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own mind, to say and do many things tending to support their inordinate desires.

It is the aim of the essayist to speak, not of those cases that are easy of determination, where neither fear nor desire are strong on the part of the patient in question, but of those cases where physical and mental conditions add to the difficulty of determination.

My observation and experience are that it takes years, with the majority of us, after we have earned the title of M. D. to learn how skil fully and tactfully to turn aside the query on the part of the patient, especially in the particular classes mentioned, until such times as we may be satisfied in our own minds of the true condition existing with the case; and even then beware, for you may err, and to err under such circumstances is humiliating.

Having satisfied one's self that the patient has been exposed, the next presumptive sign to be considered is relative to menstruation.

This by some receives first consideration, for it is looked upon as a positive sign; but a little careful thought of the matter will make it apparent that it is far from being a positive sign, and, in some cases, of and by itself has little or no significance; it is of importance only when accompanied with other presumptive signs.

Cases have been reported, varying from one or two normal menstruations after conception has taken place to those that menstruate regularly during the time of pregnancy. We often meet with cases of suppression of the menses from pathological conditions. There are also cases of amenorrhea, dependent entirely upon psychological influences. Cases have been reported where the menses occurred only during the gestation period. The author has seen a number of cases where menses have come on normally, but have ceased in from three to ten years like a normal menopause, with no diagnosable cause. When this symptom, however, is associated with a proper train of other presumptive signs, it has a strong significance.

While morning sickness, with some who have borne one or more children, has a strong significance, and may be to the patient a positive sign, in a woman's first pregnancy, it is of value only in its relative. place, that is when associated with a train of other suspicious symptoms.

Mrs. B., who is the mother of thirteeen children, says that she was never able to judge accurately of her condition in any of her subsequent pregnancies by comparing her symptoms with those occurring in pre

vious ones.

The bladder irritability that is so pronounced with some is less constant than the symptom morning sickness, and yet, when associated

with other signs of a more or less positive character, is worthy of credence. The mental and emotional symptoms, while marked in some. cases, do not appear at all in others, and, in order to be of value, should be culled out and made to fit with other manifestations considerably after the order one secures a grouping of symptoms in selecting the indicated remedy.

In the primapara the changes that occur in the nipples are decidedly significant, but when one pregnancy has occurred, even though the patient may have aborted or miscarried, the nipple discoloration has come to stay, so the value of this indication is forever lost in all subsequent conceptions.

Jacquemin's. sign, the discloration or deepening in color of the mucous membrane of the vagina and cervix, while not present in all cases, is of value; it usually begins about six weeks after conception takes place, and continues to increase in intensity with the advancing period. of pregnancy until during the latter months the membranes have a cyanosed appearance.

Hegar's sign, or the softening and relative change of the cervix in its relation to the body of the uterus, is a reasonably significant sign, and much more inclined to be a universal one than some of the other early manifestations of pregnancy.

While enlargement of the body of the uterus is always bound to take place in all normal pregnancies, unless the woman is reasonably spare there is great difficulty in determining this enlargement in all directions during the first few weeks. But as pregnancy advances it becomes a factor of much greater value.

Briefly, then, if the patient has been exposed; if there is a cessation of the menses in a case that has been menstruating normally; if morning sickness is present, without some other assignable cause; if bladder irritability exists; if there is a marked change in the mental and emotional attitude of the patient; if there are changes of color in the areola about the nipples in the primapara; if there is increased turgidity in the veins of the mucous membrane of the cervix and vagina, and the texture of the cervix has lost its normal cartilaginous sensation to the touch, we are justified in looking at the case with suspicion. But, even with all these manifestations, one would not be justified in giving a positive affirmative opinion, but should keep the case under observation for a considerable time while waiting farther developments.

To you experts, specialists, and hard and hoary headed veterans in the cause, I offer an apology for consuming your time in the manner in which I have with this subject, but I know that you will grant me pardon for the possible benefit of a short paper to the younger workers.

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The editor of THE CLINIQUE is not responsible for any opinion expressed by a contributor. Contributions are respectfully solicited, and will be published whenever available, providing they are free from personalities, and are not otherwise objectionable. Articles for publication, books for review, exchanges, etc., should be sent to the editor, Room 820, 22 E. Washington St., Chicago. All business communications should be directed to the business manager, Wм. BYFORD TAYLOR, Corner of St. Clair and Erie Sts., Chicago.

Editorial.

Clean Air. With the coming of cold weather the windows go down and the pneumonia, tuberculosis and influenza death rate go up. Church pulpits are used for tuberculosis propaganda and the same churches are reeking with vile air. As a rare church attendant came out of church on the recent Tuberculosis Sunday, he remarked, "Hundreds of dollars for new decorations and carpet, and the same old air as last year.'

School children are housed in badly ventilated rooms, five hours, five days in the week. And in some buildings even yet the rule holds that "a perfect system of ventilation is regulated by the janitor in the basement, and the windows must not be opened without his permission." The forced air system has failed wretchedly in schools, libraries and in many public buildings. The ventilation of Orchestra Hall is a disgrace to the architectural firm which constructed it and a shame to the intelligence of the audience which tolerates it so uncomplainingly.

Of the public carriers, the railroads have done the best work. The cross-town street car lines are sinners of first magnitude. With ventilators tight shut, or opened only grudgingly a half inch, the traveling public is compelled to breathe again and again the emanations from hundreds of dirty lungs and dirtier skins and the odor of clothes long. unwashed. Even the new street cars are quite inadequate in ventilating space. A complaint to official who magnanimously ask for "suggestions for the improvement of the service" brings the perfectly cour

teous reply that "the matter is under consideration. Like other progressive movements, the attempt to get clean air appears to have been snowed under.

Thousands of men die annually from occupational diseases directly traceable to bad air. Thousands of families are thereby needlessly made dependent in some measure upon public charity. For every wage earner needlessly dead from a preventable disease, probably ten are incapacitated from similar cause. The waste of human resources in this country is as extravagant as the reckless waste of natural resources.

At the polls on election day some surprise was expressed that "so many physicians wore the moose button." The progressive party did not initiate the principle of conservation, but it deserves some credit for incorporating it so emphatically in its working formula.

While the fundamental principles of conservation of human life may be heredity and infant welfare, the most important question immediately at hand under existing industrial conditions is clean air.

Clean air improves nutrition and secures sleep. And these are the conditions of a good day's work. A keen sense of smell and open windows are rather essential while the architects are perfecting the mechanics of ventilation. In the schools some principals and teachers still live in subjection to the janitor and a perfect system. Others exercise their own olfactory sense and open the windows in defiance of architectural theory.

The Public Library appears to be wholly unable to cope with the problem. The Crerar Library is somewhat better, but frequently from that floor the rush of air sucked up the elevator shaft gives a foretaste of what must be the quality of atmosphere in the general reading room.

The publicity campaign in hygiene is finding adherents in the steadily increasing numbers, who discriminate against cars, lecture rooms, churches and theatres, and even against such homes as are habitually closed to fresh air.

Practically the simplest ventilator for the sleeping room in winter is the screen frame covered with cheesecloth, for the living room the board beneath the sash, or some of its many modifications, for the free entrance of air without direct current upon the inmate. The Halnemann Hospital in Philadelphia is using a ventilating sash new in this country, originating in Australia, hence called the Austral sash. There are no pulleys, no ropes. Each sash tilts inward, giving a maximum of air space and minimum of direct current. It also appeals to the adherent of conservation of human life, in that the sash revolves into the room for washing. One needs only once to see a human body

fall in a helpless crushed mass to the pavement to welcome any device. which makes unnecessary outside window washing.

Public vehicles should have adequate heat, so that open transoms should not chill the scantily clothed poor. Then the conductors ought to be instructed, drilled and inspected in efficiency in supplying fresh air. If the demand from patrons is strong enough, public buildings will be constructed on the basis of an adequate airspace to the individual, with renewal sufficient to give no odor on entering from the outdoor air. The solution lies in the continuous publicity campaign, little and often and always at it.

S. M. H.

A Lamentable Condition.-The new system of medical education, by which the student is taught almost everything except the art of practicing medicine, is already bearing fruit in that it produces an ignoble army of highly educated medical paupers. The university schools, by virtue of their violation of natural economic laws, are turning out a class of doctors who are utterly unable to practice medicine in competition with others naturally better gifted in the art. The result is that dire, poverty faces a number of technically educated physicians in whom lack of common sense and of every day gumption is an all-too conspicuous feature.

The research field, instead of the medical field, is now over-crowded. The writer speaks from knowledge when he avers that good research workers, who have had years of experience, can now be hired cheaper than letter carriers or policemen.

Yet they call this "elevating the standard!"

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C. M.

Some Medical Syllogisms.-We are taught in our universities mental discipline, such that we do not go off half cocked," as it were, under the sad influence of misdirected enthusiasm or of ill-considered impulse, but regulate our being by the strict rules of logic. Logic is power! Hence, in our consideration of medical education we gain a powerful ally if we call Logic to our aid. A few syllogisms of the Barbara, Celarent, etc., variety will here be appealed to in order to crush forever the theory that any medical education but a university one is of the least moment. Elevate the standard! Number I:

All doctors must be educated.

All doctors are originally students. .. All students must be educated.

We hope this carries weight!

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