colleagues." The public should consider the time and money required to obtain a medical education, and that this, plus library, instruments, office and driving equipments, will run up into several thousand dollars, which represents (plus what brains he may have) a doctor's capital invested in this professional business, and he should earn something more than a skilled mechanic, who has no thousands invested in learning his craft, and usually but about one-half the number of years required to do so. An ordinarily good mechanic, working eight hours a day, earns about $1,000 to $1,200 a year, and loses no sleep while doing it, and gets his meals regularly, and his pay weekly or monthly; but how is it with the physician? He works at any and all hours, whether "dead tired" or not; eats when he can, and takes his pay when (often how) he gets it. And there are plenty of country (and some city) doctors whose yearly income is not over $1,000 to $1,200. Doctors, like other workmen, should be judged on the merits of their work, and not because of membership in some church or order. I have more than once heard of physicians, in settling an account, say "your bill is $50.00; give me $35.00 and we'll call it square;" and this, too, with people who could pay; and, when later, they died poor, and left their families illy provided for, I did not wonder. I never heard of their grocer, butcher, or merchant having settled with them in that way-if any one has, please let me know. A good many men respond to all calls, pay or no pay. The idea seems that their buggy being constantly seen on the street or road, is evidence of what a tremendous business they are doing, and is quite an advertisement. The results are that they are so busy they have very little time to "read up," or study, and so get into a rut, and they only collect about fifty to sixty per cent of their hard-earned bills, doing two dollars' worth of work for one. Not only that, but they rush, overwork and break down twenty to thirty years before they should, and by the time their life and work should be of most value to their communities, they are either dead or "laid upon the shelf." I have personally known well several such men, two of whom died from overwork, exposure and irregular hours before in practice ten years, and others who were compelled to quit practice in that .time, or sooner. PILLS OF AMMONIUM EMBELATE. Dr. Wisener, in the Pharmasvet Journal, recommends the use of pills made after the formula below, as an effective vermifuge. He directs that the patient be put on a strict milk diet for three days; then he gives ten pills to an adult or five pills to an infant, in the course of one day. He completes the treatment the next day by administering a good dose of castor oil. Ammonium embelate Gum arabic powdered, syrup of acacia, q. s. 1 grain. Make 12 pills. CURRENT MEDICAL LITERATURE. FRIGIDITAS UXORIS, SOCIOLOGICALLY AND MEDICALLY CONSIDERED.-— R. W. Shufeldt (Pacific Medical Journal, November, 1907) states that frigiditas uxoris has been but lightly touched upon by the standard writers, even Krafft-Ebing, in his "Psychopathia Sexualis," dismissing the subject in the following few lines: "The nature frigiditas, of Zacchias, are examples of a milder type of anesthesia. They are met with more frequently among women than among men. The characteristic signs of this anomaly are: Slight inclination to sexual intercourse, or pronounced disinclination to coitus without sexual equivalent, and failure of corresponding psychical, pleasurable excitation during coitus, which is indulged in simply from a sense of duty. I have often had occasion to hear complaints of this from husbands. In such cases the wives have always proved to be neuropathic ab origine. Some were, at the time, hysterical." The writer claims that this condition is on the increase among American-Aryan married women; that it is due, anatomically, to degeneration, or preputial adhesions about the clitoris; that fully seventy-five per cent of married women have no sexual appetite, or at least but little. He questions the institution of marriage. as being successful, from a monogamic standpoint, on this account. He endeavors to explain the great number of divorce cases on this ground, i. e., that coldness on the part of the wife leads to infidelity on the part of the husband, this, in turn, leading to a break in the home life, and, consequent divorce. Upon frigiditas uxoris, this writer practically lays the blame for all the ills that present-day society is heir to. The picture, as painted by him, is a dire one, and tends to fill us with poignant concern. Let us hope that he is mistaken, and that his statistics, like all statistics, "do not adhere closely to the lines of veracity." THE INDICATIONS FOR AND AGAINST REMOVING ADENOIDS, AND METHOD OF OPERATING.-Samuel W. Thurber (Archives of Pediatrics, January, 1908) describes the operation for removal of adenoids and indications for treatment. He says an adenoid is an overgrowth of glandular tissue in the nasopharynx. What constitutes a normal pharyngeal tonsil is hard to say. Indications for treatment by removal are based upon the symptoms produced. They are: I. Nasal obstruction, causing (a) broken sleep, struggling for breath, nightmare. (b) Anemia and general debility. (c) Malnutrition and stunted growth. (d) Headaches and poor memory. (e) Snoring. (f) Enuresis. 2. Mouth-breathing, with the attendant chronic pharyngitis, laryngitis, bronchitis, and croup. 3. The presence of adenoids, causing: (a) Thick speech of nasal quality. (b) Inability of infants to suck. (c) Frequent colds or a chronically-running nose. (d) Deafness. (e) Gastric trouble from swallowing nasal discharge. (f) Epistaxis. (g) Anosmia. 4. Reflex conditions, sometimes due to the presence of adenoids: (a) Asthma. (b) Hay fever. (c) Stammering. (d) Epilepsy. Another indication is a narrowing of the upper jaw, and irregular crowding of the teeth. From a given permanent incisor or molar, a dental arch curve can be mathematically plotted, and this curve is always a wellrounded one in front. The high, narrow arch is abnormal, and often seen in idiots. Secondarily, in these cases we may have deviated nasal septa. CONTRAINDICATIONS. Do not operate during acute conditions, coryza, etc., else new avenues of infection may be opened for the streptococcus or pneumococcus. Do not operate on children who have grave constitutional disorders, such as hemophilia, nephritis, diabetes, leucemia, syphilis, or tuberculosis. Do not operate just because there are some adenoids present, when the obstruction really is due to something else, such as enlarged turbinate bodies, deflected septa, new growths, or even foreign bodies. Large faucial tonsils may also be the cause of the obstruction, not the small adenoids. Be sure the adenoids are the cause of the reflex symptoms. Make a thorough physical examination to determine this point. Again, it is not a good plan to operate during epidemics of the infectious diseases, especially upon school children. These cases should be operated upon early. In infants and very young children, no anesthetic is necessary. The writer prefers ethyl chlorid as an anesthetic in older children. It is prompt, does not stimulate buccal secretion, lasts long enough to perform the operation, and is not followed by nausea or vomiting. It is given from a tube of kelene, sprayed on a special mask, or on an ordinary chloroform mask. The curette is the best instrument, a modification of the original Gottstein instrument. MORPHOLOGY OF A CILIATE INFUSORIAN.-Henry G. Graham, M. D., Bellwood, Neb. (Lancet-Clinic, November 2, 1907.) This is a paper submitted to the Mississippi Valley Medical Association in competition for the One Hundred Dollar Prize offered for the best original contributions. It is an interesting description of the method of study of protozoa. He describes the means by which protozoön forms may be observed: a number of beads flat on the surface, with as many grains of some cereal, as wheat or barley, are strung upon a thread, a bead alternating with a grain of the cereal. When the thread so prepared is of sufficient length, its ends are tied and it is laid in the form of a circle at the bottom of a shallow vessel. This is placed under the tap, and the water turned on. Cover-glasses carefully cleansed in a solution of a mineral acid are placed in a circle so that each grain of the cereal rests upon the center of one. The beads hold the thread firmly in place, while the grains of wheat or of barley attract to them the protozoa, which hover about and feed upon the cereal. These grains also prevent the washing away of the glass circles by the current of water. If too large a number of microscopic forms collect upon the coverglass, it is better to put only beads upon the thread and to place the coverglasses under a bead. Or tiny cups may be used; a cover-glass placed at the bottom of the cup and a fine-meshed cloth tied over the top. After twenty-four hours a cover-glass is removed for examination under the microscope. Should an animalcule have fixed itself to the surface, it is put back again to await development. It is advisable to have two circles of beads, new forms to be caught under the first, their development to be watched under the second. If a form is caught that it is advisable to preserve, it is dried at room temperature, stained in the flame and mounted in Canada balsam. It is well to employ some constant differential stain, such as carbol-fuchsin and methyline blue. If no object of interest is found on the cover-glass, it is better to reject it. In the removal of cover-glasses, the circle should always be traversed in the same direction. In this way the forms under observation will more closely resemble those immediately preceding. The interval of time for their removal should also be constant. A new series may be commenced in the first series after a number of cover-glasses have been removed. A single species should be isolated and cultivated to the exclusion of all other forms, but many difficulties are in the way. Three conditions that must be met with are: The organism must be grown in living water; it must have free access to atmospheric air; isolation must be maintained for a long period of time-for months, or even years. In general, it can be concluded that (a) the protozoa, in rounding out their life cycle, under proper environment, produce their young so as to. appear exactly like the pathogenic bacteria in form, size and staining properties, and are demonstrable to the eye; (b) the protozoa have the same action upon laboratory animals that the pathogenic bacteria have upon man; (c) naturally the inference drawn from these facts is that the forms derived from the protozoa and the pathogenic bacteria are identical. FATAL HEMORRHAGE FROM A DUODENAL ULCER AFTER APPENDECTOMY.-Richard Mühsam, M. D., Berlin, Germany (Deutsche Med. Wochenschrift, 1907, No. 31), gives an account of a most in teresting case of fatal hemorrhage from duodenal ulcer, after an appendicitis operation. He says that as early as 1899, von Eiselsberg called attention to stomach and intestinal hemorrhages after abdominal operations. He detailed seven cases (four of which were fatal) in which hemorrhage occurred after laparotomy, mentioning one case in particular, where erosion of the arteria gastroduodenalis occurred from an ulcus duodeni, eight days after an operation for carcinoma of the right tonsil, the right gum, and right side of the pharynx. In six of these seven cases, there had been resection of the omentum, and division of the mesentery. Busse collected from Eiselsberg's clinic ninety-six cases of post-operative stomach and duodenal hemorrhage, and quoted the experimental work of numerous writers on this subject, Friedrich, Hoffman, Engelhardt, and Neck. In these cases necrosis of the liver and gastric ulcers followed in the wake of the resection of the omentum. The narcosis did not seem to influence the condition at all. These changes followed closely upon the retrograde embolism from thrombosis in the omental blood vessel stumps (Engelhardt and Neck). These emboli are found in the venous, as well as arterial vessels, bacteria not being necessary for their production (Engelhardt, Neck and Sthamer). We now come to the experimental work of Payrs, which was communicated to the last Surgical Congress. He noted, in exposing the omentum to tearing or to high temperature, that clots of blood formed in the small vessels, and that these clots were easily loosened and floated in the blood stream towards the liver. Following this occurred gastric changes. In the smallest ramifications of the omental blood vessels were seen changes in the corpuscular elements of the blood, with retrograde embolism in the submucous, and præcapillary gastric venous channels, blocking of these vessels, small hemorrhages into the tissue, hemorrhagic infarct formation, erosion and, finally, ulceration. Among the ninety-six cases detailed by Busse, might be mentioned twenty-seven abdominal operations, twenty-five operations upon the intestinal canal (seventeen of which were appendectomies), ten operations upon the gall-ducts, and fourteen operations upon the female genitalia. In thirty-four cases, the omental or mesenteric blood vessels were ligated. In forty-three instances it was necessary to deal with purulent conditions. Fatal termination occurred in fifty-five cases. Busse contends that the gastric or duodenal hemorrhages are directly due to thrombotic changes, either in veins or arterioles. In the causation of this condition, one can mention the character of the operation, as well as the factors of local or general circulatory disturbance, poor attention to ligation of vessels during the operation, trauma during the operative procedure, narcosis and nervous influences. The hemorrhage occurs most frequently inside of the first week after operation. The anatomical changes met with are gastric or duodenal hemorrhage, erosion or ulceration. Many times there were no |