measures his work by its monetary returns. That these are the principles of many practitioners is known to you ali. That it is injurious to character and subversive of our highest ideals is equally known. But did it ever occur to you that the action of those who follow this doctrine produces a re-action in the public which tends to impair the dignity and worth of the medical vocation?

In the popular mind has grown up a feeling that physicians are merely bus:ness men, selling their goods at prices which are often exorbitant, and with this feeling has come the desire to buy the goods elsewhere and at smaller figures.

The desire expresses itsef in many commercial forms. Wealthy people recognize it in ever-increasing endowments of hospitals, dispensaries and sanitaria. Shrewd business men in the large cities recognize it by organizing medical leagues, the members of which pay a small weekly fee and are entitled to mdical attendance and medicine whenever they are sick. The doctors employed are paid small yearly salaries and the difference goes into the pockets of the organizers. The cities, counties and stats recognize it by establishing hospitals and dispensaries for the free treatment of the poor.

Quacks and charlatans recognize it by putting nostrums and panaceas on the market and advertising them broadcast as being better and cheaper than the prescriptions of the profession.

Worst of all, unscrupulous practitioners and ignorant laymen establish medical institutes, homes and similar affairs, when they hire impecunious or dissipated doctors at small wages to do the work; while they receive the high charges which they demand for the prestige brought about by judicious advertising. The largest institution of this kind in the United States, which makes a specialty of reshaping noses and beautifying the

complexion, and which treats thousands of foolish women every year, is owned and run by a man, not an M. D., who can scarcely read and write.

To this commercial element, more than aught else, is due the increased patronage bestowed on pharmacists, trained nurses, chemists, medical electricians. masseurs, teachers of curative gymnastics, osteopaths, faith curists and hotspring establishments.

Unrestrained ambition has many sins to answer for. It is well for us all to aim high and do our best at every opportunity. It is a different matter to give free reign to ambition and ride off at every tangent. When a new discovery is made there is always someone who finds that it will work miracles and forthwith a score of ambitious practititners accept the declaration as gospel truth and act upon it. In nearly every instance, they see fame ahead of them and start off in a wild canter to capture the fickle jade.

Thirty-five years ago the faculty became suddenly enamored of chloral hydrate. How many use it today? And how many chloral fiends did it make?

Thirty years ago today hundreds of self-respecting physicians began putting panes of blue glass into the windows of patients. They worked so hard as to exhaust all the stock of blue glass in the world. I haven't seen a medical glazier now in a decade.

Twenty-five years ago, Brown-Sequard. announced his various elixirs, which came close to the elixir vitae of the alchemists. How many M. D.'s forthwith embraced the doctrine and put it into practice? Is there one who does it today?

Twenty years ago, Williams, Jackson and others declared that low alternating currents of electricity would cure tumors and cancers. Immediately came a demand for batteries and cells which kept the electricians busy a twelve-month.

How many employ a battery for such purposes today?

At the present time, the faculty is suffering from an attack of illuminating, not gas, but rays. The X-ray treatment and N-ray treatment, Becquerel-ray and Finsen-ray treatment and last of all radium, polonium and other phosphorescent bodies' treatment.

To use these remediants involves heavy cost, special apparatus, long and careful experiment, special knowledge and profound study. Until definite results are obtained and a clear knowledge gained upon the subject, it would be rank folly for a physician to employ these alleged methods or even to give an opinion upon the subject.

I notice in the medical journals that some ambitious young surgeons in the east are recommending the opening of the kidney for diagnosis and its excision in many renal troubles.

That they have done this successfully in a few instances speaks volumes for their skill, and the vitality of their patients. But it is still a question, and when the kidneys are in question, it is well to mind your P's and Q's.

Progress is sublime, but it is small and slow. We know a little more than our fathers and they know a trifle more than theirs, but we know less than our sons and much less than our grandsons will know. A conscientious surgeon will never hesitate to admit ignorance on a topic. Still less will he conceal his ignorance by charging disease to some inoffensive organ. Years ago the foolish practitioner made the spleen and the ovary the scapegoat of all he did not know. Today it is that poor friendless thing, the appendix vermiformis, which bears the brunt of professional incertitude.

It is fortunate that this useless appendage which serves as a second stom

ach in some of the lower animals is the present victim. Its extirpation does not involve much danger, especially when healthy. It is not accused of being the cause of disease in remote parts of the body. The uterus, ovaries, rectum and vagina have just cause for complaint; the indignities practiced upon them for diseases of other organs by ambitious surgeons are innumerable.

The conscientious surgeon fights shy of all shibboleths. At the present time, nature is made a very big and a very bad shibboleth. The lazy, the foolish and the thoughtless use such phrases, as: "Let nature work its cure," "Live naturally," "Don't violate the laws of nature," and the like, ad nauseam. All of these commands illustrate the law that the worst lie is a half truth. Nature's chief use of an animal is as food for some other animal. Before we conquered nature, the man who was not eaten in one bite by a tiger was devoured in a million bites by microbes.

Even today, the natural man, the sav age, is a filthy, foul-smelling creaturc with parasites within and without, who is killed or dies before he is forty.

Leave a wound to nature and she fills it with germs, animal and vegetable, and utilizes it as a hot-house for untold myriads or other species.

Diseases were not caused by man. Appendicitis in the monkey is ulceration of the second stomach. Consumption is found in the kangaroo and other marsupials; cancer in reptiles and fishes.

To the conscientious surgeon, nature is a vast agency, potent for both good and evil. Her evil must always be fought and she herself kept under eternal watch.

In the viewless air are infinite armies of disease germs. In the purest water of crystal spring or silver lake are microbic forms seeking your life. These invisible enemies of our race lurk on the petals of

the rose, the wings of the fly, the surface of the snowflake, the feelers of the mosquito, the mane of your horse, the fur of the house-cat and the plumage of the canary. They die by millions every second, to be replaced by new millions. Excepting the dog and the horse, man has only enemies in the universe.

In the last analysis the surgeon is not a worker so far as production or distribution are concerned. He is a policeman, a nurse and a soldier. His duties are to help those who are injured in nature's inscrutable operations, and to fight the foes through whom and which these injuries are inflicted.

Bay City, Michigan.

certain lines of treatment that have proved to be of great benefit in the treatment of chronic synovitis. The treatment consists, briefly, of the use of an appiiance of such a character as to secure cxtension and counter-extension, together with mild mechanical stimulation over the affected part. The recent work of Lorenz and Hoffa in this country, as well as that of their scores of disciples and imitators, and the very general publicity which has been given to the results of their treatment have greatly stimulated the interest which is properly felt in this important matter of correction of deformities.

It is a field in which the ortho pædist finds the nicest and most interesting problems upon which to work. Each case is in a way an entity, and the very individuality of its character calls for special treatment in almost every single case. The results which have been obtained by this method justify, I think, its introduction to the profession by means of cases treated. It is my desire to report the two following cases, taken somewhat at random from a number of others:

Miss M., aet. 22, came to me in June last, suffering from a pronounced swelling on the left side of the left foot, in

tory of the patient was negative, and the

*Written for the Detroit Medical Journal.

etiology was obscure. She stated that in April, 1901, she was suddenly afflicted

with a pronounced swelling in left ankle-joint, with considerable pain

When the foot was firmly fixed, in a position almost in a straight line with the leg, she consulted a physician. His diagnosis was tuberculosis, and he prescribed a plaster cast, this treatment continuing for a year. During this time the patient was able to get about with crutches, but the improvement was slow, so she sought further advice from another member of the profession, who treated her with massage. Under this treatment she was able to put on a shoe, but the stiffness and pain still

remained, and on June 4 of this year she came to my office for consultation.

At this time I found some atrophy of the calf, which was due to the continual wearing of casts. The joint was swollen, tender and very painful, and there was fluctuation, which was synovial fluid. There was no extension or flexion of the foot, tibialis anticus relaxed and tendo Achilles contracted. Any attempt to move joint was very painful.

I fitted her with a support for the joint, providing for gentle extension and counter-extension, and employed mild mechanical stimulation.

The appliance or splint was made of steel, with a sandal, two bars and two bands, with joint at the ankle. There are six buckles on the sandal, three on each side, which fasten to plaster bandage around ankle, and two buckles at the top of bars, which fasten to plasters on the limb. This gives an extension and counter-extension and an elastic toe-strap is utilized to bring the foot into the extended position. The appliance is also provided with a set-screw at the ankle, which prevents motion. By this means the foot was held as rigidly as in a plaster cast, and the disadvantages of the latter were done away with.

Under this treatment, the patient improved with gratifying rapidity. The pain left in forty-eight hours and did not return. The deformity

has yielded to the pressure, and the general condition of the patient is much improved. She is able to rest her weight lightly on the deformed member, and she is encouraged to walk all she can. The accompanying photograph shows the improvement in the deformity.

Another case is that of Ernest, aet. 4, who was brought to me for treatment June 7, this year. This was a case of chronic synovitis, with a traumatic etiology. In March, 1903, he fell from a sidewalk, and the deformity shown resulted.

The left knee became badly swollen and there was an abundance of synovial fluid present at the joint, which was ankylosed.

joints were made at the knee and at the ankle, with two buckles, one on each side of the sandal, which were fastened to plasters on the limb, thus giving exten

When I examined him, I found contraction of the flexor muscles and the knee at an angle of ninety degrees, swoilen, tender and a large quantity of fluid present. The joint was twice as large as the normal knee, but there was only slight atrophy of the limb. The joint was hot, with excruciating pain on motion. It had been fixed in this position for four months, and the patient could bear no weight on the affected limb.

The boy was fitted with an appliance made of steel, a sandal, two bars, four bands and a seat-piece. In this case

sion. The seat-piece fastened to the appliance with a ratchet, thus giving counter-extension. A rachet was also provided beneath the knee, by which the limb was slowly straightened, and with practically no pain to the patient.

Within five weeks' time, treatment three times a week, consisting of mild mechanical stimulation and the proper adjustment of the brace, the condition