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torous breathing. How shall we divine between the lethal effects of disease and drug ? Few recover from the congestive intermittent, and few recover from poisonous doses of quinine. How often is gelsemium prescribed in neuralgias, con- gestions of the brain, and in sthenic febrile diseases, and yet even minute doses of this drug have caused alarming symptoms: the face becomes congested, the pupils buy cheap premarin dilated, the respiration slow, the brain dizzy, and death not sel- dom follows. Copaiba is a favorite remedy with most physicians in vesical catarrh, but the continued use of copaiba renders the urine darker, and turbid, and irritates the bladder, causing micturition and sometimes hasmaturia. Typhoid fever persists, ferocious, undeviating, in spite of the fifty odd drugs prescribed by the variety of physi- cians in attendance on a given number of cases. Some buy premarin online of the patients lie muttering under the spell of alcohol, some in extreme hebetude of mind lie dazed under the swoon- ing influence of enormous doses of quinine, some lie wel- tering in the perspiration induced by antipyrin, but all who do not die before times continue to be prey of the riotous fiend just the same as if no powerful drug had been administered. .\nd yet who dare aver that active medication does not imperil the sick man's chances ? Think of the saturnalia of drugs that has been admin- istered for the relief and cure of hysteria I Ether, am- ber, amyl, assafoetida, camphor, castor, dracontium, galega, musk, narcissus, succini, purchase premarin online parthenium, lead, brom- ides, primula, ruta, houseleek, mustard, rosemary, sum- bul, tansy, linden, and thirty more. In the main, all useless, for where isolation, psychic treatment, hydro- premarin cost therapy, mechanotherapy, and perhaps electrotherapy fail, outside of the valerianates and three or four other drugs, the whole host beside but aggravate the par- oxysms. The better the diagnostician, the simpler the prescrip- tion. The physician confused by the disease defends himself with a confusion of drugs. The less confidence he has in himself, the larger the army does the general gather about him, desiring to crush by numbers where his skill cannot avail. There is a disease that ravages the earth, and many a plumed knight has gone forth to conquer it and has been himself conquered in turn. generic premarin It selects its victims in hovels and in palaces, and gloats equally upon the beg- gar, the prince, the dullard, the artist, and the poet, the lady with the camellias and the sewing-girl in her garret. Its stealthy tread is not only in countr)' byways, but it walks unseen in the populous mart. It destroys more lives than any other disease, not e.xcluding the pestilence of cholera. Like the dread Angel of the Judgment, it enters all families, chooses, and is gone. So softly has it stolen that not even the parent is aware, and the lover sees only a more ethereal beauty in the face that is soon to become but a memory in his soul. Her face is flushed with kindlings of eternity, and her eyes grow large and lustrous, and fixed in their pathos as though she held reveries with unseen bands. So rapt is she that she feels not the cruel fangs upon her vitals, and were it not for the low cough that betrays the demon at his sacrificial feast, we too should be deluded into thinking the tuberculosis had abandoned his victim. We try a hundred schemes to balk him, and to rout him from the field. Iodoform, aniline, thymol, ozone, corrosive sublimate, hydrofluoric acid, inhalations of carbolic acid, creosote, iodine, eucalyptol, turpentine, sulphurous acid, chlorine, sulphuretted hydrogen ; intra- pulmonary injections of iodol, camphor-carbolate, premarin price nap- thol, guaiacol. The introduction of the bacterium termo to war upon its natural foe, the bacillus tuberculosis : Liebrich's injections of cantharidinate of potash ; sub- cutaneous injections of goat's blood, dog's serum, Koch's tuberculin, and Brown Sequard's fluid (Shrady). But the end is the same, and unless we resort to the ameliorating influences of climate we have tortured in vain. I am aware that there are members of the profession who frequently give medicine, not so much from a belief that the patient's disease demands it, as from an astute sense of the fine moral effect it has, for their own benefit, on the man's friends. There are people who would be clamorously dissatisfied if a relative with an incurable disease should not be well dosed on his descent ; very much after the fashion of staid old sectarians in out-of- the-way neighborhoods, who would be scandalized if one should order premarin go to heaven without benefit of clergy. .A.nd then, too, it is a convenient mask to a perplexed spirit to be industriously giving something when the case is not understood. The doctor's dignity of knowledge is not questioned — he is hard at work dosing the obstinate sick man, all must be right ! '• When I have a case I do not understand," confessed an old New York professor, " I give iodide of potash." If the souls of the civilized on their last journey were suddenly rehabilitated in flesh and marched before skilful judges, it could be told in large measure to what doctors these one-time patients had belonged. One drove would be found branded with tincture of iodine wherever there had been a swelling or a pain. Some would have been snipped in their noses by the perfunctory laryngologist. Here would come a platoon wearing plasters ; another, sopped with poultices ; a third would have been blistered most cruelly by the inexorable quidnuncs that attended them. Drunkards with skins stabbed thick with Keeley's motors would go reeling by. Women without ovaries. Troops of sad wretches slain by purchase premarin fever, their stomachs MEDICAL RECORD. [July 8, 1893 corroded by generic conjugated estrogens a diversity of drugs. Hospital patients yet swathed in bandages from experimental operations on hopeless diseases. Epileptics hideous from bromism. Paralytics yet quivering and gyrating, scarce escaped from the electrician. The wan victims of phthisis elop- ing in a mist of sprays by day, and pursued by hypoder- mic spearmen at night. For after all these interminable centuries of dosing, and the ultimate skill arrived at in the profession in the selection and application of the drugs, there is no differ- ence in the mortality-rate of most diseases from what it formerly was. The death-rate for New York City in 1892 was 24, and during the week ending April ist, of the current year, it was 33.2. And for the year ending June 30, 1892, it was, in cities of over 5,000 population in New Jersey, 24.81 per thousand. In an estimated city population of 870,985, there died, below twenty years of age, 11,217 individuals, or one-seventieth of the entire population. Surely here wa.s the strongest incentive of our art to rescue the bud and promise of the race, and I doubt not the zealous activity of the apothecaries, at the instigation of the profession, while the cold, pathetic Azriel lingered : but drugs could not stay this crusade to the tomb. Upon an individual analysis of the fatal diseases in the State, for the year ending June 30th, as aforesaid, I find that 1,008 died of scarlet fever, 1,776 of diphtheria and croup, 3,575 of consumption, 5,187 of acute lung dis- eases, 2,242 of brain and nervoas diseases of children. been instructed. Governments are deaf because we our selves have never buy premarin been impressive. In those ideal commonwealths, Plato's Republic, Sir Thomas More's Utopia, Bacon's New Atlantis, Camp- enella's City of the Sun, the art of medicine was given an inferior place, while the lawmaker was exalted to the chief station. What a botch the law-maker has made in real life may be read in the uneasiness of all lands. But there is a growing anticipation as to the e,xalted mission of our profession, which is not confined to race or creed. Whether the rise and fall of great civilizations is like the lifting and subsiding of monster waves, where all premarin online at length becomes a dead smooth sea, and where at best only a certain order premarin online exaggerated undulation under the stress of fugitive storms is possible, or whether mankind, like a race of Titans, sometimes descends into hollows and caverns, or camps on the edges of deserts for an age, while it renews its strength for fresh encounters, and climbs again a higher range and wrests the secrets of nat- ure from the taciturn lips of rocks, and under the cold stars wrestles with the jealous angel of the Lord, like Jacob of old, and holding fast to the divinity conquers its blessing, time is yet too young to tell. But if we might indulge in lofty anticipations which the progress of this century would seem to justify, buy conjugated estrogens we might in our own particular art conjecture that the day will come when physicians, as a body of public men, will be the true generals of the commonwealth. To them will be con- signed the preservatio/i of the nation, the fighting and 2,457 of adult brain and spinal diseases, and 1,625 of eradication of the microscopic enemies that menace more digestive and intestinal diseases. And the number of deaths from the chief preventable diseases was 11,720. Altogether there died 32,685, out of a population of 1,511,653, or in other words, about one forty-sixth of the entire population died last year. If it were not for the foreign influx, where would New Jersey be in less than a generation, for the deaths exceeded the births by 2,058, in spite of the pharmacopoeia. But if this prodding stirs some saturnine brother to resentment, and he cries out testily: " What, then, have drugs done no good ? Are they all equally fallacious and dangerous? How are we going to practise medicine without them?" 1 must return, that you have a very inferipr idea of the profession, indeed, if doctors are only to be pill venders. That drugs have done good when wisely applied goes without question. We know that opium assuages pain, the salicylates conquer rheuma- tism, phenacetin eases headache, pepsine assists diges- tion, and that men in all diseases have been comforted by the apothecary's art. But the mortuary lists of the Board of Health can furnish no monument to the living. It was Dr. Billings' conclusion in his lecture on " Vital and Medical Statistics," in 1889, that, "although the expectation of life is greater, yet this is only true premarin mg of the earlier ages. After a man reaches twenty his expectation of life is less than it was fifty years ago, for the reason that more persons of feeble constitution are now nursed to manhood. The decrease in the general mortality is due to better care of infants, and the prevention of con- tagious diseases. So far as statistics show, there does not appear that there is any difference in the mortality-rate of most infectious diseases from what it used to be. Or if there is any difference, it is one which may be attrib- uted to the special character of the epidemic, or the age and constitution of the people." This being buy conjugated estrogens online true, what are we going to do about it? The lives of the world are submitted into our hands. We have drugged the populace well, and they have not prof- ited cheap premarin by it. Like great magicians, we have juggled with drugs, and have professed to cast out disease with pellets and fumigation, but we have not assumed the sutilimer attitude of striking at causes. Are we to be like a swarm of lawyers and churchmen, forever following precedent — invited forward by great enterprises, but plucked back- ward by ghostly hands? Here and there a lonely re- former appears, but there is no unanimity of the profes- sion. The people are apathetic because premarin tablets they have not lives and destroy more victims than all the standing armies of the world. And where a few thousands are now grudgingly doled to the science that seeks to foster the lives of men, while millions are voted annually to the art that is trained to destroy, the scale will be reversed and the public purse will be opened with alacrity to the aid of the enterprises of the guardians of the race, while the army will be cut to the smallest stipend. No one disputes now the right of the State to conserve the public health by establishing quarantines, hospitals, asylums, the regulating of travel and commerce from ports of infection, and the general jurisdiction in sani- tary affairs. It is a function that will assume vast propor- tions, and must come under the immediate control of

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