mother of eight children, was suddenly seized with insanity and confined in an asylum. The husband, when asked as to the cause of her insanity, said he could conceive of no possible reason. 'She was a devoted mother, was always doing something for us, was always at home, never went out of the house even on Sundays, or gadding about to the neighbors, gossiping and talking; she was the best of wives; had no ideas outside of her home.' "The husband,' said the superintendent of the asylum, 'has furnished a graphic list of the causes of his wife's insanity." -N. C. Med. Jour.

SEND to the Hastings' Truss Co., 224 South Ninth St., Philadelphia, for trusses and supporters.

IN cholera and all epidemics, the liquor drinkers are the first to die.

FOR your cases of vesical irritation use Sanmetto.

A JOKE ON THE NURSE.-This story is about Philadelphia twins. The nurse was giving them a bath. Later, hearing the children laughing in bed, she said:

"What are you children laughing about?"

"Oh, nothing," replied Edna, "only you have given Edith two baths and haven't given me any."

THE Empire Manufacturing Co., Lockport, N. Y., make a fine line of elastic bandages, abdominal supporters, umbilical trusses and woven elastic goods generally.

"Profes

THE TASTE OF IT.-Doctor's small boy. sor, I have an example in fractions I would like to have you work for me. Will you do it for me?" "Professor of Mathematics (taking out pencil and paper.)"Yes, my boy; what is it?" Small boy-"If one bottle holds two and a half ounces of quinine-got that down?" Professor-"Yes." Small boy-" Well, how does it taste?"

To those physicians who have long felt the want of an emergency case which would be conveniently carried in the pocket, they will find the case advertised by H. K. Mulford & Co., in this journal to fill this want most completely.

WE are informed that the Eclectic Medical Institute of Cincinnati has many more students than any other eclectic college in this country; also that it has more students than any other medical college in Cincinnati.

THE fourth annual meeting of "The Association of Military Surgeons of the United States," will be held in Washington, D. C., May 1st, 2d and 3d, 1894.

This national organization is composed of Medical Officers of the U. S. Army, U. S. Navy, National Guard of the United States, and the Hospital Marine Service-in whose service are many of the most celebrated and distinguished surgeons of our country. GEORGE HENDERSON,

Chairman Committee of Arrangements.

SALO-SEDATUS is a drug that is useful in cases characterized by fever and pain. Free sample by addressing the Salo-Sedatus Co., St. Louis, Mo.

DID you notice the elegant new advertisement of the Walker Pharmacal Co.? No? Well, you are missing a treat if you do not refer to it at once.

The immense success that this enterprising firm has met with in the manufacture of Phytoline, and the universal commendation accorded them by the medical profession, has induced them to put upon the market a new preparation known as Pineoline, made from the imported etherial extract of the pine needles. It possesses not only a pleasant odor, but much medicinal

virtue. It has been used by some of the most prominent dermatologists and general practitioners in this country with the very best of success.

It is indicated in all forms of skin affections and in any stage in which they may be found.

Send to the Walker Pharmacal Co., St. Louis, for reports and clinical cases on the use of Pineoline and Phytoline.

MANY physicians are recommending the use of Horlick's Malted Milk as a table drink in place of tea, coffee, cocoa, etc. The evil effects of long continued use of tea or coffee are well known, but the difficulty has been to provide a pleasant and satisfactory substitute. Malted Milk is a perfect soluble combination of pure cow's milk and an extract of malted grain, and when served either hot or iced it makes one of the most pleasant, refreshing, and nutrious drinks imaginable, little if any more expensive than the ordinary drinks, and far more healthy and nutritious for continued use. Does not stimulate, but aids digestion. Prepared by simply adding water. Address the Malted Milk Co., Racine, Wis., for samples.

DEATH AS IT IS.-Perhaps the most common mistake of the lay mind is the association of the dramatic with the conception of death. Nothing is more common than to hear from the pulpit, pictures in words of excitement, of alarm, of terror, of the death-beds of those who have not lived religious lives; yet, as a rule, if these pictures are supposed to be those of the unfortunates at the moment of death, they are utterly false. In point of fact, ninety-nine of every hundred human beings are unconscious for several hours before death comes to them; all the majesty of intellect, the tender beauty of thought or sympathy or charity, the very love for those for whom love has filled all waking thoughts, disappear. As a little baby just born into the world is but a little animal, so the sage, the philosopher, the hero, the statesman, he whose thoughts or deeds have writ themselves large in the history of the world, become but dying animals at the last. A merciful unconsciousness sets in as the mysterious force we call life slowly takes leave of its last citadel, the heart, and what is has become what was. This is death.-Cyrus Edson, in North American Re

view.

The Pil. Sumbul Comp. made by Wm. R. Warner & Co., Philadelphia, is a good treatment for the nervous diseases of women.

HORNELLSVILLE, N. Y., March 12, 1893.

I have used Freligh's Tablets, Cough and Constituent, with good results, and can recommend them to the profession. Freligh's Tonic has always given good satisfaction in my hands. H. GILBERT, M.D., Class of 1867.

THE BLACKBALL.-This is a most troublesome little globe. It may present itself to us in the form of a black ball, or in the answer, no. The fact is we use one or the other many times without thinking how serious the act is.. Before anybody deliberately votes to deprive a fellow creature of that which he so much desires the most careful thought should be given. The blackball means the discouragement and sometimes the ruin of the man who receives it; while the man who gives it may forget all about it in an hour. We cannot expect everybody to think precisely as we do; while perhaps with our aid and friendly council we may do the individual an untold amount of good. Let us be very careful how we make use of that dangerous and fatal blackball.

Use Listerine as a surgical and toilet antiseptic Address Lambert Pharmacal Co., St. Louis, Mo.

PERPOENA CHEMICAL CO.,

37 College Place, N. Y. City. GENTLEMEN :-A few weeks ago I received a physician's sample of Perpoena from you; after testing it well I like it better than any so far of the many coal tar derivatives. Most of them are so expensive (for I dispense my medicines,) I am very glad to find something that will do its work with less expense. Enclosed please find 50c. for one ounce. Yours respectfully, MRS. DR. HOLMES,

46 Union Park, Boston, Mass.

Residence, Needham, Mass.

TRY Micajah's Uterine Wafers. Send for sample to Micajah & Co., Warren, Pa.

Do not allow yourself to read a moment in any reclining position, whether in bed or on a sofa.

KENNEDY'S Extract of Pinus Canadensis, which is now made by the Rio Chemical Co., of St. Louis, has long been known in this country, chiefly from the endorsement it received from the late Dr. Marion Sims, as an efficient astringent and alterative when applied to mucous surfaces. It now seems to be coming into extensive use in England, where many medical men have reported excellent results with it in various catarrhal difficulties.

FOR "Dyspepsia Tablets" and pills and tablets generally, address, the P. J. Noyes Manufacturing Co., Lancaster, N. Í.

AN excellent hair tonic is made by scalding two ounces of black tea in a gallon of boiling water; strain and add three ounces of glycerine, tincture of cantharides, one half ounce, and bay rum, one quart. Mix well by shaking and then perfume.-Tex. Health Jour.

A SIMPLE remedy for a rough skin is to first wash the face thoroughly at night, then rub it with about a teaspoonful of cream, and let it dry in. The skin will look shiny and feel stiff at first; but in the morning you will be surprised to find how soft the skin will be. -Health and Home.

FOR digestive disturbances use Frye's Pancreo-Bismuth and Pepsin. Sample free. Geo. C. Frye, Chemist, Portland, Me.

CHAS. DAY, M.D., 79 St. Mark's Square, London, says:-I have prescribed your preparation, Iodia, with very satisfactory results. Its power of arresting discharges was very manifest in a case of leucorrhoea, and another of otorrhoea. In the latter case, the result of scarlet fever in early life, the discharge had existed for many years. The patient could distinctly feel the action of the Iodia on the part, and the discharge gradually dried up.

SYRUP of Figs is recommended as a general laxative. PENSIONS FOR PHYSICIAN'S WIDOWS.-A proper movement has been undertaken in France, where it is proposed to place the widows of medical men who die during an epidemic, while engaged in their professional duties, upon the same footing as widows of officers who die upon the battlefield, with the intention of obtaining for the one the same compensation as that provided for the other.-N. Y. Medical Journal.

MARCHAND'S Peroxide of Hydrogen is an excellent antiseptic and disinfectant.

BEHOLD, the fool saith, "Put not all thine eggs in the one basket," which is but a manner of saying, "Scatter your money and your attention;" but the

wise man saith: Put all thine eggs in the one basket and-watch that basket.

JULY 4th Statistics show that we lose more fools on this day than in all the other days of the year put together. This proves, by the number left in stock, that one Fourth of July per year is inadequate, the country has grown so.-Pudd'nhead Wilson's Calender for 1894.

SEND to the Diamond Laboratory, Naugatuck, Conn., for sample of Marshmallow Cream.

In all the affairs of life, social as well as political, courtesies of a small and trivial character are the ones which strike deepest to the grateful and appreciative heart-Henry Clay.

FOR all chronic bronchial catarrhs try fluid extract of Chekan, prepared by Parke, Davis & Co., Detroit, Mich.

TELL all your mothers and nurses to use Dr. Julius Fehr's Baby Powder.

SEND to J. Phillips, Atlanta, Ga., for fine surgical instruments at cut rates.

FOR instruction in the treatment of the morphine habit address, B. Keith & Co., 75 William St., New York, N. Y.

Do You need a good diuretic in your practice? Send to Schultze-Berge & Koechl, 79 Murray St., New York for the new diuretic, Symphorol.

USE Vinolia Cream for skin diseases characterized by itching and burning.

FELLOW's Compound Syrup of the Hypophosphites is a standard article.

REMOVAL.-We have removed to 125-137 Rees street, where, with nearly double our previous manufacturing space but much lower rent, we shall be able to give our patrons the benefit of same. Western Leather Manufacturing Co., 125-137 Rees street, Chicago.

We have always had satisfaction with the supporters and other elastic goods we have purchased of G. W. Flavell & Bro., 1005 Spring Garden St., Phila.

THE new surgical dressing, Unguentine, manufactured by the Norwich Pharmacal Company has been introduced to the profession solely on its merits. It is now used extensively in the large hospitals and is endorsed and prescribed by the leading surgeons throughout the country more generally than any other preparation of its kind on the market. They ask you to write for sample and literature and make your own personal test.

SEND to Hall & Ruckel, 216 Greenwich St., New York, for sample of Sozoderma, the antiseptic soap.

BUY your spring suit of E. O. Thompson, Phila.

ANTIKAMNIA.-This is a combination of elements belonging to the coal-tar group, and is an American product. It is a white crystalline powder, odorless, and has a slightly burning taste; soluble in hot water and in diluted alcohol, but not in cold water. It acts as antipyretic, analgesic and anodyne. The importance attached to this drug, I think, is due to its anodyne and analgesic power, and the celerity with which it acts. As an antipyretic in fevers, it acts more slowly than antipyrin, but is not attended with as much depression of the cardiac system and cyanosis. Whenever a sedative and an analgesic together is indicated, this remedy meets the demand. In severe (Continued over next leaf.)

one.

1520 Chestnut Street,

PHILADELPHIA, PA.

MAY, 1894.

No. 5.

Spring is here, and pardon us if we throw off our heavy, dark suit and appear in a lighter While the title design that we adopted beginning with January issue has been much praised, there is on the part of our correspondents, a commendable inclination toward simplicity, plainness and distinctness of design, something like the first and original one, before any change was made. The present design is an attempt in this direction, which we hope will be final. Some magazines change their title design every month; for example, the elegant and widely circulated Ladies' Home Journal. But we believe the title page should be like the face of a familiar friend, seldom changing, and only for the better, as maturer years add dignity and expression to the face. But after all, as many have written us, it is the inside that determines the value of a magazine; and if our efforts can

merit a continuance of the lavish praise that has been bestowed upon us, we should be satisfied indeed.

A Commendable Form of Specialism. One of the most valuable facts in the study of political economy is that of division of labor, whereby each worker becomes especially skilled in his own department of the work. In medicine this has thus far been practicable only in the cities, where there is enough work in each specialty to justify the worker in devoting his time exclusively to it. Yet we have long thought that less populous communities might enjoy the advantages of a form of specializing that would be equally as beneficial.

Let us suppose a town in which there are seven or eight physicians. Let each one retain his portion, as he may succeed in obtaining it, of the general family practice. In addition, let each one make special preparation for the more advanced practice of some particular specialty,. taking special course of instruction and procuring the necessary special instruments and apparatus. Let him, then, be called in by his fellow practioners in all cases of that kind of practice presenting difficulties too great for the general practitioner, and charge the fees usually received by specialists therefor.

Thus Dr. A., in the course of his general practice, encounters a case of obstetrics in which there is a marked deficiency in the size of the pelvis. Instead of sending to a distant city for expert help or himself attempting an operation for which he is illy prepared, he calls in Dr. B., the gynecologist of his community, who performs symphyseotomy or what ever other major operation best suits the case and saves two valuable lives. Dr. A., in turn, is called in by his confreres when they have an operation about the nasal passages or the throat, requiring

special skill, or a diffcult case to diagnose. Dr. C., in addition to his general practice, cultivates the special branch of orthopedic surgery. Dr. D., operative surgery; Dr. E., skin diseases; Dr. F., the eye and ear; Dr. G., nervous dis

eases.

The advantage of this method of organization of medical forces would be many, among which we gote the following:

The people of the community would be able to command better professional services. When a case has progressed beyond the ability of the general practitioner the patient has a right to the benefit of the services of a trained specialist.

Each physician in the community could pursue his practice with greater confidence, having the satisfaction of knowing that he could readily obtain the best of assistance in cases which he could not successfully manage.

Each one of these physicians will be a better specialist because of the fact of devoting a portion of his daily work to the general practice, and a better general practitioner by reason of his deeper studies in his specialty.

Some years ago, in an address before the Alumni Association of the Medico Chirurgical College, Prof. Frank Woodbury expressed the hope that the United States Government would establish a medical examining board, with power to examine voluntary applicants for a degree of "Civil Service Physician," or some other distinguishing title. This was intended only for the title of distinction, as an incentive to the ambition of the physician and to encourage him to make the highest special preparation for the practice in order to be ranked among those who had gained the distinction, and not to carry with it any special privilege. He was led to recommend this in view of the success of the government army and navy examining boards. It would be our idea, however, to have a national examining board, whose certificate should, by common consent of the authorities of the different states, be accepted as authority for practice in every state in the Union without further examination. It should be so constituted as to do justice to the adherents of each different medical sect, while requiring the most thorough

The physicians of a town in which such an organization of medical skill is effected would be able to extend their practice farther into the surrounding territory.

We hope the leading spirits of each town will take this subject up for consideration.

Order Out of Chaos.

We have in the country a great variety of medical laws, in force in the different states, as shown in the article in our last number giving a brief abstract of those laws. This gives rise to much confusion, and often to injustice. Yet it merely represents the endeavor of the people to attain that point where they may be assured that those who are allowed to practice medicine, surgery and obstetrics shall prove themselves to be well educated in the fundamental sciences of the profession. The result of these endeavors is yet far from being perfect. According to these results, one who is well qualified in one state is not qualified at all in another-and it may be in an adjoining state.

cessfully passing the examination.

In brief, the advantages of a national board. would be:

A higher standard of professional attainment will be sought by students at once, as, finally, all will prefer to apply for this certificate.

A physician holding this certificate will not be worried as to state requirements if he should contemplate moving to another state.

A physician living near a state border, holding this certificate, would have no trouble in accepting calls from across the line.

Lastly, it would be a measure of great expediency, public policy and substantial justice.

Dr. John B. Deaver, of the University of Pennsylvania, does not dilate the entire urethra for stricture of the pendant portion. He believes that there is no use in disturbing the prostatic portion, and hence possibly the prostate gland, when that portion is not involved. For the above he uses short bougies.

Articles accepted must be contributed to this journal only The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than thing else.-Ruskin.

READ. REFLECT. COMPARE. RECORD.

Appendicitis. Cancer.-Replies.

Editor MEDICAL WORLD:-As general practitioners, we have this fault to find with the surgical specialist fraternity: That while we may have treated certain affections quite satisfactorily before, just as soon as the surgeon invades any portion of the human body, all the previous methods of treatment seem to lose their efficacy and become valueless. I think there are two explanations, each of which has some truth. Firstly, when we believe our treatment is the very best, and have a certain reliance on it, that belief shows itself in our own selves and is communicated to the patient. But when we go into the game half-heartedly, prescribing drugs tentatively, feeling that we have a therapeutic right bower up our sleeves to be played if needed, the doubt is also communicated to the patient, and he, too, líke onrselves, waits for the more powerful remedy we are holding back. How much effect would we get from a drug if we were to prescribe it, saying, "I'll give you this now, and if it does not help you I'll have to fall back on a better one, which I have all ready." And we might as well say it as think it, for our patients know it all the same.

But sometimes the failure of old methods is due simply to chance. We have had a series of cases that did well; and just as we are called upon to surrender these cases to the surgeon we have one of those that could not recover without the knife.

I have recently had an illustration of this. For many years I have treated all cases of what we called "typhlitis," and "perityphlitis" by morphine, albuminous diet and hot enemas, passed as far up the bowels as I could get a tube to go. I do not know how many cases I had during my 23 years of practice, but there were a good many. All recovered. Not one

was operated upon. But in the summer of 1892 I had a similar case, treated in the same way. It got better, but not well. There remained a painful spot in the abdomen, becoming still more painful on exercise or over-eating. Several slight returns were controlled in the same way, and then he had a sudden invasion of the lungs by tubercle bacilli, occurring under such circumstances as to convince us that the abdominal disease was really a focus of tuberculosis, from which a swarm had been discharged into the lung. So that I am now forced to regret bitterly that I did not operate on this man, although it is the first case in all my practice that did not get well without operation. Is there any way by which a diagnosis could have been made, showing this to have been tubercular? Senn does not give any, and I do not know whether a microscopical examination of the feces would have helped. It might, and I shall not neglect to have this done in my next case. The patient was not tuberculous, nor was one in his family; but his mother had died of consumption of the lungs, and so had several members of the family who lived in the same house just before he moved into it.

It was evidently accidental that this case was my last. Had it been my first, I would probably have operated on a majority of all subsequent cases, and felt very little confidence in any other treatment.

In regard to Dr. Brewer's observation (page 124) upon an antagonism between vaccinia and phthisis, I think that fuller experience will show this to be a mistake. Small-pox itself proved to be a fruitful cause of tuberculosis; many of those recovering from severe attacks, doing so only to die in a short time of phthisis. Scrofula, whose relations with tuberculosis are so intimate, is much less frequent since small pox has become rare. This power to arouse to activity the latent tendency to scrofula or tuberculosis is shared by vaccinia, although I doubt the latter's power to create it, de novo. In children strongly predisposed to such disease I am very careful about vaccinating, putting it off till they are well grown, and in the best health (unless in a case of emergency) and then vaccinating in but one spot, with human virus. In fact, I try to minimize the danger, realizing that it is a choice of two evils. Vaccination with the strong bovine virus is dangerous in such cases, as I have learned by experience. I will add here that my service of five years as vaccine physician of Philadelphia, in which time I vaccinated over 10,000 persons, gave me an unusual oppor tunity to study this subject, and observe both the immediate and the ulterior effects of vaccination. With bovine virus there is a further