tise of doing such work is nothing more nor less than a base deceiver, or else deceives himself or herself. Away with such nonsense as this forever unless your patient will not submit to the proper treatment and you are in such need of money or practise that you cannot very well afford to let the patient get away from you. After having tried in vain, however, to have induced the patient to submit to an operation such as a curettage or colpotomy, maybe also an oophorectomy, then in punishment for this stupidity which the patient has shown it is well enuf to mulct her pocketbook.

Ulcers of the uterus I have never seen, and do not believe they exist, unless syphilitic; then use your 606.

Endometritis! There is no such trouble, only as we might have it from an infected intra-uterin cavity, which makes all the uterus large and swollen and the endometritis is the only visible trouble because you cannot see the whole uterus. Inject the uterin cavity after having scraped it out. Possibly you will have to remove the tubes or drain them of what in modern parlance surely is not called endometritis, but can invariably be called gonorrhea.

Gonorrhea in the Female.

This brings us to the treatment of gonorrhea in the female. No medicin given per os has any particular influence on this dreaded disease. If we get any benefit from treatment other than local it is by injecting hypodermically large doses of antigonorrhea bacterin. Even that is not particularly satisfactory, but we are using it with the hope that some day a remedy as efficacious as antitoxin for diphtheria will be found for gonorrhea. Those of us who have seen the action of argentum nitrate on gonorrheal opthalmia can be easily led to see the efficaciousness of local treatment; therefore if it works so well on the conjunctiva, why would it not act as well in any other place? Try it on the mucous membrane of the parturient canal and urethra. The natural home of the gonococci is the urethra; therefore, while we are cleansing the vagina and upper structures, do not forget to take the little black syringe and inject a 2% solution thru the urethra into the bladder. This also is a good treatment for urethritis in the male, but has the advantage in the female of causing very little discomfort.

Some time ago I read an article on "How to Cure Salpingitis" by injecting iodin thru the cervical canal with such force and such quantity that it will permeate the tubes and be forced into the pelvic cavity, where it can be mopt out thru a colpotomy opening made thru the cul-de-sac of Douglass. Why not use a 20-grain-to-the-ounce silver nitrate solution in the same way? Singularly as it may seem, an infected vagina seldom admits of an extension into the pelvis thru a colpotomy opening.

The thought that a pyosalpinx never heals until the tube is removed is, in my experience, very erroneous, but by some it is held as an axiom that "all diseased tubes must be removed by excision." Many cases have in my hands apparently been cured, and many women having had them would have been rendered steril for life were I to have followed what is ever advised by some and removed these appendages. Such women often marry and become mothers, much to their delight. Such an accomplishment cannot be controverted as being beneficial; so that when any of you have a very ardent excuse or reason for making a radical operation, I would ask you to wait until such time as a colpotomy has failed to accomplish. the required results.

Many of these résumés might come under the caption of this article, but are, nevertheless, intimately associated with the thought. Yet with the versions and flexions from my text, still do I hold that I am more justified in my rambling than is the man who in a servil frame of mind adheres unthinkingly to teachings which he has possest from early education, and will not and cannot see the truth.

All I have to say in conclusion is that it is an utter impossibility to produce an artificial flexion in a healthy uterus, and I am emboldened to speak right out in this matter from the fact that of a thousand uteruses viewed I have never yet beheld a retroflext or retroverted or anteflext or anteverted uterus per se.

Petoskey, Mich. JOHN J. REYCRAFT.

DEAR DR. TAYLOR-Inclosed find check for $3, for which please advance my WORLD subscription for four years. I have been a subscriber to your valuable journal ever since I began the practise of medicin in 1896, and I think I have all my journals. In my moving ten years ago I left behind me many volumes of other journals, but I aimed to bring all copies of THE WORLD. With a Merry Christmas and a Happy New Year to you, I am E. E. LOWRY.

New Madison, Ohio.

Comments on the January WORLD. EDITOR MEDICAL WORLD:-The passage of the Harrison bill is one of the most important pieces of legislation that has ever been made affecting our profession. On its face it seems to effectually block the supply of opiates and cocain to habitués; but does it? We may prescribe these drugs, but must keep duplicates of our prescriptions to be submitted to government officials when required. This destroys the professional privilege of keeping the patient's secret. The habitué is made known as such to the officials. Talking the matter over with a pharmacist, his comment was, "there will be found a way of getting around it." Unfortunately the law-abiding part of that profession will obey the law, and the habitué will be compelled to resort to the unprincipled, who will evade or ignore it, as is now done as to previous laws.

Suppose your sister or wife takes opiates. and you cannot get the hellish drug for her legally-she will seek the places patronized by the demimonde, where the law is not obeyed. Think you will like that? Surely you will try to cure her-and to cure a woman of a drug habit permanently is so very easy! Knowing that a woman who is using a drug will stop at nothing to get it, one hardly likes to know that anyone in whom he is interested is at the mercy of such people for her supply.

Dr. Jackson's account of Wilheim's work with heliotherapy (page 11) is of more than usual interest. We all know, in a general way, that the effect of direct sunlight on the human skin is very decided, but, like many bits of abstract knowledge, we let this one go unutilized. To secure the best results, however, the patient should be so placed that he could divest himself of all clothing and take his exercise as Adam did, unhampered with garments or the restraints of a house. This means a country sanatorium, for one sex alone, and well secluded. In fact, it is a real "get-back-to-nature" method, and for that reason of exceeding efficacy if carried out naturally.

Dr. Gilbert's sphygmomanometer (page 12) looks good, but who supplies it, and at what price? We have been absurdly sensitiv over the financial aspect of remedies we advise, and for this reason many promising ideas have come to grief; like the Murphy button and Porter's stethoscope. Each of these was taken up by instrument makers and presented in shape other than the in

ventor specified, and thus his design was spoiled. Had they controlled the manufacture the profession would have been bettered.

The treatment of colds has been multifariously illustrated in recent issues, and I note that all the methods have not been mentioned. Has Aulde's use of gelsemium been forgotten? I see Dr. Badger (page 14) employs it as one of six activ ingredients in his formula. It was many years before I found any really effectiv remedy except a full dose of morphin, and that always left a headache as bad as the cold. But last month a cold got away from my formaldehyde inhalation, and so I took a full sweating dose of pilocarpin at bedtime, and had as good results as from the opiate. But near-total abstinence from food and drink, by which the blood vessels would be distended, is requisit.

Reading Dr. Harrower's statement on page 16, one wonders how far modern science is going to carry this thing of organotherapy. The practise of cannibalism was based upon the belief that eating the flesh of a brave enemy imparted his courageous nature to the consumer. Will they tell us that this ancient practise was correct; and will they utilize the idea? And how?

Does Dr. Buck (page 17) imply that there is nothing to the treatment of furuncular affections except the surgery he describes? I carry on my face a scar from a carbuncle that very nearly cost me my life, in southeastern Africa; and that it did not kill me was due to dram doses of ferric chlorid tincture. The medical missionary who used calx sulfurata so remarkably in typhus, variola and scarlatina in Syria learnt of this remedy thru its cure of a carbuncle for him. Dunglison's saline has broken many a succession of boils for my patients. For over forty years the ointment of red precipitate has prevented boils and styes for my people. I wish it were as easy to cure acne.

Dr. Townsend (page 19) speaks of severing the nerves to cure itching about the rectum. What's the matter with removing the cause of the itching? There is nothing the matter with the nerves. Just clear out the lower bowels, and get rid of the retained scybala whose decomposition supplies the irritating discharge. This came to me after exhausting the lists of local remedies, even to fuming nitric acid, without any benefit whatever. The general

practician who tackles rectal affections as they come, without special study, usually gets in the way of employing one remedy, which he applies to every form of disease until he meets something it does not cure. Many thus used gall or other astringent ointments. One pretty good man employed citrin ointment for every use to which an ointment could be put. If any one remedial measure were universally applicable it would be stretching the anal sphincter under anesthesia. Years ago I began using that operation for fistulas, hemorrhoids and every other rectal disorder, intending to persevere with it alone until some case presented where further treatment was necessary. Surely the cases did come, but it surprised me to see how many recovered after the stretching and with no other treatment. I fully believe that the stretching preliminary to operations for hemorrhoids has more to do with the cure than some specialists realize. Always anesthetize first. I tried to stretch once without any anesthetic-never again!

I would like to ask Dr. Reycraft (page 21) how his typhoid patients can absorb the plenteous diet he gives them, when the gland patches from which the lacteals convey nutriment to the thoracic duct are diseased and often ulcerated, at any rate disabled from their function. People starve to death if their thoracic ducts are obstructed, even tho all the other avenues for the absorption of nutriment are free. For this reason I have long restricted my typhoid patients to salt, water and egg albumin, which does not require digestion or assimilation, being directly absorbed into the tissues of the fetal chick without the interposition of any digestiv apparatus. The logical addition to diet for typhoid I would be oil inunctions, since the skin absorbs oils readily. But I cannot look upon food as harmless if it is put in a digestiv tract unable to care for it.

Dr. McDonald's story of contract practise (page 21) in the mining camps is a revelation. The level payment system has come to stay, but there should not be any such abuse as he describes. Were the companies to contract with the county medical society, it might meet the needs of both sides.

Leeman's remedy for bedsores reads good. The worst case I ever treated recovered with lotions of zinc sulfocarbolate. Dr. Truman Coates may recollect the case

and the strength employed-it was many years ago.

Somehow Dr. Smith's case of pseudocyesis (page 22) disappoints me. If the inextinguishable belief of the girl that she was pregnant had only induced that condition what a capital Christian Science story it would have been!

No treatment for neurasthenia is worth anything at all if it does not begin with the elimination of fecal toxemia from the case. After that, the pyrophos fate of iron is useful; a scruple in a quart of water daily, used as a beverage.

For smokers' heart spartein is better than other heart tonics-in fact, it is not a tonic at all, but it does the work far better than any of the remedies that lessen cardiac nutrition by contracting the arteries. In the valvular affections of the aged there is no remedy equal to spartein. Despite Pettey, a grain a day in divided doses suffices in most instances.

For leucorrheas, raise the local tone by applying hydrastis, and give it internally; using small doses continued for months. Local remedies are the more effectiv the longer the period of their application. For this reason the glycerogelatin masses devised by the late Dr. Mitchell were more effectiv than any lotion.

The specific remedy for flatulence is physostigmin; small doses several times a day, for three days out of each week. Quassia is also useful; but the remedy on which the patient should be left is hydrastis. Unless

If a feebleness of the erectil tissues coexists, substitute cornus florida. Like hydrastis, this is a remedy whose values are never appreciated unless it is administered for prolonged periods-a month at least. It is a chronic remedy for chronic conditions.

Here is a suggestion for use in rheumatism: We know that this infection frequently commences in the tonsils; probably the microbes pass thru to the stomach; and possibly the toxins they there generate affect the patient. At any rate, gastric acidity and fermentation play their part.

Salicylic acid has approved itself as a remedy for this malady. In so far as it acts by inhibiting gastric fermentation, its effect is limited to the period during which it is present there, uncombined. The effect of a huge dose should not differ much from that of a small one. The object is to

keep a trace of the acid constantly present in the stomach, and a trace suffices to prevent fermentation and acid generation. We accomplish this object best by giving a small dose, a centigram (1/6 grain) every ten minutes; and this should be more effectiv than a scruple every four hours. In a few cases I have tried this plan and it seemed to work well; but I have not had the opportunity to try it on a large scale yet. I do not know whether it will work out as I hope or not. If any WORLD readers feel like trying it I should be glad to hear the results by letter or thru THE WORLD pages. And note, please, what I am after is the truth, whether favorable or against my hypothesis. I have lived past the period when ideas interest me because they are my WILLIAM F. Waugh, M.D.

Own.

Chicago, Ill.

Sterility by Vasectomy.

EDITOR MEDICAL WORLD:-I have reports from five physicians that have done one or more vasotomies on one or more persons. One doctor reports four cases with perfect results, and that his patients cannot tell any difference since the operation. One reports considerable pain and swelling after the operation, due, no doubt, to cutting a blood vessel within the tunica vaginalis. I had one case with considerable swelling after the operation that was probably due to the same cause. That is the only unfavorable result that I have had with 22 operations.

Dr. Sharp, who first performed the operation at the State Prison at Jeffersonville, about ten years ago, removed a section of the vas, about one-half to one inch long, or as much as was injured by the grasp of the forceps with which he fixt it for operation. He then ligated the proximal end.

With the assistance of my wife, I cut my vas in 1909 and let the ends drop back within the tunica vaginalis, without removing a section or ligating either end. The result was so satisfactory that I advocated vasotomy instead of vasectomy, thinking that it was a more simple operation. The ends of my left vas reunited at right angles; but it seems to be impervious, as no sperma

tozoa pass.

The most of my operations have been vasotomies, and I felt sure that they were all right, but to my surprise two of my cases began to pass spermatozoa after a

month or two in which they were absent. That caused me to re-examin my other cases, but I found no others among my own, nor has there been any others reported.

At first vasotomy seemed to me to be more simple, but since making some changes in my technic, a section can be removed without adding to the difficulties of the operation.

Technic of the Operation.

With the usual antiseptic precautions, as to the field and instruments, with my thumbs and index fingers, I work the vas to the outside, so that there will be nothing but the skin and tunica vaginalis covering it. Holding it with one hand, with the other I pass a curved needle, in a holder, just as close to it as possible, which holds. it in place for the remainder of the operation.

With a scalpel, I make an incision, longitudinal with the needle, about one-half inch long, thru the skin. I formerly tried to make this incision thru the tunica vaginalis at the same time, but I think my case of hemorrhage was due to injuring a blood vessel while trying to cut thru the tunica, which is a tough, difficult membrane to get thru. I now catch it with tissue forceps, as the peritoneum is caught in operating for appendicitis, and then by cutting "over the crest" there is no danger of cutting a blood vessel. When the tunica is cut, the vas appears as a white cord, about the size of a goose-quill. With the tissue forceps it is lifted out thru the wound, and cut with a pair of stitch forceps, which holds it very nicely.

Then a section about one-half to one inch is cut off from either end, and the vas allowed to drop back within the tunica. The wound being small, and the skin contractile, no stitch is needed.

Both sides are treated the same way, and aseptic dressings applied.

My own experience, and the others reported, leads me to believe that the only bad results from the operation are from hemorrhage, which with proper precautions can be avoided.

I have had inquiries from several physicians in regard to the operation, many asking about the same questions, so I will answer the general trend of them, as probably others would like to know more about it. Some of the answers are based on my observations of my cases, but most of them are on personal experience; having had my

vas cut more than five years, I feel that no other developments need be expected.

The sexual power and desire is neither increast nor decreast. There is no change in the mental, moral or physical condition of the patient. There is no change in the testicle, atrophy, hypertrophy, anesthesia, hyperesthesia, or degeneration. The amount of semen ejaculated is neither increast nor decreast perceptably. No macroscopic change in it. No microscopic change, except an absence of spermatozoa. One question I cannot answer, viz., what becomes of the spermatozoa? In my opinion, they are not secreted. I do know that the question is material, as they do not affect the person in any way.

I have never used an anesthetic of any kind, altho, I suppose, a local anesthetic could be used after the fixation needle is in place. However, the pain is not severe, about the same as removing a wen. My patients have all continued their usual vocation. None have been laid up. All have All have exprest themselves as satisfied with the there is nothing in the mental, moral or operation. After the wound has healed physical condition of the patient that distinguishes him from his former condition, except that he is sterilized, so far as my observations go.

Dr. Sharp operated on a criminal class, and claimed that his patients were improved mentally and morally. His report probably influenced the Indiana Legislature to legalize the operation on criminals, insane and epileptics in the State institutions, but I do not think the law is being carried out. The legislatures of several other states considered such bills. Some were passed, others failed, while some were vetoed.

From the standpoint of the eugenist, I have nothing to offer for the operation, as I have had no experience in that line. But as a protection to the wife, who from some one or more of the many causes should not become pregnant, the operation is a godsend, and the physician who does not use it in such given case certainly has not done his full duty to the woman, provided that the consent of the husband can be gained, which cannot always be done, as some men would rather their wife would suffer greatly than to suffer a little themselves.

A recent textbook on obstetrics gives the following reasons for interrupting pregnancy: Acute diseases that may be made worse by the pregnancy; recent syphilis, advanced pulmonary tuberculosis; laryngeal

tuberculosis; severe valvular heart disease; aneurism of the aorta; advanced carcinoma; chronic nephritis, insanity; contracted or deformed pelvis, or anything that threatens the life of the woman. Anything that indicates an interruption of pregnancy indicates vasectomy on the husband. These cases come under the observation of the general practician, and very few there are in general practise who do not know of cases on whom the operation should be performed.

Vasectomy, instead of the other preventivs of pregnancy, would prevent sexual impotency that we so often fail to relieve. Had the physician who signed "Montana,” in June WORLD, had vasectomy instead of practising onanism, he would not now be asking for help that he may not receive.

So far as I know, there are no legal restraints on the operation, and there will not need to be so long as it remains in the hands of the conscientious physician, but should the unscrupulous do it for the unmarried and others, who, with the procreativ powers removed, and no fear of the results, which no doubt helps to hold some men in the "straight and narrow path," would become a menace to society, then legal restraints would have to be placed on it by the legislatures.

For that, and other reasons that are obvious, I do not think the operation should be heralded to the world, but that the physician should choose his subjects, explain the matter to them and bind them to secrecy. I positivly refuse to tell any of my patients of any other case that I have operated.

Some may think that I am overenthused with the operation, but I believe that if it was properly used in all cases where it is needed, it would be the means of preventing more suffering in women, and more sexual impotency in men, than any prophylactic that the profession has to-day.

Hazleton, Ind. H. M. ARTHUR, M.D.

Choleduodenostomy for Strictured Duct. EDITOR MEDICAL WORLD:-I wish to

bring to your readers' notice a case which will elucidate the condition and effects of obstruction of the common bile duct and in a measure show the effects of sympathetic influences on the heart and circulation in this particular instance.

History.

Miss M., aged sixty years, had been a sufferer with gastric symptoms and con