of this form of Intemper- ance, and the terrible sufferings endured by those trying to free them- selves from this habit."—Pittsburg Telegraph. " It is well that such a warning as is contained in this book should be Bounded."—Albany Evening Journal. "The volume seems to be a summary of the results of the most approved practice, both in Europe and this country."—New York World. " A work of more than ordinary ability and careful research. . . . For the first time, reliable statistics on the use of chloral are classified and published. . . . And it is shown that the use of chloral causes a more complete and rapid ruin of mind and body than either opium or morphine." .^Druggists' Circular and Gazette. " The effects of the habits described are set forth boldly and clearly, and the book must have a beneficial effect. It will do still better service in de. terring persons from experimenting 'to see what it is like.'"— Charleston {S. C.) Newt and Courier. " The subject of the chloral habit has not been Investigated by any one, we believe, so thoroughly as by Dr. Kane."—Medical Record. " There is ground lor a new temperance movement here. The book is a valuable one. It is written in a practical manner, and has nothing of a sensational character."—Philadelphia Ledger. THE OCEAN AS A HEALTH RESORT. A handbook of Practical Information as to Sea Voyages, for the use of Tourists and Invalids. By Wm. S. Wilson, l.r.c.p.. Lond , m.r.c.s.e. With a Chart showing the Ocean Routes, and Illustrating the Plr sical Geo, grapby of the Sea. Crown 8vo. Price $2.50. HEALTH RESORTS. Health Resorts for the Treatment of Chronic Diseases. A Hand-Book, the result of the author's own obser- vations during: several years of health travel in many lands; con rain- ing also remarks on climatology and the use of mineral waters. By T. M. Madden, m.d. 8vo. Price $2.60. " Rarely have we encountered a book containing so much information for both invalids and pleasure seekerB."— The Sanitarian. ON NURSING. A Manual for Hospital Nurses and all engaged in attending to the sick. 4th Edition. With Recipes for Sick Room Cookery, etc. Price 76 cents. Gives complete directions for the management of the sick room, for feed- ing, washing and dosing patients, about accidents and operations, use of therometer, cupping, etc., etc., etc Select List of Books. 9 HOW TO LIVE. A GUIDE TO HEALTH AND HEALTHY HOMES. By GEORGE WILSON, M.D. Second Edition. Edited by Joseph G. Richardson, Professor of Hygiene University of Pennsylvania. 314 Pages. Price, cloth, 81.00; Paper covers, 75 Cents. SCOPE OF THE WORK. The object of the author in writing this book is to advance the art of preserving health; that is, of obtaining the most perfect action of body and mind during as long a period as is consistent with the laws of nature. Though many books have been written analogous to the subject, there is none like this; sufficiently simple, and at the same time systematic and comprehensive. A glance at the table of contents will convince the reader of its completeness and reliability as a guide to all those wishing to lead a happy, healthy and long lile. Chapter I is a general introduction to the whole subject, giving a few Btatistics in regard to death rates, and remarks showing the great number of preventable diseases and the possibility of reducing the many early deaths by a proper regard of simple health rules Chapter II is explana- tory of the different functions of the human body, for the more thorough understanding of the following chapters. Chapter 111 is headed Causes of Disease, self induced and social; treating of intemperance in food as well as drink and tobacco, mental overwork, immorality,idleness, irregular modes of living, sleep and clothing, contagious diseases, consumption, etc.; unsound food, impure air, etc., e«-«. Chapter IV is more particularly devoted to food and diet, their proper choice, digestive qualities and prepar- ation. Chapter V treats the subjects of cleanliness and clothing. It is astounding, the ignorance displayed by the majority of people on these Eoints, and Dr. Wilson gives many useful hints invaluable to every one. hapter VI is on Exercise, Recreation, etc., giving the proper amount of exercise to be taken by boys and girls, young and old, explaining its necessity and good effects ; details are also given lor the proper training for racing and athletic sports as recommended at various universities. Chapter VII treats of the more general theme of the Home and its sur- roundings, drainage, water supply, ventilation, warming, outside premises, and innumerable hints of value about choosing or building a new home and the alteration and healthful arrangement of an old one. Chapter vm, Diseases and their prevention, and concluding remarks. Only an outline of the scope of this book can be had from these few gen- eral headings, but it would be impossible to give In so limited a space the thousand and one subjects handled, popular errors corrected, and useful hints given by Dr. Wilson, in these three hundred and fourteen closely printed pages. A general index completes the volume, and the well known name of Prof. Richardson on the title page, as editor, is an additional guar- antee of its trustworthiness as a guide in all things relative to health and How we should live. <* PRESS NOTICES. " The book aims at the prevention of Disease. It abounds in sensible suggestions, and will prove a reliable guide."— Churchman. " A most useful and, in every way, acceptable book."—New York Herald. " Full of good sense and sound advice."—Educational Weekly. " Deserves wide and general circulation."— Chicago Tribune. 10 p. Blakiston, Son & Co.'s ON HEADACHES. The Nature, Causes, and Treatment of Headaches. By Wm. H. Day, m.d. Third Edition, niustrated. Price, in paper covers, 76 cents ; cloth, $1.26 "The work is one that will be read with interest by those who are called on to treat the disease—and even more by those who are at the same time personally acquainted with its tortures."— Ohio Medical Recorder. THE MANUFACTURE OF PERFUMES, POWDERS, Soaps, etc. The Art of Perfumery ; or, the Methods of Obtaining the Odors of Plants, and Instruction for the Manufacture of Perfumery, Dentifrices, Soap, Scented Powders, Odorous Vinegars and Sal is, Snuff, Cosmetics, etc., etc. By Q. W. Septimus Piesse. Fourth Edi- tion. Enlarged. 366 Illustrations. 8vo. Cloth. Price 85.60 " An excellent book "—Commercial Advertiser. " It is the best book on Perfumery yet published."—Scientific American. " Exceedingly useful."—Journal of Chemistry. " Is in the fullest sense comprehensive."—Medical Record. POISONS AND THEIR ANTIDOTES. A Memoranda of Poisons and their Antidotes and Tests. By Dr. Thomas Hawkes Tan- ner. Fourth Edition. Revised and Enlarged. Price 76 cents. This most complete manual should be within reach of all; for, as an addi- tion to every family library it would be the means of saving life and allay- ing pain when the delay of sending for a physician would prove fatal. It shows at a glance the treatment to be adopted in each particular instance of poisoning. INTERMARRIAGE. A Scientific Inquiry into the Causes why Beauty, Health, and Intellect result from certain unions, and Deform- ity, Disease, and Insanity from others. By Alexander Walker. Illus- trated. 12mo. Cloth. Price $1.00 The work is not of that empiric character which its title might lead some readers to suppose : but a careful philosophical treatise. It is entitled to great consideration; and even if the author's theory as applied to the hu- man species be wrong, the facts here accumulated, on the subject of cross breeding, etc., cannot fail to be of high value and interest to stock farmers and others. There is nothing indelicate in the work, to an enlightened reader. MARRIAGE, In its Social, Moral and Physical Relations. By Dr. Michael Ryan, Member of the Royal College of Physicians and Sur- geons, London. 12mo. Cloth. Price $1.00 DANGERS TO HEALTH. »A Pictorial Guide to Sanitary Defects, showing the many defects in Sewers, Drain Pipes, etc, and how they may be detected. By T. Pridgin Teale. 8vo. Illustrated. Price $3 60 With 70 illustrations, most of them colored, showing in the clearest way the dangers to health arising from carelessly laid drains and old sewers. If any testimony is needed to show the increasing interest taken by the publio in such commonplace matters as drains and waste pipes, it is to be found in the faot that two large editions of this book have already been sold. Select List of Books. 11 LONG LIFE. The Art of Prolonginff Life. By C. W. Hufe- land. New Edition. Edited by Erasmus Wilson, m.d. 12mo. Price 81.00 "We wish all doctors and all their intelligent clients would read it, for surely its persual would be attended with pleasure and benefit."— Ameri. can Practitioner. " We all desire long life, and the attainment of that object, as far as it can be accomplished by an adherence to the laws prescribed by nature, may be furthered by a perusal of Dr. Hufeland's book, which is written in a Btyle so perspicuous and free from technicalities as to be readily compre- hended by non-professional readers."—Philadelphia Evening Bulletin. "The work is a rational and well ordered presentment on a subject of moment to all. It prescribes no panacea, but puts in requisition instru- mentalities that are in everyone's reach. It should be read by all."—North American. ALCOHOL AND TOBACCO. Alcohol; its Place and Power. By James Miller, f.r.o.s.; and, Tobacco; its Use and Abuse. By John Lizars, m.a. The two essays in one volume. Cloth, Price $1.00 Either essay separately. Price 50 cents. " A perusal of this work rather startles a smoker and chewer, and gives one an idea of the silent work going on in the system. It certainly shows that a man must sooner or later feel the pernicious Influences of alcohol and tobacco. Let smokers and absorbers read it, and then make their cal- culations on the length of time they will last under a continuation of the evils, and whether it is not best to heed the facts there laid down and ' mod- erate' a little."—Californian. " They are full of good, strong, medical sense, and ought to be very influ- ential agents against the vices they assault."—Congregationalist. "We have seldom read an abler appeal against the demon of intemper- ance, or one enforced by more cogent arguments."— Philadelphia Inquirer. THE MENTAL CULTURE AND TRAINING OF CHIL- dren. By Pye Henry Chavasse. 12mo. Price $1.00; paper cover, 60 cts. The mental culture and training of children is of immense importance. Many children are so wretchedly trained, or rather, not trained at all, and so mismanaged, that a few thoughts on this subject cannot be thrown away, even upon the most careful. ON INDIGESTION. Indigestion: What It Is ; What It Leads To; and a New Method of Treating It. By John Beadnell Gill, m.d. Second Edition. 12mo. Price $1.25 " Indigestion, pure and simple, is responsible for almost all the other dis- eases that flesh is heir to. Rheumatism and gout are the direct conse- §uences of this disorder, as well as heart and lung troubles. To cure this iseased state of digestive and assimilating organs Dr. Gill, a distinguished English physician, has written this able treatise. He has summed up some eighty-eight cases and their natural remedies, besides a system of eliminants and tonics. Great stress is laid on proper bathing, as a curative agent, and on drinking hot water and its other uses. The fact of a second edition being required within a few months of the firet, needs no comment, and points the demand."—Philadelphia Ledger. 12 c~ P. Blakiston, Son & Co.'s RULES OF ORDER; A LEGISLATIVE MANUAL. Rules for Conducting Business in Meetings of Societies, Legislative Bodies, Town and Ward Meetings, etc. By Benj. Mathias, a.m. Seventeenth Edition. 16mo. Cloth. Price 50 cts. DOMESTIC MEDICINE. A Condensed Compend of Domes- tic Medicine, and Companion to the Medicine CheBt. By Drs. Savory and Moore. Illustrated. 32mo. Cloth? Price 60 cents. ON HEADACHES. Ninth Thousand. Headaches, Their Causes, Nature and Treatment. By Henry C. Wright, m.d. Cloth. Price 50 cents. CHEMISTRY PRIMER. A Primer of Chemistry, including Analysis. By Arthur Vacher. 18mo. Cloth. Price 60 cents. PRACTICAL MINERALOGY. Practical Mineralogy, Assay- ing and Mining, with a description of the Useful Minerals, and in- structions for Assaying and Mining according to the simplest methods. By Frederick Overman. 12mo. Cloth. Prioe $1.00 ON COPPER. The Chemistry and Metallurgy of Copper; the art of mining and preparing ores for market, and the various pro- cesses of Copper Smelting, etc. By A. Snowden Piggott, Analytical and Consulting Chemist. Illustrated. 12mo. Cloth. Price $1.00 THE MICROSCOPIST. A Manual of Microscopy, and Com- pendium of Microscopic Sciences, Micro-Mineralogy, Micro-Chemistry, Biology, Histology, etc. By Joseph H. Wythe, a m., m.d. Fourth Edition. 252 Illustrations. 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