entious physician becomes anxious to know if there is any better method that he can employ in justice to his patients.

We are, therefore, much gratified to be able to place before our readers the following article written by Prof. Wm. F. Waugh, who has taken pains to inform himself upon this subject, and whose opinion is valuable and decisive:

The inner history of the vast majority of the successful nostrums vended to the public would show that they are composed of ingredients perfectly well known to the medical profession. These keen-witted gentlemen get hold of a well designed prescription, perhaps originally put together by one of the great men of the profession, and exploit it with all the tremendous power of printer's ink. When the formula is made known every one is surprised to find that the ingredients are those in every day use. A highly successful advertiser once told me he proposed to put on the market a series of "best remedies" for every disease, for the use of physicians. "Will you keep the formula secret?" I askea. "Certainly," he replied, "the best remedy is often the one most commonly used, but if the doctor knows, for instance, that we are giving him salicylates for rheumatism he will not buy it; whereas, if we disguise it so that he does not recognize it, he will use it forever."

Some time ago my attention was attracted to the flaring posters announcing the merits of a new and wonderful method of treating hernia, producing a radical cure without the use of knife or ligature, etc. The company had opened its offices in this city, as well as in several others. Desirous of ascertaining whether there was really a new discovery at the bottom of the scheme, I sent one of my assistants to interview the advertisers. He found them occupying a nicely furnished suite of offices in one of our prominent office buildings. All the appointments were quiet, in good taste, such as would probably impress the visitor favorably. None of those waiting in the reception room had the appearance of belonging to the class who could pay the charges of the company. When his turn came, our representative was ushered into the doctor's office. The ostensible object of the visit was stated; an uncle of the visitor was affected with hernia. The doctor would not say whether the case could be cured until he had had an opportunity to examine it personally. Not all cases were suited to this method of treatment; in fact, a careful selection was made and only such

cases were accepted as he felt so confident of curing that he was willing to guarantee that happy result. In such a case, the money could be deposited in a bank, subject to the terms of the guarantee; in case of failure to be returned to the patient, less the costs of drugs, apparatus, etc., which had been employed in the treatment of the case. This deduction was left indeterminate, and could of course, be made large or small at the discretion of the company. My assistant was unable to secure a copy of the guarantee, and I am therefore unable to say whether it really guaranteed anything at all. I doubt if one of these advertising concerns puts out a guarantee that really binds it to anything whatever; and while people have sued to recover their money under it, I have never known a case in which any money was recovered. In this I do not refer to the company under discussion.

The cost of treatment varied from $50 to $500, according to the case; and the doctor very wisely declined to commit himself more definitely until he had an opportunity to "size up" his customer.

My representative inquired what was the nature of the treatment, whether any cutting were done, what danger to life or as to permanent disability was involved, and what was the chance of success. To this the doctor replied that no cutting whatever was done in any case accepted by them; that no danger to life or disability was incurred, and that they expected to cure every case accepted by them, and actually did cure about 97 per cent. A process was employed by which the tissues covering the hernial aperture were condensed into a substance tougher than leather. The cure would be aided by the use of a special truss of their own invention, for a longer or shorter period.

The "leather-like" consistence imparted to the tissues brings us at once to Heaton's method of injecting a preparation of oak bark.

Our readers will see that there is here no new discovery, but that these people have simply appropriated Heaton's method, which is perfectly well known to every surgeon, and have palmed it off upon the public as something of marvelous efficiency, the secret of which is known only to themselves. There is no special secret about the method, and no special choice as to the fluid to be employed. Any agent that will cause the exudation of coagulable lymph in and around the canal, if aseptic and employed with aseptic precautions, will accomplish the object;

Heaton's formula may be used until experience has suggested a better one.

The opinion of most surgeons is that the method has a very limited application. Manley, in his really valuable book on hernia, has this to say of the merits of the injection method: "Warren injected tincture of iodine, sprayed along the interior of the empty, elongated neck, or into the walls of it, or just outside, into the interspace. Gay gave this mode a thoro trial in eighteen cases; with five cures, eight benefited, and five failures." But Heaton appears to have had better success, for Manley says: "Little wonder that he was lionized, for those who came to hin with large, old, incoercible hernias, for which the most eminent surgeons could offer nothing better than a stiff truss, left Heaton cured." Heaton insisted that the four symptoms of inflammation, heat, pain, redness, and swelling, must not be caused, but simply that grade of irritation that induces the exudation of lymph. Manley limits its use to indirect inguinal hernias, of small volume, when the sac and contents can be wholly returned. He lays great stress upon absolute rest for a week or more after the operation, with low diet; but the miracle-mongers state that their treatment does not interfere with the patient's going to his business. It is scarcely fair to judge of Heaton's method by the results obtained by injecting some other fluid, like iodine, and disregarding the precautions upon which he insisted. He also required a truss to be worn for some time after the operation. It would seem that up to the present nothing better than Heaton's original method has been devised by the regular profession or by the advertisers, and that there is more value in it than has been generally admitted. Secret Nostrums and Systems.

Surgical Suggestions.

Wounds about the face may be closed by a subcutaneous ligature, and thus render a scar less likely.

Ligatures are most frequently too tightly drawn, especially in plastic operations.

In plastic operations ligatures should be removed early, or scarring will result.

For ligatures braided silk of varied sizes will answer every purpose.

Use needles a size larger than seems necessary, and see that they are smooth and sharp. Accuracy in the approximation of incised surfaces promotes healing, prevents germ development and lessens tendency to scar for

Make the wound as dry as possible before applying the final dressing.

Finely powdered acetanilid with five per cent. of aristol added makes a most satisfactory dressing powder.

If you wish to please many people you must use a yellow powder, as they are familiar, with the color of iodoform, and ascribe to the drug great "healing" powers. This whim may be favored by adding to the acetanilid powder a sufficient quantity of subgallate of bismuth, to produce the magic color. The odor of iodoform will not be required, and is produced by no known combination save C. H. I ̧.

Dust the wounds with such a powder as the foregoing, and unless there are indications to the contrary, complete the dressing with collodion and cotton.

Unless there are special indications aseptic wounds do not need redressing for eight or ten days.

Aseptic wounds progress most favorably with a dry dressing.

Infected wounds are best treated with moist dressing.

Aseptic wounds only exceptionally require drainage.

Septic wounds require drainage and irrigation with hot water.

In irrigating wounds or cavities the least possible force should be used. An elevated irrigator, such as a fountain syringe, may do great damage, because of the great force generated by the height of the body of water and the small tube through which the water passes. Special caution should be used in the irrigation of appendical abscesses. The writer has seen water forced through the limiting membrane and into the general peritoneal cavity by an error of the kind here mentioned.

Gauze soaked in 3 per cent. to 5 per cent. warm carbolic acid solution makes a most soothing and efficient poultice.

Spare neither gauze, cotton or bandage in completing a dressing, so that it may be comfortable, efficient and of pleasing appearance.

Elevate parts that have been wounded, thereby preventing oozing and discomfort.W. J. BELL, A. M., M. D., in Medical Herald.

Delays in Surgery.

While there is room for more or less improvement in every department of surgery, we may certainly congratulate ourselves upon the marvelous advance it has made within a comparatively small number of years. Many operations have been so carefully developed that we can scarcely expect more than trifling contributions to their technic, and no region of the body can be said to lie beyond the reach of our surgical skill. Our methods have attained a degree of great perfection and efficiency, but before us constantly arises a serious obstacle which consists in faulty diagnosis. We see faulty diagnosis in regard to the nature of the patient's ailment, and, far more frequently, a faulty appreciation of the proper time for surgical interference. Every practitioner is to a certain extent a surgeon, even if he performs no surgical operations, for he is compelled to acquire certain notions of surgery before he can obtain his diploma. If the general surgical instruction given to students laid greater stress upon diagnosis, operators would not so constantly be called to see cases that have gotten beyond the reach of surgical help. As was recently said by McBurney, there must in every case be a time in the development of surgical diseases which marks the passage of the condition from an operable and curable point to one in the presence of which the surgeon becomes helpless.

Greater care in diagnosis would lessen the number of inoperable cancers of the breast, in which a patient with a lump has been told to wait a few months for developments. We see cancers of the uterus in which local treatment has been continued until hysterectomy can no longer afford a prospect of cure or of even temporary relief.

In strangulated hernias we constantly see patients that have so long been subjected to persistent and unavailing efforts at taxis that a state of collapse has been reached before the operator is called in.

It is not expected that every practitioner of medicine should be an efficient surgeon; life is too short and art too long. It is necessary, however, that he should be able to recognize danger and so direct the march of events as to give the sufferer every possible chance of obtaining efficient and timely aid.

In a large number of cases in which the patient is referred too late to the surgeon, the medical adviser is. of course, not to be

blamed for the delay. The fear of operation, the hope that the condition may be relieved without one, all are factors of great importance, and patients are only too glad to wait, and only realize at the end the price of procrastination. Every surgeon has seen people who stated that they would rather die than submit to an operation, and friends and relatives are only too prone to see things from the same point of view. This tendency is one that will never disappear, and against which all our skill and best intentions must often prove unavailing, but it is the medical adviser's duty to discourage it as much as possible. It is only too easy to tell a patient to hope for amelioration, to persuade him that he can well wait for some time in order to watch future developments, and to give him a partial sense of security. Yet we all know that such a course is an unwise one, and that it is really better always to prepare patients for any emergency that may arise, even when its prospects are remote.

Delays in surgery are responsible for the fact that we see so many inoperable cases. To them is due a large proportion of the mortality of many surgical conditions, and the fact that modern surgery has not as yet been able to fully demonstrate its possibilities. Int. Jour. Surg.

The Cure of Diabetes.

For two years I have been persuaded that uric acid diathesis, diabetes, oxaluria, etc., are different phases of one single morbific entity, and since I knew of no single case truly cured on the meat diet, and since I experienced in myself the very beneficial effects of a diet exclusively vegetable, banishing wine absolutely and rendering the blood very alkaline-in myself who used to suffer in a dreadful manner, so as to almost make me attempt suicide I made bold, by way of experiment, to prescribe the same diet, exclusively vegetable, for the first case, and saw in this patient, too, the beneficial results of such a dietary. With greater hope of success I ordered the second case to take the same diet, and in him the effects have been truly marvelous. In the vegetable dietary I excluded nothing-all edible soups, peas, beans, saccharine fruits, including the grape. I allowed everything, and the results have been as above.

In my second case it was noticed that after two months of the vegetable diet the

analysis of the urine showed not only a complete absence of sugar, but the presence of many crystals of oxalate of lime, from sixty to seventy for each field under the microscope. It might seem that this was owing to the vegetable diet, especially as they had not been noticed when the urine was diabetic. And so one might fear that the patient had only changed his diabetic condition for an oxaluric one, and we would then not know how to feed him, as the exclusively meat diet and the mixed diet had done no good. But I, firmly convinced, instructed the patient to continue the vegetable diet, and the result has been that the oxalate of lime, too, has disappeared from the urine.

One certainly cannot draw decisive inferences from these two cases, especially as the etiology of diabetes is multiple; but we can, I think, conclude that many diabetics can be cured on the vegetable diet. I have under my care at present a case in which the analysis of urine shows more than 100 crystals of oxalate of lime for each field of the microscope. This patient is improving on the vegetable diet. -Pietro Lupo in Canadian Practitioner.

Phthisis and Child-Bearing.

1. Conception may take place even in advanced pulmonary tuberculosis.

2. The disease is generally held in abeyance during pregnancy, altho it may advance or even originate at this time.

3. Labor is short and easy in proportion to the severity of the disease.

4. During the puerperium a rapid advance, leading in some cases to speedy death, occurs; or the disease may originate at this time. In either case the temperature chart suggests puerperal sepsis.

5. Premature labor is more common the more advanced the disease, altho pregnancy often goes on to full term even in advanced

cases.

6. The average weight of the full-term. children and their general condition at birth is not markedly below that of children of healthy mothers, except in the rare instances. of congenital tuberculosis.-Dr. Townsend, in Boston Med. and Surg. Jour.

On Diagnosis.

It is not the end of diagnosis to determine the name of the disease from which a patient is suffering. It is a great satisfaction to know John Smith has

typhoid fever; it is much more satisfactory to know that John has typhoid fever in the second week; that he has probably no serious local lesions; that his general condition is good, and his heart sound. This expresses in a way the difference between a good diagnostician and a poor one. Some men are pleased to be able to label every case more or less accurately; this is but the first step in diagnosis. It is the clinician's duty to recognize every abnormal condition presented by a patient and the probably pathologic causes. Refined diagnosis goes still further: it makes clear the interdependence of various morbid states presented by one patient. An individual may have two distinct diseases at the same time; much more frequently the several conditions arise in sequence, one causing another, or all may be due to one underlying morbid process. We have known three clinicians of world-wide reputation make the diagnosis respectively valvular heart-disease, abdominal aneurism, organic disease of the spinal cord in the same patient; not one recognized the three conditions present or the fact general arterial disease was the underlying evil. Accurate treatment follows naturally upon accurate and ultimate diagnosis. In other cases, if inaccurate, the treatment is accidental.-Phila. Med. Jour.

A Sign of Cardiac Failure.

Henry Jackson says one of the signs of cardiac failure is of great import, namely a discrepancy between the rate of the arterial pulse and the rate of the heart beats. He has observed in many instances that in cases of extreme cardiac weakness the pulse was very slow, intermittent and irregular, while the heart was rapid, and he does not refer to cases in which it is

extremely difficult to count the pulse, as is always the case when the pulse is irregular, especially when the rhythm is irregular, but to cases in which the most accurate taking of the pulse by trained individuals does not show a rapid pulse-rate, yet examination of the heart shows that its action is

said he smoked all the time except when eating and sleeping. He went out after a few days and returned very sick, with an apex beat of 140 and a pulse of 70. There was then discoverable a slight dilatation of the heart; in the course of two weeks there was a very rapid increase in the size of that organ, and with that increase there was the development of a diastolic, regurgitant murmur in the aortic region, which was supposed at the time to be due to an acute ulcerative process in the valves. Under digitalis the heart gradually became slower, the man ended his stay in the hospital by becoming insane, and was transferred to Danvers.-Boston Medical and Surgical Journal.

The Diagnosis of Scarlet Fever.

The diagnosis of scarlet fever is not always easy, and Lindsay has very well summarized the main points to be born in mind. These are;

1. Initial vomiting, very constant in children under ten, less so above that age, and rare in measles, German measles, and diphtheria.

2. Undue frequency of pulse-say 140 or 150-out of proportion to the other symptoms.

3. The rash beginning on the upper part of the chest, over the clavicles, and about the flexures of the neck, often well marked on the back of the waist.

To discriminate between scarlatina and German measles Lindsay is in the habit of relying on the following points: In scarlatina there is initial vomiting; a brief but well marked prodromal stage, with vomiting, chills, headache, and sore throat, sometimes going on to ulceration; no early enlargement of the post-cervical glands. In German measles there is no vomiting, no prodromal stage, the rash being often the first symptom and always appearing on the face; little or no constitutional symptoms; no ulceration of the throat a very characteristic early enlargement of the post-cervical glands.Medical Age

The Country's Health.

The annual report of Surgeon-General Wyman of the Marine Hospital Service shows that during the past year, ending June 30, 1897, the country was comparatively free from epidemics as compared with some less civilized parts of the globe,

Then there is the constant friction between the Marine Hospital Service and local boards of health. For as a consequence of the yellow fever in the South, one State board of health has been compelled to resign.

The official number of cases of yellow fever reported in the Southern States during the recent epidemic, up to November 10, was 4198, with 423 deaths, and of these 1722 cases and 244 deaths were from New Orleans, and in spite of the elaborate safeguard and precautions with shot-gun quarantine and the commingling of suspects and healthy persons the disease continued until frost came.

In this connection it is interesting to note that last week Senator Caffery of Louisiana introduced a bill in Congress for a revision of the quarantine laws, the distinctive feature of which is the placing of the quarantine regulations exclusively in the hands of the national authorities.

If all those supposed to be interested in the sanitary condition of this country would forget their petty jealousies and personal ambitions and work for the prevention and extinction of disease, perhaps more would be accomplished.-Maryland Med. Jour.

Practice in the Yukon.

We notice that many practitioners who hold only United States qualifications are finding their way into the Klondike region. This locality naturally comes under the jurisdiction of the Western territorial laws, and the medical council there should see that none but duly qualified and registered medical men be allowed to settle in medical and surgical practice thruout this region. Wel hope that the proper authorities will bestir themselves in this matter without delay.Canadian Med. Review.

Antipyrin and Lactation.

For some years it has been noted that antipyrin has a great effect in diminishing