At my regular clinic, Mrs. B., age 22, appeared for the removal of a sarcoma of the right breast, on February 16, 1898. Her heart and lungs were carefully examined, as well as the condition of kidneys ascertained, and no trouble found in these organs. On the administration of ether, which was carefully attended to by Drs. L. Case and C. L. Brown, she at first developed symptoms of slight bronchial irritation, but these soon subsided and she apparently took the anesthetic very nicely. The extirpation of the breast proved very easy, enucleation being made in about five minutes, and not more than an ounce of blood was lost. Immediately after enucleation the patient became cyanosed and died despite every effort to resuscitate her.

Selections.

CHOLERA IN JAPAN.-In view of the important events happening now in the far East, any information concerning Japan is of interest. Dr. W. F. Arnold, of the United States navy, has published in the "Report of the Surgeon-General of the Navy for 1897" a most valuable paper on cholera in Japan. It is stated that the first appearance of cholera in Japan was in the year 1822, and that the disease was introduced into the country by means of Dutch ships from Java. The second epidemic outbreak, according to Japanese accounts, was from 1858 to 1860, when, if local traditions can be relied on, it caused several hundred thousand deaths. Davidson, of London, asserts that one hundred thousand deaths occurred in Tokio in one month. With the third epidemic in Japan, the reliable history of the disease begins. This happened in 1877, and was ascribed by the Japanese to an English man-of-war which put in at Yokohama, with one of her crew dead from cholera. The fourth epidemic broke out in 1881 and 1882, and the fifth in 1885 and 1886. The sixth outbreak of cholera on a large scale was in 1891 and 1892, and the seventh and last, in 1895, was without doubt a result of the war between China and Japan. Although an enormous amount of work has been done among the Japanese in

the way of instructing the common people how to avoid infection with cholera, yet there are many risks to the public health maintained everywhere in the way of primitive waterclosets, while the water supply in the large towns is defective. An unusual incident of the efforts to instil into the minds of the common people the necessity of cultivating habits likely to afford them immunity from cholera has been, says Dr. Arnold, the establishment of a microscope in a temple. It is said that the demonstration of the living organisms in water to housewives was much more impressive than were lantern exhibitions or any other means of illustration. The opinion of Davidson that cholera is of late years endemic in Japan is not in accordance with the conclusions arrived at by Dr. Arnold, who says that it would appear that the conditions of life favor the survival of the cholera vibrio the least in Japan, where the dark, hot, and crowded living-rooms of the Chinese do not exist. In general the life of the cholera vibrio is longest in dark, moist places at room temperatures."

On the other hand, Dr. Arnold goes on to say: "The primitive arrangements serving as waterclosets throughout Japan, the conservancy of human excrement, and the liability of many water supplies to contamination, are conditions as favorable to the requirements of the cholera vibrio as could have been supplied by design. Under these circumstances, there would appear to be little difficulty in understanding both the customary subsidence of cholera in Japan in the late autumn and the comparatively numerous but widely scattered cases of the year or years succeeding. Other countries, in which infection is more infrequent, have shown, and are now showing, instances of the survival of cholera vibrios that are more noteworthy than any of the recent experiences of Japan. They are not expected to become permanent homes for the cholera vibrio, whence it may be carried to yet other countries; and I doubt if Japan has much to fear in this direction."-Medical Record.

BORIC ACID, so valuable in cystitis, may cause digestive disturbances, in which case it may be given best an hour before food and at 10 P. M., making four daily doses.-Slocum, Ex.

PROFESSIONAL ETIQUETTE.-The following is told of the late Sir William Gull, and as illustrating the doctor's maxim that it is necessary before all else that the patient shall have confidence in his medical adviser. Being called in haste to a patient under the care of a very young practitioner, Sir William found that brandy-and-water was being given at intervals, with certain other treatment. The great physician carefully examined the patient, and said: "Give him another spoonful of brandy." He then retired to a private room with the young doctor in charge. "It is a case of so-and-so, he said, as soon as the door closed; you shouldn't have given brandy on any account." "But," said the junior practitioner in amazement, "I thought, Sir William, that you just told the nurse to give him another spoonful." "So I did," said the great man. "An extra spoonful of brandy won't hurt him, but we musn't destroy his confidence in you, or he'll never feel comfortable or believe anything you tell him again."-Peoria Med. Journal.

[Alas! Alas! Such "Gulls," like angels' visits, are few and far between.-ED. S. P.]

SUPRAPUBIC CYSTOTOMY.- Professor John Wyeth, in the New York Polyclinic, in speaking of suprapubic cystotomy,

says:

1. The parts of the field of operation and where the urine might flow, should be shaved.

2. The patient should rest in full extension upon a table.

3. It is of advantage to have the hips higher than the shoulders; as the weight of the intestines will be thus removed from the bladder.

4. Rectal distension is never necessary.

5. Water is the best thing with which to extend the bladder. 6. The longitudinal incision beginning one inch above the margin of the symphysis pubis and two inches long is the best. 7. Arrest hemorrhage as the operation proceeds.

8. The size of the incision in the bladder must be regulated to suit the individual case.

9. The peritoneum should be dissected up from the bladder and if cut or torn should be sutured at once with catgut.

10. Close the opening in the bladder when the case will admit of it by using catgut and the Lembert suture.

11. Pack the superficial opening with iodoform gauze and let it close by granulation.

12. The bladder must be kept empty for three days, either by frequent catherization or by leaving the instrument tied in the bladder.-Med. and Surg. Bulletin.

VEHICLE FOR CASTOR OIL.- A new method for disguising the disagreeable taste of castor oil is recommended by Klein (Pharm. Central). Fifteen to twenty grammes (say one-half fl. oz.) of the oil are mixed with a glassful of milk and heated under constant stirring. In a few minutes a perfect emulsion is had, to which is then added a little syrup of orange flowers, resulting in an active preparation of an agreeable taste. Another method consists in shaking castor oil with brown beer in a bottle, or mixing the two in a jar with a rotary motion. This is said to yield a mixture that is very agreeable to take —Times and Register. [At any rate-there is more of it.-ED. S. P.]

Editorial.

NATIONAL QUARANTINE: ASKING FOR BREAD, ARE WE

TO RECEIVE ONLY A STONE?

Almost the united voice of the medical men of the United States, emphasized by resolutions from the representative medical organizations of the country, including the American Medical Association, the American Public Health Association, and both State and local medical societies and associations have gone out in an appeal of most striking unanimity in behalf of a Department of Public Health, with a properly qualified representative of the medical profession as a member of the President's Cabinet, the Department to be organized like other departments of the National Government.

Yet, at this time, about all that is in sight, or that seems to be having favor with our national law-makers is the "Caffery Bill." This bill has been published in the Journal of the American Medical Association, Feb. 5, 1898, and is defective in that it still retains this most important and vital

question in the hands of the Marine Hospital Service, which, so far, has shown itself inadequate to meet the needs of the occasion. Furthermore, one clause in the bill, by which the rules and regulations, to be formulated by the Secretary of the Treasury, are to be enforced by the State or municipal authorities at their option, and in the event of the State and municipal authorities failing or refusing "to enforce said rules and regulattons, the President of the United States shall execute and enforce the same," will certainly result in a repetition of former dismal failures.

This clause is a "sop to the State's rights whale and will result in locking the stable door only when the horse has been stolen. If there is a need for the Chief Executive to take this matter in hand, he can surely accomplish far more satisfactory results if he alone, or through his direct representative, is fully empowered to act and is held responsible therefor. To wait the action of State or local authorities is not only dangerous, but will sooner or later prove disastrous, and if State rights are to be ignored if State and local authorities do not act, in the interests of the whole country, it would be far better to lay this pet doctrine aside ab initio, just as in case of foreign invasion of armed men, or domestic insurrection and internecine strife.

No, the "Caffery Bill" is entirely insufficient and inadequate. We should not rest until proper and adequate measures are thoroughly constituted, as they can only be by a well equipped Department of Public Health. It has been said that this is asking too much. That it is more than can be expected or more than will be granted by Congress. While in many cases "half a loaf is better than no bread," the facts have shown that a niggardly, "penny wise and pound foolish" policy has been abso. lutely worthless. State and local health authorities have an important work to do in keeping up to the highest possible hygienic standpoint their immediate vicinage. The invasion of exotic epidemic diseases, and their spread from one state to another, or from one locality to another, is beyond the preventive measures of any State or municipality, and requires National interference, yes National, with the biggest sort of N., just as do the foreign trade relations of the several States with foreign countries and nationalities. Texas cannot regulate her commerce with Mexico, the great States on our lake borders cannot control the trade relations with Canada, our Gulf States their commercial and social intercourse, with the Atlantic islands and Central American Republics, and it is no interference whatever with the State's rights theory that these matters are vested solely in the hands of the National Government. In the earlier days of this republic, with its then more sparse population, its materially limited intercourse with foreign people, and that between the States and locali ties, this great need was not apparent any more than was there a need for a Department of the Interior or Agriculture-but with the passing of time and the great increase of our population and facility of travel such needs arose, and were promptly met by those in authority. Another need now of most vital importance, as emphasized by the history of the last fourth of a century, is at hand, and shall it still be met as in the past, with meas