DR. C. FLETCHER SOUDER has received a great many letters from all parts of the country in regard to his article in November WORLD on the injection treatment for hernia. These letters ask for further particulars, details of the procedure, etc. As it was impossible for him to answer all in full, he wrote to nearly all the inquirers that he would cover all the points of inquiry in another article in THE WORLD. This article we expected for this issue, but we are compelled to say that it cannot be gotten ready until next issue. The doctor promises it certain for next issue.

"KNOCK out drops" around here are colorless, and are either chloral hydrate or cocaine hydrochlorate. I think it would be impossible to use laudanum on account of the bitterness, except on a drunken man.

DR. CARL FAIRBANKS.

Parkville, Mich.

The following frank expression was contained in a letter accompanying an article submitted for publication. The article is published in this issue, and it did not need much trimming:

"Now, sir, publish this if you think it worthy of a place in your journal. Shear it, correct it, rewrite it or "dump" it if your judgment so decides. I am doing the best I can here in the mud; have considerable egotism, but am willing to learn, and so will not feel hurt or sulk if I get the g. b."

THE N. Y. Cancer Hospital sends the following notice to the physician of every patient applying for treatment at that institution:

"DEAR DOCTOR: M.

has applied to enter this hospital.

been under your care; kindly let us know if you consider.. . . a proper

case for free medical treatment.
"An answer will oblige,
"Yours very truly,

"Superintendent."

THE Sec. of the Chicago Eye, Ear, Nose and Throat College writes us that they, in their clinics, adopted the same idea several months before the N. Y. institution did, and credit is asked for precedence in a practical means for discouraging clinical pauperism.

Following is the treatment employed at the Jefferson Hospital by Prof. Horwitz for Acute Anterior Urethritis, when uncomplicated: The measures are (1) hygienic, (2) local, (3) systemic. Instruct the patient to soak the penis twice daily in as hot water as can be borne. Apply dry absorbent cotton every time the urine is passed. Guard against letting the infection reach the

eye. For first few days light and nutritious diet; after that ordinary diet, excluding salt fish, salt meats, cheese, asparagus and strawberries. Keep as quiet as possible—no dancing, rowing, cycling, or horse-back riding. Take two of the following capsules, t. i. d.: R. Ol. resin. cubebæ, Parabalsam copaib,

Salol,

gr. x

gr. v

gr. v

nerve, etc.

2. Do not forget to dictate the postmortem notes while the autopsy is in progress.

3. Respect the feelings of the friends in every possible manner, and always return everything in a private house to its proper place. Be sure to leave no bloodmarks behind.

4. Be sure you have the legal right to make the post-mortem before you begin. The nearest relative, or the one who is going to pay the expenses of the funeral, should give the consent in writing.

5. Do not take away more tissue from a post mortem than you are able to thoroly work up.

6. Try to encourage a demand among the laity for the performance of autopsies.

7. In making an autopsy, have a regular method for its performance, which is only to be modified by exceptional circumstances. Finish the examination of each organ in as thoro a manner as possible before the examination of another organ is commenced.

8. Label all your specimens at once with name of person from whom the specimen is removed, character of the specimen and relations in the body, date, and preservation fluid employed.

9. If you are so unfortunate as to cut yourself, wash the wound with running water for four or five minutes, and then dress antiseptically. Do not, out of bravado, go on with the post mortem if there is anyone else present who can complete it.

10. If you are not making the autopsy

yourself, do not be too forward in making suggestions to the one who is making it; but always be ready to do anything that you are asked to do in connection with the autopsy.

II. Let your medical friends enjoy the autopsy and specimens with you.

12. Get all the post mortems you can. Never refuse to make an autopsy for another when you possibly can.

13. Tact will get you many autopsies; curiosity of relatives and friends can often be worked upon to get permission for an autopsy.

14. As the object of the autopsy is usually to find out the cause of death, either for legal or scientific purposes, the post mortem should, therefore, be conducted in as thoro a manner as possible.

15. In legal cases, be sure to protect yourself in every way. The jars, which should never have been used, containing the specimens, should be sealed in the presence of a witness.

an

16. If you value your peace of mind, do not put yourself forward as expert witness in medico-legal matters. Knowledge, which you already have, should be freely given to the court in criminal cases, but the court can not compel you to obtain expert knowledge without your consent.

17. In Germany, the legal evidence of a post mortem held by gaslight, has been judged by the court, except under certain peculiar circumstances, to be void.

18. If two persons are lifting a body, the lightest weight is at the feet.

19. Chloroform placed on a towel, and the head enveloped therein, will quickly dispose of pediculi capitis.

20. Many signs of inflammation, especially of the mucous membranes, disappear after death. Remember, red

flannel often colors the skin red.

21. Make the undertaker your friend. Do not recommend an undertaker who disapproves of post mortems.

22. It is a good knife that will keep its edge in more than one post mortem.

23. Do not jump at conclusions too quickly. Tentative diagnoses alone should be made until the post mortem is complete.

24. Always weigh the important organs, and have some method by which

you can tell the right from the left organ in case of the double ones. One nick in the left sided organ, and two in the right will readily distinguish them.

25. Wash you hands frequently during the performance of an autopsy so as not to allow the blood to dry on the skin.

26. In opening a cystic kidney, be careful that the liquid does not injure the eyes nor soil the linen, as when the kidney is opened, the liquid in the cyst is under pressure, and may squirt several

feet.

27. A duct can often be easily followed by making a nick in it and then introducing a grooved director in the direction you desire to dissect. This is especially useful in the ureters and the ductus choledochus communis.

28. In writing the account of an autopsy, describe what you see; do not use names of diseased conditions; these should be put in under the head of pathological diagnoses.

29. Wine or aromatic spirits of ammonia will best take off the odor from your hands. This odor is usually gotten from opening the intestines.

30. Ammonia will usually remove iodine stains. A weak solution of the hypobromite solution will remove carbol fuchsin and other aniline stains from the hands.

31. Any organ which you desire to save should be placed in a safe place, so that it will not be returned to the body and sewed up.

32. The dissecting room is a poor place to study pathology on account of the chloride of zinc forming with albumen an insoluble albuminate of zinc.

33. Nervous tissue for microscopic study should not be placed in zinc chloride or in alcohol.

34. Remember that a post mortem, with the exception of the brain and cord, can be made with a pen knife.

35. Remember that the thoracic and abdominal organs can be removed by the rectum or the vagina.

36. Before removing the calvarium, have a basin so placed that it will receive the blood and cerebro-spinal fluid.

cultures of micro-organisms, and microscopic slides are valuable additions to a well written account of an autopsy.

38. A lesion in one part of the body will often suggest a careful search for a lesion in another part of the body.

39. Do not mistake the normal for the abnormal.

40. Squeezing the gall-bladder after the duodenum has been laid open, will often cause bile to pass out of the papilla; the ending of the common bile-duct can

thus be demonstrated.

41. Remember that frozen sections of fresh tissue can be cut and mounted in a half hour to one hour.

42. Three hours is none too long in which to make a complete autopsy.

43. Be careful that the first rib does not scratch your hands when removing the tissues in that region; therefore, cover over the cut ends of the clavicle and ribs with the skin flaps.

44. Blood makes a good glue for affixing labels, and the blood of a person dying from hydrocyanic poisoning makes a most excellent red ink, which will keep for years without the addition of any preservative fluid.

45. Remember that after the brain has been removed the fundus of the eyes can be removed by a circular incision posteriorly, without disfigurement. The inside should then be stuffed with dark colored wool or cloth.

46. In private cases, you will frequently be judged as to your skill as a pathologist by the neatness with which you sew up the body.

47. If you discover suspicious lesions, always stop the post mortem and report the case at once to the coroner.

48. Remember, in warm weather, that the intestines are especially liable to undergo rapid decomposition when exposed to the air.

49. Remember that a railroad train or cart may pass over the body and there be no more abrasion in the skin than a brush burn.

50. Remember that the color of organs is frequently changed when exposed to the air by the oxidation of the hemoglobin; also that the sulphide of iron frequently discolors organs after death, due to the sulphuretted hydrogen during decomposi

tion precipitating the iron of the hemoglobin.

51. The clavicle can be grasped and moved, and the claviculo sternal articulation thus readily discovered.

52. In removing the cord, the following method may be used without disfigurement to the skin of the back part of the neck: Make a circular incision from the middle of the trapezius muscle of the one side to the middle of the same muscle on the other side, using as the center of the circle the external occipital protuberance; this will take you in the median line to about the second dorsal vertebra; then dissect away the skin with the muscles attached, and elevate the flap with a tenaculum and draw the shoulders backward; a sufficient amount of space will then be given to remove the cord in the usual manner.

53. If the rectus muscle on each side be cut near its origin, in the direction of Poupart's ligament, the abdominal cavity will be much more thoroughly exposed to view than in the ordinary manner; first, however, examine with the finger

for hernia.

54. And, lastly, be honest. Everyone diagnoses lesions during life which are not found at the post-mortem. Even after a most careful post-mortem, it is often impossible to tell from what the patient died.-Medical Review.

Improvement of the Race.

Thruout Brazil there prevails a remarkable and self-imposed law in relation to matrimony. It is recognized among all the higher classes. The man who is about to marry is required to furnish a certificate from one or more physicians that he is free from disease of a certain character and that he is free also from all signs of any of the diseases which are liable to be transmitted to the offspring. Not only that, but the physicians must testify that, so far as they can learn, there exists no reason to believe that the union will be other than in accord with the laws of sanitation. Such a selfimposed family law is certainly very creditable to our sister republic, and is a most worthy example for us to follow until we can have something better.

As an embodiment of an idea (which can be changed as experience may

dictate), I would suggest that the State, or, better, the Nation, appoint a medical staff of three experts for every county in the State, to examine all boys and girls at the age of from twelve to fifteen, relative to their physical condition and family history, and a record be kept of all applicants. I would have three distinct classes:

Class A Those being physically and mentally sound, of good habits, and having no history of any hereditary disease (mentioned in this paper as prohibitory to marriage) for at least three preceding generations.

Class B-Same qualifications as in class A, but family history to descend to grand parents only.

Class C must necessarily be applied to all those not included in classes A and B.

Certificates for classes A and B should be granted by the medical examiners. No one should be allowed to marry outside of the class to which he or she belongs, and those having certificates should be required, when about to marry, to make an affidavit that they are free from all communicable diseases and are temperate in their habits. This would tend to make classes A and B constantly stronger and better, and a growing desire to be so.

Class C, at first, would greatly predominate, but a few generations would suffice to make it the smallest. In those possessing hereditary taints, and deprived of the privilege of mating with the healthy, nature soon solves the problem of eliminating them.-Dr. E. T. Rulison, of Buffalo.

times a day, preferably after a fit of coughing. The Academy referred the paper to a committee to study the question.-Chem. and Drug.

Doctors and Population.

The following table, compiled by Dr. Fanny Leake, of Austin, Texas, with great pains and care, is interesting, as showing the extent to which the doctors prevail in the United States; and also throws some light upon their relative ability to deal with disease. Those States having less than 500 to each doctor, are embraced in the upper bracket; States having one doctor to 900 or more population, embraced in the lower bracket. Table showing proportion of population to the doctor-by States-with death rate in each:

course of the Amick consumption cure, and the places that once knew them will know them no more. Without doubt the Keeley cure was the means of reforming some, who wisely took advantage of this opportunity to break away from old associates and assure them that

they no longer had a desire for strong drink. But who believes to-day that the remedies employed had a particle of power to destroy an appetite, often the direct result of hereditary influences? The Quarterly Journal of Inebriety says that during the year 1896, twenty-two so-called Keeley gold cures suspended and dissolved; twenty-seven gold cure homes, where specific treatment for alcohol and opium was given, have gone out of business; five new companies have been formed to sell rights to use secret inebriate cures; three ex-superintendents of gold cure establishments have committed suicide.

To this we would add that in three years we have made notes of the relapse of nineteen physicians who have been medical directors of gold cure establishments. Ten of these persons sought treatment in regular asylums, where no specifics were used.

The editor of the Fort Wayne Medical Journal calls attention to the harmful influence which the Keeley cure exerts upon the human system as affecting the longevity of life. He says that carefully compiled statistics by life insurance companies show that the life of a Keeley Cure graduate is very materially shortened, even though the individual was not originally considered an inebriate, and in consequence several of the most prominent life insurance companies absolutely refuse to consider the application for a policy from any Keeley cure graduate, no matter in how good condition the health might be.-Nat. Med. Review.

Treatment of Strangulated Hernia.

We see in Parisian Medical Chit-Chat by T. C. M. in the Lancet and Clinic, of September 18th, that a very fashionable as well as effectual treatment of strangulated hernia in some of the European hos pitals at the present time, is a large hypodermic injection of morphia in the neighborhood of the inguinal opening,