in view of the fact that the patient had previously, under cocaine anesthesia, shown no special predisposition for its ill-effects.

THE DOCTOR.

BY J. A. HOUSER, M. D., Indianapolis, Ind.

[Written for the MEDICAL BRIEF.].

The responsibility of the doctor is so different from that of any other person that it is not easy to make a comparison. All other callings permit special hours for rest and work. The doctor is always on duty. No day so fine nor night so stormy that permits him to rest or shirk. Be he ever so weary, at the call of duty and disease he must take his place to do battle with death and stay the destroyer yet awhile. Others may seek and choose their task; the doctor must take what comes and give his best service, though no recompense beyond the thanks of the helpless is his reward. Though the doctor's learning must be of the highest standard of any professional man, and more difficult to obtain, his labors take him alike to palace and hovel, where his duties are always the same in importance and gravity, and often upon his decision the scale turns to life or death. In his duties he must render the same service to prince and pauper alike, and he feels not less proud to restore the tramp than the millionaire to health. Each to him is a suffering human being, God's creature, and he an humble servant of the Most High.

The doctor was there at your birth when you were ruthlessly cast upon the bosom of Nature, like a helpless shrimp tossed among the seaweed by an ocean storm. He heard your first wail of agony and soothed your first pain. All through life he holds your hand, guards your steps and cheers your sad hours. He hears your secrets and shields you from calumny. The highest court on earth can not open his lips to betray your trust.

When "the pale horse and his rider, Death," comes and stills forever your throbbing heart, the doctor is there to comfort and solace to the last. His touch is the last you feel, his voice the last you hear, his face the last you see before reason fails, memory fades, eyes dim, and all the world swoons, and you pass to the unconscious sleep. He turns away, like a noble knight defeated again by the "King of Terrors," goes to battle again just as bravely for another smitten by the plague. Though he could beat back no more the relentless reaper he comforts his own heart with the conscious belief that he had done his best.

The doctor is a king among men. No prison can lock him out, no castle defy him, no court unseal his lips. He can stop a ship in midocean when suffering or danger demands it. He can hold the world's rulers in quarantine until he says they may come ashore. If he raise

the yellow flag, men flee and leave a city to be a desert, and fall on humble knees when he holds aloft the Red Cross. Though the nobility of his life and his fidelity to his kind opens the hearts of all, and his learning gives him the highest seat in the temples of wisdom, his wealth is not in gold nor his treasures in riches that smaller men would seek. His dower is to know, to help, and to heal.

Though he prolongs the lives of others, the doctor dies soonest himself. He is shortest-lived of all professional men. His great care and responsibility are often too heavy for his physique. In the field of medicine is found the highest per cent of insanity, and suicides are more frequent in the doctor's office than among the same number of any other class.

The doctor's religion is usually an agnostic, sanctified, creedless, humanitarian devotion to suffering humanity. Though his name is generally on the church books, his soul is too wide for any narrow bonds; he is the cosmopolitan evangel who has a tongue to soothe the misery of every race and a balm for all conditions of men.

Unitarian and Trinitarian, Armenian and Calvinist, Catholic and Jew, are all the same to the doctor. They are bits of animated clay which have taken their impression from some other clay which are in turn moulded by some preceding clay, but all follow the same light as they see it, and all, finally, reach the same rest.

To the doctor all life comes from God and returns to God, and no man is keeper of the gates, nor guards the portals of "The City Not Made With Hands."

The doctor works out his own destiny with patience, making the lives of others less painful while they pass onward to the catastrophe which appalls reason, shocks sensibility and defies explanation; the usher to the charnel house who leads the unwilling guest to the phantasmagoria of horrors where life is lost in the unexplored beyond. To this end and his death he journeys with his kind, and yields at last to the foe he battles with so long.

The doctor sees humanity at its best and worst, without its mask and shield. He aids it in its noblest efforts and pities it-in its grief. He is nearer its troubled heart than any, excepting only the "Man of Galilee." He hears confessions which never fall upon the ear of minister nor priest, and which will not be heard again until given to the Infinite and the Eternal.

When life's journey is done and the end of all on earth has come, and each awaits his reward from the unerring Judge, none more worthy, none more noble, will be found than he who relieved the pain of frail flesh and quieted the fears of weak humanity.

CURRENT MEDICAL LITERATURE.

Cervical Tumors Simulating Enlarged Glands Associated with Laryngeal Paralysis.

Andrew Wylie (British Medical Journal, September 26, 1908) has clinical and pathological reports of thirty-three cases of cervical growths which simulate enlarged glands. Most of them proved to be endotheliomata, but some were dermoid cysts and lymphadenomatous glands; two were composed of thyroid tissue; there was also a lipoma, a gumma and an epithelioma. All the endotheliomata were deeply seated and intimately blended with the deep cervical fascia and the carotid sheath. One of them almost completely embraced the jugular vein, eventually piercing it and involving the Gasserian ganglion. Another involved the superior thyroid artery close to its origin; it was sharply encapsulated and was removed entire, with excellent results.

He reports two cases in details, showing the likelihood of confusing these growths with enlarged glands. The first case was a firm but mobile swelling one inch by three, situated in the anterior triangle and extending beneath the sterno-mastoid at the level of the thyroid cartilage. It exerted pressure upon the left cord by limiting the abductor movements, as seen with the laryngoscope. It was diagnosed as an enlarged gland causing pressure upon the recurrent laryngeal nerve, and its removal was advised. On account of its becoming more painful, it was removed two months later. It was found to be attached to the carotid sheath and was infiltratng the cervical fascia. Microscopic study showed it to be an endothelioma, and not an enlarged lymphatic gland. After its removal a distinct improvement in the activity of the vocal cords occurred. The case illustrated the difficulty of distinguishing between a real new growth and an enlarged gland in this situation.

Another case reported in detail was a man of fifty years, with a smooth, fixed swelling in the left side of the neck, pressing upon the trachea. It caused difficulty in breathing and slight paralysis of the left vocal cord. On removal, it was found to be an encapsulated endothelioma.

A New Operation for Depressed Fracture of the Nose.

T. G. Ouston (British Medical Journal, September 26, 1908) reports a new method of treating depressed fractures of the nose. He says that this accident occurs more often than the literature of medicine tells us, and that but little attention is paid to the proper treatment of it in practice. If internal displacements occur, submucous resections of the septum and allied operative procedure are usually carried on later in life, if at

the time of the accident the patient is young. If external deformity occurs, a child with this condition is brought to the surgeon for advice, and one of the four following opinions is probably given: (1) that the child will grow out of it; (2) that nothing can be done; (3) that the surgeon will try to rectify the condition, but that success is very doubtful; (4) that after the child has attained full growth, the deformity can be corrected by the injection of paraffin.

Time will show the fallacy of the first opinion. The second is eminently unsatisfactory, albeit honest in intent. The third has been given four times in four cases by this writer; the first two results were failures, the third, however, a success. The method by which this success was obtained is as follows: The patient, a girl of ten years, had fallen on her nose a few weeks previously. The upper lateral cartilages were displaced backwards from the nasal bones and separated posteriorly from their attachments to the nasal processes of the superior maxillæ. The lower ends of the nasal bones projected, with a depression below them where the trianglular cartilage was markedly indented. The operation was performed by passing a tenotome subcutaneously through the side of the nose at the site of the depressed nasal cartilages, dividing the structures uniting them posteriorly with the nasal bones and the nasal processes of the maxillæ. By transfixing the nose with this knife, the whole nasal mass could be uplifted to the normal level. The nasal bones were transfixed with a large, strong needle as near their common anterior suture as possible, this being effected by means of sharp taps with a mallet. Strips of gauze were then wound around the two needles on each side in a figure-of-eight manner. The upper needle acting as a fixed point assisted in bringing up the depressed parts by tightening the strips. Although some local swelling occurred, no constitutional effects were seen. The child was quite confortable, and on the tenth day the needles were removed, leaving behind as a result of the treatment only two small pressure ulcers where the strips had rested. These healed in a few days. Six months have elapsed, and the nose still preserves its normal appearance, justifying the excellence of this new operative procedure.

Professor Koch's Views on the Prevention of Plague.

Professor Kitasato (U. S. P. H. and M. H. S., Public Health Reports, September 11, 1908, translated from the Tokyo Jiji Shimpo, July 22 and 23, 1908, by Passed Assistant Surgeon Moore) states that:

Not only has plague in Japan occasioned great expenditure of public money and labor, but the indirect losses through interruption of commercial intercourse and interference with business undertakings can not be easily estimated.

Since the discovery of the cause of the disease increasingly exact investigations into the avenues of infection have rendered us familiar with the extremely important rôle that anti-rat measures play in its prophylaxis. Such measures were enforced at an early date in this country, and the number of rats destroyed has reached an annual total of from several hundred thousand to a million. Nevertheless, at the present day no appreciable diminution in the number of rodents can be noticed. Reproduction keeps pace with destruction, so that we are at a loss to know how to proceed. When we consider that on the one hand plague has already obtained a firm foothold in two or three localties in Japan, and on the other hand, that new infective material is being constantly introduced from abroad, it would appear that the absolute suppression of the disease is an almost impracticable task.

However correct may be the underlying theories upon which we base our procedures, antipest measures, being of a negative character, and necessarily involving great expenditure of time and money extending over a long period, are apt, eventually, to incur the disfavor of the public at large. Consequently, they are not properly carried out. Therefore the urgent need of the present time is a plan for the destruction of rats, simple of application and requiring a minimum expenditure of time and labor-a demand, however, that we are not yet in a position to meet.

Taking advantage of the recent visit of the eminent bacteriologist, Robert Koch, to this country, I laid before him in detail the present status of the plague epidemic, and requested his advice in the premises. As his views, which I had the good fortune to obtain, touch upon some points of vital importance in the prophylaxis and eradication of plague, I give a résume, as follows:

"The rat is the chief agent in the diffusion of plague, and our preventive measures must be based on this principle. The encouragement of the destruction of rats, as early practiced in Japan, is an eminently proper procedure, but in the extermination of animals of such great reproductive power the use of artificial methods, like mechanical devices and poisonous drugs, must prove laborious, expensive, and at the same time comparatively inefficient. On the other hand, in the natural world the mutual relations of living things is extremely intricate and subtle, and by paying attention to this point we may discover natural methods of dealing with this problem, the limited powers of man being far inferior to the boundless resources of nature.

"Permit me to cite two or three instances of the very successful utilization of the natural correlation between living beings which may, by analogy, serve to illustrate the proper means to be employed in the work of demurization. Some years ago an amateur botanist admiring its pretty flowers, introduced a verbenaceous plant called lantana from America into.