as to include the very latest advances in this important branch of medical science.

Tuberculosis:

Recast from lectures delivered at Rush Medical College, in affiliation with the University of Chicago. By NORMAN BRIDGE, A.M, M.D., Emeritus Professor of Medicine in Rush Medical College; Member of the Association of American Physicians. Handsome 12 mo volume of 302 pages, illustrated. Philadelphia, New York. London: W. B. Saunders & Company, 1903. Cloth $1. 50 net.

In this excellent work the practical side of the care and management of those sick with the various non-surgical forms of tuberculosis has been concisely stated. Full consideration has been given to prophylaxis, an all important phase of the subject that has heretofore been much neglected.

The Care of the Baby. A manual for mothers and nurses, containing practical directions for the management of infancy and childhood in health and in disease. By J. P. CROZER GRIFFITH, M D., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania; Physician to the Children's Hospital, Philadelphia. Third

edition, thoroughly revised. Handsome 12 mo. volume of 436 pages, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1903. Cloth, $1.50 net.

Dr. Griffith's manual on the care of the baby is without question the best work on the subject we have seen. The fact of a third edition being called for within such a short time is sufficient evidence of its popularity.

Treatment of Gonorrheal Endometritis with Intrauterine Injections of Picric Acid.

A saturated solution (about 1 per cent.) of picric acid, is freshly prepared with warm water and filtered, After douching the vagina and cleansing the cervical canal, the nozzle of the intrauterine syringe containing the medicament is inserted to the fundus uteri and, after slight withdrawal, the liquid is injected into the uterine cavity. The vagina is packed with iodoform gauze. The treatments are repeated twice weekly, and in the intervals the patients are instructed to make vaginal irrigations with permanganate of potassium.-PostGraduate.

Mrs. J. P., called in consultation with Dr. H. Harris, May 12, 1900. Diagnosis: Bezold mastoiditis. Dr. Harris stated he had only seen her for a short time, and another physician had treated her for rheumatism of the neck for several months. May 14. Operated. Opened Bezold Opened Bezold abscess two inches below mastoid and removed between one-half to one pint of pus. The pus cavity extended from mastoid to within two inches of the shoulder and backwards almost to the spinous processes and over the jugular. Then did mastoid operation, removing all of outer plate of mastoid and cells and incus and malleus. No facial paralysis. Packed with iodoform gauze and inserted drainagetube in neck.

June 8. Neck doing well, but has splenius abscess and removed small abscess and scraped some necrosed bone from occipital bone. Packed all cavities with iodoform gauze.

August 29. Wound entirely healed. Hearing very good.

of mastoid over lateral sinus, removed most of epitympanum, ossicles, some bone from over semi-circular canals and facial nerve. Facial nerve slightly injured and facial paralysis for some time. (One year after almost complete recovery from facial paralysis.)

December 16. Temperature normal. Peroxide, aristol and gauze dressing. Give cod liver oil and arseniated hemaboloids. Wound heals slowly. Dress with iodoform and sterate of zinc.

July 18. Discharged cured. Hearing good.

CASE III.

February 20, 1901. W. F., aged thirtyseven. Had influenza three weeks ago, and shortly after the ear broke and discharged. A week ago had pain behind right ear, which rapidly increased. Great swelling, pain and tenderness over mastoid and sterno-mastoid muscle.

February 21. Did Schwartze - Stacke operation. Cells shallow and necrosed. Removed entire tip of mastoid. Removed necrosed bone from tympanic walls and epitympanum. Malleus and incus removed. Facial not injured. Lateral sinus injured. at highest point. Hemorrhage arrested with gauze plugs. Use iodoform and gauze dressing.

May 28. Removed necrosed bone from floor of tympanum, about Eustachian tube orifice, over carotid canal, vaginal plate. Facial not injured.

April 11. Curetted some diseased bone from over vaginal process, jugular bulb and carotid canal.

May 2. Removed small portion of diseased bone from over lateral sinus.

August 7. Discharged cured. Hearing

CASE IV.

March 19, 1901. Miss M. J., age nineteen, mastoid disease. Drum perforated, discharging thick pus. Mastoid extremely tender on pressure. Temperature 102°. Ears gathered three weeks ago from influenza. Operated, removing all mastoid cells, antrum and part of tegmen tympani. Malleus and incus necrosed and removed them. Inner plate mastoid healthy.

March 23. Temperature normal. Granulating nicely.

July 4. Found redundant granulations. Temperature 99.°

July 10. Operated, removing all of inner plate of mastoid, epitympanum, large amount squamous portion of temporal, portion of vaginal process interfering with deglutition for a few days, a portion over facial causing facial paralysis for some time (a year after almost complete recovery from this). Dressed with iodoform, sterate of zinc and iodoform gauze.

September 24. Complete recovery. Hearing good.

ated, removing some dead bone from roof of tympanum, over cochlea and semicircular canal and facial, but facial not injured.

May 11. Temperature 98.2°.

May 12. Opened from level of auditory canal two and a half inches above down to bone. Found some necrosis on squamous part and also over frontal, also discased bone from upper part of mastoid. Removed all of tip of mastoid and lower one third of inner plate.

June 21. Operated and removed zygomatic cells, a portion of necrosed bone about the size of a half-dollar just above and back of this in squamous portion, exposing dura. Inserted drainage - tube. Also scraped small portion necrosed bone. over cochlea.

June 23. Temperature normal. Kidneys in bad shape. Gave Basham's mixture. August 7. Discharged cured. Hearing fair.

The Physiological Action of Boracic
Acid.

The physiological action of boracic acid and its salts is a subject upon which we are urgently in need of precise information in view of their extensive employment as preservatives in articles of food. Dr. Merkel, of Nuremberg, has just published the results of a series of observations undertaken by him on the internal administration of the acid. He gave from fifteen to thirty grains in aqueous solution to a number of patients suffering from slight ailments for periods varying from two to eight days, and he obtained unequivocal evidence of gastro-intestinal irritation. The symptoms were excessive formation of gas in the stomach and intestines, with eructations, colic, epigastric pain and diarrhea. Invalids proved much more sensitive to its influence than healthy individuals, the latter being able to take moderate doses of the acid without manifest inconvenience. The moral is that boracic acid is not suitable for use as a preservative in articles of food intended for consumption by invalids or by the young; and it is particularly objectionable in milk, since it has to be used in comparatively large quantities, and the adulterated article is likely to be taken by those persons in whom it is likely to cause more or less distressing digestive disturbances.-Med. Press and Circular.

MEDICAL SCIOLISM, VS. MEDICAL SCIENCE.

BY BROSE S. HORNE, M.D.,

MARION, IND.

He that is possessed with a prejudice is possessed with a devil, and one of the worst kind of devils, for it shuts out the truth, and often leads to ruinous error."-TYRON EDWARDS.

I would not destroy institutions. I would not say that your school of medicine is all wrong, or that my school had all the truth, but I would destroy medical prejudice if in my power. The mist of prejudice has hung over the regular pro fession for years, until only the few have been able to see the light of truth behind the clouds.

For years an aristocracy in medicine has existed, based as it always has been on fads and errors. Our attention has been called, time and time again, about certain errors that were gradually creeping into the very foundation of our system by men who loved truth more than they did public opinion. The average physician, not being acquainted with the history or principses of medicine, has trusted certain self-appointed leaders, who had accepted the easy, "go-as-you-pleasemethod" of therapeutics.

We have no objection to the classification of disease under a name, so as to be able to classify or express a number of symptoms by one word, but the true physician, who sees the grim monster, Superstition, hidden under a German cloak of medical science, by degrees deceiving the very elect in American medicine, he can not resist the temptation to protest against it.

Nosology was never intended to be used as the guiding principle of therapeutics. In our process of medical evolution we discover that there has been evolved a nosological therapeutics, viz., treating each disease by name with certain drugs-too often a German product.

The American practitioner cannot afford to forget the great fact that there is a wide and distinct difference between nosological diagnosis and therapeutical diagnosis. The first is unscientific, and is the son of those who wish to keep alive in the profession the use of patent or proprietary products, with the name of the disease on the bottle, or the noxious liquid in the squirt-gun, ready for the physician's

use.

Such a system has the rank and file in her grasp, and if she continues the regular system of medicine will perish from the earth.

For those who have been enchanted by these false lights in medicine, the only hope seems to be for a reincarnation of the spirit as advocated by Williams and Chambers, of England, and Scudder, of America. Cullen himself, the founder, we might say, of our present system of nosology, warned his followers not to base their treatment upon such a classification, but, in spite of his warning, scientists, so-called, invented a nosological treatment, and were damning the patent medicine evil while doing it.

As a result of this medical sciolism, imported from Germany, we have a new combination every day on the market, represented to be a sure cure for typhoid fever, etc., etc. Patent medicine houses have started all over the country. Medical journals have lost their independence, with the exception of a few, from this commercial influence. The true science of medicine still exists. The system of the fathers in medicine, where the pathological processes are met by direct medication, only waits for our acceptance. Let those who love the profession turn from the medical sciolism of the present and only go back to the principles of medicine, and American medicine will shine for ever. Prejudice has caused us to insult those who have brought us messages of truth. Egotism has blinded our eyes to the facts, but it is not too late to change. Remember, "Prejudice is a mist which in our journey through the world often dims the brightest and obscures the best of all the good and glorious objects that meet us on our way."

While we are watching Germany, and waiting for a new therapeutic discovery, we may be overlooking important ones. here in our own country. Ah! it has been done too often in the past. Instead of casting away the good at home, because it is "home made," let us accept it and give credit where credit is due.

Not very long ago I had the pleasure of talking with a very distinguished professor of materia medica and therapeutics in one of our prominent regular colleges. He was speaking about a certain remedy and of its great value. I said: "Yes, the Eclectics introduced it to the profession,"

and he replied that they did, and they had also introduced many others of value, but there was such a strong prejudice among the general practitioners of medicine against the Eclectics that it was not safe for a writer to lay too much stress on their discoveries or give them credit. This statement from the distinguished professor called to my mind the saying of Sydney Smith "Never try to reason the prejudice out of a man; it was not reasoned into him, and cannot be reasoned out." But I cannot accept the conclusions of the professor; I think he and other writers have more fear than necessary. Men to-day are governed more by the Golden Rule, and are willing to accept the good and lay the isms and creeds aside. The physician who never investigates outside of his own school looks through a prejudiced eye, and locks himself up in a dark mental chamber where spiritual light and truth never enters, and he will surely die from the venom of himself.

No reasonable man can doubt but that John Scudder delivered a message to the profession, and as time goes on he will receive credit. If saying this, or if giving credit to those who we honestly think have done good, should cause us to be censured, or would classify us with another sect, then you or I or any honest man should be willing to be classified as an irregular, and be glad of it.

Emerson says in substance that the intellectual man should be a non-conformist. We should live above the ism of the school of medicine we are members of. If our fellows wish to manifest the spirit of hate and ostracise us, let them do it. They are simply poisoning their own banquet, which they will afterwards eat themselves.

It is the duty of every man to say what he honestly thinks, leave his message, and trust to the future. When the spirit of love rules supreme, each will receive proper attention; even the radical will be treated with tolerance. Voltaire almost told the truth when he exclaimed: "Prejudice is the reason of fools.

In conclusion, we may say in all honesty that nosological therapeutics is medical sciolism. Direct medication is medi

cal science.

"Our real blessings often appear to us in the shape of pains, losses, and dissappointments; but let us have patience, and

we soon shall see them in their proper figures.

SURGERY Of prostate, PANCREAS, DIAPHRAGM AND SPLEEN.

BY B. MERRILL RICKETTS, PH.B., M.D.,

CINCINNATI.

(Continued.)

SURGERY OF THE DIAPHRAGM.

ANATOMY AND PHYSIOLOGY (1661–1903).

The diaphragm is the chief characteristic in mammals (among them man); it forms a thin muscular fibrous partition between the abdominal and thoracic cavities. It is the base of a closed cavity containing the heart and lungs.

It is absent or rudimentary in birds. Amphibia and animals below them in scale of structure have no diaphragm.

First trace is in the crocodile and birds; even in birds it is not complete.

In cetacea the centrum tendineum is almost obsolete.

It has four divisions-central tendineum, middle, right and left leaflet. Its fibres vary greatly in length; those from the middle leaflet arising from the ensiform appendix are short, while those of the right and left leaflets are much longer.

They arise from the whole of the internal circumference of the thorax, and attached to the inner surface of the cartilages, and bony portions of the six or seven inferior ribs interdigitating with the transversalis; and behind to two aponeurotic arches, the ligamentum arcuatum externum, and internum, and to the lumbar vertebra.

The fibres of the diaphragm touch those of the psoas and quadratus lumborum muscles.

The diaphragm is perforated by the esophagus, vena cava and aorta. The right cons transmits the sympathetic, and the greater and lesser splanchnic nerves on the right side.

The left cons, the greater and lesser splanchnic nerves of the left side, and the vena azygos minor.

There is a deficiency in the fibres of the diaphragm about the ensiform appendage and the cartilages of the adjoining ribs, owing to areolar tissue, pleura upon the thoracic side, and peritoneum on the ab dominal side.