of laying in his stock under special advantageous circumstances, and can justly make such an announcement. But all doctors, like all lawyers obtain their "stock in trade" through the same channels, along the same lines. One may have had superior advantages of study, wider clinical facilities, but he would be regarded as a vain braggart to advertise such a fact or facts through the newspapers, and none would do him less reverence than the very members of the Press Association. It is customary in each locality, rural neighborhood, hamlet, village, town, or city, for a uniform minimum rate of fees or charges to be made by the doctors thereof. This does not preclude the possibility of one charging a higher fee in some cases where the parties are well able to pay the advance, any more than it restricts the gratuitous services to those who are not able to pay anything. If a doctor should even privately let it be known that he would charge less than the usual rate, it has invariably resulted in a like low estimate being placed on his services; and if he were to advertise the fact that he was "cutting under," no one would be as chary of seeking his aid as the members of the Press.

How would it look if people were "progressive" enough to advertise for a doctor? How would it look for instance to see in the "want column" something like the following:

"Wanted: A good obstetrician. The wife of the editor expects to be confined on date, and bids for services are solicited. The right reserved to reject any and all bids. Apply at this office." Or, "Wanted:- The daughter of the editor of this paper is suffering from tuberculosis, and bids are solicited for the treatment of the case."

As I have stated, a doctor has no right publicly or privately to claim a higher degree of skill than his fellow. Naturally mature age and continued work adds to his experience, and some are more naturally gifted, intellectually more brilliant than others; yet in some cases, by reason of greater care, closer attention, and more time at his disposal, one of less intellect, even a mere neophyte in the profession on whose diploma the ink is scarcely dry, in a given case may be more successful than one more bril

liant and experienced. Every doctor is expected to do the best he can in behalf of any suffering mortal confided to his professional care, and the law as enunciated by the highest tribunal in the land can only demand "reasonable skill."

However, I will not tax you longer, gentlemen, and will conclude by stating that the only advertisement that a doctor needs, after having obtained "reasonable skill" during his novitiate, is cleanliness of person, neatness of dress, courteousness in manner with kindliness, a habit of study devoting a reasonable time to the standard medical works and periodicals, and a sincere interest in all cases that come to ask his aid; all of which will be learned quite soon enough by the public without resorting to the newspapers.

Finally, the following quotation from "The Physician Himself," a very excellent and interesting work by Dr. D. W. Cathell of Baltimore, which doubtless some of you have read, may be appropos. He says:

"There are two classes of wrong: Things that are essentially wrong, and things that are wrong because they are forbidden. The 'ads' of physicians are of the latter kind, and for these reasons: Merchants and tradesmen attract customers by handbills and newspapers, and yet, even though these do exaggerate, such methods are not considered dishonest, because their customers are supposed to know something of the price and quality of the articles offered; besides, they can go from one store to another to examine and compare before buying. But with quacking physicians the stranger has no such opportunity, no such safeguard; because their ads. and puffs tell only one half the story and successes and studiously omit the other half- failures to cure and cases made worse; and, since strangers allured to physicians by these methods can neither compare their skill, weigh their pretenses, nor gauge their honesty, all such pretensions of physicians who do advertise to be better than those who do not, or to cure more people than they do, are deemed ethically wrong; for these reasons, advertising is not resorted to by members of our profession."

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cures

Clinical Reports.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

Stated Meeting held March 5, 1906.

The President, Dr. J. J. McPhee, in the Chair.

PARTIAL GASTRECTOMY FOR CARCINOMA.

THIS patient was presented by Dr. J. I. Edgerton. G. C. M.; male; 41 years of age. Father living and in good health at 78; mother died of stomach trouble, probably cancer, at 58 years of age. Patient had malaria severely 25 years ago, but has had no recurrences. He indulges moderately in tea, coffee, and alcohol, and smokes regularly from 15 to 20 cigarettes daily. For the past 13 years he has suffered with heartburn, which has been more constant during the past two years, during which time he has also suffered from nausea and pain in the epigastrium after eating. During the last few months he had burning pains after eating; was hungry all the time, but afraid to satisfy his hunger, for when he took solid food it remained in his stomach for an hour or so, and then was vomited. On one occasion last winter he vomited some mucus streaked with blood. He began washing out the stomach twice a day on October 4th and brought up greenishclumps of mucus resembling moss. There was no vertigo. His bowels were constipated, and he lost about 25 lbs. in weight during the last few months.

On Nov. 27, 1905, the stomach contents contained free hydrochloric acid; moderate reaction; odor butyric. A mass could be felt over the region of the pylorus, and operation was advised and accepted by the patient. The usual preparation of cleansing the stomach by lavage was performed, and in the operation Mayo's technic was followed. The abdomen was opened near the median line and the gastric artery was doubled, ligated and divided near the cardia. The gastro-hepatic omentum was also doubled and ligated close to the liver, leaving most of its structure attached to the stomach. The superior pyloric artery

was treated in the same manner, and the upper inch or more of the duodenum was freed. With the fingers as a guide beneath the pylorus in the lesser cavity of the peritoneum, the right gastro-duodenal artery was ligated. The gastro-colic omentum was cut distal to the glands and vessels up to an appropriate point on the greater curvature and the left gastro-epiploic vessels were ligated.

With a running suture of catgut through the seared stump the end of the duodenum was closed. The proximal end of the stomach was double clamped along the Miculicz-Hartman line, and divided with a cautery, leaving 1-4 inch projection. Then gastro-jejunostomy was done.

The tumor was found to occupy the pyloric end of the stomach, extending around the whole circumference. No adhesions were present. There was a delay in finding the nearest point of jejunum that could be brought to the stomach wall, and in taking great pains to suture the opening in the mesocolon so as to prevent hernia into the lesser cavity of the peritoneum.

His temperature at no time following the operation was above 99.6 degrees F., and there has been no vomiting since. operation. He took water in 8 hours and liquid nourishment in 24. His bowels were moved by enemas during the first week, but there was no distension; in fact, no more discomfort than from an ordinary exploratory laparotomy alone. The man has gained about 25 pounds in weight and is at his regular employment again with no discomfort whatever referred to his stomach.

CASE OF MORPHINE POISONING.

The report of this case was presented by Dr. D. A. Sinclair. The patient was 63 years of age, weighed 180 pounds, was 5 feet, 6 inches in height, full blooded, with marked organic heart disease. He had been coming to the speaker's office for the past two or three years suffering from alcoholism. He was a periodic drinker, and when first seen, two or three years ago, had been treated along the regular lines for such a condition. He informed the speaker that he had been in the habit of receiving injections of morphine from previous doctors and that was the only treatment that did him any good. Accordingly 1-4 of a grain of

morphine was injected, which the patient reported at the next visit was of no benefit whatever, stating that it was, he knew, a very small amount nothing like what he had been used to getting. The dose of morphine was very carefully increased to 1-2 grain without any effect, and finally, at the earnest solicitation of the patient and his assurances that he could stand the morphine, the dose was increased to one grain. This injection bore out his statements as to his previous experiences and "just about steadied him," without producing anything but a very short sleep. His subsequent periodic sprees were treated along the same lines, from 3-4 to one grain being used at an injection. It became so much a matter of course to inject this patient, and see no untoward effects whatsoever that there was no hesitation on the part of the speaker about giving him a grain of morphine two or three times a day, according to the exigencies of the occasion. Between the sprees the man, who was of more than average intelligence, not only abstained from alcohol, but did not have the slightest desire for morphine or any other drug.

The treatment detailed above was carried out until the last spree, about a month ago. On this occasion he presented himself, intoxicated, but retaining all his faculties, and begged for an injection of morphine, saying that he would only be put "on the ragged edge" as he expressed it, if he received the usual dose. He stated that he had taken as many as 3 grains of morphine without any bad effects, but this statement he afterwards denied. He had a very important meeting for the next day, and therefore was desirous of securing a good night's rest. One and one-half grains of morphine sulphate were injected into his left arm. In about half an hour the speaker was called to him hurriedly, and found him in a much stupefied condition.

This was about 8 P. M.; a small dose of cocaine was injected and the speaker left, returning about 9 o'clock, when the patient was breathing slowly, about 5 or 6 a minute. He was walked up and down until about II o'clock, at which time his respirations had diminished to one in two minutes. Up to this time there had been injected hypodermatically 3-5 of a grain of cocaine, 4-150 of atropine sulphate, 4-30 of strychnine and 4-100 of nitroglycer