The MEDICAL FORTNIGHTLY, in its humble way, stands for progress, honest practice, independent thought and the good will of medical men. This is our policy, and we hope to ever be worthy of it. There are temptations daily thrown in the way of the physician, which may lead him to forget his duty to his profession, to his family and himself we know these temptations exist, and in the field of journalism temptations to come in to allure us, but we propose to hold to the old and time-tried policy which Polonius gave voice to, as follows:

"Look thou character, give thy thoughts no tongue; nor any unproportioned thought his act. Take each man's censure,

but reserve thy judgment. This above all-to thine ownself be true; and it must follow, as the night the day, thou canst not then be false to any man."

In the year of 1906 we will try to follow this policy, and we assure our readers we will try to make the columns "worth while," and our policy for the best interests of the medical profession. F.P.N.

THE value of open-air treatment of tuberculosis is daily becoming more and more reccg

Open Air Treatment of Surgical Tuberculosis.

nized as the treatment par excellence. It has long since passed the experimental stage, and the tendency now is to further extend its usefulness in the treatment of the very varied tuberculous lesions. W. S. Halsted, of Johns Hopkins University as long ago as 1889, suggested the value of openair treatment in all cases of tuberculosls irrespective of the situation of the lesion, and following this possibility he inaugurated the open-air treatment of surgical tuberculosis practically as soon as the first tuberculous patient was admitted to the surgical wards of Johns Hopkins Hospital. The results of his labors and observations covering this period of nearly sixteen years, are detailed in an excellent and valuable address appearing in American Medicine (Dec. 2, 1905). Halsted describes the evolution of the open-air methods as practiced in the hospital, and recites a series of private cases treated at sanatoria and elsewhere by open-air treatment. He says, "it is from my private patients that I have learned the almost incredible value of true out-of-door living in the treatment of tuberculosis. In the cases reported, says Halsted, "the lessons taught, can hardly fail to awaken positive enthusiasm in others, as

discuss the relative merits of localities, but does emphasize the importance for some patience of the twenty-four hours a day out of doors. When the thermometer registers 20 deg. below zero, a night out of doors is not an agreeable prospect and may be a difficult problem; and so occasionally there might arise the question, is it better to have from eight to ten hours of the day in the open air in cold climate or twenty-four hours in a more temperate one. The advantages of a speedy recovery are so evident that they need not be urged Furthermore, the prospect of years of treatment, in a sanatorium, or away from home, or at home on a roof in the city, or simply camping day and night in the country, is dispiriting and not readily consented to by patients or friends. But a few months or a year of such life, coupled with almost a guarantee of recovery might be anticipated with relish, and regarded as an outing combining duty and pleasure and immeasurable profit.

Tradeau in commenting upon life out of doors says: "The more I go, the more convinced I am that it is of little use merely to tell people to live out of doors. They must be provided with accommodations which enable them to live out-of-doors easily and comfortably. Special buildings must be planned and constructed for the purpose. Some day you will have to carry into effect your plans for an infirmary for cases of surgical tuberculosis. Those patients should sleep outof-doors all night and live out-of-doors all day, being provided with every comfort and convenience."

As

Halsted insists that "one should, if possible, have the benefit of the proper influences of place, of people, and must important the true physician, in order to acquire the stimulus necessary to the faithful carrying out of the treatment." He further says, "I should have the greatest confidence in the efficacy of massage in the treatment of these cases. to diet, is it necessary to stuff our patients? A non-tuberculosis patient is usually more vigorous if he is not over-fed. As to the use of tuberculin Halsted says it has been our main reliance for nearly fourteen years in diagnosis, but it has never assisted us in deciding when to discontinue fixation and to permit use of the affected joint. Again, he says most cases of surgical tuberculosis will recover without operation if they are given an opportunity in the open air, I am convinced, nor should I be surprised if it proved to be, in general, an easily curable disease. My hardest task in the treatment of these cases has been to persuade the relatives and friends, and alas, the physician of patients,

of the necessity of taking so much trouble, of instituting a disturbance of the even tenor of the family's existence, or, of involving themselves in such unanticipated expedition, I have submitted the pros and parried the cons with the parents for hours, and until so weary of the battle that I have vowed never again to misplace so much energy. But interest in the subject, as great occasionally as in the particular patient, has usually stimulated a renewal of the attack. Unless acquainted with the lamentable results usually obtained in the treatment of cases such as these herewith presented, one can hardly comprehend what has been accomplished by the open-air treatment of them, and realize what assurances it holds for the future. How eagerly we should welan achievement which properly curtails the indications for the practice of surgery, a therapeutic measure so crude and so crude and often so mutilative. In the huge multitude of cripples from the ravages of tuberculosis we find overwhelming proof of the inadequacy of past and present methods of treatment. How different is the story just related of the open-air treatment. In not one instance did the disease make appreciable advance after the treatment was inaugurated.

The surgeon's duty is not done when he advises his tuberculosis patients to live out-ofdoors. He must, if the patient's means permit, and if other localities promise decidedly more than home, send him among strangers and entrust him to a physician or companion who will assume the responsibility of insuring a continuous of out-of-door life. Public opinion, which has compelled the sceptical physician to transfer his case of appendicitis to the proper surgeon, will soon hold the surgeon responsible for bad or indifferent results in tuberculous disease of the hip, the knee, the peritoneum.

Thus concludes this masterly presentation of this very important subject, and one in which every progressive physician should be actively interested. It shows the possibility for great and useful service on the part of the sanatoria, public and private, which just now are prominently before the profession. And, too, the many hospitals throughout the country can organize to meet the demands of such cases while in the home, where it is impracticable for patients to go elsewhere, organization is possible along the lines suggested by Dr. Halsted. F.P.N.

To obtain the best results in cases of Colles's fracture the patient should be placed under an anesthetic during reduction.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

BERG'S SURGICAL DIAGNOSIS. A Manual of Surgical Diagnosis For Students and Practitioners. By Albert A. Berg, M.D. Adjunct Attending Surgeon to Mt. Sinai Hospital, New York. In one 1mo volume of 543 pages with 315 engravings and 21 full page plates. Philadelphia and New York: Lea Brothers & Co. (Cloth, $3.25, net.)

The author by his work has placed before the medical profession a useful reference book. For the student it is practical, brief and concise, and will act as a quick, accurate reference book. The engravings are some original and some taken from authorities, while the plates are clear and very instructing. The author's exposition of the various tumors in various localities is neatly illus. trated as well as clearly explained. The author adds to his work the chart and description of the hyperalgesic skin are as according to Head. The localization of these areas are well illustrated. Methods and means of forming a surgical diagnosis is aptly explained. The author's article on pancreatic cysts is worthy of the perusal of the most skilled surgeon. His engravings and description of this disease gives one some new ideas on this point. In concluding the reviewer wishes to say that not only is this volume filled with some plates and engravings found nowhere else, but the graphic descriptions of various surgical diseases make it worthy of a place in the library of the student as well as the busy surgeon. D.

THE PRACTITIONERS' VISITING LIST (Heretofore known as the Medical News Visiting List) for 1906. An invaluable, pocket-sized book, containing memoranda and data important for every physician. and ruled blanks for recording every detail of practice. The Weekly, Monthly and 30Patient Perpetual contain 32 pages of data and 160 pages of classified blanks. The 6-Patient Perpetual consists of 256 pages of blanks alone. Each in one wallet-shaped book, bound in flexible leather, with flap and pocket, pencil and rubber, and calendar for two years. $1.25. Thumb-letter index, 25 cents extra. By mail, postpaid, to any address. Descriptive circular showing the several styles sent on request. Philadelphia and New York: Lea Brothers & Co.

1935.

Being in its twentieth year of issue, The Practitioners' Visiting List embodies the results of long experience and study devoted to its development and perfection. It is issued in four styles to meet the requirements of every practitioner; "Weekly, dated for 30 patients; "Monthly," undated, for 120 patients per month; "Perpetual" undated, for 30 patients weekly per year; "60 patients," undated, for 60 patients weekly per year. The text portion of The Practitioners' Visiting List for 1906 has been thoroughly revised and brought up to date. It contains among other valuable information a scheme of dentition; tables of weights and measures and comparative scales; instructions for examining the urine; table of eruptive fevers; incompatibles, poisons and antidotes; directions for effecting artificial respi

ration; extensive table of doses; an alphabetical table of diseases and their remedies and directions for ligation of arteries. The record portion contains ruled blanks of various kinds, adapted for noting all details of practice and professional business. Printed on fine, tough paper, suitable for either pen or pencil, and bound with the utmost strength in handsome grained leather, The Practitioners' Visiting List is sold at the lowest price compatible with perfection in every detail.

MANUAL OF DISEASES OF THE EYE. By Charles H. May. 400 pages, 21 colored plates, including 65 colored figures, 360 engravings in the text. Fourth Edition. 51 Fifth Ave., New York: William Wood and Company. (Price, Muslin, 2.00 net.)

The rapidity with which the first three edi. tions of this incomparable text-book for students was exhausted is the greatest commendation of its merit. The author has made a number of additions to the fourth edition that the little volume remain fully abreast of the time. Among the many advantages that this book possesses may be mentioned the division and classification of its contents. Its conciseness, nothing but essential matter receiving consideration. The colored plates greatly enhance its value for the medical student. And lastly, the final chapter reserved for ocular therapeutics in which the strength of the remedies most in vogue and their ap. plications are fully enumerated deserves especial mention. The ignorance of the non-ophthalmologist on this subject is only too well known. If the author continues to slightly revise the methods which are being altered as our experience broadens, there is no apparent reason why his text-book should not remain the favorite of the student as well as the busy practitioner.

NEUROTIC DISORDERS OF CHILDHOOD; Including a Study of Auto and Intestinal Intoxication, Chronic Anemia, Fever, Eclampsia, Epilepsy, Migraine, Chorea, Hysteria, Asthma, etc By B. K Rachford, M.D., Professor of Diseases of Children, Medical College of Ohio. University of Cincinnati. 440 Pages. 241-143 West 23d St, New York: E. B. Treat & Company. (Cloth $2.75)

This field, though by no means new, has not hitherto been treated in text-books with the individuality which it so richly deserves. In these studies Rachford strikingly calls attention to the radical differences in anatomy, physiology and morbid conditions between the nervous system of the child and the adult. The book is written in such scholarly, logical and altogether readable form as to gain and hold the attention at once. sesses all the ear marks of being the result of wide experience and careful investigation, and fairly occupies the middle ground of the best thought of today along these lines. Of great value alike to the neurologist, pediatrist and general practitioner as covering an important field rather neglected by all. To the general practitioner part II of the book is

It pos

especially valuable, as the individual neurotic conditions are taken up seriatim and given a thorough practical consideration, including a comprehensive and detailed discussion of therapy.

COLOR REVISION AND

A

COLOR-BLINDNESS. Practical Manual for Railroad Surgeons. By J. Ellis Jennings, M. D., (University of Pennsalvania). Formerly Clinical Assistant Royal London Ophthalmic Hospital: etc. Second Edition. Thoroughly Revised with Illustrations. 132 pages, Crown Octavo. 1914-16 Cherry St., Philadelphia, Pa.: F. A. Davis Company, Publishers. (Price, Extra Cloth, 81.0), net.)

As the author states there is nothing original in his volume as far as known facts are concerned. But he deserves the greatest praise for his painstaking labor and the interesting manner in which he has arranged his subject. The volume is original in so far as it is more practical than most treatises on this topic, and for this reason alone, should be in the hands of every railroad surgeon and ophthalmologist, many of whom are not over familiar with this essential department of ophthalmology. The author has kept his admirable manual up-to-date, and we hope that the second edition meet with the same well merited sale of the former.

THE PHYSICIAN'S VISITING LIST (Lindsay and Blakiston's) for 1906. Fifty-fifth year of its publication. Containing calendar, various tables and other condensed emergency information, and space for the daily bookkeeping of the physician for the year. In flexible leather. Pocket size. 1012 Walnut St., Philadelphia: P. Blakiston's Son & Co. (Price, regular edition for 25 patients per day or week $1.00; 50 patients per day or week $1.25. Also in larger sizes and the monthly and perpetual editions.)

Carcinoma of the Breast.-Prof. Schinzinger, Muench. Med. Wochens., No. 36.)-In 1889 at the Surgical Congress in Berlin, the author proposed the castration of the woman for carcinoma of the breast. Since cancer seems to be more malignant in the very young his idea was to castrate and bring the breast to a more rapid atrophy, and if possible to give the cancer a chance to encapsulate itself in the shrinking tissue. He advised early operation, and even in menstruating women to do ovariotomy before the breast amputation. He reviews the literature on the subject, and shows that quite favorable results have been obtained. He also reports three cases of cancer of the breast in men.

CORRESPONDENCE

The

AS TO WHOLESALE POISONING, ETC. My attention has been drawn to an article by Dr. R. G. Eccles, of New York, in the MEDICAL FORTNIGHTLY of November 25, 1905, entitled "The Wholesale Poisoning Scare;" an answer to my article, "Shall Wholesale Poisoning Be Sanctioned?" Dr. Eccles has a similar article appearing in the "Alkaloidal Clinic" for December. language in the Clinic is more temperate, but the arguments are the same. Possibly he has similar articles appearing in other pub. lications which I have not seen. Dr. Eccles' article is plausible, well written, and may be convincing to those who wish to be convinced. He closes with a burst of enthusiasm which leads me to think that he came very near convincing himself of what he was writing. Though I read his article carefully, more carefully I think than Dr. Eccles read mine, I am still unconvinced that black is white, or right is wrong. Briefly stated, Dr. Eccles' article records his vigorous opposition to pure food laws and their enforceinent, his disbelief in adulteration of food sold at standard prices, and is a sweeping defense of the use of preservatives without regard to kind and quantity.

Neither does he see any crime in the substitution of an inferior article for a superior one, as long as the inferior is harmless to health. The use of fraudulent labels which would lead the public to buy cottonseed oil for olive oil, corn meal for flour, oleomargine for butter, etc., is not only condoned, but defended. "How ridiculous," say Dr. Ec cles, "that the substitution of a red label for a green label, or the omission of a word or two on a label, should subject the dealer to arrest or fine." If Dr. Eccles is not describing and defending dishonesty, then I do not know the meaning of the term. That any one should stoop to defend such practices does indeed show how one's enthusiasm may "play foot-ball with one's logic," or his moral sense. The manufacturers and dealers are divided by Dr. Eccles into two classes: First, the grasping and avaricious scoundrels who seek to force their pure food down our throats at exorbitant prices; and secondly, those kindly and philanthropic gentlemen who furnish us with our formaldehyde milk, glucose sugars and syrups, and borated meat at prices within the reach of all.

Dr. Eccles sympathizes with this latter class, and on reading my paper, sees as in a vision the poor and deserving public clamoring for food, their chicory coffee, their

glucose syrup, and bean meal and terra alba flour, torn from them by a cruel and unjust law. "Alas," says Dr. Eccles, "it is unfortunately only too true that dealers all over the country are being fined for selling adulterated goods." In plain English, thieves are being punished, and Dr. Eccles is sorry. Why? In that sentence lies at once the keynote and the explanation of Dr. Eccles' entire article. It is against the laws on this subject that the doctor inveighs most bitterly. He finds them unjust, unconstitutional and ridiculous. The pure food law which failed to pass the Senate last winter, he calls a caricature on justice. This law which was supported by the medical profession all over the country, was killed by the whiskey rectifier's trust, as I stated, who paid well for its defeat. They too thought it was a caricature on justice.

Dr. Ecoles professes to see a great injustice in the action of certain chemists who have analyzed and reported unfavorably on certain adulterated foods; claiming that in most cases the samples used were bought from firms whose products were generally known to be adulterated. Exactly so. Dr. Eccles hereby admits that adulterated foods may very easily be found when they are looked for. That is just the statement that I made in my paper. It is against the producers of such goods that my article is aimed, and not against the manufacturers of pure goods. Though Dr. Eccles may have opportunities for the acquisition of information bearing on this subject, that I do not have, yet I believe that I am reasonably well informed as to the status of the food products I have discussed. my paper I quoted authorities for many of the statements I made, and I believe they cannot be questioned. The best authorities, those who have given unprejudiced study and thought to these matters, are unanimous in warning the public against the dangers of the widespread adulteration of our pure food supply, and the increasing use of harmful preservatives. The doctrine that Dr. Eccles teaches, is a dangerous one, and cannot be too strongly censured and condemned.

In

With the use of harmless preservatives I certainly have no quarrel, and they are just as well known to me as to Dr. Eccles.

But the law should certainly have the right to define which are, and are not dangerous. Whether the present laws are unjust or unconstitutional, is a matter of opinion, and opinion is too often a matter of personal view-point, certainly

"No rogue e'er felt the halter draw
With good opinions of the law."

The arguments that Dr. Eccles uses in support of his position are not new. They

have been used before, and with equal skill by the Press Bureau of the Proprietary Medicine Manufacturers, the Whiskey Rectifiers' Association, the Wholesale Grocers Trust and other concerns engaged in similar dirty business.

However, Dr. Eccles' article is better than the average of its class, and will no doubt please those most interested in the dissemination of such literature. If he had not been capable of writing an apparently clever and convincing argument, it is safe to assume that he would not have had the privilege of writing it at all. C. F. WAHRER, M.D. Fort Madison, Iowa, December 2, 1905.

PROPRIETARY MEDICINES.-H. P. Loomis, New York (Jour. A. M. A., Dec. 9), calls attention to special objectionable features of the proprietary medicine business, the secrecy in some, the commercialism, the dressing up of old remedies with new names, and the fraudulent recommendations. He sent circulars of three proprietary medicines widely distributed and pretending to give concise details involving chemico physiologic facts, to three well known physiologic chemists asking for a simple explanation of the reading matter. The answers were essentially the same in each case that the pretended concise descriptions were largely mere jumbles of words without meanings or else a tissue of falsehoods. He asks how the average physician can discern the truth when the expert fails. This does not apply of course to some honest manufacturers who are doing excellent work, but does in the case of a large proportion of proprietary remedies advertised and sent out to physicians.

In ex.

REDUCTION TREATMENT.-John W. Wainwright first reviews the ideas of v. Noorden and other authorities concerning obesity and the best measures for its reduction. pressing his own views the author says that the fact must always be remembered that obesity cannot be successfully treated by the same or similar methods in every case. Corpulent persons, who are otherwise healthy, by careful dieting, plenty of exercise, baths, and other rational means may reduce their superabundant adipose deposit, or at any rate may prevent an increase. But on the other hand, obesity alone may, and probably will, have an injurious effect upon the patient's general condition. The cause must be governed by the disease from which he is suffering. He then describes in detail the various measures of diet, exercise, bathing, etc., that are useful, and points out how they may be adapted to the needs of different individuals.-Medical Record.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

OBSTETRICS AND GYNECOLOGY

W. H. VOGT, M. D.

Pulmonary Tuberculosis as an Obstetrical Complication.-Charles Sumner Bacon (J. A. M. A., Oct. 7, 1905) is convinced that in many cases pregnancy has a bad effect on the tubercular process. In all severe forms the exhaustion from loss of energy and from the depletion of the system is extreme and not rarely leads to a fatal termination. The effect of tuberculosis on pregnancy is as a rule slight, except when the case is severe with considerable fever and coughing. In these cases abortion frequently takes place. The puerperium almost always has an unfavorable influence on tuberculosis. Unless the woman can live in the best hygienic sarroundings she should be sterilized. When an operation for sterilization is determined on, one should be chosen which does not remove the ovaries, and the author recommends the vaginal resection of the tubes as the simplest and best. If a tuberculous woman has become pregnant we must decide whether or not the pregnancy should be interrupted. In this case it will depend on circumstances. If the patient can live in the best of hygienic surroundings and receive good food and care, she might be allowed to continue with pregnancy; on the other hand, if such favorable conditions are not possible, abortion should be performed. Kidney diseases, heart discase and severe vomiting are additional indications for its performance, but should be done before the twentieth

week of pregnancy. If pregnancy be allowed to continue the patient should be treated according to the following principles: 1. She should live in the open air as much as possible; she should breathe fresh air. 2. She should be well fed with good nutritious food. 3. She should avoid exhaustion or fatigue. After the child is born she should under no circumstances nurse the child, and the child should not be kept in the same

room.

Conservative Myoma Operations.-Graf, (Zeitschrift für Gebwitshilfe u. Gynaekologie, Bd. 56, 1905) gives a report of the 39 myoma enucleations performed in Schauta's clinic during twelve years. The results have not been satisfactory. A recurrence is not uncommon, nor does the method give absolute relief of all suffering. The hopes of pregnancy occurring in a uterus so operated have also not been fulfilled.