company can give, for each member will have the moral support of the entire society, including the help of any members that may be called on to act as expert witnesses, as well as the salaried attorney, and all the other advantages of membership in the society, all for a single and very moderate annual fee. It is strange that this wonderful possibility was not discovered long ago. The binding together of the members of the medical profession for mutual protection against malicious prosecution is a new and wonderfully pleasing spectacle. Every local society in the country can do the same thing. Medical societies in the past have done much for the profession scientifically and socially. Here is an additional field of mutual service and protection. As these features are added to the functions of medical societies, their membership will increase, until every respectable and desirable practician is "gathered in."

Febril Urin.

The text-books are generally satisfied, in describing the urin of febril diseases, to say it is "scanty and high colored." It has a much greater importance than the space given it; it oftentimes gives warning of the advance of complications; it even sometimes would presage death if examined properly.

At

The color of febril urin depends upon the height of the fever, the state of metabolism and tissue waste, and the amount of toxemia present. It is, furthermore, due to the fact that the normal solids, especially urea, are both relativly and actually increast, while the watery element is diminisht. The urea has been known to reach as high as 85 grams per day. the outset of a given disease the color is high, the quantity small and the reaction intensly acid. The chlorids are always absolutely diminisht. In acute febril attacks of short duration there may not be any albumin present, but if the fever is very high and the attack prolonged, albuminuria always exists (Ogden). As the temperature falls the amount of urin increases, and polyuria is not an infrequent accompaniment of convalescence. As convalescence begins, the solids dimin

ish, altho the patient is taking more food. Nature tells us she is replenishing her storehouse for the return of health. If, in the acute stage, there is a steady and progressiv diminution of all the solids, death may be prognostigated. Sometimes a few days before death, even less than a total of 10 grams are excreted. In acute diseases, complicated by serous exudation, the chlorids are less in quantity than if no exudation be present, or may disappear entirely. There is less urea in cases of serous exudation, tho it may still exceed

the normal amount.

Scientific Urinary Examination by the General Practician.

There is no function of the human

The

organism more essential to health than a properly working urinary system; and no other excretory organ is more delicately constituted as the kidney; and perhaps no other organ and its functions are less understood and consequently more neglected by the average practician. purpose of this series of articles is to give in condenst form what the best authorities have to say in their latest issues regarding the application of modern tests for the more common evidences of disease, and to give it in such manner that any physician may equip himself for a proper examination of any specimen submitted to him.

Office Equipment.-Good light is an essential; a clear window by day, and a good lamp for night work. A sink with close joints and a waste pipe long enuf to convey the drainage sufficiently far away from the office. Hot and cold water pipes are convenient, but in lieu of them a large bucket answers the purpose. Such things are found in every well equipt office; so we will speak of the special equipment:

1. A dozen assorted test tubes, in a rack, with a brush or swab with which to cleanse them. (The rack is quickly made by a block of wood and a few augurs, and there is no better cleanser than a piece of sponge wrapt around a small stick and tied firmly with a few turns of fine thread.)

2. A spirit lamp and a little alcohol.

3. A fluted urinometer or specific gravity bottle, with certificate.

4. A few wine glasses or graduates to be used only for urinalysis.

5. A urea apparatus.

6. A large and a small glass funnel.

7. Some filter paper cut in circles of 4 and 8 inches diameter.

8. Some red and blue litmus paper.

9. A few glass rods.

10. A few pieces of assorted sizes glass tubing. 11. An evaporating dish.

12. A few watch glasses.

13. Platinum wire in a glass rod.

14. A piece of platinum foil.

15. A set of 50 cc. burettes graduated in cc. 16. A burette stand with clamp.

17. A retort and stand.

18. A tripod and cover of copper gauze. 19. A water bath.

20. Wooden test tube holder.

21. A 500-centimeter wash bottle.

22. Three pipettes, 5, 10 and 50 cc. 23. An Esbach's albuminometer.

24. A good thermometer.

25. A good microscope with objectivs such as Leitz 3, 5 and 7, and eye pieces 1 and 3: an Abbey condenser; and a inch oil immersion lens, with glass slides and cover glasses, cedar oil, and Canada balsam in solution.

26. A centrifuge; not absolutely necessary, but convenient. 27. A record book and pencil.

28. An ounce of chemically pure sulfuric acid.

29. An ounce of chemically pure nitric acid.

30. An ounce of chemically pure hydrochloric acid.

31. An ounce of chemically pure acetic acid.

32. Ammonic hydrate.

33. Sodic hydrate.

34. Fehling's solution.

35. Esbach's reagent.

36. Distilled water (obtain from exhaust pipe of engin or mill if not convenient to make or purchase.)

37. Caustic soda.

38. Common salt.

39. Chromate of potassium.

40. Sulfate of ammonia.

41. Sulfate of magnesium.

The entire quantity passed in the twentyfour hours should be mixt and accurately measured. Care must be taken to keep the vessel clean and perfectly free from dust or other foreign substances. It should be kept cool and must be examined within twenty-four hours unless some preservativ (which should only be used in case of necessity) be added. If a preservativ be necessary, three drops of formalin or an ounce of a saturated aqueous solution of boric acid will suffice. In certain small proportion of cases it is desirable to collect and examin the urin of the day and that of the night separately, in which case each bottle should be carefully labeled and kept separate. The normal variation in quantity may be stated to be from 1,200 to 1,600 centimeters (in the male adult), owing to fluids ingested and other circumstances. In renal disease it is often necessary to make daily measurements for a period of from one to three weeks before an accurate estimate can be made of the average daily quantity.

The Technic of Vaccination.

Most physicians become highly indignant when their ability to perform vaccination properly is called in question, but we have seen many more vaccinations faultily done than were rightly performed. All know that death from scratches and We may abrasions are not unknown. call it the simplest of operations, but it is an operation, and the modern method is vastly different from that in vogue ten years ago. We no longer have the right to scrape, cut and stab our writhing patient till a large area has been denuded of cuticle.

It is just as easily done right as it is done wrong. Wash a small area with soap and water and dry with aseptic absorbent cotton. sorbent cotton. Use no antiseptic of any kind during the operation. With a clean needle or a scalpel denude to square inch of surface until the serum commences to appear; then stop before the blood flows. If the tube is used, allow the serum to flow gently upon the denuded area; if points are employed, the virus is gently rubbed into the scarification, for any force will cause the blood to flow and imperil the results. The serum should be allowed to dry, caution being used that it is not contaminated by any external object. It may then be covered with a piece of steril gauze bound over the wound. A convenient plan is to lay a small clean cork on either side of the wound and run a

strip of adhesiv plaster over them in such a way that it is held up from the abrasion ; the whole is then covered with the gauze bandage. With this method absolutely nothing can touch the wound, not even gauze. Others use large bunion plasters and cover them with a strip of adhesiv plaster. Others employ the commercial protectors, sold by all manufacturers of virus, but these should be condemned, unless the protector is covered by aseptic gauze. Otherwise, the holes left for ventilation admit lint from the underwear, which is very likely to infect the wound. The wound should be protected; and these so-called "protectors" are really traps for infection, in the way they are usually used. Really, there is nothing better than simply a piece of aseptic gauze bound directly on the wound, or held in place by strips of adhesiv plaster.

Vaccination is the only method recognized by authority for stamping out the dreaded smallpox. Not only Pennsylvania, but many other states are reporting large numbers of cases, and it is the duty of every doctor to perfect himself in this simple procedure. The doctor and the patient are oftener at fault than the virus. The Pennsylvania school law now allows the school board to compel vaccination of every child every five years, or to exclude the child from school, or a fine of $1.00 per day, or imprisonment of the parent refusing to comply. With the cooperation of doctors who can vaccinate properly, the disease should be controled.

Hysteria.

The true nature of hysteria has long been one of the mysteries of medicin, and its treatment is one of the most vexing problems which confront the practician. Formerly, hysterics were deemed only silly fools who took a fiendish delight in troubling busy doctors, neglecting to pay their bills, and abusing their medical counselor between attacks. We now know that if many are to be blamed and treated harshly because they are senseless simulators, others are to be pitied and relieved with the greatest tenderness. Those who sham hysteria generally have, if any, only minor complaints and suffer little except when they realize that they have not fooled" the doctor. The true hysteric suffers honest agony, and viewing her torture, one can not appreciate how she would prolong it voluntarily for

no other possible reward than notoriety and the instigation of morbid curiosity, seldom tempered by any real sympathy. The hysteric patient is repulsiv to most practicians, and even the laity appreciate our disgust so much that we do not dare to use the word in the presence of the patient or the friends. He was a medical genius who coined the word "neurasthenia; "' it isgenteel, and no stigma attaches to it.

We regret that the word "hysteria" has passed into disrepute, even if "neurasthenia will cover all cases, for both hysteria and neurasthenia exist as separate and distinct conditions. Until our "coarse and blundering tools of microscopes" reveal to us the flight of thought and motive, we should be satisfied to pose as physician students rather than selfconstituted judges. One of the best definitions of hysteria is given by Thompson, in Practical Medicin, publisht by Lea Brothers & Co., Philadelphia, where he says, on page 865: "Hysteria is a state of the nervous system resembling a combined psychosis and a neurosis in which exaggerated ideas result in inhibition of mental volition and alteration in functions. The condition appears to be purely functional, as no organic lesion exists." The pampered child of wealth is apt to develop hysteria; it is seldom seen in the homes of the poor except as a sequel of alcoholism or heredity. It is by no means rare in the male, but is most frequently seen in neurotic and anemic females between the period of puberty and the age of 30, only a very few cases developing after that age, and then they are generally connected with a natural, abnormal or artificial menopause. Almost any symptom may develop in the course of hysteria, but the manifestations are much milder when the patient thinks herself unobserved, and always disappear completely under complete anesthesia. The possibility of extremely high temperatures in hysteria is admitted by some clinicians and denied by others; the use of an anesthetic should determin any given case.

Organic nerve lesions are the only conditions from which hysteria is difficult to differentiate, the latter presenting the globus hystericus, anesthetic or hyperesthetic areas, limited visual field, possible paralysis, and in severe cases contractures, together with an unmistakable mental

condition; the symptoms promptly returning after complete disappearance under anesthesia.

In contra distinction, the patient with organic nerve lesion is not affected by anesthesia further than the effects of the drug itself extend. If paralysis be present, it is apt to be unilateral, and the reflexes are exaggerated or annulled. If the hysteric has never heard of reflex tests, they are readily elicited; if they have been the rounds of any number of good doctors, they can simulate or retard or emphasize or hold in abeyance any of the reflexes. If lesion exist, there will be insomnia and intense pain, or delirium or coma. The hysteric patient can not manipulate the pupils, and she signally fails an temperature when it is taken in the axilla. Organic lesions frequently give subnormal temperatures, while the hysteric patient always works up an elevation if thermometer be placed in mouth, rectum, or vagina. If blindness be complained of, the patient with a lesion can not see an object that may hurt them, while the hysteric always does. Organic anesthesia or hyperesthesia always follow the defined nerve tracts, while hysteric symptoms so referred are located anywhere the patient deems best. The hysteric can not accurately simulate the spastic or paraplegic gait. If the hysteric complain of loss of taste, the ingenuity of the physician will provide a dose nauseous enuf to provoke complaint or grimace, when true cases swallow it unmoved. Anesthesia and subterfuge will separate any case of hysteria from organic nerve lesion.

The successful treatment of hysteria demands patience, kindness, a judicious firmness, and absolute control of the patient by the practician: all obtainable only after entire confidence and co operation of the patient and friends has been won. The hysteric of comfortable means should be placed on tonics, digestivs, nervines, and saline laxativs; the poverty stricken should embark in the ambulance for the nearest hospital, or have a commitment obtained to the "county home." In other words, nursing and environment with enuf and not too much attention will aid drugs in curing hysteria of acute or chronic type; but neither will ever do it alone. Iron, arsenic, strychnin, and manganese are desirable tonics in anemic cases. Any palatable digestant of known efficiency will do well in any case. None

of the nervines do so well as the oldfashioned asafetida and valerian in full doses. The various mild salines are the best laxativs. Avoid hypnotics and anodynes as the plague. Make all examinations of females in presence of some reliable female attendant who knows how to keep quiet; always under some covering, and avoid genitals, abdomen, and breasts except when absolutely necessary, and even then be quick and chary. Never use finger, speculum, or probe thru vaginal canal except in case of emergency, and never use the catheter under any circumstances; better anesthetize and allow the urin to flow. Inveterate cases are best excluded absolutely from the admission of any but the attendant and physician, no members of the family being admitted, and no books or papers allowed.

Probably the most successful treatment of hysteria is that used so successfully by Prof. S. Weir Mitchell, the principal features of which are briefly outlined: The patient is placed under the care of a skilled nurse in an isolated room, and at absolute rest in bed. She sees none but her attendant and physician. She is allowed no diet but milk, and if she will not take it, she takes nothing but water until she "gets hungry." She is treated with all gentleness, and is bathed and massaged regularly; but her complaints and convulsions are passed over with a kindly word or are completely ignored. The physician's visits are not frequent and are short, and he consults the nurse and chart much more than he does the patient. If pains become unbearable he applies the Paquelin cautery with gentle touch and words of solicitude. If anesthetic areas become extensiv and paralysis ensue, an aseptic needle inserted deeply and attached to a battery accomplishes a cure'in a few hours. Few cases resist such treatment many weeks, and the resultant cure is generally permanent.

The practician in the country can never, without skilled assistance and the cooperation of triends, hope to cure chronic hysteria; but, if such aid be obtainable, nearly every patient will recover.

Presuming that they are convalescent, amuse them by outdoor exercise, a little needlework, having the nurse read letters or quieting books, drawing or painting in great moderation; but all the time insist on isolation from any but two attendants. It is the only successful cure for hysteria.