ber of side issues that should not be admitted. So I say that the operation should be limited to simple progressive glaucoma and of the hemorrhagic variety filtration of the angle occurs.

Dr. Kerr states that his patient was one of the first or the first one in this city to be operated upon, but I beg to remind him

that it was one of the soldiers at Fort Douglas on whom it was first performed, and in this case an iridectomy was first done, and then a sympathectomy followed that, but on the other side, and as a result of the operations the patient got absolute and complete relief, and vision became normal, and is perfectly normal at the present

time. I believe if we could get a correct report of cases operated upon before obliteration of the fil tration angle, we could say that the percentage of cures would reach 100. I have yet to hear of a case of simple progressive glaucoma that has not remained well when the operation was done reasonably early. I know of one case in which it is stated the patient was relieved for a while, but was as bad off as ever in six months. The operator believes now that in that case the removal was not complete, or that he removed the middle cervical ganglion, and this is the only case that I know of where results have not been permanent.

ST. BARNABAS HOSPITAL

MINNEAPOLIS

LARGE FIBROCYSTIC GOITRE IN THE SERVICE OF DR. W. E. ROCHFORD Mrs. L, aged 50, German, born in Columbus, Ohio, mother of 12 children. When two years old she moved to Minnesota, where she

er at 81. No member of her family had goitre. Aside from childhood diseases, she has never been ill.

About twenty-six years ago she first noticed a swelling in the neck, which seemed to grow more rapidly at each childbirth. She never experienced any special inconvenience from it, and no pressure symptoms. About two months ago she sustained a contusion of the goitre, which caused considerable hemorrhage into the tumors. Discoloration on one side and a slight rise of temperature followed. A few days of rest in

The patient entered the hospital September 13, for operation. Examination of the goitre showed it to be quite soft with a shallow groove near the middle, dividing it into two unequal parts. Until lately the patient had experienced no difficulty about breathing, and could sleep in the recumbent position. An operation was now decided upon, and after two days of preparatory treatment in the hospital, chloroform was given and an extensive transverse-curved incision was made over the tumor. The enlarged veins in the skin were cut between ligatures, and the incision continued through the skin fascia and platysma muscles. The goitre was exposed, and with the hand the enucleation was begun. The sternocleidomastoid muscles were retracted, and the shelling out of the tumor continued with the hand, bleeding vessels being tied as the operation progressed. When the large mass was lifted out and turned over on one side the rings of the trachea could be plainly secn. Great care was taken not to injure the recurrent laryngeal nerves. The operation was completed with the scalpel. Lying alongside of the trachea there was quite a large gland, which appeared to be a large lymphatic. A part of it was removed and it proved to be parathyroid tissue. The remainder of the gland was left together with another gland of similar tissue.

In removing the large mass, while lifting it up and out, the cystic portion ruptured, and a dark bloody fluid poured out. After carefully tying all the bleeding points and sponging out the wound cavity with normal salt solution, the cut muscles were re-united, and the wound was closed by a continuous suture. A small piece of gauze was left in each angle of the wound for drainage. Very little oozing followed, and on the second. day when the wound was dressed it was not necessary to use further drainage.

The operation consumed less than an hour. from the beginning of anesthesia. The hemorrhage was not severe, and the patient seemed to be in an excellent condition all through the operation, the pulse and breathing remaining good.

Soon after the patient was placed in bed the attending nurse came hurrying up to the oper

a bad condition. I went immediately to the patient's room, and found her body quite cold, and pulse imperceptible at the wrist, with symptoms of profound shock. More hot packs were immediately placed around the patient, hypodermics of strychnine and adrenalin were given, followed by hypodermoclysis, and a little later with rectal enemas of whiskey and coffee. The condition of the patient did not improve any for the first six hours, and then gradually a change for the better set in. The pulse could now be counted at the wrist and was 148, respiration 38, and temperature normal.

To the faithful and efficient work on the part of nurse Metca, I feel that I owe the life of this patient. The change from an almost hopeless condition to one of assurance came rapidly the following morning, and from this on the patient picked up rapidly, and was able to leave the hospital practically recovered on the thirteenth day after the operation. The wound never gave any trouble and healed without infection. There was no oozing after the first dressing. The tumor was composed of about two-thirds fibrous tisues, and the remaining portion cystic. cystic part contained, besides bloody fluid, the residue of recent hemorrhages. The voice was a little hoarse or husky for the first ten days. The photographs were taken the day before operation and on the day the patient left the hospital.

MICROSCOPIC EXAMINATION

The

The parathyroid gland shows less connective tissue than the thyroid. The glands are more numerous. They are closely placed, and contain more colloid substance and some blood in the lumen, and many have leucocytes also. The epithelial lining is not so high as in the thyroid, but is not degenerated. There is no evidence of malignancy.

The tumor is composed of glands, connective tissue, and blood vessels. At one side apears the wall of a cyst. The glands are racemose, lined by a single layer of low cuboidal epithelium, Many of them contain some colloid substance, and others are filled with blood, and there are also blood sinuses. The connective tissue, in places, has crowded out the gland structure, and it also surrounds the cyst wall. Much of the epithelium of the glands is normal, but shows some degeneration in places. There is no evidence of malignancy.

At a meeting of the faculty of the College of Medicine and Surgery of the University of Minnesota, on December 1st, a post-graduate course was established. The scheme is to be worked out in the coming weeks, and will be perfected in 1906. The course is to consist of instruction in laboratory work and of such chemical instruction as may be determined.

There have been many requests for post-graduate work in the various laboratories from physicians in Minnesota and the Dakotas, and as the new building now under construction will relieve the present congestion, the physician will have an opportunity to refresh himself in the subjects of pathology, bacteriology, histology, practical and sanitary hygiene, and anatomy. Chemical instruction will not be offered until the new University State Hospital is under way.

The courses will all be practical, and the opportunities for instruction are exceptionally fine.

A large attendance is not desired, and small sections only will be encouraged during the year 1906.

ADVERTISING IN MEDICAL JOURNALS

In many of the medical journals throughout the country there is an awakening, a hesitancy, a sudden uprising, or a return to a somnolent state concerning what should, or what should not, appear in the advertising pages.

THE JOURNAL-LANCET is one to undergo a certain amount of house cleaning; one room at a time perhaps, but eventually, and at no distant date, the paper will be free from objectionable matter. It will be impossible to expunge all advertising to suit the most fastidious. Some of the contracts for advertising will not expire for some time, neither would it be fair to condemn certain proprietary preparations until their composition is more fully investigated.

The Department of Pharmacy is preparing a book that will guide medical journals in the selection of their advertisers, but until definite information is acquired we shall continue to receive advertising matter that appears unobjectionable.

Many of the advertisers of proprietary articles furnish formulæ that are conclusive: the drugs themselves are known, but the preparation and methods of combination are protected. Articles which make extravagant claims are to be excluded unless the promotors are willing to moderate the claims for their therapeutic values.

It is frequently a waste of time to vigorously attack a certain product unless it is notoriously bad. A better plan is to educate the physician to employ reliable drugs compounded by reliable firms, or to encourage physicians to work out their own formulæ and order them prepared by responsible druggists. For a time, however, a number of protected remedies will be employed by the busy practictioner.

At the Portland meeting, Dr. Frank Billings read an interesting and valuable paper on "Secret Nostrums," and referred to preparations that were advertised in most of the medical journals. One enterprising firm at once abstracted a portion of the paper, and turned it to its own profit by assuming that Dr. Billings referred to

one of the numerous substitutes for its own emulsion.

The Journal of the A. M. A. has already dropped many of its former advertisements, and will doubtless drop many more unless the manufacturers are able to convince the Council that their preparations are as representd.

All products that contain dangerous drugs and go to the laity will, of course, be excluded, but it hardly seems necessary to discontinue the exploitation of a harmless compound that is either used externally or is only recommended for a few simple diseases. The advertisers will continue to reach the physicians, and many physicians will call for prepared preparations, rather than take the time to write out a thought-demanding prescription. It is possible also that the reform movement against patent and proprietary remedies may be overdone, and the doctor and the patient may sympathize with the under dog, as has been the case in many spasmodic movements. One thing is assured, however, the socalled "red-clause" advertisments that have been so forcibly brought out by the Ladies' Home Journal and Collier's Weekly will not be in the better class of medical journals.

Unfortunately, the average medical publication depends upon the advertiser for its existence, and therefore the only remedy lies with the profession. The doctor must support the journal or the advertiser will.

Many of the journals of the state associations are in danger of extermination unless they are loyally supported by the profession. In the large states where the membership of the societies is relative to the population, the publication of a journal may be borne by the society without embarrassment, but in the smaller states neither the membership nor the revenues of the society is equal to the demands unless assisted by the advertisers.

THE JOURNAL-LANCET expects to carry only clean advertising, and, by the exclusion of objectionable matter, hopes to acquire better advertisments. Hospitals, sanataria, and physicians' cards may be added to the advertising pages. The well-known chemical houses and manufacturers of staple articles, publishing houses, and such proprietary products as are approved by the Department of Pharmacy will be continued. This is the time when new contracts are made, and, if by chance the bounds are overstepped, due corrections will be made. Give the

journals time for investigation, and when a clean journal is presented to you for subscription take it in preference to the one that carries any kind of an advertisement that is carried simply to pay the running expenses of publication.

Reputable firms have nothing to fear from this crusade. On the other hand, they have much to gain; for the member of every state association publishing a journal will look to its pages to see what products receive the profession's endorsement. Every member of a state medical association will scrutinize its own journal very carefully, will criticize the advertising pages, and will naturally patronize the advertiser receiving the endorsement that admission to the association journal carries. Every district and county society must, of necessity, give the state journal hearty support by encouraging the advertisers asked to help support its state journal.

THE JOURNAL-LANCET is not exclusively a state journal, for it had a large constituency before it became the journal of the State Association, and its ambition is to extend its sphere of influence into every northwestern state, and even into other fields.

THE ETHICS OF CONSULTATION

B. D. Bosworth, Knoxville, Tenn. (Journal A. M. A.), calls consultation the highest function in medical practice and protests against the unreasonable neglect into which it has fallen. It is a duty, he thinks, of the young practitioner to avail himself of the counsel of the more experienced men with whom he has begun to compete. He also believes in exclusiveness in consultation, no matter how far the bars may have been let down, and is thankful that there is no law to prevent the exercise of individual judgment and discretion as to whom we shall meet in consultation. It is better that the medical attendant should first propose the calling of counsel, but the choice of the patient's family should be respected. He gives the mode of proceeding in an ideal consultation, and the need of conciseness and brevity, both for the sake of the patient and his friends, is insisted on, and he makes a special point that unless it is demanded by the family physician himself, and for good and sufficient reasons, no one who has been called as a consultant is ever justified in taking charge of the case, or should ever intimate that any part of the treatment did not receive his assent. norance, he thinks, is the invariable excuse for the flagrant violation of ethical principles in these matters. The members of the profession ought to give more careful study to the Principles of Ethics that have been promulgated by the Association.

Ig

Dr. J. E. Gemmel, of Rush City, died last month at the age of 45.

Dr. John Hewins, has moved from Neche, N. D., to Minot, N. D.

Dr. Willian Pfisterer died at New Ulm last month at the age of 40.

Leonard, N. D., is without a physician, Dr. McEssey having moved to Lankin.

Dr. Edward Darrow has taken possession his new hospital building at Akeley.

Dr. C. A. Anderson, a 1905 graduate of the State University, has located at Easton.

Dr. T. B. Francis has moved from Edgerton to Fairmont, where he formerly practiced.

The City and County Hospital Association of Albert Lea has leased the Wilcox hospital.

Dr. John A. McKay, of Langdon, N. D., will spend a year in Chicago in post-graduate work.

Dr. H. L. Knights, of Adams, has returned from Berlin, where he has spent a year in study.

Dr. C. F. McCann, of Fairmont, has decided to go South and will locate in Okiahoma.

The new hospital at Oakes, N. D., conducted by Dr. H. P. Boardman, has been opened.

Dr. Carl Klemmer, of Minot, N. D., has resumed practice after a year spent in post-graduate work.

Dr. S. A. Berg, who has been studying in Chicago for the past year, has located at Mayville, N. D.

Dr. Albert A. Tofte and Dr. Josephine Bingham, of Ruthton, were married on Nov. 29th at Pipestone.

Dr. Enoch Haugseth, State University, '02, who has been practising at Detroit, has located. at Lake Park.

Dr. E. A. Lupton, of Minneapolis has moved to Grand Rapids. Dr. Lupton is a Rush graduate.

Prof. Henle and Dr. Fittig, of Breslau, were visitors of St. Mary's Hospital, Rochester, last month.

Dr. J. P. Rathbun of Faulkton, S. D., was married last month to Miss Susie Y. Ellis, of Indianapolis, Ind.

Dr. J. A. Smeallie, of Duluth, died last month at Cass Lake where he was living in a tent for his health.

Dr. C. J. Montgomery, of Overly, N. D., was married last month to Miss Grace Graham, of Petersburg, N. D.

Dr. A. M. Fisher, a recent graduate of Northwestern University, Chicago, has located at Underwood, N. D.

John Manning, the proprietor of the hot springs at Boulder, Montana, is to build a hospital, to cost $10,000.

Dr.

The report that Dr. D. F. Wood, of Hanska, had moved to Kansas, is not true. Wood remains at Hanska.

Dr. R. G. Stevens has moved from Brewster to Heron Lake. Dr. Stevens is a recent graduate of the State University.

Dr. Wm. S. Frost, State University, '04. has decided to locate at Lilly, S. D., instead of Kenmare, N. D., as recently reported.

Dr. N. J. Nessa, a State University graduate, class of '05, has moved from Madelia to Brewster. He goes to an unoccupied field.

The first building work on the State Sanatorium at Walker was begun last month. A cottage, to cost $2,000 will be finished in Jan

uary.

Dr. J. Harlan Stuart, of Minneapolis, will hereafter limit his practice to r-ray work. and office electrotherapeutics, consultation,

work.

Dr. C. E. Gates, State University, class of '04, who recently located at Luverne, has formed a partnership with Dr. H. P. Sawyer, of Goodhue.

Dr. N. O. Pearce, of Duluth, a recent graduate of the State University, was married on the 6th inst., to Miss. Elizabeth C. Harden, of Minneapolis.