for each part of the body. In China and Japan, in spite of the influence of deities, the medical profession has always been distinctly separate from the priests, and were it not for the nature of the people might be expected to have reached great heights, which is happening for the first time only in the last

century.

In only one of the above countries can we find no trace of definite practitioners who were consulted at their offices and paid visits to the homes of the sick. In Babylon it was the custom to expose their sick on the streets to be interrogated of passers-by as to symptoms. In the case of any of the latter having come through the same experience, it was his duty to explain the means successfully adopted Thus it is to Babylon we must give credit for a system which, standing the test of time, exists in many places at the present time to serve the useful purpose, no doubt, of counteracting the too scientific tendency of modern medicine.

No lack of medical literature seems to have hampered any of these peoples, and in most cases abundant writings, supposedly of divine authorship, were forced upon the physicians with definite instructions set forth which could not, under pain of punishment, be departed from. Thus the Egyptians, in their celebrated Papyros Ebers (now in Germany), had a work which was a compilation of the writings of the God Thot, together with those of the most skilled physicians of all countries at the time, a famous Egyptian filling the duties of editor. Thus at so early an age have we evidence of international medical intercourse! The Persians and others were similarly guided by Zend-Avesta or Living Word, the work of a great priest, Zoroaster, who lived about B.C. 1000. It was acknowledged in the pages of this work, however, that the "Word " needed practical help in the curing of disease, but a cure under its directions was claimed to affect the soul as well as the body. The Jews had for their foundation an extensive work known as the Talmud. The Indians and the Chinese had many laborious books, of which those possessed by the latter were used entirely, also by the Japanese.

Medical education varied from the oral teaching of the Indians to the laborious memorizing in toto of voluminous. Chinese books in Japan, to the bedside teaching of others, and to the presence in Egypt of five medical colleges, with libraries, laboratories and students' residences. In China, however, it has been possible for anyone to assume the title of doctor and to commence the practice of medicine without any preliminary education.

The knowledge acquired by these peoples must certainly seem wonderful when it is considered that, in the first place,

the most ignorant superstitions were brought to bear on causes, treatment and outlook, and in the second place, no accurate knowledge as to anatomy could be formed on account of religious objection to dissection. In therapeutics, purgatives, bathing, cupping, the use of enemata and of emetics, were common-sense measures which underlaid many fanciful remedies. In physiology, such experiments as successfully removing the spleen in animals had been performed. In midwifery, though it was the custom in ancient times for women to attend to the duties of the lying-in chamber, yet the physicians were always brought in when difficulties presented themselves, and hence a knowledge of treatment, at least, was necessary. Thus in India considerable skill in cephalic and podalic version, embryotomy and Cesarian section was possessed, and in Japan several centuries ago a celebrated and worthy obstetrician sprang into prominence whose writings. show a knowledge of embryology and other aspects of the branch. It is in the use of the knife, however, that the greatest strides were made by all, the people of the Ganges being the boldest. Circumcision, venesection, laparotomy, herniotomy, cranial surgery, operations for imperforate anus and plastic surgery all being practised before the Christian era.

A curious operation for stone is described in which by two oiled fingers in the rectum the stone was pushed forward to make a projection above the symphysis pubis, whence it was removed by excision, a warning being uttered to leave no spicules behind in the bladder.

The preparation of mummies by the Egyptians was to some extent connected with the medical workers, and in any case is of interest. The brain being removed through the nasal cavities by means of hooks, and the abdomen being emptied, the two cavities created were filled with spices. The body was then placed in caustic soda for seventy days, after which it was removed, wrapped in fine linen, and placed in an air-tight coffin. The fact that most of the mummies found seem to be the remains of great dignitaries is accounted for probably by the costliness of the process.

In both India and amongst the Jews the inoculation of natural and artificial virus of smallpox was practised as a preventative measure, and it is quite possible that a knowledge of this may have given no little strength to the courage of Jenner in advocating his views with such persistence!

The remuneration received by the medical men by the dif ferent races of antiquity seemed to result in most cases, favorably. In Egypt golden and silver models of the diseased part of the patient were given as fees, together with wine and fine meats. The Persians had a regular tariff, the form of exchange

being in the way of cattle. Thus the chief of a tribe paid with a farm, and the son of a family with a large ox, and the famous doctors of the day were consequently owners of great numbers of animals. In China, affairs were so favorable for the physicians that the government issued an official notice to the people that, as physicians were in the habit of refusing to see patients before one p.m., and many were accustomed to sit up very late smoking opium and drinking, they should only receive one half their fee if they did not come at once when needed. In Japan, unfortunately, a prophet advised people to refrain from paying physicians well, lest they should neglect their professional duties, and the custom is to pay according to the success of the treatment. And yet Japan is not the most advanced medical nation in the world!

In spite of the theurgic element in medicine the position universally accorded the physician amongst these peoples was one of high respect. He in turn must observe certain forms of conduct, and we find in Indian writings the following qualities set forth for a doctor to possess: "Absence of passion, chastity, temperance, amiability, veracity, generosity, consideration for the sick, earnestness, a desire for knowledge, freedom from boasting, secrecy, and above all reflection and independence of thought." A goodly list and one not diminished in practical value because of its age. In seeking in the literature mention of the opinion held in regard to the position of the physician, no less a source than the Old Testament need be consulted, wherein we find the following noble sentiment: "Honor a physician! The skill of the physician shall lift up his head, and in the sight of great men he shall be in admiration. When thou feelest sick call upon God, and bring the physician, for a prudent man scorneth not the remedies of the earth."

AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS.

Fourteenth annual meeting, held at Washington, D.C., September 16th, 17th and 18th, 1902. The President, Dr. Edwin Ricketts, of Cincinnati, O., in the chair.

Removal of the Gall-Bladder Through the Lumbar Incision.

Dr. Walter P. Manton, of Detroit, reported the case of a patient 38 years of age, the mother of five children (two abortions), never robust, but able to attend to her domestic duties. She had suffered from a number of gastric attacks, but there had been an absence of symptoms pointing to disease of the biliary tract. Examination showed a loose left kidney, while the right kidney, displaced downward and inward, appeared to be double its normal size and had certain projections which led to the diagnosis of nephroptosis, with probable cystic metamorphosis of the kidney. At the operation, through the nephropexy incision, the fatty capsule of the kidney was found to be embedded in adhesions, which had given rise to the appearance of the enlargement. The kidney, which was normal in size and structure, was delivered on the back and placed astride the wound. Below the kidney pouch a distended gallbladder, containing fluid and nineteen gallstones the size of hazelnuts, was found surrounded by adhesions. enucleated, tied off at the cystic-duct, and removed. The kidney capsule was split and peeled off to the lateral line, fixation sutures were introduced and the organ was returned to its place. A strip of gauze for drainage was carried from the upper angle of the external wound to the stump of the cystic duct. The patient made a good recovery.

Abdominal and Pelvic Surgery and Drainage.

This was

Dr. Joseph Price, of Philadelphia, said that the more progressive and successful specialists practised most extensive sponge packing or drainage. The modern operator did the same by his gauze pack or the dry operation. A number of operators, doing fairly good work by the suprapubic route, condemned or partially rejected drainage. Some of them, he said, never learned and never would learn how to handle drainage well. After abandoning the suprapubic route, these men were placed in the uncomfortable position of admitting that drainage

did what they had refused to do by suprapubic surgery. About all the reported operations were coming from operators opposing drainage or practising it only when they were compelled to do so.

Tetanus Following Abdominal Section, Due to Infected Ligatures-The Angiotribe in Abdominal Surgery.

Dr. Walter B. Dorsett, of St. Louis, detailed at length two cases, which were of women who had undergone ventrofixation of the uterus, or adhesions of the uterus to the surrounding tissues, due to previous inflammatory conditions. The material used for fastening the uterus was kangaroo tendon. This was the source of infection. He had used the angiotribe successfully 25 times, as follows: abdominal hysterectomy, 10 times; hemorrhoids, 1; pus tubes 5 times; extrauterine pregnancy, 4 times; dermoid cyst, 1; ovariotomy, 3 times, and one in a case of vaginal hysterectomy. He concluded that (1) patients upon whom it had been tried suffered less post-operative pain; (2) no adhesions to stumps had followed; (3) no secondary hemorrhage had followed; (4) it can be applied, when two instruments were used, alternately by the operator and the assistant without the fear of the slipping of a ligature knot, and in

less time.

Ruptured Pus Tubes.

Dr. Charles Greene Cumston, of Boston, spoke of two methods of dealing with pus tubes; one by posterior colpotomy, followed by incision and drainage of the sac, while the other was to remove the tube, and if the condition was bilateral to do a total hysterectomy. Drainage of the perforated pyosalpinx through the vagina was naturally the easiest and least dangerous method. The vagina was incised, and then the pyosalpinx and the walls of the pus tube might be united to the vaginal wall by means of forceps. The best treatment for perforated pus tubes is by abdominal incision. The extirpation of perforated pyosalpinx is particularly urgent in those patients in whom drainage by posterior colpotomy had been unsuccessful, and also in tuberculous lesions of the tubes.

Pelvic Abscess and its Treatment.

Dr. Herman E. Hayd, of Buffalo, spoke of a class of cases in which vaginal incision and drainage, supplemented by curettage, should be first employed to eliminate the pus, and then an abdominal section should be done later to relieve the patient of her suffering. Large collections of pus, low down in the pelvis, in a moribund woman are best evacuated through the vagina. He spoke in reference to strong women who were suffering