We hope you like it. The face of a maga zine is like the face of an old and familiar friend, and it should not be changed except for distinct improvement. When, a few years ago, we changed from a plain type heading to an ornamental design, many of our readers sighed for the old plain heading. Our present change is in the direction of plainness and distinctness, yet not devoid of ornament. We hope it will be received kindly by our readers. We send this issue to a number of subscribers who have not yet renewed for 1894, that they may not forget an old friend in a new guise. In more than one department we have added to our expenses, even in the face of "hard times." It may seem strange to make improvement during

a period of financial depression, but when you consider that our readers cling to THE WORLD even closer during hard times, you can see that we can afford improvement as well now as any other time. We strive to be the proverbial "friend in need," and these are needy times. It is gratifying to know that we fulfill our chosen mission so acceptably.

Value of Efficient Sanitary Service, We wonder if the general public realizes its great debt to the hard-working, poorly-paid, self-sacrificing medical profession for that most important and nearly always unrecognized phase of its activity, the prevention of diseases and epidemics. All such work is directly against the financial interests of the profession, as reducing the amount of practice to be done, and is also a very unappreciated devotion to our higher duty to our race. This is the only example in our industrial system of a class of workers helping to destroy the market for their own services in the interests of those who would otherwise have to employ them, and shows the medical profession to be the only truly socialistic profession in our industrial field. The whole country has witnessed with interest the battle going on for the past eighteen months in New York harbor and other exposed ports between the dreadful scourge of cholera and our advance sanitary picket line, in which our scientific defenders have thus far maintained a victorious front. But we doubt whether the social and commercial world realizes what the profession has saved them in health, lives and the vast commercial and industrial interests threatened by a great epidemic. Truly, he who prevents or limits the spread of disease is greater than he who wins a hundred battles. In view of this and other examples of the value of preventive measures

55313

against disease we hope soon to see the establishment of a complete national system of sanitary service, extending down to the most remote hamlet and township in the country, scientifically qualified, thoroughly equipped and well paid, with due authority to take any necessary measures to prevent the development or extension of disease, so far as is known to sanitary science. We believe that every true physician, those in the highest sense worthy to practice the healing art, entertains these wishes for the benefit of humanity even if against the advance ment of his own temporary interests.

A National Medical College.

We note with pleasure that an Army Medical School has been established in Washington in connection with the medical department of the United States Army, for the higher scientific education of those who have in recent years been admitted into this department. We predict that it will prove as great an educational success in its sphere as are the Military Academy at West Point and the Naval Academy at Annapolis. We should be very much pleased to see established a well organized system of medical schools in the different sections of the country, entirely under the auspices of the National government, for the thorough professional education of those who wish to avail

themselves of its advantages, and for the examination, according its high standard, of all those educated in other institutions, domestic or foreign, who wish to begin practice in any portion of the United States, and whose diploma or certificate of successful examination shall be accepted as sufficient authority for practice in every State. Education in medical science should be conducted entirely with a view to the protection of the public and the advancement of true science rather than to the enrichment or glorification of self-constituted professors.

In the hygiene of old age it is recommended with high authority that the diet should consist more of the heat producing foods rather than those which contribute to tissue building. Also the food should be taken more frequently but less in amount than when in the prime of life.

A Caution in Local Applications.

It should be well known to all practicing physicians physicians that no local applications of mercury in any form-calomel, ointments, powders or washes containing any of the salts of mercury-should be made to any diseased surface of skin or mucous membrane of a patient who is taking iodine in any form or any of its salts internally. The iodine appears in the natural secretions found on the membranes-tears, saliva, mucus-and in the pathological secretions of sores, ulcers and inflamed surfaces. Coming thus into contact with the mercury, the very irritant and even caustic iodide of mercury is formed. Many a doctor has been puzzled as to why the eye or the ulcer became suddenly so much worse when he only applied the usually mild calomel. Patients should be questioned before any local mercuriai application, or even its administration by the stomach, as to what they may have been taking unknown to the physician.

Radical Treatment of Naso-Pharyngeal Catarrh.

Dr. S. Lewis Zeigler, 1504 Walnut St., Philadelphia, in a private conversation with the editor, gives the following local treatment, with which he has had marked success.

The instruments required are slender nasal applicators and a throat applicator, with the necessary mirrors and specula for examination

Pure compound tincture of benzoin is firs painted upon the entire membrane, anterior and posterior nares and pharynx.

This is followed with an application of camphor-menthol (camphor and menthol of each five grains, in one ounce of liquid vaseline or other liquid petroleum). These applications are made every other day.

As a preliminary application, to prepare the membrane for these remedies if the membrane is in a state of acute inflammation, with full tissues and free discharge, the entire surface is thoroughly painted or swabbed with first a so lution of cocaine, (twenty grains to the ounce) to constringe the tissues and soothe the irritated nerves, followed by a solution of antipyrine (thirty grains to the ounce); whicq has a similar effect to cocaine. lásting several hours: in

about three minutes the surface is ready for the principal reatment with benzoin and camphor-menthol as given above. In acute cases treat daily.

These are all applied by the usual means of a mop of absorbent cotton, twisted on the applicator. After this treatment has been followed two or three times a week for several months, until all soft pathological enlargements have been entirely reduced, there may remain some cartilaginous or bony growths which will have to be removed by the chisel, under cocaine local anesthesia.

International Prevention of Diseases.

There is a large class of diseases recognized as being more or less communicable or due to uncleanliness or other preventable causes. It is one of the very first duties of a government to protect its citizens as far as possible against ex. posure to all forms of contagious or other preventable diseases. We legislate carefully enough for the protection of our cattle, horses and hogs, and are ready to go to war for the financial value of a few thousand seals on remote islands in the sea. Is not the health of our people of infinitely more importance than such interests as those? What can be more to the credit of a nation than to be able to show a healthy population and a low death rate? This with due attention to enlightened intelligence, a high standard of morals and an equitable diffusion of wealth among the people make a nation strongest in every respect-one that its subjects will love and will protect with their lives if

necessary.

The proposed establishment of a cabinet department of public health would be a practical step in the direction of caring for the health of the people, supplementing the work of our State Boards and bringing the systematic direction of the work over the entire country under one efficient department. This is national protection.

The next logical step must be international protection We must have our sentinels located in all countries with which we maintain commercial relations. These should study constantly the sanitary conditions of the countries

in which they are stationed and should have full' authority to guard against the importation of diseases by means of immigration or commerce. A clean bill of health from them should be required of all intended immigrants or of all car-goes bound for this country before they are ad-missible into our ports. We would suggest that we already have representatives in all civilized countries, whose positions, so far as active duties are concerned, are principally ornamental. Tothe nominal duties they now have might. appropriately be added this real one. A measure like this, taken up by civilized nations generally, would result in much greater attention being paid to restricting epidemics to the actual points where they originate and suppressing them in their incipiency. If the authorities. of a country were convinced that they must establish hygienic conditions among their own people in order to maintain their commercial relations with the world they would at once see the practical side of the matter. Then we might hope that in time those diseases that are preventable by general public action would finally die out altogether, and we would have to contend with only those that are due to individual imprudences and exposures.

For Shock and Collapse.

Atropine is the quickest and most valuable remedy known in surgical shock and in those conditions in disease which resemble it, as the stage of collapse in cholera and cholera infantum. It may be given hydodermically, or by mouth in the form of a granule dissolved in hot water every ten minutes until the desired reaction occurs.

Mucus Our Natural Protector.

Recent bacteriological experiments have demonstrated that the normal secretion, mucus, is an effective bactericidal agent. To be effective, however, it must be normal in quality and, further, its germicidal property may be exhausted by an overwhelming supply of rapidly growing germs.

Hydrastine is said to possess powerful antispasmodic properties and has recently been recommended for the treatment of epilepsy.

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.

Notes and Comments.

Editor MEDICAL WORLD:-On page 419, December WORLD, M. R. C. describes a case where the umbilical cord was three times around the child's neck, causing asphyxiation. Many years ago I had such a case, and there was also a knot in the cord. The child lost its life during birth. The shortening of the cord teemed to check the progress of the child through the pelvis. Several times since I have noted the presence of an obstacle, and found it was due to this cause. Once I managed to get the for. ceps on and delivered in a hurry, and always I have had trouble to save the child.

That gonorrhea lessens the chances of pregnancy cannot be doubted. The gynecologists all call attention to the frequency of pyosalpinx and ovarian disease, necessitating castration in gonorrheal women. But women do become pregnant in spite of gonococci, and that frequently, so that the sterility is not absolute in such cases.

Dr. Sonn (page 427) asks why hepatic disease is attended with epistaxis. Obstruction to the circulation in the liver causes difficulty in unloading the veins, and hence engorgement of the capillaries. Nowhere do these bear distention so ill as in the nose, and hence the tendency to hemorrhage.

Wild hairs are extra sets of eyelashes, by an eccentricity of nature forming inside the lid, and causing no end of annoyance.

The malic acid of cider readily unites with zine to form a malate, whose properties resemble the acetate of this metal The treatment should be by demulcents, anodynes and stimulants, with emetics if the patient has not already

vomited.

Has not Dr. Mitchell's case (page 427) a urinary calculus? Salol, five grains every four

hours, relieves acute cystitis speedily, with hot cloths and anodynes as adjuvants.

For Dr. McDonough's case I would use antiseptic baths, wash the afflicted skin with pure soap and then rinse off with cold water; dry and apply ointment of red iodide of mercury, five grains to the ounce of lanoline. Then apply benzoated zinc ointment with a little oil of rose. Keep the general health in good order. If the case does not get well there is a local cause at work that must be destroyed by germicides, or else the general health is so far below par that healing processes cannot be instituted. This means iron, quinine and cod liver oil. Why not try keeping the skin wet with Bovinine, The effects of this on chronic ulcers are said to be remarkable.

Dr. Coates might get a clear solution (page 428) of benzoin by adding ammonia, making benzoate of ammonia; but the gum will precipitate in water.

In the Current Medical Thought, under the head of Requirements for Medical Practitioners, there is a mistake in regard to Pennsylvania. The registry law requires colleges to examine an applicant before endorsing his diploma.

In the December number I asked for reports regarding hemorrhage from quinine. (Why don't you reform the spelling of that word? It is worse than the diphthongs.) Dr. C. C. Stockard, Atlanta, Ga., writes to me as follows:

"Noticing your request in THE MEDICAL WORLD for reports of cases of hemorrhage from the use of quinine, I will give the following: I was called a few years ago to see a child whose urine had been bloody for several weeks. As it was in a malarious locality, I put it on iron and quinine. About a week later the mother informed me that it had gotten worse steadily. She said that before I saw the child she had given it a tonic and that, as several years before her urine became bloody after taking quinine, she thought the tonic she had been giving might have quinine in it, and after stopping it the urine had gotten clearer till she took the medicine I prescribed, when it immediately became more bloody. I told her my medicine contained quinine and to discontinue it. In a few days the urine was clear and I've never heard of any return of the trouble. I think the quinine certainly caused the hemorrhage."

I think so, too. My reason for asking was that I had a case of purpura hemorrhagica from quinine. I am inclined to credit this drug with causing hematuria sometimes. I have also received the following letter from Dr. Ben. H. Brodnax, Brodnax, La.:

"In 1868, while in Mississippi, I was troubled for the first time with chills. Dr. Hart made