The Amalgamation of the Schools. DEAR DOCTOR :-One of the first things that attracted me to THE MEDICAL WORLD was that it is the only medical journal in the English language on which all the schools can meet; and if amalgamation ever does take place THE MEDICAL WORLD will be one of the pioneers the first literary one-to blaze the way to the goal.

Of all men, physicians should be the most tolerant. The wail of suffering humanity is forever in their ears; and various methods of relieving that wail are so manifest that the practician of one school that vows all the others are humbugs only displays an ignorance that in a man otherwise educated is more melancholy than provoking. It is generally the tyro or the unsuccessful practician that has turned bookworm that utters such sentiments. The man who has contended with pneumonia in the North, typhoid in the West, or the fierce fevers of the South, the man who has been actually under the fire of virulent disease, struggling for human life, knows better. For my own part I prefer the doctrin of similia, because I do not have to do so much guess work, or rely upon the other fellow's experience with a patient whose constitution may be wholly different from the one I am treating for the same disease. I know that a crude dose of a certain drug will produce certain symptoms on a healthy person, and that the same drug in a small dose will cure those symptoms in a sick one. Where this desired consummation does not take place I know it is the fault of my gray matter, and not of the law of similia. As my old professor of philosophy in Trinity College, Dublin, Ireland, used to say, "I can give a man an education if God has given him brains!" Not always can the prescriber of any school hit the right remedy at the first or even the second trial. But the disciple of similia has this advantage: that if he goes wrong in his diagnosis, but is correct in the selection of his drug, his patient recovers. If the regular goes wrong in his diagnosis, nature has to pull the patient thru, and do so often hampered with the physiological action of mighty drastic medicin. But because I prefer the law of similia am I to call the conscientious, self-sacrificing, well-trained men of the other schools humbugs, and their therapeutics of no account? Has it been for nothing that I have seen the action of kali iodid or echinacea, or of that mighty boon in septic conditions that the eclectics have introduced, echafolta? If I thought I could ever be capable of such contemptible bigotry a burning match would be giving local treatment to my diploma this moment. I claim to have a fair, indeed, if necessary, a good working knowledge of the

therapeutics of the regular and eclectic schools. A man does not have to devote such an awful amount of time of study to accomplish this. Only the lazy, or those who have never tried, will so assert. One hour a day devoted to one's library will accomplish a mighty lot at the end of the year, if he has been well trained as an undergraduate. And this just brings me to the point of that basis on which alone the schools can amalgamate. Neither Homeopaths nor Eclectics will abandon their therapeutics simply to be styled "regulars," which they can style themselves anyhow, as I do. But when in every college of regular medicin there are homeopathic and eclectic chairs of materia medica and therapeutics that the student must pass, as well as his regular chair in the same subjects, then that blessed day will dawn on humanity. Should distinctiv names be mentioned, the doctor of that time will reply: Shall I ask the brave soldier who fights by my side in the cause of mankind if our creeds agree?

You are doing your share towards that end, Dr. Taylor. VERE V. HUNT, M.D., LL D. Dallas, Texas.

Malpractise Defined.

A physician or surgeon is liable to be sued for malpractise in treating a patient

1. When he does not possess ordinary skill, science, and information; or

2. When he does not use reasonable and ordinary care and diligence in applying his knowledge and exercising his skill; or,

3. When he does not use a reasonable and ordinary degree of skill and knowledge in treating the patient; or,

4. When he does not exercise ordinary care and diligence in attending and treating the patient; or,

5. When he fails to give proper instructions to the patient as to the care of himself; or,

6. When he fails to use ordinary care and diligence in determining the frequency of his visits and the cessation of the same; or,

7. When he fails to follow the establisht modes of practise of his particular school and the advancement in it, and injury results to the patient.

And all this whether or not he is to receive compensation. Medico-Legal Bulletin.

Quinin has no place in the therapy of malarial methemoglobinuria, or hematuria, as it is usually called. This should be treated like a severe nephritis of toxic origin. A glance at some kidney sections in my possession will verify this statement. The uriniferous tubules are blockt with granular detritus, not blood clots, as in the hemorrhagic cases. Intertubular drainage is interfered with, resulting in still further tubular compression and more complete urinary stoppage. The glomeruli are distended and the efferent circulation more or less impeded. This impediment cannot be forced by sodium hyposulfite, turpentine, diuretin, digitalis, or a quart or two of salt solution. These measures add insult to injury by in

creasing the pressure and still further impeding kidney action. Cupping of the loins, hot packs, pilocarpin, are here indicated, and at times must be used with a free hand.-M. Goltman, M. D., of Memphis, in Ther. Gaz.

Bismuth subgallate is a valuable astringent and protectiv in moist eczema.

QUIZ

New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous "treatment Please notice that our query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to "boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity.

Only such queries will be publisht as are likely to interest and instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultatious that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us.

Case Record Wanted.

Editor MEDICAL WORLD:-I want to procure a book for general practician's use, to keep a record of patients; something having an index for names, from 500 to 1000 pages, and pages printed in suitable manner for the report of one or two cases each, with spaces for diagnosis, prognosis and treatment. Can you or any of your many readers inform me where I can procure such a book, price, etc.? As the information sought may be of benefit to many of your numerous other subscribers, I make bold to ask for an answer in your next issue. W. DE MOULpied.

Hemmingford, Quebec, Can. [Such books are publisht, but they are seldom sent to reviewers, hence we are not able to refer you to such a book at the present. Doubtless if you write W. B. Saunders & Co., P. Blakiston's Son & Co. or Lea Bros., all of Philadelphia, some of them will be able to furnish what you wish, or to tell you where you may get it. Inclose stamp when writing to each, and mention the WORLD.-ED.]

Dysmenorrhea.

Editor MEDICAL WORLD:-A severe and most obstinate case of dysmenorrhea of twenty years duration in an unmarried woman age thirty-five. Family history excellent; parents were hale, hearty, and rugged persons; neither afflicted with any diathesis. Father died a few years ago of some hepatic trouble; mother still living at seventy-five. Patient a mild brunette, fine physique, nearly six feet and well proportioned, weighs 200 pounds or more, and is the very personification of health, never having been sick since childhood, but every month writhes in the terrible attacks of this bete noir-dysmenorrhea-the first provokt (?) by getting her feet wet on the approach of a menstrual flow, when a girl-so says her mother.

The

There is neither uric acid, rheumatic or neuralgic diathesis, unless the dysmenorrhea be an expression of the latter. Kidneys normal, bowels slightly constipated, digestion good. In short she is well between her menstrual periods and makes her living by sewing, her reputation by singing. Her menses are regular, coming promptly every twenty-eight days, lasts four days, flow regular, not spasmodic or in gushes, bright red, unclotted, and non-membranous. The flow comes on with the ordinary premonitory symptoms, the first day scanty and pains moderate, but invariably on second day promptly at nine o'clock a. m. the pain comes with cyclonic force, and for the remainder of the day she writhes in pain that even stiffens her jaws and is scarcely lulled by morphin 1⁄2 gr., pilocarpin nit. % gr. hypodermically. The pain continues during entire period, but lessens as flow diminishes. pain is severest when flow is freest, and the most acute and agonizing pain is low down, at entrance of vagina, but of course radiates to entire pelvic region, to back and thighs. During intermenstrual periods she has occasional colicky pains (but no especial tenderness) in right ovarian region. Pain most always under ribs of right side preceding and during menses. Not the slightest leucorrhea or metrorrhagia. Tho a woman of strong nerve, during the cyclonic periods of pain she is nervous, the least sound startling her. There is absolutely no hysteria in her make up. fifteen years patient has been plyed with viburnum, cimicifuga, pulsatilla in small and large doses, senecia in material and homeopathic doses, magnesia phos., all the coal tar derivativs, passiflora, almost every other known antispasmodic and anodyne has been given, together with uterin tonics without number and without relief. In her desperation recently she submitted to an examination with the expectation on the part of the writer of finding stenosis of canal or os, then dilate and insert a soft rubber stem (Leuf). Upon examination twenty-four hours before approaching period, found womb slightly prolapst, uterin canal over three inches long (3%) measured by flexible sound (remember patient is large), external os and canal well open. But as I was prepared with soft stem, hoping against hope, with a Palmer dilator I increast slightly the caliber of the os or canal, and with some little effort inserted stem. In forty-eight hours, at nine a. m.. as usual, the same old hurricane of pain came on. What shall I do? I sincerely hope the

For

the Editor of the quiz department and others will come to our help. I should be pleased to have suggestions from some of our homeopathic readers. Will the invariable nine o'clock exacerbation and fact that patient always has bitter taste in mouth help in selection of remedy? MD.

[The case is certainly one of markt severity, and it is not possible to say that anything we mention will give certain relief, but we make the following suggestions, in the hope that some of them may be of service. Gelsemium, in full doses, will often relieve such uterin pain; we would suggest three minims of the fluid extract at appropriate intervals. Belladonna might be added with advantage. Electricity applied by the intrauterin electrode has been of service in many obstinate cases. It would do no harm to dilate and curet, under aseptic precautions; the exfoliation of a new endometrium might be followed by favorable results, even if no leucorrhea is present. There may be a congestiv condition there which is not demonstrable on examination; this is highly probable in view of the fact that there is slight flexion. We would try several weeks depletion by means of boroglyceride suppositories used on retiring. If the copious hot douche would be

used properly, it would aid this process, but it is very hard to get even the most intelligent woman to use it properly.

The pain under the ribs on the right side, and the continuous bitter taste in the mouth, would indicate that the hepatic function needs attention. A continued course of mild laxativs would doubtless aid any other measures undertaken.

Have our readers other suggestions to offer the Doctor? Probably matrimony, with subsequent pregnancy, would benefit this patient.ED.]

Movable Cartilages in Knee Joint.

It is

Editor MEDICAL WORLD:-A man fifty years old has what I believe to be rheumatic nodules, but what other doctors have told him were floating cartilages. They are located in the knees, the most prominent in the right. The one that I examined was in right knee. They disappear at times and cannot be found. freely movable from just above the patella externally to the outer tuberosity of the femur; it can be plainly seen and felt. I should think it was the size of a lima bean. He thinks there are several of them. They lock the knee joint and bother him a great deal at times, and he would like to get rid of them if possible. He has been troubled with rheumatism since he was thirty years of age. He comes from a rheumatic family; his mother has rheumatoid arthritis of hands and fingers, and he has the same of fingers. Is there any treatment other than surgical that will remove them? Answer thru THE WORLD. I can find nothing in my text-books of any service in the matter. Burdett, Kan.

W. V. ELTING.

[We think they are floating cartilages, and we know of no means of relief except surgical. Read up on this subject in a standard work on surgery.--ED]

Is She Pregnant?

If so, is She Threatened With any Unusual Danger?

Editor MEDICAL WORLD:-I have a case over which I am puzzled, and would like your opinion, together with any of the WORLD readers who have had any experience with similar cases. A young married woman twenty two years old came to me to find out if she is pregnant; and if so, if she is in any unusual danger. Patient mensturates regular every month. About one month ago she felt peculiar movements in her abdomen which resembled quickening or life movements in a former pregnancy. Then upon examination she thought her abdomen larger than usual. She then confided her condition to several of the omnipresent old ladies who are so wise concerning such things, and who assured her that out of the many calamities that might befall her, the least she might expect would be that she would die or give birth to a monster. She came to me in a highly perturbed condition and wanted to know what she might expect.

Two years ago she gave birth to a healthy child, and has always enjoyed perfect health. Womb seems to be enlarged, but not to a degree one would expect if she really felt life. One month ago cervix seemed small and hard-at least not what one would expect to find in a uterus three to five months pregnant. Nipples she declares are darker than formerly, and I succeeded in drawing, at first a watery, then what appeared a milky substance, from nipples. She also complains of nausea some time nearly every day, but not in the morning like she did when formerly pregnant. Her urin contains no albumin.

Now what can I tell this lady? Is she pregnant? And if so is there any complication? And is there any remedy that will stop the menses? Any information that will help me to intelligently handle this case, from

you or any of the WORLD family, will be gratefully received.

Would also like to have you give in next issue of THE WORLD, the diagnosis of pneumatosis. After reading your article on that subject in last WORLD, have concluded that I have a patient thus afflicted. She is a young woman, single, habitually constipated, and on certain occasions, especially during or after excitement, is troubled with most distressing and noisy eructations. Digestion seems good, and trouble has no relation to meals or kinds of food. Has been this way for six years. Where I am situated I am obliged to be very cautious what I tell patients, for other doctors are anxious to have me make mistakes. Ill. W. Y.

[Doctor, your books don't trouble you very much, nor do you trouble them much. You would rather trouble us. Read up carefully and thoroly on these two cases (which you evidently have not done,) and come to us, if necessary, only as a last resort. You should be able to tell if that woman is pregnant. You know that a monthly "show" (apparent menstruation) sometimes continues regularly during the entire period of gestation. Whether or not you can tell with certainty at present concerning her pregnancy, you should at any rate be able to quiet her fears. The idea that she is threatened with any unusual danger during labor is all moonshine. Those old women-stop them by all means. Old women who delight in going about telling frightful stories to young pregnant women, and making dire prognostications as to the outcome of their pregnancy only to see the poor victims turn pale and tremble with horror-such old women should be incarcerated for the good of society.-ED.]

What Was the Cause of Death?

Editor MEDICAL WORLD:-Will some reader of THE WORLD tell me what was the real cause of death in the following case?

Was called on Tuesday. Patient had felt bad since Saturday; Monday began to have an eruption. Diagnosed measles. Wednesday diagnosis confirmed; eruption out nicely. Had been to a city a few times to have a specialist treat her throat. Glands of throat and neck somewhat enlarged.

Temperature never went above 103°, and that was only for two hours; most of the time 1011⁄2 to 102°, the highest for four days, then it dropt to 100°, then to 98%, and remained so until death, which occurred Tuesday, just a week after my first visit. She had been subject to asthmatic attacks since I knew her; that was 16 years, she being 16 the first time I saw her in one of the asthmatic attacks. Had had such attacks, I was told, since a small girl.

Well, the day she died, I found her pulse normal but weak, owing to her having had a loss of blood from the bowels for five days, at first, in my opinion, from piles, but could not discover any. I suggested counsel. I knew she was always frail, not for a moment expecting any sudden termination, but looking for a sequel in the line of tuberculosis. Consultation was held about 12, the consultant suggesting no change, for he found all things normal. Bowels had moved, water was a little cloudy after standing; but a general weakness was evident. The only change suggested was to add iodid because the suspicion in his mind was future tuberculosis. I saw her again 6 p.m.; no apparent change, only weakness; coughed some, but not severely. Had taken what would be called plenty of nourishment. I went away agreeing to call on my

return at midnight, because of her weakness. When I did arrive, a little past midnight, she had gone into a sudden collapse (at about 10 p.m.), rallied a little, then began to grow very weak, in which condition I found her. A trained nurse who had been called in said at times she was pulseless. When I got there a faint pulse could be felt, which grew weaker. Gave her nitroglycerin, which brought up pulse. She askt for things to drink, etc., which I gave her. Was in a warm profuse sweat. Pulse went down, came up, went down, until 5.15 a.m., when she ceast to talk or notice things, and in about ten minutes ceast to breathe-never struggled at the last but simply ceast to breathe. Measles had begun to go off nicely the day before her death-gradually disappearing.

Madison, Conn.

A. D. AYER, M.D.

[How about the hemorrhage from her bowels? Was that thought of and lookt after? Hidden hemorrhage into the bowels-the patient having bled to death in her bowels (as they sometimes do in typhoid fever), is strongly suggested to us. Was the last bowel movement black, showing the presence of blood?-ED.]

Septic Infection from Finger.

Editor MEDICAL WORLD:-Find inclosed money order for $3., for which please give me credit for amount already due, and let THE WORLD continue to rotate this way.

I like THE WORLD because it is plain and clean; because of the interesting matter it always contains, and because of the many instructiv reports and experiences of its numerous readers who thru its pages are educating the overworkt and poverty-stricken doctors, like myself, who are not able to take a post graduate course every year.

I have been in the practise of medicin for 15 years, and am a constant reader of almost as many medical journals, but I rarely ever find time to write to any of them. I was never a very fluent writer, at any rate, but am always interested in the writings of others"Perplext," for instance, and last but by no means least, the occasional spicy sketches by ye Editor.

For my own benefit I wish to relate a case which I am now treating, and ask your opinion of the diagnosis and treatment:

Mrs. M., aged 50, while dressing on Wednesday morning, February 10, prickt her finger with an ordinary brass toilet pin. The pain at the time was severe, but in a short time practically subsided. Pin penetrated the last joint of the index finger for something near one-quarter its length, ranging upward and inward; the wound failed to bleed, even a drop. In eight hours after receipt of injury pain returned, and and in less than six hours more I was summoned to attend her.

The pain at this time was so intense that she could scarcely be quiet a minute at a time. She would walk the floor and almost shriek with pain. The finger from the point of entrance of pin to the tip was of a gray, almost black color and intensely swollen; the patient was extremely nervous and anxious. A livid red streak extended from finger to the axilla, lymphatics enlarged, hard and painful, and an occasional rigor. Diagnosis, septic infection.

Treatment.-First with an aseptic scalpel I laid the finger open to the bone from point of injury to end of finger. No bleeding for nearly a minute, then only a few drops of dark, thick blood. Drest antiseptically and by the aid of morphin secured a short rest for my patient. Removed dressing in a few hours. Finger immensely swollen, and hand beginning to swell. Incised finger for entire length and drest antiseptically. Pain now so intense it required massiv doses of morphin to relieve her.

Second day: Hand and arm intensely swollen; hard, whitish nodules appearing over palmar surface of finger and hand; end of finger slufing; pain still

severe.

Treatment.-Numerous incisions over back and palm of hand; continuous bath in 1 to 250 carbolized solution, followed by alcohol and menthol bath; dusted incisions with iodoform, covered entire hand and arm with ichthyolated vaseline, ten percent. Continued treatment up to this writing, thirteen days.

Condition now: Arm normal in size and color; lymphatics normal in size but still a little sore; hand very little swollen; entire finger slufing with considerable oozing of blood. Patient reduced considerably in flesh and strength and very anemic. No pain. Was my diagnosis correct? Was the treatment all that could be desired? or could the case have been treated better? What further treatment would you advise? I would like to hear from the readers as well as from the Editor. J. C. JOHNSON, M.D.

Hamilton, Ala.

[Your diagnosis was undoubtedly correct, and your treatment rational, yet somewhat less radical than others might have adopted. Many would have amputated, and if the condition is such as we imagin from your letter, you will probably have to amputate yet, if you wish to prevent further extension of the process.

You should now keep her on tonics to build the system up as rapidly as possible, and if you can not secure resolution in the slufing part, you would better amputate without waiting till further tissues are destroyed.

Our only criticism would be that you should have carried your primary incision into the healthy tissues so as to have obtained a free flow of blood, and afterwards drest with something like the U. S. P. citrine ointment, diluted with one-third vaseline.--ED.]

Bladder Trouble.

Editor MEDICAL WORLD:-I would be greatly obliged for information on the following case, either from yourself or from some of the many WORLD readers.

Mrs. K., aged 54, weight 145, married and with good family history, contracted la grippe seven years ago and ever since then has had bladder trouble. She complained in the beginning of symptoms of acute cystitis, pain and frequency, which gradually emerged into a subacute condition." For this condi

tion she was operated on by a prominent surgeon who establisht bladder drainage by means of a vaginal incision, the bladder being irrigated daily. The wound was allowed to heal at the end of two months. She obtained quite an amount of relief, but was not cured. Since the operation, about six years ago, her condition has been as follows: When the desire to urinate presents itself, she is unable to empty the bladder, and dribbling takes place, consequently she resorts to the catheter several times in twenty-four hours, drawing from two to four ounces each time. For this later condition a physician dilated her urethra, thinking perhaps some obstruction was present, and since the dilatation the dribbling has been slightly worse. He also advised her to continue the use of the catheter and at the same time irrigate with kali permanganate, but she did not improve.

each kidney to be normal. Was able to pass a 28 F. sound easily and without pain. The urethra is of a pale color and is infiltrated as demonstrated by endoscopy and palpation. The maximum bladder capacity is eight ounces, the solution flowing with fairly good force from the catheter.

I have used silver nitrate irrigations of the bladder, and the urin has cleared up completely. Also used ichthyol salve in the urethra and massaged it. I advised dissecting the urethra and giving it a half twist and sewing in place, to stop the dribbling, but she will not consent. With this brief description of the case, I hope some of you will enlighten me as to the diagnosis and treatment. H.A. K.

Spokane, Wash.

[Doctor, you have given the correct diagnosis, and it looks to us as if all you wanted was a name for it. You have described the case well, and have treated it properly. We would think the operation you propose would be beneficial, and if the procedure was carefully and diplomatically explained to the lady, we feel sure her consent could be secured. The description of such an operation would be more or less horrifying to any layman, but if it were lightly tinted, we think objections could be overcome. Make sure, however, not to “guarantee relief." You do not say that you have tried to keep the urin neutral, but we presume you have; this is the only suggestion we could make. Will any reader help the Doctor further?- ED.]

[Water absorbs, to a certain extent, noxious odors; but the practical results would not be appreciable. The practise of placing a bowl of water under the bed is known in many sections of the country, and its reputed virtues are legion. In certain malarial regions it is supposed to "keep off the chills;

in many

sections it is used to "insure rapid and easy delivery of the afterbirth" in cases of confinement; in other places it is said to "prevent bed-wetting by children;" it is also said to be a certain (?) preventiv of childbed fever; in still other sections it is supposed to insure fecundity, etc. We had not before heard of it being used for night sweats. It is, of course, a superstition, and unworthy the attention of the practician of medicin, provided the water is changed often enuf to keep it from becoming foul. We have accidentally disturbed such vessels with our foot when going about a confinement bed, and found it decidedly not fresh.

This is our first knowledge that there is a "New Austrian Catarrh, Asthma, and Con. sumption Cure," and unless some of our read

ers know of its composition, we can not aid you.-ED.]

Deep Ulcers on Ankles.

Editor MEDICAL WORLD:-I wish some help in a case of ulcers of ankles following typhoid fever. One week after fever commenced, complained of ankle and it had to be lanced. The other acted same way. Now has four well-defined deep ulcers of six months' standing. Had consultation with another doctor and we scraped the bone, after which they seemed to improve for a short time only. There is a well-defined sinus extending from the ulcer on the inside of ankle to one on the outside. They pained her a great deal at first but do not now. They get better for a week or two, then worse. I had one healed up, but it broke and is as bad as ever now.

Small pieces of bone have workt out of each one, showing the bone to be affected. They are all about two inches above ankle-joint. I have been using peroxid of hydrogen to keep them cleansed, and then apply campho-phenique and boro-chlorotone as a dressing.

Do you think it will make a cripple of patient? who is 12 years old. H. M. LEFEVRE, M.D. Aud, Mo.

[We have observed a few cases of undoubted necrosis of the bone healed over by the ordinary treatment of cleanliness, dryness, and as near asepsis as possible; but they are rare. Your treatment has been correct as far as it goes. The reason they ulcerate again after being healed is that the pus burrows toward the healed ulcer and causes it to again ulcerate; you have failed to remove all the diseased bone. We have seen Dr. John Ashhurst have success in such cases by the use of "Liquer de Villate," made according to the following formula:

of each 15 grains 30 grains 3/21⁄2 drams

Mix, and use as an injection. The most accepted treatment is thoro curetting after the necrosed bone has been amply exposed. The country practician can do this just as readily as the special surgeon, but he generally makes the mistake of making an insufficient incision to expose his operativ field, or of being too gentle in his cureting. The operation may have to be repeated, even when done by a master and experienced hand.

We could not say without seeing the case what the probabilities for permanent loss of function may be. The recuperativ powers of the bone in the young are often surprising, if the general health can be kept up to par.-ED.]