as though it was intended to operate on another patient, and with other instruments, open the frontal sinus by the KuhntLuc method. 3rd step, return to the maxillary sinus, again inspect its cavity and close the buccal wound.

2nd, Double maxillary type. The co-existence of double maxillary sinusitis aggravates in no respect the prognosis. It is not rare that the two sinusitises are of a different age, and that one heals readily by conservative treatment, whilst the other demands radical cure.

3rd, Double frontal type. Perform a radical cure in the same séance, by the Kuhnt-Luc operation, and have care to totally destroy the intersinusal septum. Deformity may follow, but is much less disfiguring, since it is symmetrical (Luc).

4th, Double fronto-maxillary type. If the general state of the patient does not permit quadruple intervention in a single séance, it is necessary to perform at one time two frontal and one maxillary operations: because, in the last, the reinfection of one side by the other is little to be apprehended.

5th, Pansinusitis. It is a pansinusitis when the fronto-maxillary suppuration is associated with an infection of the ethmoid or of the sphenoid. It is these last lesions, little accessible, which impress a grave prognosis. It is particularly in these that the treatment should be considered, but not caring to detract from this subject, I leave it to the care of Messrs. Grünwald and Lambert Lake, who are charged to introduce the discussion upon this point before the British Medical Association.

THE VALUE OF

HISTORY-TAKING IN GENERAL PRACTICE.

BY RAYMOND WALLACE, M.S., M.D.

CHATTANOOGA, TENN.

It is scarcely comprehended what a vast mine of valuable information, both clinical and scientific, lies unblasted at the feet of every practicing physician. In the past few decades medicine has made wonderful strides, but the greatest part of this progress has come from the hospitals and medical centres of the world. The reason why Germany has given so much.

to clinical medicine is because her men are trained in the penetrating observation of detail and the systematic tabulation of prolonged observation and experiment.

The real value of accurate observation and a full record of notes cannot be overestimated in any field of science. From earliest times the most valued additions to our actual knowledge have come not from the wild speculations and theories of the philosophic, but from the detailed and careful records of the penetrating student. Leibnitz, Hume and Kant held the whole world spellbound in the thralls of their philosophic meditations, but it was not until the days of Lamarck, Darwin and Weissmann that real progress was initiated along the lines of biologic and anthropologic problems.

So also in the realm of medicine. How invaluable are the classic records of John Hunter or of Sir James Paget. Even Hippocrates, the father of all medical lore, has left records which bear with impunity the searchlight of modern thought and investigation.

History-taking as a routine measure in the office and at the bedside is not only of value because of the facts themselves, but by stimulating a search after the whole truth; thus training one in accurate observation of detail, it helps in attaining a correct diagnosis, and the systematic arrangement of facts in the cases of a general practice makes the accumulation of trustworthy statistics possible. Notes taken at the bedside, though poorly written and worded, are better far than the most elegantly arranged notes which have been, perhaps, padded and changed in the copying.

A recent editorial, in contrasting theory and observation in medicine, suggests that it would be a priceless boon to medicine if the lesson could be learned that not brilliant speculation, nor theories, however suggestive they may seem, are so much wanted as patient, painstaking observation. A realization of this would make the humblest of the profession a contributor to the great fund of knowledge which is redeeming the practice of medicine from an art based upon trembling theories, and help to place it upon a foundation of cold, scientific observation and fact.

Various methods of history-taking and history-recording

are employed, and the methods may become almost as numerous as the roll of the profession. But in general it may be stated that the less complicated the plan the better. In hospitals and asylums the plan is, of course, more elaborate than in private practice, for the collaboration of nurses and orderlies makes it possible. But the purpose of this article is to point out to the man in general practice how he can, simply, advantageously, and without much expenditure of time and effort, make records which shall be not only of inestimable value to himself and his patient, but to the whole profession and humanity.

It is scarcely worth while to attempt to discuss the myriad forms of history blanks which may be used. For a small expenditure a thousand blank cards may be cut to fit the pocket, and the printed matter should be as simple as possible. I have seen history blanks carried by men in general practice which had outlines to include everything, from the maladies which carried away the five preceding generations of ancestors to a rehearsal of the most unessential facts which could never be of the slightest value. The general headings are sufficient, and the details may be varied with the individual case. Indeed, no one outline could be made that would exactly fit every case. The salient headings which may be employed in the majority of cases may be enumerated as follows: Name; address; social condition, such as married, single, widow, number of children, etc.; then under the heading of Family History, the various elements of heredity and predisposition may be included; the next caption in logical order is Past Condition,-which may include every fact regarding past illness, habits, accidents, etc., which may be of any relational value; then under Present Illness, the details of the immediate trouble should be outlined in logical order with a full recognition of the salient facts of the case; under Physical Signs may be included the objective data which are observed according to the practitioner's routine method of examination. These points should be outlined, with space left for subsequent records on the progress of the case. Some physicians employ a pulse and temperature chart upon a portion of the back side of the card, but as in the majority of

cases there is no reliable person to make observations between the physician's calls, such a chart seems to me of little value, such data being inserted with other observations. At each subsequent call the results of the laboratory examinations of blood, sputum, urine and stomach contents may also be inserted at the close of the last notes taken on case. If the illness is prolonged, and the first card has been filled, a blank card may be carried upon which to continue the notes.

The details to be entered under each major caption need not be discussed here, since the relative value of this will depend upon the inherent capability of the observer. But even in the hands of the untrained, if observations be made without bias and in a careful and penetrating manner, they must become of increasing value, and I am sure the physician in every case will feel well paid.

As to the disposition of these card-histories after the dismissal of the case, a simple drawer index and file may be improvised according to the wishes and disposition of the one employing the method.

Let me urge upon those who have systematically taken and kept histories of their cases to begin and try it for a few months, and if the gratifying results in improved diagnoses, clearer conception of the disease processes and better results from treatment, because more logically determined, do not follow, then the experience of those who today are giving to the world the greatest amount of reliable clinical data is of no value, and the method of routine history-taking may be cast into utter oblivion.

Loveman Building.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.

Visiting Physician St. Joseph's Hospital, Memphis.

A Notable Improvement in the Therapy of Typhoid Fever. The recent discovery, by Duval and Basset, of the presence of the bacillus dysenteria (Shiga) in forty cases of infantile summer diarrhea, awakens renewed interest in the subject of

Al

intestinal antisepsis. But a few months have elapsed since Drs. P. C. Freer and F. G. Novy, of the University of Michigan, demonstrated the enormous germicidal power of benzoylacetyl-peroxide, more familiarly known as as acetozone. though the preliminary reports of these investigators were of necessity based upon results of laboratory experiments, their expectations are already being realized in clinical work, in the treatment of typhoid fever, particularly.

In the city of Chicago, where a large number of cases of typhoid have been reported, acetozone has been used exclusively in the treatment of about three hundred of them. The consensus of opinion is that it causes the temperature to decline earlier than usual in the course of the disease, and it ameliorates the mental and physical condition of the patient, in all probability by controlling the toxemia.

Two Chicago practitioners, I. A. Abt, M.D., and E. Lackner, M.D., have thus far reported (Therapeutic Gazette, October, 1902) forty cases of typhoid, in children, treated with acetozone, with but two deaths, a mortality of 5 per cent. One of the patients that died succumbed to pneumonia and pulmonary edema, the other to great pyrexia on the fifth day. Stupor and tympanites were almost entirely absent in all cases; the characteristic typhoid fetor of the stools was markedly diminished, and the hemorrhage occurred but twice, and in the same case. The average duration of the febrile period, in thirtyseven cases, after beginning acetozone treatment, was thirteen and one-half days. The drug did not seem to act upon the heart or respiratory apparatus.

Early this year Eugene Wasdin, M.D., of the U. S. Marine Hospital Service, Buffalo, N. Y., reported twenty-seven cases (American Medicine, Feb. 8, 1902) of typhoid fever, twentyfour of which were treated with acetozone, all of the patients recovering. The writer says: "Its application in typhoid fever has been followed by very happy results; its use has been directed to the destruction of the germ in its primary lung colony and also in its secondary intestinal colony, and it has been used by hypodermoclysis to combat terminal expressions, with the result that in twenty-four cases the disease has been limited almost entirely to the expression of intoxi