of Mr. Kihlberg, who formerly conducted a similar institution at Excelsior Springs. A vote of thanks was unanimously extended to Mr. and Mrs. Kihlberg, the K. C. Southern railroad, the Benton County Medical Society, and the citizens of Sulphur Springs for the royal entertainment extended to the doctors. The formal opening of the Kihlberg will occur about May 1st. Mr. Jno. C. Clemmons, formerly of St. Joseph and Kansas City, will manage the house.

Dr.

Among those in the party were the following: Chris. Sampson and wife, Dr. J. H. Sampson and wife, Dr. Chas. Wood Fassett, Mrs. W. T. Elam, Mrs. H. A. Todd, A. B. DeMuth and wife, St. Joseph; Dr. J. P. Lord, wife and daughter, Dr. Ewing Brown, Omaha; Dr. T. B. Lacey, Dr. M. E. O'Keefe, Dr. C. W. Hennessy, Dr. F. T. Seybert and wife, Council Bluffs; Dr. A. McMichael, Rockport; Dr. A. Herring and son, Highland, Kas.; Dr. J. J. Carter and wife, Weston, Mo.; Col. S. G. Warner and wife, Kansas City, Mo.

SIDE LIGHTS.

Dr. H. J. Boldt, of New York City, who lived in St. Joseph thirty-three years ago as a boy, was the recipient of much attention while in the city. Luncheons and dinners were given him by Drs. J. W. Heddens, Jacob Geiger, W. T. Elam, as well as by a number of his classmates in the High School. Before taking the train on Friday evening, Dr. Boldt was surprised by a number of St. Joseph men who had studied under him in the New York Post-Graduate School, in which Dr. Boldt holds the chair of Gynecology.

The professor was presented with a handsomely engraved gold-headed cane, the donors being Drs. W. T. Elam, L. J. Dandurant, O. G. Gleaves, Jno. M. Doyle and W. J. McGill. The presentation speech was made by Dr. O. G. Gleaves, and feelingly responded to by Dr. Boldt.

The secretary received a note from Dr. Chas. H. Mayo, regretting that he would be unable to attend the meeting, owing to the absence of his brother, who is in Mexico. Dr. Mayo expressed his appreciation of the program, stating that it was one of the best ever put out by a Western society.

The badges, which were unique, were furnished by the Business Men's League. The button was a facsimile of the League's trade mark, bearing the words "St. Joseph: Central Western Gateway," while the name of the society and date of meeting appeared on the small ribbons attached.

Panorama of the

Medical Sciences

PHARMACOLOGL AND THERAPEUTICS.

neither is absorbed from the gastrointestinal tract. This latter fact, in the case of bismuth, has resulted in its use for various local disorders of the alimentary canal, but so far as the literature furnishes any evidence, the use of cerium oxalate has been directed, in great part against the reflex vomiting of early pregnancy, a condition in which no one could rationally think of using bismuth. It certainly seems reasonable to suppose that cerium oxalate ought to prove efficacious in alleviating all those conditions for which bismuth is at present used; in other words, those in which a protective coating to the wall of the viscus is desired. In this respect its use at present extending; for instance, some men find it efficient for relieving the irritability of the stomach in alcoholic gastritis, others for allaying the gastric disturbances that occasionally manifest themselves in the course of infectious diseases.

There is no reason for doubting its value in these and similar conditions, such as gastric ulcer, in which the vomiting is due to a local irritation of the mucous membrane. But in the doses that some men prescribe, 0.15 gm. to 0.20 gm., it can hardly be hoped that it will prove efficient. In view of the manner in which it now appears that cerium oxalate accomplishes its purpose, namely, mechanically, by coating the wall of the stomach, these doses seem ridicu lously small. Cerium oxalate ought to be administered in doses comparable to those in which bismuth subnitrate is given."-The Archives of Internal Medicine.

"A Plea for a More Exact Therapy." What is the cause of this lack of faith in drugs, and the growth of nihilistic tendencies?

It is because of the variableness in the potency of the remedies prescribed, the variation of the active principle upon which depend the desired effect. Take, for example, tincture of opium, which contains some eighteen or twenty different alkaloids. How is the physician to know how much morphine his patient is getting, or what percentage of apomorphine, or cocaine or heroin? Take digitalis. When he prescribes the tincture, how is he to know whether he is getting the required percentage of digital in the heart tonic, or dignitonin, the diuretic properties of the crude drug? And so we might go through the whole list of fluid extracts and tinctures. It is true many of these drugs are assayed, but only for one of the many active principles they contain, and we never know how much of the other active principles they do contain. Besides the assayed drugs vary by the effect of age in the quantities of the active principles. I will mention a few of the most generally used drugs taken from a list of twenty assayed by Mr. Sharpe, of the firm of Sharpe & Dohme, for the years of 1899 to 1905, giving the percentage of active principle, and showing the variation in quantity for these years:

of active principle it contains; and if this be true, why not eliminate all extraneous matter, such as woody fibre, alcohol, water and all inert matter, and other active principles not wanted, and which may not be antagonistic to those for which we prescribe the drug, and use the remedy in its purity?

The pure alkaloid is so quickly dissolved and absorbed that we get results much sooner, and we do not have to wait until the active part of the drug is dissolved out of the mass of the extraneous matter to be found in the crude drug.

Another consideration in favor of the alkaloid is the smallness of the dose, and the absence of disagreeable taste; besides, it may be used hypodermically. A sugar-coated granule, the size of a pinhead, is much easier swallowed than a teaspoonful of a bitter, nasty, nauseating dose of fluid extracts or tincture, which we administer ad nauseam just to get into the patient's stomach perhaps one-sixtieth grain of active principle.-The Virginia Medical SemiMonthly.

Lactic Acid Bacteria.

North reports the results of himself and about forty other physicians who have been trying the ef fects of the use of lactic acid bacteria in various forms of bacterial disease. This practice is based on the antagonism between lactic acid bacteria and some micro-organisms of the putrefactive and pathogenic species. The organism used was the Bacillus bulgaricus, cultivated in a medium of broth containing calcium carbonate. He describes the preparation of the medium and the cultivation of the bacillus. If necessary the diseased surfaces are first cleansed with warm saline solution, but antiseptics must not be used. A syringe or spray is used, the broth culture being injected in its full strength. The dose varies according to the extent of the inflammation. The conditions in which it has been advantageously used are the atrophic rhinitis, acute rhinitis (including coryza), ethmoiditis, disease of the antrum, chronic rhinitis, hay fever, cystitis, and certain surgical and dental conditions accompanied by supperation. The effects were temporary in tuberculosis sinuses, and in cystitis and leucorrhea were not uniform. In gonorrheal ophthalmia the results were good, as also in conjunctivitis, both pneumococcus and diplobacillary. North writes conservatively, but concludes that a few things have been learned by the work that may be more positively stated and seemed to warrant a further study of the treatment. These things are that:

1. The bacillus of Massol can be grown abundantly in dextrose bouillon by the addition of lumps of calcium carbonate.

2. The use of these cultures as a wash or spray on inflamed surfaces or cavities often diminishes the discharge on such surface or cavities.

3. The use of these cultures often diminishes odor caused by putrefaction.

4. The treatment sometimes reduces swelling, especially in the erectile tissues of the nose.

5. Both acute and chronic inflammation caused by infections sometimes appear to be checked when their seat can be reached by an injection of these cultures.

6. The use of the cultures seems to be accompanied by no special danger and they cause no irritation. Journal A. M. A.

The Claims of Water as a Therapeutic Agent. Simon Baruch of New York claims great things in therapeutics for the various methods of using water. It may be a stimulant when used with a sudden cold dash in faintness, in the asphyxiated infant, in ty

phoid fever, and in frost bite; as a sedative at a temperature of 100 degrees, the time being prolonged; as a tonic it is well known; as a diuretic it is used frequently; as a diaphoretic it is used in the form of the hot pack. Tepid water internally has an emetic effect. As a purgative even the layman uses it. To promote metabolism it is necessary. As an antiseptic it has taken the place of poisonous drugs. As an antipyretic the tepid bath is valuable.-Medical Record, February 27, 1909.

The Doctor First.

It is gratifying to have those in charge of the Emmanuel movement state with emphasis that all patients treated by the clergy will first have the care of a physician. A set of rules has been drawn up by an advisory board of physicians who believe in the Emmanuel movement, but also consider that new methods are necessary and in order. The rules are designed to avoid the earlier mistakes made by the clergy among those patients who have no family physicians. The rules have been adopted by the clergy; this at any rate is a sensible step.-Medical Fortnightly.

Influence of Heat and Cold Upon Infection in Peritonaeum.

Danielsen (Zentralbl. f. Chir.) finds that absorp tion of the infection is best prevented by the application of cold. When the germs, however, are not very virulent the protective and defensive vital processes are best promoted by the application of heat. By wise discrimination here the recovery of many patients with peritonitis may be hastened. Danielsen cordially endorses Gelinsky's advocacy of superheated air in the treatment of peritonitis, but he decidedly deprecates the use of this agent in cases of very virulent infection.-From Medical Progress, January, 1909.

Truths About Tuberculosis.

A person who has had or is likely to have tuberculosis should choose, demanding as little physical labor, anxiety or wearing responsibility as possible, and affording the shortest hours, the most out-door life, or best ventilation inside, with sufficient remuneration to provide sanitary quarters and plenty of good food. Journal of Outdoor Life.

Tannic Acid in Skin Diseases.

Tannic acid mixed with tale as a dusting powder, as a lotion in aqueous solution, or as an ointment combined with zinc oxide and cold cream, has been uniformly successful in allaying inflammation and checking serious discharge in cases of dermatitis venenata and eczema vesiculosum.-Dietic and Hy gienic Gazette.

Therapeutic Progress.

C. W. Edmunds, Ann Arbor, Mich. (Journal A. M. A., February 13), gives a general survey of the history of therapeutics and materia medica, showing how but few drugs have come down to us from our forefathers, and now the barbarism of therapeutics of former times has led to a therapeutic nihilism which has been modified of late years by the progress in chemical and pathologic physiology. The isolation of the active principles from the crude drugs, the new methods of administration, such as the hypodermic method, and the greater activity of labora tories, have greatly multiplied our resources, and he gives examples of modern pharmacologic methods in the introduction of such drugs as the coal-tar deriva

tives, adrenalin, and especially strophanthus. The advances in bacteriology and physiologic chemistry are also duly noted. Edmunds notes the present complex situation of therapeutics from the existence of different schools, magnifying some little truth to the exclusion of the great mass of scientific verities, the development of the psychotherapeutic movement, the evils that have crept in with commercialism and the the multiplation of proprietary remedies, sent out by the manufacturing pharmacists with extravagant claims, etc., etc. The fact, however, that we notice such methods, shows that we have knowledge of better things, and manufacturing houses are learning that physicians are doing their own thinking. There is a large and ever-increasing number who prescribe drugs scientifically, and it would be of great advantage to medicine if physicians would more generally keep more clinical records of the drugs they use and publish, from time to time, critical comments on them. He concludes his article with a statement of the characteristics of the ideal physician.

Why Have Playgrounds?

Children always play if they have a chance, but do they need to? What useful object does play accomplish?

Briefly, play builds the child. Muscles are developed by use. So also of the heart and lungs and So also of the other organs, even of the bones. mind and character. Play is growth. It is nature's prescription of the activities that shall form the child. It is her method of making him a man. The child plays for the same reason that the grass grows or the flowers spring up; for the same reason that he is here at all.-The Playground.

Editorial Notes from the Wisconsin Medical

Recorder.

A writer in the Lancet suggests that the evils of over population in England can be easily remedied by the repeal of the vaccination laws.

A Kansas City food inspector is said to have condemned a certain food product whose label shows an eagle, because the contents did not consist of canned eagle, says the Western Druggist.

In Austria, druggists are forbidden to put up prescriptions which are illegible. In fact there might be a law compelling physicians to write their prescriptions with a typewriter.

Book Notices

International Clinics.

A Quarterly of Illustrated Lectures and especially prepared original articles on treatment, medicine, surgery and the allied sciences by leading members of the medical profession throughout the world. W. T. Longscope, M. D., Editor, Phila delphia. Vol. I, Series 19, 1909.

The first volume of the nineteenth series of International Clinics opens with an article by Fleck on "The Hospital for Advanced Cases of Tuberculosis." It is a plea for humane isolation and presents the subject in a very readable form. Walsh writes on Occupations and So-called Rheumatic Pains. While this article belongs to the class of clinical lectures and does not present anything especially new, the author's style makes it well worth reading. Mikuliczs Disease and Allied Conditions are extensively discussed by Howard. He reviews 55 cases of the disease proper, 20 cases of pseudo Leukaemia and 6 cases of Leukaemia, The bibliography is exceptionally

complete covering over 100 references. Poncet and Lericke on "Acute Tubercular Rheumatism" is a well presented dissertation on an often puzzling subject. The Diagnosis of Dilatation of the Stomach by Sommerville presents little not found in any good textbook. Typhobacilosis by Ludozy is a rather well sustained contention for a separate type of tuberculosis described by the author some years ago.

The department of surgery contains the report of a case of nerve grafting in facial paralysis by Truman. A discussion of suppurating in appendicitis by Corner, both of which are fairly well represented. Excission of the Hip-Joint in Arthritis Deformans is discussed at considerable length by Richardson; he reports some cases and favors the procedure. "Conditions Modifying Operative Work," a clinical lecture by Wilmoth, states what every operator knows and what is of little importance for those who do not operate to remember.

Jardin's report of a case of Acute Yellow Atrophy of the Liver and Pernicious Vomiting of Pregnancy. Intestinal Obstruction during pregnancy and the Post Partem by Cumston reviews this subject without adding anything to our knowledge of it.

Kelsalls Clinical lecture on "Rupture of the Urethra; Acute Urinary Retention; Secondary Syphilis" is of the usual type of such lecture and an estimation of International Clinics should not be based on such articles alone. A case of Tubercular Stricture of the Rectum with Excission is reported by Earle and is of value simply as a case report. Grayson under a somewhat lengthy title writes in neurovascu lar disturbance of the nose.

The attention of the Medical profession being recently directed to Spowtrichosi's the article by Daval & Vinard appears as a timely description which is well worth reading.

The last and in most ways the best article in this volume is MacCalluns on Absorbtion from the peritoneal cavity. He covers his subject quite thoroughly and his conclusions are of interest especially to the surgeon. His bibliography is well selected containing about 20 references.

The last hundred pages of this volume contains a brief review of the progress of medicine in 1908 and while of necessity brief is well worthy of careful reading by anyone interested in the general progress of medicine as a whole.

Since trained nursing has become so popular and so necessary, in its wake has naturally followed a large number of text-books (?) for the education and edification of the trained nurse. The latest applicant for favor is the book under consideration by a former Superintendent of the Columbia Hospital, Pittsburg, etc., and the author modestly credits a number of standard text-books with the information which has been necessary to compile this work. In its 400 pages it briefly covers nearly the entire subject of medicine, including cookery, and concludes with a form of quiz-compend which the reviewer imagines will be sufficient, if properly mastered, to sufficiently pass an examination to entitle her to practice her favorite calling.

The book is unusually practical in all its details and is bound to accomplish its aim and be well

received among training schools. The plan of the book is well arranged and the subjects treated are simplified and concise and easy of comprehension, besides being well illustrated. The pupils mastering the major portion of this work will be well fitted and have a good foundation to pursue the more difficult studies that follow the first year's work.

Medical Chemistry and Toxicology.

A text-book by James W. Holland, M. D., Professor of Medical Chemistry and Toxicology, Jefferson Medical College, Philadelphia. Second Revised Edition Octavo of 655 pages, fully illustrated. W. B. Saunders Company, 1908, Philadelphia and London: Cloth $3.00 net.

The second edition of Medical Chemistry and Toxicology has been thoroughly reviewed to accord with the recent edition of the United States Pharmacopea and with the recent advances in physiological chemistry. The book covers the essentials of general organic and physiological chemistry and toxicology. Especial reference is made to the texts most commonly used by physicians. The illustrations are very good and the colored plates in most instances are the best we have seen. The subject matter is clearly presented and while of necessity brief is sufficiently comprehensive for the medical student or practitioner.

The author obviously has direct control of all the departments of chemistry in the college with which he is connected and in that event his book is of great value. In most medical colleges, however, the teaching of organic and physiological chemistry is under the direction of several men of different training to whom a text-book covering the entire field, even though all subjects were presented reasonably well, would not be acceptable. For the practitioner, however, this apparent disadvantage is in reality an advantage and for such the book is admirably fitted. The press work is up to the publishers' usual standard of excellence.

Diseases of the Skin and the Eruptive Fevers. By Jay Frank Schamberg, M. D., Professor of Dermatology and Infectious Eruptive Diseases in the Philadelphia Polyclinic and College for Graduates in Medicine. Octavo of 534 pages, illustrated. Philadelphia and London: W. B. Saunders Company, 1908. Cloth, $3.00 net.

The major part of.this work is devoted to diseases of the skin and the subject is presented in as practical a manner as brevity will permit.

The book is especially adapted for the general practitioner, and advanced student; giving a clear, concise definition, etiology, symptoms, pathology, diag nosis, prognosis and treatment of all of the common affections and a short discussion of the rarer ones. Only the generally accepted theories as etiological factors are mentioned. The points of special merit are the clear, definite and terse statements of the causes and treatment of skin diseases. The value of the work would, perhaps, have been enhanced by devoting more space to differential diagnosis.

The second part is devoted to the exauthemata. The author has done full credit to the subject by giving a most excellent discussion of the acute eruptive fevers, especially the differential diagnosis; more valuable because from the viewpoint of the dermatologist.

The text, printing and paper are excellent, and the numerous reproductions of most carefully selected photographs of typical cases make the work a splendid reference book.

Progressive Medicine.

A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. By Hobart Amory Hare, M. D., assisted by H. R. M. Landis, M. D. Vol. XI, No. 1, Lea and Febiger, Philadelphia and New York.

The contents of Progressive Medicine for March, 1909, is as follows:

Surgery of the Head, Neck and Thorax, by Charles H. Frazier, M. D.

Infectious Diseases Including Acute Rheumatism, Influenza and Croupous Pneumonia, by Robert B. Preble, M. D.

Diseases of Children, by Floyd M. Crandall, M. D. Rhinology and Laryngology, by D. Braden Kyle, M. D.

Otology, by Arthur B. Duel, M. D.

The subjects are covered with the usual care of these authors and while a review of this character of work is impossible its value remains unquestioned.

Changing Values of English Speech.

Hinds, Noble & Eldredge, New York. Price $1.25 postpaid. Gilt top.

The Changing Values of English Speech is the name of a new book from the pen of Ralcy Husted Bell. The contents of the book itself has no definitely practical value. But the book is written with such a charm of style, and such ease and naturalness, and such a refreshing sense of humor, that it might serve as an object lesson on the English language as it should be written.

Books, Pamphlets, Etc., Received. From P. Blakiston's Sons & Co., Philadelphia: Refraction and How to Refract. Including sections on Optics, Retinoscopy, the fitting of spectacles and eye glasses, etc., by James Thorington, M. D., 220 illustrations, 13 of which are colored. Price $1.50 net.

From Funk and Wagnalls, New York:

Self Control and How to Secure It, by Prof. Paul Dubois. Price, cloth, $1.50 net; by mail, $1.60.

From Geo. M. Niles, M. D., Atlanta, Ga.: Anorexia (reprint Southern Medical Journal, Dec., 1908).

From Albert E. Sellenings, M. D., New York:

A Modified Operation for Inguinal Hernia (reprint (Amer. Journal of Surgery).

From Samuel E. Earp, M. D.:

Sydenhamis Chorea-Bedside Clinic at the Indianapolis City Hospital (rep. Indiana Medical Journal, April, 1909).

Exophthalmic Goitre (Rep. Medical Council, March, 1909).

From New York State Commission to Investigate the Condition of the Blind.

Report of the Committee of 1906.

From Department of Commerce and Labor-Census Office:

Mortality Statistics-1907. 8th Annual Report. From Illinois State Board of Health. Medical Dept. of the State Government:

Monthly Bulletin-Vol. IV., No. 11-12.

From Treasury Department U. S. Public Health and Marine Hospital Service:

The Prophylaxis of Yellow Fever, by G. M. Guiteral (Feb., 1909).

COMPLETE SERIES, VOL. LVIII, No. 6

NEW SERIES, VOL. III, No. 6

$2.00 YEARLY

Contributed Articles

THE OPERATIVE TREATMENT OF HEM

ORRHOIDS.

W. H. STAUFFER, M. D. St. Louis.

When does palliation become unscientific, and when should operative measures be advised, are questions which are likely to be answered by the attendant, according to his experience and proficiency in treating diseases of the rectum and anus.

The patient and his environment demands our first consideration. In our desire to relieve him of a very distressing condition, we must not forget that he is entitled to a truthful statement as to the diagnosis and prognosis. A proper understanding as to what may reasonably be expected when assuming charge of a case, often forestalls any unpleasantness. For tunately there are few conditions that yield more kindly and promise better results, than the proper treatment of hemorrhoids.

The pathological condition must be definitely determined. How much of the anus and rectum are involved. If the parts are ulcerated, a section should be submitted to a microscopical examination, as to malignancy, syphilis or tuberculosis.

At least thirty-six hours should be taken for the preparation of the patient for operation. The intestinal canal being thoroughly emptied and the parts rendered as nearly aseptic as possible. The use of local anesthetics for operative interference in this region has kept pace with all departments of surgery. Like all other good things, there is danger of overdoing. It has been conclusively demonstrated that they are by no means devoid of danger, however skillfully employed. Their use is largely responsible for incomplete and bungling work

The performance of so-called minor operations in the office of the surgeon, however well equip ped, with the exception of external hemorrhoids is not to be encouraged. It is impossible to prepare your patient properly or care for him adequately afterwards.

For general anesthesia, I prefer and use ether, unless contraindicated. The patient should be entirely under its influence before beginning any operation, and it is always well to advise the anesthetist when you are ready to begin, so that due caution may be exercised.

The violent and extreme dilation of the sphincter ani is unnecessary, and often harmful. Any undue traumatism predisposes to infection or tissue unrest. Unnecessary manip ulation and violence to tissue, no matter what operation is practiced, often add more to the time and discomfort of convalescence, than the operation itself.

The operation to be selected depends upon the three following factors, named in the order of their relative importance. 1. Complete restoration of function. 2. The time required. 3. The pain produced.

The various operative methods may be divided into the three following classes: 1. Complete excision of the pathological tissue. 2. Devitalization and tissue necrosis. 3. Partial excision and devitalization.

The operation of excision by means of one of the various methods devised, and the union of the parts by catgut sutures, is no doubt the ideal method, but the great difficulty in procuring an aseptic field and keeping it so will always limit this procedure to selected cases, such as mixed and external hemorrhoids, especially those associated with prolapse of the mucous membrane. Only the pathological tissue should be removed, and no attempt should be made to substitute a major operation when a minor one is indicated. All bleeding must be controlled, and the stitches so placed as to