developt to a high state. Union men can give pointers to lawyers all day on true and sound principles of government. As to the grangers, they have lecturers who devote much time to the presentation of economic problems; and many farmers can talk all around the average lawyer on the money question, or the transportation question. In New Zealand the farmer-labor government took hold of progressiv, economic problems, including finances, the land question, etc., in a way that was bewildering to the conservativ mind-and they didn't make a single mistake; their every move was in accordance with sound and progressiv principles, resulting in a higher degree of success than had before been attained.

Before we leave this subject let us see what England is doing in this direction. The surprise of the last Parlimentary elections was the election of 53 labor candidates, divided as follows:

Taxing the Millions at the Death of the Millionaires.

Last month I quoted approvingly the part of the President's "muck rake" speech dealing with an inheritance tax on all large fortunes. My friends write me that it is strange that so many prominent men regard this as a new thing when I advocated it earnestly and in detail over ten years ago. When I have time I will hunt up and give you some of the things I wrote on this subject years ago. Also see the treatment of this subject in The Elements of Taxation" (see adv. of Equity Series). But the President's speech brought out many interesting expressions, one of which is the following, clipt from the Ledger for April 27:

ASHMAN WOULD TAX WEALTH.

JUDGE BELIEVES MILLIONAIRE SHOULD PAY DEARLY FOR

HIS HOARDS.

Judge William N. Ashman, of the Orphans' Court, told the members of the Temple College Realty Class, last night, that he believed in President Roosevelt's proposal for a tax on wealth and is in favor of putting a prohibitory tax on wealth exceeding $10,000,000.

"I am glad that our friend Roosevelt at last has come around to my theory," said Judge William N. Ashman. "President Roosevelt has, of course, never heard of me and doesn't know about my theory, but nevertheless the proposed tax on great wealth has been my theory for the last ten years. I believe that wealth, which owes the greatest part of its value to the protection it gets from the government without which wealth would dwindle away, should pay more toward the support of the government than the poor. I believe that every millionaire, say in excess of $10,000,000, should be taxt so that it would be almost prohibitory for him to accumulate more.

*

"I don't believe in the man with a thousand millions. Think of the power he has, the power to ruin parties and destroy a thousand homes. When we have fewer of the enormously rich we shall have fewer poor people. The time will come then when we shall have an old age pension, industrial insurance, a pension for the school teachers, good healthy free city amusements, shorter hours of labor, and, in short, a world that will be more like heaven than it is now."

The Literary Digest for May 12, thus gives the European view of the same subject:

WHY MULTIMILLIONAIRES DO NOT MULTIPLY IN

EUROPE.

The "muck-rake" speech of President Roosevelt has been discust with general approval by the London papers, especially that part advocating a tax on large fortunes, and the idea put forth in some sections of

the American press that the speech exprest the views of "advanced socialism" is scouted. "To English ideas," says The Pall Mall Gazette (London), "his suggestions for the regulation of private wealth scarcely overstepped the limits of the commonplace," and, indeed, " a progressiv tax on the transfer of fortunes swollen beyond healthy limits' would be a milder enactment than we have already existing in the United Kingdom." While the London Express describes the President's speech as "one of his momentous utterances," it thinks that it derived the idea from a consideration of the excellent working of our own (England's) system of death duties." The London Standard passes off Mr. Roosevelt's "muck-rake" oration simply as one of his admirable lay sermons" characterized by "his special form of public humor." In the opinion of the London Mail, "the practical difficulty of legislating in the direction suggested by Mr. Roosevelt would be to know how and where to draw the line." The Spectator approves the Presi dent's wisdom in speaking as he has done, and takes occasion to say that

"few Americans who study the political phenomena of their country are prepared to deny that the President's warning as to public danger from 'unhealthily' large fortunes is required, and should be pondered with a view to possible action. He had a right to notice this like any other cloud in the national sky."

This influential journal is then led to refer, as the papers above quoted have done, to the condition of things in Europe, especially England, where “unhealthily" large fortunes are made impossible by the statutes of the land, as well as by other influences. Thus :

"The aggregation of colossal fortunes is checkt on the European Continent by the independence of the different countries, by severe laws of distribution at death, and by the desire of the rich to enter on careers other than that of money-making. In this country free trade still checks the monopolies which are so easily secured when the world at large cannot pour in competing produce, and which on the whole furnish the most rapid methods of accumulation. Moreover, idiosyncrasy counts even in commerce, and the British multimillionaire almost invariably desires either to 'found a family,' which is a process requiring great outlays, or to achieve distinction by something other than continuous devotion to business,' which his son or other successor may probably denounce as somewhat sordid."

This will give you an idea of the book, and it will also show you what great value we are giving you for the pittance of 25 cts. This subject is on the top wave of public interest just now-it is the "dominant issue." We hope doctors will come to the front on this issue, and they can easily do so by ordering and reading this book. Address this (WORLD) office, or Equity Series, 1520 Chestnut street, Philadelphia, Pa.

In last month's "Talk," page 202, second column, fifth line, "appeal" should be repeal.

observers think that high altitudes and climatic extremes exercise a power of predisposition. Overwork, either mental or physical, is the main and most important etiologic factor. The more study that is devoted to neurasthenia, the more important becomes the mental phase of the subject. There is no pathology related to this disease or condition. The feebleness of mind and body would appear to arise in the cebrospinal axis, and especially in the very cellular constituents themselves. It appears to be purely a fatigue neurosis.

These facts and accepted theories point out the line of therapy, and aid us in interpreting the protean symptomatology. One important point in diagnosis is to remember that we find impairment, weakness, insufficiency, but never total absence or entire loss of functional power. The loss is in quantity, not quality, and is never absolute. Charcot declared headache, backache, gastro-intestinal atony, neuro-muscular weakness, cerebral depression, mental irritability, and insomnia as the fundamental symptoms of this disorder; but a host of adventitious symptoms may present themselves for exclusion. A volume could be filled with a consideration of the various phases of the symptomatology of neurasthenia, as in it, like in hysteria and in pregnancy, any symptom known to the diagnostician may be encountered. They may be groupt as motor, sensory, visual; disorders of hearing, smell and taste; gastrointestinal disturbances; circulatory disorders; secretory disorders; genital disorders; mental disturbances, etc. Anemia and emaciation are apt to develop in a long standing case, tho plumpness is occasionally observed in most inveterate examples.

Neurasthenia is essentially a chronic condition, and once well establisht is only removable by some decisiv change in the life and habits of the patient. It is prone to remissions, whether treated or untreated, and both patient and physician may be deceived into the belief that recovery has taken place. But, if the patient resumes his customary work, he speedily relapses. Nevertheless, the prognosis in neurasthenia is generally good, provided the practician can institute and maintain the indicated treatment. This presupposes perfect co-operation and absolute submission on the part of the patient, together with the financial ability to obtain the protracted rest and change of scene which are an essential part of the treatment. The prognosis, too, is directly influenced by the age at which the neurasthenia develops. Cases under twenty years of age are prone to yield readily to treatment, and, alas, to relapse speedily on resumption of the ordinary avocation; after forty the confirmed neurasthenic seldom, even temporarily, regains his full power. In the latter case it is to be remembered that the exhaustion has involved tissues and organs

which are on the decline, and which no longer command the youthful resiliency and recuperativ power they once possest.

As "irritable weakness" is the condition which confronts us, so must rest be our main curativ therapy. This rest may be partial or complete, and may even be understood to mean a certain degree of activ employment different in kind from that which induced the neurasthenic condition. A short, hot bath, with some harmless drink like hot milk, will often be sufficient to overcome the insomnia, when taken just before retiring. A cold sponge on arising (if the patient yet possess sufficient reactionary power) tones the tissues and fits him to begin a new day stimulated harmlessly. Functional derangement of any organ must be corrected, for all treatment will be frustrated if this is neglected. Neurasthenics generally dread water, either internally or externally, but hydrotherapy is one of the most successful agencies at our command, and they must be compelled to drink water freely. Outdoor recreation devoid of exertion is important. The diet must be nourishing and easily digestible; but never stimulating, for truly here nature must build for herself without artificial encouragement by agency of drugs, and stimulating food defeats its own aims. Women often respond readily and permanently to the Weir Mitchell rest cure; but men seldom tolerate it long, the forced confinement causing them to fret themselves. The benefits to be derived from the rest cure are only experienced when the practician has the services of a thoroly competent nurse specially experienced in this line of work. The mental condition requires even more tactful management than does the bodily infirmities. Suggestion here, by experienced practicians, bears fruit nobly. As a rule the neurasthenic does best at some quiet seaside resort.

The study of neurasthenia is a specialty in itself; and the successful management of the disorder requires ripened judgment, the most diplomatic tact, undaunted perseverance, and forceful personal magnetism of the highest order. The general practician possessing these qualifications who is able to command a suitable nurse, and who can select his patients according to their financial standing, can do as well as any specialist. However, the general practician unable to command an experienced neurasthenic nurse attempting to treat a patient in straitened circumstances will come to grief, and both he and his patient are to be pitied.

We have not mentioned drugs; it is not worth while. Drugs never yet have cured a neurasthenic. Certainly they are to be used when the indication is plain, but always in mild form, never in heroic dosage, and always to be suspended as quickly as possible. The indications are the same in the neuras

thenic case as in any other, except that here the patient must be imprest with a wholesome respect for their harmful possibilities.

Some Points of Value on Chloroform Outside Its Anesthetic Power.

Usually when one thinks of chloroform, it is to dismiss it from the mind as a mere agent for producing anesthesia by inhalation. Chloroform is an agent of value which may be used to advantage by the practician in his daily work in many other ways than for the induction of anesthesia. Employed in many of these indications, it is not only highly efficient but is very inexpensiv; and as the quantity required is small it may be carried easily in the emergency satchel.

In painful ulcer or superficial burn, it may be evaporated from a saucer placed under a paper cone and the fumes directed upon the lesion; it relieves the pain promptly, and may be repeated as required.

Evaporated from the palm of the hand held close to the eye, it will allay photophobia.

Poured into hot water and sprinkled upon a handkerchief, it gives relief when inhaled in cases of hay-fever, asthma, and reflex cough.

It is a powerful pulmonary antiseptic, and may be used by inhalation (a few whiffs, occasionally) in phthisis, acute nasal catarrh, bronchitis, influenza, etc.

Used internally, it is one of the best palliativ remedies for the cough of tuberculosis.

Applied to the skin, it often acts as a satisfactory anti-pruritic. Many substances intended to be used by inunction are better applied as a lotion, dissolved in chloroform.

Internally, in proper dosage, it relieves dysmenorrhea, cholera morbus, colic, and vomiting.

In saturated aqueous solution, ingested in ounce doses, it relieves nausea and quiets gaseous eructation. This dose may be repeated every 15 minutes till three or four doses are taken. It is readily prepared by shaking thoroly a dram of chloroform in a pint of water and pouring off the water after the excess of chloroform has settled to the bottom of the bottle.

In 3 to 10 drop doses, properly diluted, it tones up all the powers of the stomach, and is a satisfactory adjuvant to anti-dyspeptic medication, especially if the trouble be acute. In true cholera, it has been declared to be of more service than any other single remedy. In gastric ulcer and gastralgia it assuages the pain immediately.

Fluidextract of geranium is an efficient astringent, its action corresponding to that of tannic acid. It is devoid of unpleasant taste, and is thus well suited to infants and to adults with susceptible stomachs. It is useful in diarrhea, dysentery, cholera infantum, hemorrhages, and in relaxt conditions of any mucous membranes.

Echinacea Augustifolia.

The practician of the regular school who is perfectly satisfied with the results he obtains from the exhibition of all his remedies is sufficiently learned (?); he cannot be taught anything. We are glad that such men are the exception in the profession; but we regret that there is a considerable number who, in their longing for other remedies than those they now possess, fail to look outside arbitrary therapeutical lines.

It

Had echinacea been developt by the regular school, it would ere this have had extensiv use and popularity, because it has intrinsic merits. The man, whatever system he chooses to follow, who does not use echinacea, is losing much and is not altogether so good a doctor as he might be. It has been classed by the eclectics as an alterativ and an antiseptic; it is both of these, and more. has points of usefulness not in the command of any other alterativ, and as an antiseptic it can be employed in more different ways than any other drug employed for like purpose. Used in the latter way, it is employed both internally and externally, and the effect is prompt and pleasing. We do not know any other drug or combination of drugs of so great value in blood poison. Whether the septic process be acute or chronic, slowly progressiv or fulminant, the beneficial influence of echinacea may be observed soon after its ingestion. In uremia, septicemia, pyemia, septic fever, poisoned wounds, bites and stings of poisonous insects, etc., it is useful.

The best proof of the efficacy of the remedy is its increasing sale among physicians of other than the eclectic school, and the fact that the "regular" or homeopathic physician once using it continues to employ it. We should like to see its employment extend still further, and we urge those who have not tried it to do so at the first indication, with the assurance that it will not prove disappointing in any indicated case.

The Itemizing of Accounts.

We observe upon the billheads of many of our subscribers, statements somewhat as follows: "An itemized account can be seen at the office." This is evidence that the doctors using such stationery are binding themselves by the old "fee bill" idea. In other words, that they have utterly failed to form any conception of what their services are really worth. The words: "mile," "trip," "office consultation," etc., are no measure of the value of professional services, and are but an imperfect index to what the charge should be. The country doctor who lives in a community with bad roads will spend two hours in making a trip in disagreeable winter weather, and make the same charge for it that he made in the summer time when the roads were good and the weather pleasant,

and in the latter case he has occupied but a half hour. Where is the justice, not to mention the sense, in making such bills? The same doctor will visit a patient's home and make a vaginal examination and apply treatment to an eroded cervix; probably extract a tooth for another member of the family; likely prescribe for a third or fourth member of the same group; and finally ride home, satisfied to "charge up one trip."

Such practises, continued thru many years, and habitually employed by the majority of country practicians, have educated the laymen to believe that the physician charges "by the trip," and no matter what the nature of his services may be, has no right to charge or to expect more than the customary "fee by the mile.” Such practises are rank injustice to the profession, and hamper them in obtaining a just and proper remuneration for their services. It is worth much more to make a trip and remove a foreign body from eye, throat, or ear, than it is to make a trip to the same house and prescribe a cathartic for acute constipation, and the laity should be taught the difference.

An itemized bill has no place in the conduct of a modern medical practise except where the practician is compelled to follow due process of law to collect a just bill for services rendered, when, of course, such itemization can be demanded by the debtor. The specialists have long since cut loose from the antiquated habit of charging for the "trip" or for the "office consultation." By rendering a "lump" bill, they are able to throw a true light upon the value of their services, and the patient appreciates the fact that he is paying for skill and professional services, rather than for so many hours' time consumed by him from the working hours of a man who might as well be a plumber, so far as his method of rendering a bill is concerned. itemized bill cannot but cheapen professional services in the eye of the layman.

An

It is the duty of every practician to let his patients understand plainly that he charges for time, inconvenience, exposure, skill, and for professional services in accordance with their value and importance; that he will not make a journey of a given distance in the winter time over bad roads and in zero weather for the same fee for which he will make the same trip in pleasant weather over good roads; that he will invariably charge more for night trips than for those made in daylight; that "Sunday" work is always charged for at an advanced rate; and that he makes no charges

and it does it in a way that leaves no room for the "grouchy" patient to query or quibble over it, for when it is explained to him that the bill is not for "trips" or "office calls," but for professional services, rendered and charged for at their value, the "wind is taken out of his sails," and he is at once confused, for he himself must confess that only the physician can estimate the worth of services. See fee-bill and comments on another page of this issue.

Diet in the Treatment of Enuresis. All practicians recognize the value of withdrawing water during the evening hours in the conduct of treatment for nocturnal enuresis, but not many have given much consideration to the diet day by day. This is unquestionably an important matter, and a little attention to it will be of aid to any indicated drug therapy. The laity, indeed, intuitivly feel that diet is important, and often ask their medical adviser about it without receiving any intelligent advice on the matter.

Often enuresis is due to hyperacidity, and in such a case the adoption of a simple diet, say of bread and milk, or of some of the cereals and milk, is immediately followed by happy effect. Fruits and sweets are rigidly excluded. Condiments and highly seasoned "made" dishes are not permitted. Asparagus, parsnips, rhubarb, and other articles known to have a stimulating effect on the urinary organs are best excluded. From among the other vegetables a liberal diet may be selected, and as the case progresses toward a cure animal foods may be cautiously tried in gradually increasing quantities.

Obstetric Charges in Multiple Births. Here is a question for discussion by the WORLD family. It is one of the few ques tions of a medico-economic nature that our "family" has never brought forward for discussion. We will introduce it with the following clipping:

NO TRIPLE BILL FOR TRIPLETS.

COURT DECIDES DOCTOR HAD NO RIGHT TO INCREASE
CHARGES.

[Special Telegram to Public Ledger.]

NEW YORK, June 1.-Lawrence H. Raben, of Ozone Park, L. I., to whose home recently there came three babies, won a verdict in court today against the doctor who sent him a bill of triple size.

Doctor Sasselberg was engaged for the occasion for $18. He contended this was on the basis of a single blessing, and when the triplets arrived he made the bill an even $50. The Judge held that the doctor was entitled to $18 only for his services, but added $12 to the bill for extra medicins furnisht.

We understand it to be usually customary for the doctor to charge double for a twin birth. Should a triple charge be made for a triple birth? or in consideration of the unexpected expenses and responsibilities of the parents, should the physician make his charge extra light instead of extra heavy? Or should the doctor take the risk, and stand by the