connective tissue. The base of the ligamentum latum consists of a maximum collection of tissue and organs which extend from the lateral cervical border to the pelvic wall. The base of the ligamenta lata constitutes a supporting beam for the cervix. Dr. Frank P. Foster, of New York, announced years ago that the vagina and the ligamenta sacro-uterina form a supporting beam for the cervix. Foster's claim for a dorsal-ventral supporting for the cervix is exactly what I claim, that the ligamenta lata is a transverse supporting beam for the cervix. The supporting or suspensory power to the uterus of what I term the transverse supporting beam of the cervix (i. e., the ligamentum cardinale uteri-Kock's-or the ligamentum transversum-Colli-Mackenrodt's) is composed of different structures which, analytically, must be exposed to realize their elementary influence.

I. There is a mass of connective and elastic tissue-a strong band extending from the lateral border of the cervix uteri to the lateral pelvic wall.

2. There is the "tunica vasorum uteri," the vessels (lymph and blood) and nerves which exercise considerable influence in uterine suspension.

3. There is the limited quantity of muscular fibers lying between the blades of the ligamentum latum. The special power of the "transverse supporting beam" of the uterus lies in the fixation of its cervix to the lateral pelvic wall.

LIGAMENT OF HYRTL, KOCK AND MACKENRODT.

So much significance has been attached to the ligamentous apparatus of the uterus that three physicians possess eponyms referring to its support: Hyrtl, Kock and Mackenrodt made a special study of certain ligaments which they viewed as of maximum importance in uterine support.

Mackenrodt, a gynecologist of Berlin, called it "ligamentum transversum colli," or Mackenrodt's ligament. This is simply the base of the ligamentum latum, with its elastic and connective tissue, muscle strands, vascular and nerve bundles. Kock, a German gynecologist, called it ligamentum cardinale, or Kock's ligament. This is practically the same as Mackenrodt's ligament, or what I have been naming the transverse supporting beam of the cervix.

Hyrtl called it the ligamentum pubo-vesico-uterinum, or Hyrtl's ligament. This ligament extends from the uterus to the bladder and pubis. It may be viewed as an antagonist to the ligamentum sacro-uterinum. By its contraction it anteposes the uterus. From its minimum structure it possesses a minimum fixation power (Joseph Hyrtl-a Viennese anatomist). We may conclude, from a study of the uterine ligaments, that neither the peritoneum nor the uterine ligaments can exercise significant

supports over the uterus, which describes such extensive excursions painlessly within the zone of health. The excessive slackness of peritoneum and ligaments prohibits them from being a sufficient fixation apparatus to maintain the uterus in anteversion during gestation. I am not convinced that it is true. During gestation the round ligaments do not become tensionized; when spanned, they elongate and hypertrophy; hence, there exists practically no difference between the round ligaments during uterine quiescence, or during uterine gestation. During the puerperium the round ligaments atrophy, involute with the uterus; hence, no influence over the position in the puerperium is exercised by the round ligaments. In autopsy, during puerperium, I have not been convinced that the round. ligament was distended or stretched. At that time the uterus practically completely occupies the lesser pelvis, and does not require any dragging to antevert it. As a student of anatomy and gynecology I am convinced that the ligamenta rotunda uteri are not agents which suspend the uterus or maintain it in position. In fact, the uterus rests more proximalward than the distal ends of the extended ligament. The uterine ligaments are similar to the intestinal mesenteric attachments, viz.: To prevent entanglements of viscera, and to limit, like a tether, the zone of health. The functions of the uterine ligaments are limited to a minimum influence in the uterine fixation, for the uterus does not rest in an empty space; other organs hinder it from excessive distalward displacement. If the uterine ligaments are placed on tension, they extend, stretch and yield. In fact, matters are pathologic when the uterine ligaments support the uterus, and every gynecologist knows how poorly the uterine ligaments support the uterus when the suspension is pathologic.

(c) LIGAMENTA ROTUNDA UTERI.

The round ligaments of the uterus are practically more significant than any other uterine ligament, because of their enforcement into surgical procedures. Authors become divided into two divisions in regard to the signification of the round ligaments. I shall assume, after considerable study of the round ligaments, that: first, they are not uterine supports, and should be disregarded as uterine supports, and, second, they have practically no influence over the normal position of the uterus. opens a cadaver it will be evident that by no kind of uterine movements can the round ligaments be demonstrated as uterine supports. During peritonotomy the round ligaments remain slack in a curved state. By forcing the uterus dorsally in the cavity of the sacrum, the round ligaments become placed, on limited tension. During lateral uterine movements, as well as during distalward movements of the round ligament, they remain slack, untensionized. The round ligaments are irrelevant to the normal position of the uterus. By removal of the oviducts and a segment of the round ligament, the uterine position is practically not

changed, except in accentuation of uterine anteversion. As to the round ligaments producing or maintaining the uterus in anteversion during gestation, I am not convinced that it is true. During gestation the round ligaments do not become tensionized. The round ligaments do not become tensionized, spanned, elongate or hypertrophy. Hence there exists. practically no difference between the round ligaments during uterine quiescence or during uterine gestation. During the puerperium, the round ligaments atrophy, involute with the uterus; hence no influence over the position of it is influenced by the round ligament during the puerperium. At autopsy during puerperium, I have not been convinced that the round ligament was distended or stretched. At that time the uterus practically occupies the lesser pelvis, and does not require dragging to antevert it. As a student of anatomy and gynecology, I am convinced that the round ligament is not an agent to support the uterus or maintain it in position. If it be true that the round ligament possesses practically no influence over the normal position of the uterus, either as a suspension or fixation apparatus—a matter I have taught for some fifteen years-it behooves us to abandon an unnecessary and harmful operation, viz.: The Alexander operation. To suspend the uterus by the round ligament is like undertaking to keep a man's hair of proper length by clipping it every four or five months-the operation should be repeated likewise. The Alexander operation is permissible for hygienic reasons, i. e., to obtain therapeutic suggestions and rest in bed a few weeks.

It is mistaking neurology for gynecology. It is a mistake, for mobile uterus requires neither surgical nor medical treatment. Hysteropexy, by means of abbreviation of the round ligaments, will pass into oblivion like normal ovariotomy; like circumcision; like the abused trachelorrhaphy; like the cruel curettage. Hysteropexy, by all means, is irrational, as it substitutes one pathologic condition (alleged excessive mobility) for another (that of fixation). Fixation of any viscus is irrational as it is ungynecologic.

(To be continued.).

TREATMENT FOR WARTS.

In the treatment of warts on the hands and lips, Mantelin, in the Bulletin Générale de Thérapeutique, recommends both local and internal medication. He directs that nine grains of magnesia be taken every day, and that the following collodion be applied to the warts:

NOT DIAGNOSIS, NOR THERAPEUTICS.

BY R. B. ELDERDICE, McKnightstown, Pa.

[Written for the MEDICAL BRIEF.]

The business or financial side of the medical profession has of late been pretty well discussed in society meetings, and elesewhere, and the general concensus of opinion seems to be that we doctors "get left" more frequently than any other class of business men. There is also much said about the duty of the physician to the public, and the public usually has plenty to say. If the grocer, butcher or merchant refuses to "deliver the goods" without the cash to persons already owing him a long-time unpaid bill, the only comment we are likely to hear is: "What else could they expect, if they won't pay?" But, let a physician refuse to attend those "nopay beats" and these same people will be "up in arms," and say the doctor should respond to their calls, at all hours, in any kind of weather, as promptly as if they were his best-paying patrons, and expect him not only to give his time and work, but also to furnish them with free medicines, both when seeing them and on any office calls they may choose to make. And nine of every ten of these people could pay if they would. When he wants some wood sawed, or any little job done, these folks can't do it— they must loaf at the village store or shops, and he may hire some one who does pay his bills to do the work. This is fact, not fancy, and a frequent experience. When you have a chance to do worthy people a charitable action, do it, and let them see that you do it with a good grace and a good will, saying nothing, either then, or ever, about it. But "business. is business," and I wonder how many of you can think of the time (or, fortunately, can not) you attended Mrs. A. in confinement, for the second or third time, without any pay, and never expecting any, and while so doing, Mrs. B. in one of your best-paying families sent for you in like case. Finding you, likely, some miles away, and no certainty of time of your return, she had to have "some one else" called in your absence, when you've lost the fees in the case, and like enough (if the doctor called was near-by), the future practice of that family; as I notice, it is the woman of the house who usually selects the family physician. But, people will say, "are you going to let the poor woman suffer without help?" She should not, but place the responsibility where it belongs, on her husband, and if he is a loafer, place it on the county, where it belongs-not on the near-by doctor. The county is the proper medium for the care of such unfortunates, and the community (or the county), can more readily bear the burden than can the few physicians of a county. In some sections, medicine and attendance for those unable to pay is paid for by the public authorities, at a reduced rate. This should be done in every county in the United States, as has long been done in all the principal cities. We doctors all pay our taxes, and why we should be expected to supply medicines

and services worth many thousands yearly, free of all remuneration, is a conundrum I can not answer. The reason why we are the only business men in the world with this state of affairs to hamper our advance in the world's prosperity, is simply our own fault and that of our predecessors. I never heard of very many of us getting free of charge our dry goods, groceries, drugs, clothes, horsefeed, buggies or blacksmith bills, not to mention life insurance; and there is no reason why any one should expect a physician to give his time and best skill to any case free of charge, any more than they would a legal gentleman to handle their case in court without a fee; which he could do without exposure to cold, rain and storm, and without loss of sleep. If any State in the Union, with its hundreds of thousands' population, or their counties, with their thousands, can not afford to pay for the medical care of the poor within their borders, they can not expect the few doctors in their jurisdiction to assume the burden. I am quite well aware that every county has its almshouse, as well as its jail; each with its county infirmary, and that all cities have the same, with numerous hospitals and free dispensaries. But the greater number of the poor in all country districts, are outside of the "poorhouse,' living from "hand-to-mouth," and when they become ill (as they are sure to do), the care, trouble, and in most cases, the expense of their medicines, falls, not on the community they honor by their presence, but upon the hard-working, under-paid country or village doctor. I think eight of every ten men who have been in country practice from ten to forty years, will say this statement is about correct. Pure food laws, sanitary inspection and preventive medicine are paid for by many of the States, and why not curative medicine? Much has, at various times, been said of the "duties of the physician to the public," and I have a faint idea that there might be just a little bit said about the duty of the public to their physicians. Often the man who joyfully hands his (or, rather, her) pastor a handsome fee for a ten-minute wedding ceremony, will later on (usually about ten months), think the doctor's fee of one-half, or, perhaps, onefourth of that amount, for hours of hard work, and likely the loss of a night's sleep in aiding the safe arrival of his first-born, is entirely too much, and either want a reduction, or make him wait a year or so for his fee, or move away and forget to pay the bill. I have known a case in which the parson received a $50.00 fee while I was begrudged the $10.00 I finally got with difficulty, for a much more strenuous job than his. But, then, things were different on these two festive occasions. You've all, no doubt, "been there," and know that such things do happen. The New York Law Journal says: "The charges of physicians should be fixed according to the practitioner's standing and experience, and the amount of labor involved." The Medical Review says "the man who makes calls for reduced fees is a man of limited ability or inferior character (God's truth), and in doing so shows he thinks he is worth less than his