to Ballston, and thence thru the forest to the Kayaderosseras River, and finally to the High Rock spring, the "Medicin Waters of the Great Spirit." Obeisance was made to the Manitou of the spring, and then "Warraghiyaghy," the White Brother of the Mohawks, partook of the water of the healing stream as it spouted thru the orifice of the High Rock cone, and bathed in its waters. The old cone stands to-day where Sir William saw it, now in the little High Rock Park, protected by a pavilion, and against the background of the limestone scarp of the geologic "fault." Military duty called him away before his recovery, but he was so much benefited as to be able to walk part of the way thru the forest to Schenectady, after taking the Saratoga Cure. Sir William shortly wrote to General Philip Schuyler concerning the healing waters of the High Rock Spring, and this report is supposed to have actuated General Schuyler to cut a roadway to the spring thru twelve miles of forest in 1783, and to erect a shelter for himself and his family while for several weeks they used the water. Ten years earlier a clearing had been made and a cabin built by a hardy adventurer, whose camp had long since been destroyed. But from the time of General Schuyler's trip thither the locality was visited by many celebrated people, including George Washington, Alexander Hamilton, George Clinton, Colonel Humphrey, Colonel Fish and others. From that day to this Saratoga has been a resort more or less popular, reaching the position of perhaps the best known and most fashionable spot in America, about a hundred years after Sir William set the fashion.

No resort in this country has entertained so many distinguisht literary, scientific, military or diplomatic celebrities or statesmen. Of the presidents, Harrison, Madison, Tyler, Van Buren, Fillmore, Buchanan may be mentioned of the ante bellum guests, while Daniel Webster, Stephen A. Douglas, Gen. Winfield Scott, Daniel D. Tompkins, DeWitt Clinton, Silas Wright, Wm. L. Marcy, Chancellor Kent, Washington Irving, Fenimore Cooper, Gerritt Smith, Gottschalk, Joseph Bonaparte (ex-king of Spain), and many other illustrious people were among the guests at the spa a generation ago, when its tide of gayety reached the high-water mark.

The history of its gayety, its gambling and its racing is well known. The desultory and unscientific use of the waters led to nothing further, and a level of mediocrity was reacht, judging the matter from a physician's standpoint. During the years the springs were most visited, their waters were employed more because of certain establisht fashions than with an intelligent idea of the proper use of specially selected waters to meet definit diseases or conditions.

Action of the Saratogians resulted in an act of legislature in 1909 which provided for the purchase by the state of lands, mineral rights and mineral springs. Thus began the state control, comparable with the method of conservation of mineral waters in European countries for generations, our old-world cousins having developt similar properties years ago, by invoking governmental ownership, for the enlargement of public health.

While the underlying aim and incentiv of the development of this health resort are the prevention of disease and the relief of the sick and suffering, it is an undoubted fact that a properly

constructed bathhouse and drink hall well equipt and conducted will result in a large and constant income to the state.

Our Saratoga waters resemble in many respects the fewer springs at Kissingen, and the range of application of these mineral agencies is very similar in the two resorts.

The amount of spring water available may be appreciated from a consideration of the fact that the Champion Spring No. 3 spouted 142 gallons a minute, or 202,480 gallons a day, when its neighbor, Champion No. 2, was sealed. The gas (carbonic oxid) has always been present in very large quantities. From the Adams Spring alone a total of about 1,200 pounds a day was extracted by the General Gas Company and sold for $5,000 a year. The Island Spring produced a revenue of $3,000 a year for a long period. All the waters are supersaturated with carbonic oxid.

The mineral waters may be classified as follows: Saline-laxativ, alkaline-saline and ferruginous or chalybeate. Others are also mildly chalybeate, and many waters fall into two of these classes. Of special value are the table waters, Geyser and Minno-nebe. The latter resembles the Grande Grille of Vichy, and since it contains about one-half as many bicarbonates, it is suitable for free use during meals.

Prescribed as chosen for individual cases the waters are variously indicated for use in gastrointestinal disorders, gout, rheumatism, arthritis and anemia. Some are admirably adapted for use in incipient kidney disorders, in neurasthenia, general fermentation from increase of acidity in the digestiv tract, certain skin diseases, and in the elimination of various poisons from the body and the removal of certain exudations due to dis

ease.

Saratoga has also a spring which resembles the Spring No. 12 at Nauheim, Germany, since it contains the same calcic and magnesic salts. It is, therefore, suitable for use in giving the Nauheim system of baths for incipient arteriosclerosis, certain other circulatory disorders and especially for some forms of heart disease. The chief field of activity, however, will be in the domain of disorders of the digestiv tract and in diseases producing tissue change, and in the reduction of obesity.

All Saratoga springs are radio-activ. The radio-activity is due to dissolved radium salts, and not merely to absorbed radium emanations. Therefore they contain a permanent agent which will produce activ emanations indefinitly.

The reservation commission obtained the presence of Dr. Paul Haertl, the director of the chemical and balneologic laboratory at BadKissingen, Germany, who studied the Saratoga Springs situation thoroly, and said that the springs at Saratoga are unexcelled in the world.

EXAMINATION QUESTIONS.

Kentucky, December 11-13, 1913.

OBSTETRICS AND GYNECOLOGY.

1. What is the hygiene of pregnancy, and what advice would you give a pregnant woman from a hygienic standpoint? 2. How would you differentiate between pregnancy and ovarian tumor?

3. (a) Describe an eclamptic attack, (b) give premonitory symptoms.

4. (a) How would you manage inevitable abortion? (b) Give some of the dangers of an abortion.

5. (a) How soon after the birth of a child would you ligate the umbilical cord? (b) How would you ligate and dress it? 6. (a) What indication would induce you to insert your hand into the uterus during or after labor, and (b) what precautions would you observe?

7. What are the dangers in the use of forceps in delivery, and how are they avoided?

8. What care would you give the mother after labor? 9. What is phlebitis and how would you guard against it while managing a case of labor?

10. Give the symptoms and treatment of mammary abscess.

Answers

1. By the hygiene of pregnancy is meant the care which should be observed by the pregnant woman for the preservation of health and strength both of herself and of the fetus. The pregnant woman should take moderate exercise in the open air; in the last month massage may take the place of exercise. Daily bathing in tepid water, care of the teeth, regularity of the bowels, ample sleep in a well-ventilated room, plenty (but not too much) of simple, nourishing and easily digested food, at regular hours, clothing not too tight, especially about the abdomen and breast; attention to the nipples, regular examination of the urin, and the restriction of marital relations are the main points to which advice should be directed.

2.

PREGNANCY.

The usual signs of pregnancy are present.

The patient is generally in good health, with an increase of body-weight; there is no characteristic facies.

The abdominal tumor is hard, non-fluctuating, situated in the median line, and reveals the fetal signs.

There is generally a suppression of menstruation.

The cervix is soft (Goodell's sign).

There is history of exposure to the possibility of impregnation, with rapidly developing enlargement in the median line.

OVARIAN TUMOR.

There is an absence of the chief sign of pregnancy, as a general rule.

In advanced cases the ovarian facies is presenta pale, drawn expression, with yellowness of the skin and general emaciation.

The abdominal tumor is soft, fluctuating, showing usually more or less growth to one or the other side, and does not reveal the fetal signs.

Continuance of menstruation is the rule, although it may be altered in character; suppression has been noted. The cervix is probably not altered.

The history is obscure, with a slowly developing tumor beginning on one or the other side.

-Dorland's "Obstetrics." 3. "Puerperal eclampsia is an acute morbid condition, occurring during pregnancy, labor, or the puerperal state, and is characterized by tonic and clonic convulsions, which affect first the voluntary and then the involuntary muscles; there is total loss of consciousness, which tends either to coma or to sleep, and the condition may terminate in recovery or death. The causes may be: Uremia, albuminuria, imperfect elimination of carbon dioxid by the lungs, medicinal poisons, septic infection; predisposing causes are renal disease and imperfect elimination by the skin, bowels, and kidneys. Symptoms: Headache, nausea, and vomiting, epigastric pain, vertigo, ringing in the ears, flashes of light or darkness, double vision, blindness, deafness, mental disturbance, defectiv memory, somnolence; symptoms easily explained by the circulation of toxic blood through the nerve centers. These may be preceded by lassitude, and accompanied by constipation or by diarrhea. Headache is perhaps the most significant and common warning symptom. In bad cases the urin is reduced in quantity (almost supprest), very dark in color, its albumin greatly increast, so that it becomes solid on boiling. Next comes the final catastrophe of convulsions. The convulsiv fit begins with twitching of the facial muscles, rolling and fixation of the eyeballs, puckering of the lips, fixation of the jaws, protrusion of the tongue, etc., soon followed by violent spasms of the muscles of the trunk and limbs, including those of respiration; hence lividity of the face and stertorous breathing, biting of the tongue, opisthotonus, etc. The fit lasts fifteen or twenty seconds, ending in partial or complete coma, possibly death; or consciousness may return, to be followed by other convulsions."-(King.) 4. Management of inevitable abortion: "Two methods of treatment have been advised for these cases. The first is the expectant plan: Place the patient in bed, and if the bleeding is profuse insert a tampon of iodoform gauze (one yard) well up against the cervix. If this fails to control the hemorrhage, reinforce it by another yard or two of gauze and a perineal pad and binder. Small doses (3%) of the fluidextract of

ergot should now be given every two or three hours. At the end of from eight to twelve hours remove the tampon, when the ovum may be found extruded from the cervix; if not, a vaginal douche of mercuric chlorid (1:4000) must be given, and another tampon introduced. If, upon the removal of this second tampon at the end of ten or twelve hours, the ovum is not discharged, then more vigorous methods to secure its expulsion must be adopted. Activ plan: The physician's hands and instruments are sterilized; the patient is etherized and placed on an appropriate table; the genitalia are thoroly cleansed and a vaginal douche of mercuric chlorid (1:4000) is given; the anterior lip of the cervix is brought down to the vulvar orifice; the cervix is dilated if necessary; the placental forceps is introduced into the uterus, and as much as possible of the ovum is removed; the uterus is thoroly curetted, and an intrauterin douche of steril water is given. A light tampon of iodoform gauze is placed in the vagina; the patient is then returned to bed. A strip of gauze may be placed in the uterus in cases of sharp retroflexion, to secure free drainage, and occasionally an intrauterin tampon will be necessary, when the uterus refuses to contract and hemorrhage persists after the use of the curette."-("Pocket Cyclopedia.") The dangers are: Sepsis, hemorrhage, and subinvolution.

5. Ligature of the cord.-"As soon as respiration is well establisht, lay the child on the bed on its back. Wait for a few minutes until the cord shows signs of ceasing to pulsate. Then take the cord at a spot about 2 inches from the umbilicus, squeeze away the Wharton's jelly so as to make it a thin cord, and apply a ligature, and tie tightly with a surgical or reef knot. Apply a second ligature about 3 inches from the vulva. The second ligature is not necessary unless there is a second child in the uterus, when it may save its life if the circulations of the two children communicate. Cut the cord between the ligatures half an inch from the umbilical ligature. Take care to hold the cord up on the fingers when cutting, otherwise you may easily injure the infant. When the child has been bathed and is ready to be drest, the cord should be carefully dried; it should be seen that it is not bleeding; then it may be powdered with boric acid and starch powder and wrapt in a small dressing of dry steril gauze."-(From Johnstone's "Midwifery.")

6. The hand may be passed into the uterus: To aid in version, to extract an adherent placenta, to remove a piece of placenta which has remained behind, to stop a postpartum hemorrhage. Except in the last case (when there is no time to be lost) the hand should be made as steril as possible, and a steril glove should also be worn.

7. The dangers in the use of forceps are: Sepsis, injuries to the soft parts or to the child, and hemorrhage. All antiseptic and aseptic precautions should be observed, extraction should not be made too rapidly, the utmost care must be employed, compression on the fetus (particularly on the skull) must not be too prolonged, the mother's bladder must be emptied, and traction should be exerted only during the pains.

8. Care of mother during puerperium: "During the first week the patient keeps the bed, but after the first few hours she has considerable license. She may assume the sitting or half-sitting posture to take her meals and to nurse the baby, and, if necessary, for evacuation of the bladder and rectum. She should assume the lateroprone posture both right and left, several times a day, and lie upon her abdomen for at least an hour daily. Frequent change of position favors uterin drainage and massages the uterin supports. During the second week she has greater liberty, while the greater part of her time is spent on the bed or lounge. She may sit up for her meals, to urinate, and for bowel movements, and she should spend at least half an hour, twice daily, in abdominal and leg exercises to keep up her muscular tone. The third week she may be moved to a chair for a part of the day, having the liberty of the room. After sitting up for any length of time she should be instructed to take the genupectoral position before lying down. Prescribed exercises for the legs and abdominal muscles are to be taken daily. The fourth week, if all goes well, she may leave the room and have the benefits of air and sun. Physical exercises should be continued. The duration of the lying-in period and the degree of freedom to be given the patient after the second week must, however, depend on the character and amount of the lochia, the general progress of her convalescence, and the rate of the uterin involution."-(Polak's "Obstetrics.")

9. Phlebitis is inflammation of a vein, and is due to infection during labor or the puerperium. The most rigid asepsis and antisepsis must be observed by physician and nurse; and nothing which is not as near steril as possible should be allowed to come in contact with the genital tract of the parturient or puerperal woman.

10. Mammary abscess is characterized by pain, swelling, tenderness, feverishness. Sometimes it begins with a chill, fluctuation may be elicited, the neighboring lymphatic glands may enlarge. Treatment consists in making an incision radiating from the nipple, and drainage, though antiseptic and aseptic precautions must be observed; the breast should be put at rest for a couple of days; saline cathartics may be necessary, also supportiv measures.-Medical Record.

(To be concluded.)

etter degree of participation in even the luxuries of life for family. And he will get these d have them. ***

sympathy for the workingman, the increast cost of living that erially to his burden during the

right of the industrial workers capitalist when he is permitted power is apt to become arbie labor union. Both need legal : laborer has as much right to sts by organization as has the

st, in my opinion, is on the iniate that condition of unrest ne, but we are still a long way nd England in solving the prob11 be made, because the employe recently undergone a great are getting away from the old

-Thomas, in Detroit "News."

my views. The democratization of industry, the establishment of all these betterments-unemployment insurance, old-age pensions, workmen's compensation, and the like-embody the only solution of the problem of industrial unrest. The United States Government must take over these activities, including Federal employment exchanges.'

Remember who these words come from-not from a socialist agitator. And you know who John D. Rockefeller is. He is certainly not a "populist." He said:

"I believe that a prime consideration in the carrying on of industry should be the well-being of the men and women engaged in it, and that the soundest industrial policy is that which has constantly in mind the welfare of the employees as well as the making of profits, and which, when the necessity arises, subordinates profits to welfare. (Continued over next leaf.)

ley Retail Druggists' Association." He was very activ in his efforts to secure legislation to prevent physicians from dispensing or at least require them to keep extensiv records.

Now the eclectics are entertaining him. in one state while eclectic physicians elsewhere are howling about the national narcotic law and demanding its repeal. If they would avoid further entanglements of the kind they should watch the activities. of the druggists and their attorneys.

The working of the bill is considered onerous by druggists doing a strictly legitimate business and they are very much dissatisfied with it and are so expressing themselves. Eclectic writers are blaming the bill on the American Medical Association and the regular profession. And other physicians are placing the blame for the bill on the druggists.

So it looks as if we all must have had some share in it.

It is the purpose of all trustworthy physicians and druggists to secure proper control of the narcotic traffic so that it may be confined to legitimate use. To that end the professions should work together. The useless antagonism engendered between pharmacy and medicin should give way to friendship and co-operation. The regulars, eclectics and homeopaths should forget what little animosity now remains among them and consolidate. Then the united profession can secure fair and useful legislation. Without such much acrimonious legislation may be attempted.

The question sometimes agitated by physicians of all schools is how to get together. It is like the question of how to resume specie payments that arose after the civil war and was answered by Horace Greeley that "the way to resume is to resume." Similarly the way to get together is to get together. Attend each other's meetings and conferences and take an activ interest in those affairs. If you want to have friends be a friend-be friendly. And do not notice any antagonism that may ensue, which is likely to occur here and there in some prejudiced person.

These are the words of the new national narcotic law:

Nothing contained in this section shall apply(a) To the dispensing or distribution of any of the aforesaid drugs to a patient by a physician, dentist or veterinary surgeon registered under this act in the course of his professional practice only;

provided, that such physician, dentist or veterinary surgeon shall keep a record of all such drugs dispensed or distributed, showing the amount dispensed or distributed, the date and the name and address of the patient to whom such drugs are dispensed or distributed, except such as may be dispensed or distributed to a patient upon whom such physician, dentist or veterinary surgeon shall personally attend; and such record shall be kept for a period of two years from the date of dispensing or distributing such drugs, subject to inspection, as provided in this act.

See particularly the words in italics. The following is the ruling of the Bureau of Internal Revenue:

Where a physician personally visits a patient and administers any of the drugs coming within the scope of the Harrison Act, he is not required to keep a record of such administration, but where he leaves a supply of any of these drugs or preparations to be taken by the patient in the physician's absence, he will be required to keep a record of such drug or preparation, the same as he would in his office. A physician must keep a record of all drugs or preparations dispensed or distributed in his office, whether administered personally or given to the patient to be carried away with him.

We consider this ruling very unjust to physicians. In this connection the accompanying correspondence with the Bureau of Internal Revenue may interest you. We hold that "personally attend in the course. of professional practice" should include the leaving of necessary medicins for use between visits; and also include the dispensing of needed medicins at the office after consultation; that the words of the law do not mean "personally administer."

when

In our editorial last month on this law we said on page 84 that "When the physician *** does not personally attend-i. e., personally see-the patient he must keep a record." That editorial was written before the official interpretation by the Commissioner was made. We are not the only editors who gave out interpretations that proved to be different from the internal revenue bureau's pronouncement made. The Journal of the American Medical Association several weeks ago stated in an editorial on this law that physicians would be required to keep records of dispensing in their offices, but not of remedies dispenst at the bedside. The Bureau now says that records must be made of dispensing at the bedside. The fact that editors and practicians almost generally believed that dispensing would not require to be recorded is fair proof that the general understanding of the law is substantially as we have heretofore stated. And it must not be