fatal to-day as it was in the time of our fathers in medicine.

In the 6th century, the physicians of Constantinople were greatly troubled at what they called the plague of drowsiness and distraction, and to-day we are seized with equal horror at seeing the same manifestions of symptoms, the only difference being that we call it by a more scientific name, and have the satisfaction of writing cerebro-spinal-meningitis in the death certificate. The late scourge of yellow fever in the South, and the prevalence of typhoid fever in our northern suburb, is a disgrace to an enlightened people.

But it is in regard to brain and nervous affections that we find the most appalling state of things. The statistics in regard to idiocy and insanity are truly startling. In the Medical Press, Dr. Downs gives some very interesting facts in regard to idiocy. There are at present in the United States, nearly as many idiots as insane, and the rate of increase nearly as rapid. In 1850, there were 15,787; in 1880, 76,895. He says that in periods of great excitement, as war or political intrigue, the per cent. of the feeble-minded has been greatly increased and is sometimes capable of being demonstrated with mathematical accuracy. Alcoholism is held responsible for much of the mental and consequent physical degeneracy. It was found that in Norway, after the removal of the spirit duty, insanity increased 50 per cent., and congenital idiocy 150 per cent. In regard to idiocy as influenced by the trades and professions of the parents, Dr. Downs found among four hundred cases with fair social cond tions, 25 per cent. children of the three learned professions, 3 per cent. were children of lawyers, 4 per cent. of physicians, and 18 per cent. children of ministers. Of the men of eminence, he found that the legal profession gives birth to 11 per cent., the medical to 9 per cent. and the clergy to 4 per cent.

It is estimated that there are now in the United States, 168,900 insane. In 1850, the ratio of insane in our population was one in 1,500-in 1860, one in 1,300-in 1870, one in 1,000, and in 1880, one in 550-an enormous increase in ten years. In comparing the statistics of our own country with England, France and Germany, we lead with a horrible majority. Eng

land has within 15 millions, as large a population as our own country, and not half the number of insane. France has a population by 13 millions less than the United States and only a trifle over half the number of insane. Germany has only 5 millions less in population, and 50 thousand less insane. Late statistics from New York State show an increase during the year '87-'88, of 710 over the last year, there being in 1888, 14,772 insane in the State of New York alone. This was the greatest increase in a year in the history of the State. The asylums are full, many over crowded. In our own State the public asylums are taxed to the utmost to care for all who apply.

These statistics show beyond a doubt that idiocy and insanity in our own country are alarmingly on the increase. The following statistics in regard to the use of narcotics, may throw some light on the cause. Dr. Hammond, in a lecture before the N. Y. Medical Society in 1885, said that in 1840, about 20 thousand pounds of opium were consumed in the United States. In 1880, 533,450 pounds were bought and used. In 1868, there were about 90,000 habitual opium eaters in the United States; now they number over 500,000, and the majority of these are women. The statistics in regard to some of the principal diseases of modern life, are almost beyond belief. In Massachusetts, for instance, the increase of death from Bright's diseases. In 1850, the mortality was 1.1 in 1,000 deaths; in 1860, 2.9; in 1870, 10.5; in 1880, 19.7, and in 1886, 30.5. The points here given are sufficient to show that we are not as a nation under the most favorable hygienic conditions, and that as regards the prevention and cure of mental diseases at least, we are far behind the principal European nations. The cause is not so easily found. Many factors combine to produce the state of things these statistics reveal. But one potent factor is clearly the demoralized condition of the medical profession in our country, and of public opinion in relation to it.

The medical profession is fast loosing the confidence of the people. The result is a rapidly increasing use of all sorts of patent medicines, full of narcotics and poisonous drugs of every description. Our drug stores are thrown open to the people→

medicine is dispensed by the 5 cts. worth, without a physician's prescription, and the country is flooded with patent medicines. Fourteen million dollars worth of patent medicines is sold annually in the United States, and it is said that ten millions more are spent in advertising these drugs. Dr. Emlen Painter, says, in-the "American Druggist," that there are 36,500 proprietary medicines in the market. He claims that they are totally unworthy the distinction of being prescribed by medical gentlemen, that they are directly at variance with scientific progress; and had they never existed, both medicine and pharmacy would have this day reached a higher place in the development of science. Our medical journals are full of advertisements of patent medicines.

Do not doctors read enough to support the journals without the aid of proprietary medicine advertisements? Our religious and literary journals are also full of these advertisements. It is stated in some of the eastern medical journals that the Open Court of this City, is the only literary paper which, to their knowledge, refuses to publish them. Sample copies of the New Ideal, another liberal journal published in Boston, show none of these advertisements. Prof. Chandler, in a strong appeal to physicians to take some steps toward remedying this evil, said: "These firms of manufacturers of patent medicines, nine out of ten, live solely by the newspapers, and sometimes are admirably managed. I know some establishments," he says, "in which there is a regular staff employed. There is the literary man who writes the letters giving marvelous accounts of marvelous cures; there is the artist who shows the patient before and after taking 22 bottles of the medicine; there is the poet, who composes poems upon the subject; there is the liar who swears to what he knows is not true, and the forger who produces testimonials from his own imagination. The real business is advertising for dupes, the medical part is a side issue."

What is the explanation of this state of things in a country claiming to be civilized? Statistics may again help us to a solution. By the latest census there were 65,000 physicians in the United States-an excess over any of the European coun

tries, of 50,000. Our land is flooded with an army of half equcated physicians, disputing among themselves until they have lost the confidence of the people. The profession is divided into so many schools and "pathies," that there is no opportunity for concerted action on a scientific basis. So much time is consumed in trying to prove each other fools and knaves, that very little is left to instruct the people in hygiene and sanitary regulations. Our colleges are to a great extent financial enterprises. Competition runs high, and students must be obtained, no matter how unfit or unprepared for entering the profession. In cities with a population which does not warrant them in supporting two colleges, are found ten and twelve, thereby so dividing the clinical material that only a very small per cent. of the students can obtain practical hospital work.

The prevailing fashion of having every idea in medicine represented by a separate college, is unique to our country. We have our allopathic and homeopathic colleges, Eclectic Schools, and Christian Science Institutes, and not long ago there was unearthed in Cincinnati a vitapathic college, whatever that may mean, with a course of instruction of four months. The citizens of Cincinnati, to their credit, were indignant at this discovery and investigated; but found the institution chartered and were helpless. In a recent address before the Chicago Medico-Legal Society, the President, Dr. Doering, said: "I question which is the greater public calamity, an occasional epidemic of cholera, or the regular recurring annual epidemic of some 4,000 doctors let loose on an innocent and unsuspecting public." During the year '86-'87, the twenty universities of Germany, graduated 847 students. In the same year the 117 colleges of the United States graduated 4,000. Truly we are a great people. What is the result of this division of medical education, this half educating principle in vogue in our country? Each physician chooses what he will learn. He studies that system of therapeutics to which he is inclined by his previous education, and in favor of which he is prejudiced by his surroundings-remains totally ignorant of any other, and wrapped in his mantle of ignorance, sits comfortably down -easily satisfies himself that in his system of therapeutics' is

comprised the whole of medical knowledge, and calmly denounces all who differ with him, as either fools or knaves.

It is time that a scientific spirit be infused into the medical profession, and if it cannot come in any other way, it must come through the law of supply and demand. Many physicians object to the popular discussion of these subjects, claiming that such a reform should come from within the profession and not from without. Very true; but they have had time enough. The subject has long been agitated by individual members of the profession, and by some of our more independent medical journals. The doctors show no encouraging symptoms of being willing to mix their own medicine, and indeed after all these centuries of drugging, it would seem but fair that the people should have a chance to mix the doctors a dose.

The "Medical Record" said not long ago in an editorial on this subject: "The discussion of this question in conventions on social topics and similar gatherings, shows the inevitable trend of public opinion. An impartial observer of the progress of medical education in this State (N. Y.), must admit that it has been retarded by the financial plan on which our colleges have been managed. The whole matter of raising the standard of medical education is in the hands of a small minority of the profession, and this minority must be influenced by public opinion." Is there any way out of this lawless state of things? How can justice be done to both the profession and the public? Clearly by establishing one standard of medical education. The public should insist that a physician should be a physician -not a "pathist" of any description. That he should understand all known systems of cure, and be intelligent enough to use what is best in all or to choose from all the best. until medical education is under the control of the State and the public demand from their medical advisers one standard, can there be any great advance in medical and sanitary science.

Not

This brings us to the last question. How can a national system of hygiene be established and what would be its limits? In seeking for a solution of this question, we cannot begin better than by noting the systems in vogue in other countries, and what is being done in our own. England has a Central Board