gave him Basham's Mixture, a teaspoonful every two hours. In case of return of pain, I left him a solution of morphine, % grain to a teaspoonful to be taken, if required. I allowed him to take light nourishment, consisting of a small amount of milk with brandy and soaked crackers. The patient made a good recovery. This case recalls vividly to mind one similar which occurred in a lady aged 70. During the night of October 10, 1892, she was seized with what seemed to be an attack of cholera morbus. Under hypodermic of 1⁄2 grain morphine she gained some relief, but the next day was attacked by vomiting, which in a few hours became stercoraceous, and this continued for five days with intervals of a few minutes' intermission. She had hiccough and pain in the abdomen, situated at the umbilicus. To relieve this she was given 1⁄2 grain morphine hypodermically every six hours, and warm-water irrigations by the bowel were used to overcome the obstruction. This was done by means of an improvised tube made by fastening tubing together from several Davidson's syringes, to the extent of five feet; this was inserted into the bowel and 1⁄2 gallon of water with 1⁄2 pint of oil were injected through it, at intervals of every six hours. The treatment was kept up regularly for five days, when it succeeded in overcoming the obstruction and the patient made excellent recovery. I know we are at a loss many times to tell exactly whether we are dealing with an ob struction due to impaction, an intussusception, or a volvulus. Possibly we may have an internal strangulated hernia. But upon a thor ough examination of all the points of exit to a hernia, whether the patient has ever suffered with a protrusion of bowel, with negative history and failure to find any signs of hernia, we can exclude this hypothesis. When we find a tumor in the abdomen,-say, at the umbilicus, or more often in the right iliac fossa,—of recent origin, accompanied with stercoraceous vomiting, we are almost certain an obstruction exists due to an impaction. Should the abdomen become very tympanitic in twenty-four or thirty-six hours after inception of pain, we may rightly infer that the bowel has ruptured, allowing an escape of fæces and gas into abdominal cavity, setting up a general peritonitis. This would suggest perforative appendicitis. In case of intussusception, where there is not an entire occlusion of the lumen of the bowel, we shall not have obstruction so absolute; the bowel may be inclined to be dysenteric with considerable tenesmus. Making our diagnosis therefore to a considerable extent by exclusion (if I may use the expression), we best arrive at and accept the most likely hypothesis. But my object is not so much to make a differential diagnosis as to insist, that after making out the case to be one of intestinal obstruction, due to impaction, we should persevere in the use of our remedies. I know we often become discouraged and feel like giving our patient the benefit of the last resort-the knife; yet by persistency we often snatch success from the very shadows of dissolution. Suppose the case to be one of intussusception or volvulus, could a better plan of treatment be devised? Would not the weight of water and the lubricating properties of the oil be effectual in overcoming the invagination or twist? Or would we be justifiable, in the light of advanced surgery, at once in opening up the abdominal cavity? This is a point worthy of reflection, and one that possibly every physician will be compelled sooner or later to answer for himself. THE POWER OF BOARDS OF HEALTH. BY JOHN A. DE ARMAND, M D., DAVENPORT, IOWA. HERE is a feeling which is akin to per THE fect security that health boards are doing a wonderful work in restricting the criminal and careless spread of the contagious and infectious diseases by quarantining them. The power of these boards, however, does not extend to its just limits; and until this power can be made to encompass not only the cases but also the causes that threaten public security and public health, these organizations will not fill their true mission. Acting in the capacity of health officer to the city poor board, I had occasion to visit two cases that seem to bear on this point, and for that reason they may be referred to. Both were old women. Both lived alone. One was slightly disabled owing to disease. She was no longer able to care for her wants, and her rescue was made in time to avert death from cold and hunger. The other was an old woman who, through improvidence and fondness for liquor, had become more or less of a reprobate not unknown to the police of the city. Abject want appeared in every corner | wonderful privation, not to say great suffering. and crevice of these two habitations. Filth Still, we know that all this is right and just and of the vilest and rankest kind was added to the necessary. We know that to stop the spread general squalor. Both houses were so foul- of scarlet fever and diphtheria there is nothing swelling and filthy that the nostrils were of- to compare with isolation. The old, deluded fended by even the recollection of the odor idea that it is better for children to have chilthat hung over the entire place like a pall. dren's diseases and be done with them is nonBefore these two old women were removed to sense. Then, the proper thing to do is to keep quarters where cold and starvation could not the disease within safe quarters. When we finish the work of neglect, complaint was made recognize the fact that a filth disease is a disto the board of health that the conditions ease that has for its fountain head a cause that there were such as to warrant the action of the is embodied and told in one word, and that board in destroying or cleansing the premises. word is "filth," we have said much that should This the board-and a most excellent one, too form the basis of an intelligent guide toward -did not have the power to do, and, conse- the remedy for its removal. quently, nothing was done. A large number of immigrants are unfit for citizenship because they will stand in the way of health aims and hygienic reforms. They crowd into small, illy ventilated hovels, and live like rats, even to multiplying. In larger cities they offer the same affront to cleanliness, and when the doors to such immigration are closed an important step toward safety will have been taken The inability of the boards to assail these and kindred sink-holes of disease, even to the destruction of the houses, is not in the line of consistent work, nor is it in accord with scientific investigation. All the filth diseases are surely fed by filth. There is nothing like un sanitary conditions and surroundings for the spread and maintenance of this class of diseases. Now, if it is sound theory to quarantine diseases which are a menace to the health of a community, surely it would seem as though it would be both safe and natural that the food-supply of these diseases be cut off. What would you think of a fire company that would go to work to fight a fire that threatened lives and property, and at the same time not endeavor to remove a tank full of oil that was feeding the flames? The only end subserved by locking the barn after the horse has been stolen is to save the harness. But of what use is that when the nag is wanting? There is not much more use in quarantining people and houses if the fountain head of disease is let run. To the unsuspecting the mere matter of quarantine carries with it an idea of safety which the facts do not altogether justify. And to those who are poor and shut off from the avenues of trade, and whose opportunities for seeking employment are cut off, it works Filthy houses, filthy homes, filthy surroundings are a constant and never-ending encouraging incentive to diseases of a dangerous type to come, and, what is worse still, to stay. The end of good sanitary work cannot be said to have reached its legitimate bounds until it can attack not alone filth diseases, but filth the cause of these diseases as well. It is a crime against the family and against the health and happiness of the community for a family, through ignorance, carelessness, or general shiftlessness to pollute the atmosphere of any community. Poverty is no crime, but the filthy ways and filthy lives of many people are criminal, and this interpretation should be put upon the wholesale disregard of hygienic surroundings by the authorities. The man who throws a dead animal into the alley is held amenable to the laws of the land, while the woman who lets all sorts of filth accumulate within her house is protected by the door of her house; but she should not be. We will not approach the point of eradicating diseases which are eradicable until we go at the work at the right end and in the right manner. There are human pigs, and they are not so scarce as to excite wonder either. These must be handled by the usual means of abating nuisances; and if the healthy well being of a community depend upon house cleaning by the strong arm of the law, why, in goodness' name, let it come to that! There is a great problem that our age is not likely to settle, and it relates to the welfare of the poor, for they are with us always. Poverty stalks abroad in the land, and to relieve it calls for a new deal somewhere. This great question the wise men who make our laws will settle to their own but not to their neighbors' satisfaction; but the one fact re mains undisproved, and that is that cleanliness is less expensive than quarantine. When the State health boards are empowered to make people be clean, the strongest prop will have been knocked from a large and most fatal class of maladies. There are low, bad quarters in every city almost, where sanitary matters, like moral affairs, are at sixes and sevens. There you will always find infectious diseases. The spread of these diseases to other and sanitary localities is only warning that the beast is abroad, and that it behooves all to keep the powder of care dry and the locks of protection in good order. Then let the effort be made to give to local boards the power to clean up the filth without any regard to where found. Dirty people are bad people, and it is folly to say "He that is filthy, let him be filthy still." Without any desire to cast reproach upon a teaching whose import is wrongly construed, I am heartily in favor of constructing a new command, which will say, "He that is filthy, let him be cleansed," nolens volens. The health board has come to stay. It is a long stride in the right direction. Give it the power, and it will do a work that cannot be compassed by all the discoveries that all the investigators in medicine can be expected to make in a century! After all, the true work of the physician is to prevent disease quite as much as to cure it. When the work the boards of health have done is remembered, it cannot be even guessed at what can be done when the good work is carried to its legitimate ending by the covering of the ground as can be done if the power is but given. When this power will not restrict the honest liberties of a single man, but will remove disease and death from the land, the end should justify the means, however apparently presumptive to those who do not know what is best either for themselves or the community. A SIMPLE DEVICE FOR STERIL- BY WILLIAM EASTERLY ASHTON, M.D., Clearly we cannot depend upon the so-called aseptic gauzes, sponges, ligatures, etc., which are so freely sold in the market; for, even granting that they are sterile when packed at the factory, they cannot remain so long, and they are certainly unsafe after being in a drugstore for an indefinite period. I have been using the following simple. device when operating in private houses,—not only with complete satisfaction so far as simplicity in technique is concerned, but also with a decided lessening of personal anxiety and discomfort. I use a No. 2 Arnold Steam Sterilizer, which has ample space for all the necessary articles needed in abdominal work, and, therefore, of sufficient size for all branches of surgery. To render it portable, I have had Messrs. Chas. Lentz & Sons, of Philadelphia, make a round leather case of the following dimensions: Fourteen and one fourth inches high by twelve and one fourth inches in diameter. The lid fits over the top of the case in a way similar to that of the ordinary hat box. The sterilizer fits snugly into this case, and can be carried about with no more inconvenience than a small hand-bag. The following articles are packed in the sterilizer and kept ready for use at a moment's notice: Two dozen gauze sponges; two large and four small gauze pads; one yard of iodoform gauze; three glass drainage-tubes, of different sizes; two rubber drainage-tubes; rubber tubing for intestinal ligatures; the irrigatingtube and nozzle; five large towels; one dozen safety pins; a nail-brush, and the dressings, which consist of two yards of gauze, absorbent cotton, and one yard and a half of Canton flannel. With the above articles in the sterilizer the surgeon has at his command all that is required in any abdominal case, and he is therefore ready for any emergency. Upon arriving at the house of the patient the sterilizer is taken out of the case, filled with water, and placed upon the kitchen range. I always keep on hand a duplicate set of the articles which go in the sterilizer, and immediately repack it after every operation. The N these days, when success in surgery de general surgeon may either keep the sterilizer PHILADELPHIA. ization, the surgeon is often put to his wits' end to know just how to accomplish this when operating in private houses. deem necessary at the time he is called to a patient. The advantage of this portable sterilizer is |