riding for men and women, horseback riding, the comparative advantages of different makes of bicycle saddles, appendicitis, the superior value of a specified health resort-all are placed under contribution for personal advertisement and consequent increase of their office practice by medical men. How will the excuse prevail that the public need and demand enlightenment upon these subjects? If this were so, why is the required information not obtained from the faculty, as a whole, of our leading medical colleges or from the executive committee of our various medical societies, speaking for and in the name of their associations? Surely, in a matter of great and public interest, information could be obtained in this way, would be representative, would be authoritative and far more conclusive than the offhand (!) statement of opinion by any individual physician.

We pass by without especial comment the method of advertisement by testimonials to medicated wines, cordials, proprietary medicines and surgical appliances-these all bear the indorsement and names of prominent medical men with their respective addresses. We would not be very much surprised, indeed, if some day we should see on a full-page advertisement the smiling features of some medical man bursting through a cardboard, with the cheery salutation and familiar question: "Good morning! Have you used Pear's soap?" Of course this would be accompanied by the legend: "This is what Dr. X. says " (name and address given).

All this is against not only the spirit but even the very letter of that law universally upheld among medical men as embodying the distinctive and vital difference between our noble profession and that occupation of the majority of men, which consists merely in buying and selling and is called trade. Why may this law be daily broken with impunity? Because the methods of self-advertising we have described are not labeled such; they are called by any other name and thus the medical conscience remains at peace.

We also believe fully in the justice and necessary maintenance of this law, but we believe that it is far more important to follow it in its spirit than in its letter alone. What is this law and what does it demand of us? That we should not announce Our talents among the laity, however great we believe those to be nor however much we covet appreciation, either verbally or in print. In other words, we are forbidden to place our own valuation publicly upon our medical wares, as mere traders do, but are commanded to work and wait that the public "may know us by our fruits." This is the law, properly interpreted both in spirit and in letter; yet as we have seen it is constantly broken unblushingly and with impunity by many prominent niedical men. But let the word "advertisement" be used in conjunction with the name and special work of a practitioner, even in a medical journal,

and many would cry out that the code of medical ethics had been ruthlessly violated. Here again is a great inconsistency. It is altogether permissible that a so-called specialist should announce, before a few unbelieving members of his society, who know both him and his work, his wonderful methods and wonderful statistics for the gaping information of the many far-distant readers (who do not know him) of the medical journal which will report his words. This is allowed. Why then is it not permissible that reputable specialists should insert regularly paid advertisements, announcing that they are specialists, in the advertising columns of medical journals? We believe it should be. Not only this, but we further believe that such a course would be greatly to the benefit of all specialists, if such a custom prevailed. It would have the effect of separating the true specialists those who really practice what they preach-from those who speak with the authoritative utterance of specialists before special societies, but whose very general practice in reality is as far removed from that of a specialist as is their previous special training. These latter are known only as specialists to the readers of special journals. Their immature opinions are given the same weight as those of the true specialist, whose entire time is devoted to the development of his especial branch. Advertising only and through distinctly medical channels would thus establish "protection" for specialties against the inroads of general practitionersa form of unskilled and cheap labor fatal to the development or continuance of any specialty-and the medical man from a distance would be enabled to know with whom to consult as an authority in difficult cases requiring special skill. At present, such an inquirer is frequently deceived by the continuous "puff" every would-be-considered specialist gives himself in the medical journals and often approaches with a reverence a consultant who in fact knows possibly less about the specialty than the acknowledged general practitioner who seeks him out. It would undoubtedly be the duty of a medical editor to see to it that no medical advertisement entered his journal from a professing specialist who was not one in fact; he must, if only in his own interest, use the same careful supervision necessary to exclude any other bogus advertisement. Nor would he permit the advertiser (if any specialist showed so little sense of decency as to wish it) to recite the superiority of his personal merits over those of his competitors. But such an advertisement as appears in all our medical directories in the list of physicians, with the addition that each insertion be placed under the caption of the specialty to which such an individual exclusively devotes himself, would in our opinion be both beneficial and proper. The present defenseless condition of all specialties has invited and incurred the inrush of a multitude of medical "wreckers," who are ever on the lookout to increase their pecuniary gains. Specialties, as such, therefore are fast ceas

ing to exist, under the strain of competition between those who are and those who "profess," and many men, well-equipped by previous training, special talent and personal desire to devote all their time and energy in one special field, are compelled to face the alternatives of becoming "jacksof-all-trades" or starvation. If any check could be placed upon the ruthless ravages of outsiders, we believe many men, thus debarred, whose intentions are honest and upright, would become true specialists and thus raise to a standard of accurate knowledge and dignity branches of our science which have now fallen in a state of decadence and confusion which, in the case of gynææcology at least, points to a not very far distant desuetude.

We firmly believe in the necessity of specialists in medicine, in the sense of exclusiveness, and we will gladly adopt and further any just means by which they may be protected and encouraged. If by opening our advertising columns to them such an end may be even partially attained, we will not only gladly do so but will also urge upon all our special medical contemporaries the wisdom of the same course.

It does not need the gift of prophecy to foresee, in the present trend of medical desire and practice, that the day will soon come when the hunger for advertising, induced by the unjust competition we have described, can no longer be restrained under the cloak of pretense and apparent respect for the law. When that time arrives, the profession will burst, like an irresistible deluge from the time-honored barriers of dignity and self-restraint and, in spite of county medical societies and the hopeless protests of the conservative, will vie publicly with patent-medicine men and quacks for the suffrages of the laity.

To delay this tendency, to direct and, if possible, to divert it, we suggest this method of medical advertising, at once both dignified and justifiable.—Editorial in the American Gynæcological and Obstet.

Journal.

:0:

THERAPEUTICS.

THE USE OF FORMALDEHYDE AS A DISINFECTANT.

By E. A. DE SCHWEINITZ, PH.D., M.D.

Professor Chemistry and Toxicology Medical Department, Columbian
University, Washington, D. C.

In order that a disinfectant shall be thoroughly satisfactory there are a number of conditions which must be fulfilled. In the first place, it should destroy surely and quickly the most resistant forms and spores of injurious bacteria. It must be a substance that can be easily used, non

toxic and non-destructive to mineral or vegetable matter in the concentration necessary to insure complete disinfection. Further, it should be a substance which can be applied in a gaseous condition to secure thorough contact and penetration of the objects to be disinfected. Again, it must be a substance which is stable in character, not easily decomposed, cheap, and if possible, possesses an odor which dissipates quickly, and should be a good deodorizer. To a certain degree formaldehyde possesses all of these properties and its practical use has been the subject of a number of investigations. Commercially, we find formaldehyde in the market as a 40 per cent. solution of the gas in water or alcohol under the trade names of formalin and formol. This gas can be prepared with great ease. Already in 1888 the strong antiseptic properties of formaldehyde were recognized by Law, and in 1893 Trillat published the statement that a bouillon containing I part of formaldehyde to 50,000 was not suitable for the growth of the anthrax germ. Aronson after making similar experiments tried the poisonous properties of the gas upon guinea pigs and found that they could live for an hour in an atmosphere rich in formaldehyde gas. During this experiment the animals were very restless, but recovered very quickly in normal air. Zuntz had already shown that the poisonous dose for rabbits after a subcutaneous injection was about 0.24 grams per kilo.

In 1893 formaldehyde was recommended for the disinfection of brushes and combs as well as for use to destroy the germs of diphtheria, tuberculosis, cholera and the like on such materials that would be injured by other disinfectants.

Another authority asserted in 1893 that after one hour in solution of a million and after hour in 1:750 anthrax and tetanus germs were destroyed. The results further showed that in the air 2.5 per cent. by volume of formalin or I per cent. by volume of formaldehyde gas was sufficient to destroy fresh virulent cultures of typhoid, cholera, anthrax, etc., in hour. Other experiments have shown that bandages and iodoform gauze can be kept well sterilized by placing in the jars containing these same formaliths, and it was also possible for Stahl to make carpets and cloth materials germ free by spraying them with 0.5 to 2 per cent. formalin solution for to hour, without the color of the carpet being in any way affected. In 1894 the deodorizing property of formaldehyde was explained to consist in a direct chemical combination of formalin with sulphuretted hydrogen and its products.

With Scatol a disagreeable constituent of the faces formaldehyde combines upon the addition of acid to an odorless compound.

Formalin further forms direct compounds with ammonia and am

monium bases which fact has been made use of to determine the quantity of aldehyde.

The researches of Pottevin in 1894 confirmed those of Aonson and Trillat, that a concentration of 1:20,000 was safely a retardent of sufficient strength.

As Walters has shown so far as the action of formaldehyde in gaseous form is concerned that is dependent upon the concentration of the gas the temperature and whether the articles to be disinfected are moist or dry. The killing of the germs is better accomplished when the objects. are moist, not wet, and the temperature is 34°. A property which has long been well known for sulphur dioxide chlorine and bromine.

Of the practical methods of applying formaldehyde, those in which the gas is allowed to work in statu mascendi have given the best results. Several forms of lamps have been devised by which the formaldehyde is obtained by the imperfect combustion of methyl alcohol. Two simple ones have been described by Robinson and de Schweinitz. These have the advantage that the lamp can be filled with wood alcohol and placed in a room or the closed place which it is desired to disinfect. They have the disadvantage, however, that some of the alcohol undergoes complete combustion and a certain amount of carbon monoxide and dioxide are also obtained, and consequently a larger amount of alcohol is used than is necessary. Practical experiments made by Miguel, Bardet and others in disinfecting rooms by means of lamps have given very satisfactory results. The principle of the lamp is to allow the lamp flame to burn over a wire mantle of platinum or platinyed asbestos. Formaldehyde has also been recommended for the purpose of destroying the spores of smut by the action of 1:1,000,000 formalin solution.

In all experiments attention must be paid to the fact whether reference is made to the formalin 40 per cent. solution or to formaldehyde gas.

Walter has made extensive series of experiments with formalin and also with formaldehyde gas. His experiments were made first by preparing different kinds of culture media to which formalin had been added in different proportions. The results of these experiments upon anthrax spores, choler typhus and diphtheria germs showed that the proportion of 1:10,000 to 1:20,000 formalin, 1:25,000 of formaldehyde gas is sufficient to check the growth of germs. When the gas is used the staphylococcus pyogenes aureus seems to be the most resistant while strange as it may appear the spores of anthrax so difficult to kill by most germicides are very easily destroyed by the formalin. This is one of the principles of disinfection, laid down by Koch that some substances would be found which were destructive to pathogenic bacteria but were less injurious to