of an inch. A style may be made of lead, silver or gold, men are as liable to be led away by fads as are members should fit easily and should be provided with a small of other professions, and the question to be determined knob or bend at the top so as to prevent its sinking in- is whether, after all, these milder means may not pos to the duct. The patient should return every few days sess a certain value, and whether their use in many to have the duct cleansed and the style replaced. If it cases would not result in as satisfactory, though not as causes no irritation it may be worn for months at a time brilliant, results as the more modern and more radical with little or no discomfort. surgical procedures.

In all of the operations above mentioned gentleness, patience and a deft hand are essential to win the confidence of the patient, and, while it is not possible to cure every case, we can do much to relieve the most annoying symptoms.

The Value of "Local Treatments."

BY J. F. BALDWIN, M.D., COLUMBUS, OHIO, Professor of Surgical Gynecology, Ohio Medical University; Gynecologist to Protestant Hospital, Etc.

Probably the most common cause assigned for the use of these local treatments was "ulceration of the womb." We now know that so-called ulceration is in a vast majority of eases due to laceration of the cervix and consequent rolling out of the lacerated surfaces together with the enlarged Nabothian follicles and thickened mucous membrane. Stimulating applications to such a surface will produce temporary benefit, and will perhaps even cause the surface to apparently heal over; but on cessation of treatment the diseased condition promptly returns to its original state and the patient has been in no ways benefited. Or if the surface remains scarred over, the source or irritation remains, and the liability to rasulting malignant degeneration. True ulceration of the cervix doubtless exists, but it is either syphilitic, tubercular, or cancerous in character. If syphilitic, local treatment is not necessary; if tubercular or cancerous, surgical procedures should be promptly instituted.

Read before the Ohio State Medical Society, June 16, 1895. Up to about twenty years ago, the work of the gyne cological specialist, in addition to an occasional ovari. otomy, plastic operations on the vagina and perineum, and the invention and application of multitudinous pessaries, consisted almost entirely in what was known as The next most common cause for local treatment was "local treatment" of his female patients. By local endometritis. If the endometritis were of a simple and treatment was meant applications to the vault of the inflammatory type, local stimulating applications doubtvagina, the cervix, and endometrium of such medica- less effected a cure; but in a great majority of cases enments in Churchill's tincture of iodine, Battey's iodized dometritis, as is now recognized, is specific in character, phenol, nitrate of silver, and occasionally the hot iron. and is best treated by dilatation, so as to secure drainIn following out these methods, which were those of age, and thorough curetting of the affected surfaces and the late Prof. Ellerslie Wallace, the writer, twenty packing with gauze to give pressure and maintain years ago, weekly transferred from one page to the drainage. Possibly there is no other disease which may next of his visiting list, the names of twelve to fifteen patients who were receiving once or twice a week these "local treatments." Now, for months at a time, his visiting list contains the name of not a single such pa tient, and what is true in his experience is true in the experience of multitudes of his brethren. Has this change been entirely salutary, or has the pendulum swung to an extreme from which it will sooner or later, part way at least, return?

be so well compared with chronic endometritis as chronic nasal catarrh; and certrinly those physicians who have made a specialty of diseases of the nose have found caustics of very little avail in the treatment of these chronic conditions. They resort quite promptly to the use of the saw and chisel to straighten a deflected septum, and to these instruments or to the curette, or sometimes to the galvanic cautery, to remove diseased membrane or the hypertrophied turbinates. Drainage here, as in endometritis, is one of the most important, considerations.

It was to determine, if possible, approximately at least, the feeling of prominent gynecologists that I instituted, some time ago, quite an extended correspon- What physician would expect to be successful in dence on this subject. A majority, indeed a large ma treating a fistula with tincture of iodine or carbolic acid jority, of those from whom replies were received have applications? Every intelligent physician well knows entirely abandoned all these forms of local treatment, that the sinus must be laid open and the fistulous tract the nearest approach to anything of the sort tolerated destroyed before he can expect to effect a cure. Now being hot-water douches and the application of tampons saturated with glycerine, boro-glyceride, ichthyol, or some similar agent. Cases not relieved by these methods are subjected to thorough dilatation, curettage and packing, or to the still more radical procedure of re moval of the appendages or of the womb itself, either by abdominal section or through the vagina.

I think we all fully appreciate the fact that medical

and then, to be sure, a recent fistula may be cured by these topical applications, but so rarely does success follow this line of treatment that the exception serves merely to prove the rule. For vulvitis and vaginitis, or for simple uterine or peri-uterine congestion, rest and hot water, simple or medicated, with hygienic measures, will accomplish about all that can be secured.

For cases of retro displacement of the uterus, or sim.

ple prolapse, if recent and uncomplicated, a properly short an early pregnancy. Indeed, I know of at least adjusted pessary will almost invariably give relief and one physician who adds somewhat materially to his inwill sometimes effect a cure. Even if adhesions are come by the use of these applications at monthly interpresent, especially if the result of post partum perito- vals among his society patients; among whom the axiom nitis, persistent tamponing of the vagina may cause that "delays are dangerous" holds good, if not in its these adhesions to disappear and permit the adjustment original sense. of a pessary. Certainly there is a field, limited to be sure, for the pessary.

CONCLUSIONS

First-Local treatment of the endometrium possesses certain inherent dangers.

Third-For chronic conditions, these usually being dependent upon either specific or septic infection, local applications will accomplish little or nothing and may do great harm, either by exciting acute inflammatory complications or by causing the postponement of more radical measures.

For cases presenting exudates in the pelvic connective tissue and thickening of the pelvic peritoneum, hot water and pressure by tampons will sometimes Second-Acute or sub-acute inflammatory conditions bring about rapid absorption and effect a cure. The of the uterus, if not specific or septic in character, may exudates which thus yield are most frequently those be treated, sometimes, with advantage by local stimuwhich are the result of post-partum inflammation. [lating applications, although if good drainage is secured When they are the result of specific infection, these the hot-water douche and glycerine tampons combined local measures will accomplish little if any good. Paint with hygienic measures will probably bring about as ing the vault of the vagina in such cases with tincture good results with less risk, with less annoyance, and of iodine or iodized phenol I have never found a benefit. with less expense. Indeed, I have never been able to attribute much bene fit to the local application of iodine to any part of the body. I know it is used widely to produce absorption of effused fluids and exudates, but I must confess that I have never seen a case in which I could clearly attrib ute any specially beneficial results to such applications. Nowhere more than in pelvic disturbances does the Fourth-In cases of adhesions from post partum in practitioner need to feel the importance of recognizing flammatory exudates, properly applied vaginal packing the constitutional origin of many local diseases. Many with some elastic material, such as absorbent wool, will complications of pelvic disorders will be found to be afford more prompt and satisfactory results than will due to local congestion, which in turn will be dependent local applications to the vaginal vault and endometrium. upon a weak heart, or obstructed portal circulation, cr to simple lack of bodily exercise. Neuralgia is said to be the cry of the nerves for better blood, and malnutri tion and anemia will be found, in many cases, to be at the foundation of pelvic complaints, associated with manifestations of hysteria and neurasthenia; and in many of these cases local treatment, by simply keeping the mind of the patient directed to the pelvic organs, greatly retards or even prevents a cure.

No paper on local treatment would be complete which did not contain some warning as to the dangers necessarily inherent to such methods. Price, Goodell, Emmet, and others have called attention to these dangers in very positive language. Some of the most com plicated cases which finally reach the gynecolagical surgeon are those whose history indicates much local tinkering and repeated attacks of more or less severe pelvic peritonitis resulting therefrom. The cotton wrapped applicator, saturated with some powerful germicide fluid, may carry, probably does, with its bane its own antidote; but less powerful applications, and especially the death dealing sound, afford no such pro tection. While I have frequently found practitioners who claim to dilate and even curette the uterus in their offices, I know of no experienced gynecologist who does not perform those operations under full anesthesia, and with as thorough aseptic precautions as he does his ab dominal sections.

In addition to the dangers of septic infection from unclean instrumente, is the danger of innocently cutting

Peripheral Neurotabes.-Dejerine (Rev. de Med., April, 1895) records the case of a man, aged 42, who developed sensory disturbances and difficulty in walking about a month after the onset of a diphtheritic angina. Two months later he presented the typical ataxia gait and Romberg's sign. The muscles of the lower extremities were not wasted and presented no trace of paralysis. The patellar and cutaneous reflexes were absent. There were no pains in the legs but a sensation of numbness in the feet. Sensation to touch, temperature, and pain was impaired over the feet and the lower two thirds of the legs. When the patient was lying down marked evidences of inco-ordination could also be obtained. In the arms there was no ataxia, but in the hands sensation was impaired as in the feet, though in a lesser degree. The pupils reacted normally, and there was no ocular paralysis; the sphincters were intact and the genital functions unimpaired. Some six weeks later the inco ordination had disap peared and the sensory disturbances had almost gone. The affection developed rapidly, the cycle being completed in three and one half months. The author thinks that the sensory nerves were alone affected. In this case the history, the absence of eye changes, and the in tegrity of the vesical functions formed the chief elements in the diagnosis. Contrary to what is usually observed in peripheral neuritis, there was no tenderness of muscles or nerve trunks.—British Medical Journal.

The luxurious life, the gorgeous toilets and feigned aristocracy are, by the way, in many instances the mere enamel or cloak for intellectual shallowness, illiteracy publication. No attention will be paid to anonymous com- of a degeneracy of the Wagnerian and similar types. and superficiality and sometimes even the forerunners

Entered at the St. Louis Postoffice as Second-Class Matter. profession.

Life in a large city, with its innumerable impressions upon the nervous system, its multiform noises and diver- The calm and peace, and the serene and sometimes sified excitements connected with its business as well as beautiful surroundings, which may be enjoyed in the social duties and many other fertile causes of that now country, away from artificial, fashionable life, will be a fashionable form of nervous bancruptcy "neurasthenia" most welcome change for many sufferers from neurasnecessitates for its average inhabitants, preeminently thenia, particularly, if they be admirers of natural,

modified by, his education and understanding of na plant, consisting of simple but highly oxidized chemical ture's forces and laws, particularly those, which govern combinations is converted, after its assimilation, into the variable forms of vegetable life As an offset to highly complicated but feebly oxidized products, formthese pleasant features of the country we will, however, ing the above enumerated constituents of the plant: be surprised by the dissatisfaction displayed by the carbohydrates, albumins, fats and ethereal oils. The younger generation of farmers, who are craving the metabolism of the plant, being, therefore, a synthetic excitement of city life to even a greater degree than process and a process of reduction by which the kinetic the metropolitan is craving rest for his tired brain and energy of the sun's rays is converted into potential nerves. The only salvation for the farmer of the fu- energy of these highly complicated constituents. ture, who wishes to be contented, will be to study the art and science of agriculture, for which the facilities are offered at agricultural schools, and it would be a great benefit to the country at large, if such schools or colleges could be attended, like the public schools, free of charge. For the prosperity of the whole country depends, to a great extent, upon the prosperity of the farmer. If he prospers, everybody else will prosper, and the prosperity and happiness of the farmer will no doubt increase with an appropriate specialistic edu. cation in his particular field of labor. With such an education, he will be more apt to be conscious of the dignity of his calling and less inclined to be dissatisfied or to envy his city cousins for his greater facilities to enjoy life.

In order to make the occupations of the farmer as attractive and interesting as even some of the most coveted city occupations, he should acquire, in addition to a fair English education, a more or less thorough knowledge of chemistry, of the morphology and phys iology of plants (which presupposes, of course, a fa miliarity with the microscope) and some knowledge of botany and zoology. There can be nothing more in teresting to the student of natural science than the study of biological processes of animal and vegetable life. The former constitute, to a large extent, the studies of the physician, and the latter should form the study of the agriculturist or scientific farmer.

The synthetic process, by which the plant is enabled to build up its body from inorganic substances, is, by the way, a proof that the first organic life upon our earth can only have been vegetable life and, in consequence of this metabolic process, the plant is enabled to exist solitarily, away from all organic life.

**

The metabolism of animal life is the opposite, an analytical process by which highly complicated, but feebly oxidized materials, carbohydrates, albumins, fats, are incorporated and changed into products of a simple chemical composition by a gradual process of oxidation, consequence of which the eventual products are: water, carbon dioxide, ammonia and a number of nitrogenous substances, e. g., urea, uric acid, etc.

in

The metabolism of animals consists, therefore, in the main, in a process of oxidation by which the potential energy of the food is converted into kinetic energy of heat and motion. It is true, that in the plant also a slight process of oxidation takes place-even at day time it absorbs some oxygen and gives off some carbon dioxide, from parts of the plant, which are not green (do not contain chlorophyll); but this process of oxida tion plays such an inferior part in the metabolism of the plant that, practically, it can not be taken into consideration when compared with the overwhelmingly predominant process of reduction.

The difference in their metabolism is the only feature by which plants and animals can be distinguished in doubtful cases and in some of the very lowest forms of life even this method of distinction seems to fail. But

A propos the metabolism of plants, a recapitulation of which will be in place in discussing this subject. The higher forms of vegetable life absorb from their it is not only the physiology of the higher order of plants, as well as the relations existing between the surroundings: water, carbon dioxide, ammonia and va rious salts; of the latter are of prime importance the bacteria of the soil and its fertility, which is of the nitrogenous chemical combinations, for instance, the greatest scientific interest and of the highest practical nitrates, which readily undergo decomposition of which importance to the farmer and his future prosperity, but ammonia is one of the products. These substances also the pathology of plants most naturally belongs to are assimulated by the plant, the main constituents of his sphere of investigation. The analogy of the studies which are carbohydrates, various albumins, fats and of the agriculturist, as they should be, to the education of ethereal oils. In the chlorophyll of the plant an ex the physician-"as it should be"-is consequently very change of gases (respiration) takes place by which, striking, and it is strange with the present overcrowd under the influence of the sun's rays, the carbon dioxing of the medical profession that the sons of farmers ide, which has been absorbed from the air, is reduced. should study medicine instead of scientific farming. The resulting carbon being retained by, and deposited in the tissues of, the plant, while the oxygen passes into the atmosphere. At night, however, an exactly oppo site process takes place: The green parts of the plant, the leaves, absorb oxygen from the air and give off carbon dioxide.

The studies of the agriculturist, the physiology and pathology of plants, with all its bearings upon practical tion as the study of animal, resp. human, physiology farming and gardening should afford as much satisfacand pathology.

What a sublime concatenation of thoughts must By this chemical process, the nourishment of the spontaneously occur to the meditating mind upon the

realization of the complicated and iuteresting metabol- make an independent living for himself and his family, ism of the leguminous plants, such as peas and beans, which derive their nutritious properties, their richness in nitrogenous compounds, their albumins (legumin) as result of the metabolic process of a parasite infecting their roots. The nitrogen combinations found in the soil being insufficient to supply this family of plants with an abundance of nitrogen, necessary to produce such nutritious fruits as peas, beans and lentils.

and at the same time, have the satisfaction of being the peer, in point of education, of the most refined metropolitan citizen. The satisfaction of rich and gorgeous toilets and the luxuries and pleasures of modern swell society, with all its jealousies and superficialities, must dwindle away when compared with the calm, peaceful and dignified life which the scientific agriculturist of the future would thus be enabled to lead.

As an offset to some of the thoughts expressed in the most excellent article of Dr. Julius Kohl, of Belleville, Ill., "The Physician of the Past, the Present and the Future-A Definition of His Social Position," published in the Journal of the American Medical Association, June 22, 1895, we would draw attention to the exceed. ingly noble calling of

THE FUTURE FARMER.

This parasite is a bacteroidal organism which enters the root hairs of the leguminous plants, producing by the consequent irritation of the cortical tissues a hypertrophied layer of cells. These cells are filled,as fast as they are produced, with large quantities of these bacteroids, which do not harm the cells, but stimulate them to intense physiological action by which large quantities of carbohydrates are taken from the plant, some of their carbon atoms combining with oxygen and water, forming carbonic acid. The nitrogenous compounds, albumins, are the result of a chemical union of the nitrogen of A proper appreciation of the dignity of occupations as, the air with some of the remainig carbon and hy. for instance, that of the scientific farmer or agriculturdrogen atoms (of the carbohydrates) in statu nascendi. ist, would probably also have an effect upon the reduc. In other words: "The energy obtained by the conver tion of the multiplicity of medical students and medical sion of carbohydrates into carbon dioxide is used in do. colleges. ing the necessary chemical work of splitting up the nitrogen molecules obtained from the air and compell. ing them to enter into combination."

The nodules thus formed by the hyperplasia of the cells gradually become disorganized and their contents are absorbed by the plant; the shell of the nodule, to gether with a few of the parasitic organisms, which have escaped destruction, being rejected as debris.

Dr. Kohl advocates a thorough classical education and examination by the State before a student is admitted to a medical college. A student, equipped with the knowledge required by such an examination, is too in telligent to allow himself to be "taken in" by the bogus medical colleges, so that the latter would be compelled to close their doors. The idea is a most practical one, and Dr. Kohl does by no means stand isolated in his views upon this subject. He has struck the keynote and suggested the only remedy against bogus colleges, the cancer of the medical profession. He has applied his ax to the roots of this malignant growth. might add, as a supplementary thought, that the framers' sons, educated as above indicated, would, if they should feel an inclination to study medicine, also avoid said bogus institutions.

We

The fertility of the soil can thus be much increased by the planting of a crop of peas and beans, and by similar application of the growing agricultural scientific knowl edge it may be with confidence expected that in the future our fields will yield a much larger quantity and better quality of vegetables, enabling the farmers to supply a much larger number of the earth's inhabitants with food, than at present, so that in spite of a prospective rapid increase of our globe's inhabitants as a consequence of If our "Summer Vacation Thoughts" are appreciated intelligent hygienic measures and the suppression of vice, this globe may become many centuries older, be- as a hint with the "fence post" that the medical profesfore the natural food supply will give out and man will sion is enormously overcrowded, we feel confident that have to take his recourse to the manufacture of artificial these lines will meet with the approbation of the vast food products by synthetic chemical processes. majority of the better element-morally and intellectually in the profession.

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*

It is honest work which dignifies, no matter whether such work be done in a log cabin or in a palace. But the scope which agriculturists have in extending the work connected with their calling is almost infinite and A Treatment for Warts.-The Lyon Medical its possibilities in results equal to the accomplishments for June 19, publishes the following formula, attributed of the highest intellects in other fields of knowledge. to Kaposi, of a mixture to be used in the treatment of The educated farmer will have no reason to envy his warts: Flowers of sulphur, 150 grains; glycerin, 375 city cousins; for his loftiest ambitions may be satisfied grains; pure acetic acid, 75 grains. Applications of this if he is enabled by a scientific education, to make ade- mixture should be made every day, and gradually the quate use of his intelligence. His future is, therefore, warts will become shriveled and dry and finally drop a bright one; for with comparatively little ground, the off. The mixture should be well shaken before it is future scientific farmer will probably be enabled to used-New York Med. Jour.