the forceps to the ignorance of those who employed them, or to the action of the instruments themselves. Much is justly attributable to the views which many celebrated men have taken of their necessity and utility, and to the rules they have laid down for their employment. In many instances the evils which appeared to follow their application really had existed before they were employed, and might, we are persuaded, have been certainly prevented, had a timely and judicious use been made of them."

Over-Distension of the Uterus.

QUERY NO. 29.-In a recent case the uterine contractions seemed inefficient and the head showed no tendency to advance, although the os was thoroughly dilated and the head was not impacted. I was tempted, on account of the inefficiency of the pains, to give ergot, but the universal accord in condemning its use caused me to not do so. After waiting as long as I thought proper I introduced the forceps blades, but removed them because they did not lock properly, and before I could readjust them efficient pains came on and prompt delivery followed. There was considerable escape of liquor amnii during my attempt to apply the instruments. Did I inadvertently relieve the uterus of a distension which overstretched its fibres, or did the irritation of the cervix reflexly stimulate the contractions?

In a

Ample authority can be found to support either of these hypotheses. There can be no doubt that irritation of the cervix will reflexly stimulate uterine contraction. It is equally certain that the discharge of an excess of liquor amnii is followed by improvement in the uterine force. The only question is whether this is due to permitting the overdistended uterine fibres to retract or to some other mechanical factor. The first is the view usually held, but which may, it seems to me, be met by several objections. sense it may be said that the uterus is gradually distended by the developing ovum, but when you recall the fact that its walls actually grow during the so-called distension, and that the size of the organ after delivery bears a more or less definite relation to its size before delivery, it will be evident that distension is of questionable propriety as a descriptive term. In cases of accidental separation of the placenta, with concealed hemorrhage, the shock is out of all proportion to the amount of blood lost, because the uterus is actually distended by the emptying of blood into its cavity which cannot escape. The induction of labor by intra-uterine injections, which was so popular a few years ago, has been largely abandoned, because severe shock was often induced by over-distending the uterus. It is therefore evident that an acute distension of the organ is not present, and

that over-distension can only be assumed as the cause of inefficient contractions in the absence of another adequate explanation.

If you will observe in cases of this kind I believe you can soon convince yourself that there is another mechanical factor of much more importance. When the membranes rupture a portion of the waters escape, but in some cases the head acts as a ball-valve, and there is sufficient pent-up waters to prevent the uterus from effectually exercising its propulsive powers. You may in most cases secure the emptying of the excess of liquor amnii by raising the head upon the examining fingers before the beginning of a pain. This may have to be repeated several times before the uterine action is materially improved, and in my experience this improvement in uterine force will be coincident with the lessened capacity of the uterus, which allows the fundus to make direct pressure upon the breech of the child. An overstretched muscular fibre will usually require a considerable time to regain its contractility, but in the class of cases under discussion just so soon as the head is in contact with the cervix and the breech with the fundus efficient contractions begin.

It is not my purpose, in this column or elsewhere, to quibble over mere words, but I am convinced by experience that a recognition of these points will frequently hasten progress and prevent the necessity for artificial assistance.

Euthanasia for the Unfit Infant.

QUERY NO. 30-Is the physician, in your opinion, justified in resuscitating an asphyxiated child when it is apparent to him that if it lives it will be an idiot or a serious cripple? Would it not be more humane for him to hasten its death where it is apparent that life means physical or mental helplessness?

The gentleman propounding these questions has never practiced medicine, his whole source of knowledge in this respect coming from the lecture-room and text-books. He puts the question as blithely as a boy who takes no thought of the profundity of knowledge which would be required to properly answer them. Such knowledge we do not possess, but there are some things which we may be able to point out, which, while not elucidating the subject, may at least enable us to discern some of its difficulties.

It is rarely possible at birth to distinguish between the normal and the idiotic child. It is sometimes several months before the differentiation can be made. The same is true of many of our worst cripples. Spastic paralysis and idocy of various grades are fre

quently due to intra-cranial and spinal hemorrhage occurring at the time of birth, and showing no signs until the general development of the child calls attention to the lack of development of the part affected or of the mental capacity. On the other hand, intracranial or spinal hemorrhage may early manifest unmistakable symptoms, and yet the child permanently and perfectly recover. If this were not true we might, by permitting all asphyxiated children to die, lessen the proportion of defectives to the general population. But of many asphyxiated children only a few are blighted. What shall we do, therefore, even if we grant the propriety of the sentiments expressed in the query?

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it

If infallibility of judgment was ours it might be wise to discuss this aspect of the subject, but in the simple yet profound philosophy of Cooper's immortal "Pathfinder, is not our gift." But "would it not be more humane to hasten death where it is apparent that life means physical or mental helplessness?" Perhaps it might, but who shall decide the question? To whom is given, by the laws of God or man, the privilege of passing judgment? The fatuous reporter who spreads moral filth and bad English on paper for a consideration, writes glibly of euthanasia. The fanatic, from pure love of notoriety, will proclaim its propriety. But who shall decide the question and execute the verdict? Not the physician who, in his youth, has felt the thrill which comes from reading understandingly the Hippocratic oath, and in his manhood has spent days of toil and nights of study to prevent suffering and death. He believes in painless death, but in the painlessness of medicine and in the death of nature. That the perfect child should die and the defective survive does not seem in accord with rational management of the affairs of men. But while we cannot shield the fit we must not sacrifice the unfit. not give we dare not take.

What we canYet each of us,

probably on numerous occasions, has unconsciously contributed to this end. Our efforts, however conscientious, will lack something of that saving zeal if we feel that success would be a calamity. Only a few months ago I was called to assist a physician with a breech case, and upon arriving found the body of the child had just been born. Upon hurrying to the assistance of the attendant I saw that the child was a hideous monster. The body was unusually long, the legs and arms unusually short, while neither feet nor hands looked like those of a human being. I soon discovered that its prompt extraction was impossible without contact with the geni

tal tract, and my hands were not clean. In such an emergency with a normal child, its imminent peril would be more than a justification for some risk of maternal infection, but would it with such a child? I know of no rule of conduct in such a case, but I washed my hands before attempting delivery. Other developmental anomalies, not then apparent, showed that the child was robbed of no chance for life, but even if it had been, when we, by no fault of our own, are brought face to face with alternatives, we must decide our course of action and rest content.

Health, Matrimony and Motherhood.

QUERY NO. 31.-There seems to be a general belief in the profession that pregnancy and parturition constitute good treatment for young women in ill health. I have seen so many girls who were not benefited by marriage and motherhood that I have come to doubt their beneficial effects. Yet a belief so general both in the profession and among the laity must have some basis of truth. Please give us your views on this subject.

If we could with an unfaltering trust accept the traditions of the fathers we would be spared a great deal of brain fag, and the practice of medicine would be a tranquil calling where facts could be shrouded in theories and mistakes would be dispensations of Providence. John Graham, pork-packer, tells us he has extracted a great deal of wisdom out of proverbs by reversing them. So it is with many of the traditional beliefs in medicine. Occasionally a young woman whose lungs have become invaded by tuberculosis seems to recover as a direct result of preg

nancy.

We now recognize the fact that in the early stages of pulmonary tuberculosis the patient may promptly and permanently recover if we can get her into a state of extraordinary nutrition. Now some women during pregnancy are possessed of an enormous appetite, and, gifted with extraordinary digestion, take on flesh, become plethoric, and enjoy an amount of health seldom seen outside the pregnant state. If this state of extraordinary nutrition arrives at a propitious time in the history of the tubercular infection, we may have a speedy cure, and have a case directly in point to prove that bearing children is advantageous in tuberculosis.

On the other hand, many women have ill-health during pregnancy. The appetite is capricious, digestion imperfect, the emunctories inactive, and anemia is a necessary sequence. In such a subject the disease will advance more rapidly than it otherwise would have done. Pregnancy, therefore, lessens the probability of recovery. Unfortunately,

there are more of this class than of the former. Even in the last considered class a fallacious appearance of health may be kept up until after labor is over, when the decline is rapid.

In those who improve and apparently recover during pregnancy its frequent repetition is apt to prove disastrous, for, as a result of the strain upon the organism, her extraordinary nutritive powers become overtaxed and she sinks into the second class, where the strain of pregnancy hastens the progress of the disease.

The subject is too extensive to permit of adequate presentation, but too vital to allow us to neglect another class of cases often believed to be benefited by pregnancy. Pelvic troubles in the female are popularly supposed to be benefited by marriage. Girls of the Girls of the amorous type will be benefited by having their nervous system tranquilized and their local congestions relieved, but girls of this class constitute a small-indeed, a very smallminority. The belief that marriage will have a beneficial effect upon pelvic diseases in general is erroneous. Instead of advising young women to marry in the hope of receiving benefit, we should insist upon disease of the pelvic organs being cured before they assume the duties of wifehood. There are exceptions to this rule, but their proper consideration would require more space than can be devoted to it at this time.

There can be no doubt that pregnancy sometimes stays the progress, but there is also no doubt that it oftener hastens it.

What Charleston, W. Va., is Doing.

A tented colony is being maintained near Charleston, W. Va., in which twenty-five victims of tuberculosis are being treated successfully, says the Fairmount (W. Va.) Times. Plenty of air and substantial food is all that is prescribed. The sides of the tent are kept up all night when the weather is good. The patients arise early and take plenty of exercise before breakfast. Every individual in the colony has expressed pleasure at the outing and the improvement of their condition and each tries to induce other victims to take the same kind of treatment. The tuberculosis colony is situated a short distance below the city in the Edgewood addition, and is on an eminence about two hundred feet above the level of the Great Kanawha River. It was started at the suggestion of the West Virginia Anti-Tuberculosis League of which hundreds of the leading citizens, both men and women, of Charleston are members. The Ladies' Auxiliary League has been doing a great deal of work for the organization and the success of the colony is due in great part to their efforts.

A Decided Opinion.

"You might as well use kerosene to put out a fire as to use alcohol to cure tuberculosis,'' asserted Mrs. Cora Agler at the convention of the Franklin County, O., W. C. T. U. at Columbus last week.

Medico-Legal.

E. S. M'KEE, M. D.

Substitution in Prescriptions as a Penal Offense.

In France, Germany and Denmark, and probably in other European countries, the offense of tampering with physicians' prescriptions constitutes a crime visited by severe punishment. In many instances the guilty parties are prosecuted and brought to justice by their fellow-pharmacists, or a body to whom this duty is delegated by the pharceutical associations. In New York City the criminal law has been invoked to punish the tampering with physicians' prescriptions. Most honest pharmacists and physicians are decidedly of the opinion that willful substitution in a physician's prescription of any ingredient or ingredients other than those specified, for the purpose of gain and without the knowledge of either the physician or patient, is distinctively a criminal act, that it should be punished as such, and that such States which have not already made such provisions on their statute books should do so at the earliest possible opportunity.

A prescription is an order from a physician to any pharmacist to compound certain drugs named therein, in proportions specified, and to deliver the same when compounded to the bearer. The pharmacist must follow his instructions explicitly. He is without discretion in the matter. He does not see the patient, does not know his needs nor idiosyncrasies nor the peculiarities of his surroundings or occupation. The slightest change may upset the calculations of the physician, defeat his skill and put the patient's life in jeopardy. Let no honest druggist beguile himself into the belief that substitution does not exist, or if at all present, it is in such a small extent as to be of no importance. Every physician and druggist can scarcely be blind to the fact that it is alarmingly prevalent; investigation is all that is necessary to prove it. The druggist who substitutes robs the manufacturer of the article ordered but not supplied; but that is not the worst-he abuses the confidence of the physician whose skill and reputation depend on the strict compliance with his instructions. He trifles with the health and life of the patient and gives a stab as insidious as it is deadly at every honest pharmacist in the land.

Lawyers try to drive out the shysters from their ranks. Physicians are constantly trying to expel the quacks. Merchants try to expose dishonest competitors. Honest pharmacists are made to suffer not only in their

reputations, but from unfair advantages in trade, which the substitutor gains by his substitution of cheaper articles, and should, in self-defense alone, catch the substitutor wherever they can and brand him so that his infamy may be known to all men.

The pharmacist is not unlike the payingteller in a bank. A check is presented at his window for so many dollars and cents in United States of America money. He must deliver that amount, no more, no less. He must not pay it in part counterfeit money nor in part English money, which is just as good." If the check is incorrectly drawn he must refuse to pay it till the mistake is corrected.

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Licensed Pharmacist Necessarily Present at Sale of Medicine.

Tincture arnica, tincture iodine and spirits of camphor were compounded by a licensed pharmacist and placed on a counter in bottles sealed and labeled. While the only licensed pharmacist in the establishment was in the laboratory across the street a sale was made by an unlicensed clerk. Action was brought against the pharmacist for selling medicines in his store without the presence of a licensed pharmacist. The lower court gave a verdict for the druggist, but the decision was reversed in the Supreme Court, which thought that one registered pharmacist should be in the store every minute during business hours. The court thought that the health of the community and the public welfare could not be threatened in any more perilous way than by the sale of medicines by inexperienced per

sons.

Can't Collect Commissions on Prescriptions.

Some of us have been shocked by physicians asking and pharmacists offering commissions on prescriptions. The most surprising thing of all, however, is the fact of physicians advertising their method of petty grafting. Two physicians recently have entered suit for a 25 per cent. rake-off from druggists, which it seems had been promised

them. One of these suits was entered at Racine, Wis., and the other at Benares. They were both disallowed, however, both judges claiming that an agreement of this sort was illegal and against public policy.

New York Optometry Bill.

In spite of the efforts of the medical profession, the New York Senate has passed a bill creating an examining board for opticians and giving them the right to practice in a limited way what is defined by the new medical law as a specialty of medicine." This

optometry bill gives opticians the right to fit glasses for the relief of headache and other reflex symptoms. If four years are necessary to fit practitioners to treat children, why should opticians receive similar privileges without complying with the same requirements?

Since writing the above the bill has been very properly vetoed by Governor Hughes. Is Crime Infectious?

Crime is as infectious as smallpox, says Dr. Funk, the eminent New York psychologist, and he adds: "Unless immediate radical steps are taken to put a stop to the epidemic of crime which is raging in New York, the whole country will become infected with the desire for murder and an epoch of bloodshed will follow." The doctor recommends quick trials and justice of the severest type. He attributes the cause and increase of so much crime to the yellow press and the influx of so many immigrants from the European countries noted for their hot-headedness. The infectiousness of crime is due to “unwritten law," "brain-storms," insanity that gives a license to would-be criminals to commit a crime, hoping that they will be acquitted on the ground of their insane condition. The thing we need to subdue crime is quicker and severer punishment-Czolgoz-like.

Italian Medico-Legal Society.

The headquarters of this recently-formed society are in Rome. Prof. Lombroso is the honorary President, the actual President being Professor S. Ottolenghi. The aims of the society are the development of a "true and healthy medico-social conscience, the furtherance of medico-legal scientific research, and the enlightenment of public opinion on such subjects." The first problem with which the society proposes to grapple is the establishment of intermediate institutions for the reception of offenders who can neither be imprisoned nor admitted into a lunatic asylum.

Duffy.

The legal lights of New York, after a great deal of discussion which has been collected and has filled a 124-page book, have come to the conclusion that Duffy's Pure Malt Whisky" is a liquor, and can only be sold as such by dealers. It seems that New York judges are not up to this subject. They should have called in a Kentucky judge.

HERE is the inscription over the door of the ancient library of Thebes: "Medicine for the soul."

The X-Ray.

KENNON DUNHAM, M.D., Lecturer Electro-Therapeutics, Medical College of Ohio. The X-Ray at the British Medical Association.

The seventy-fifth annual meeting of the British Medical Association, which was held at Exeter, England, during the last week of July, recognized the value of electricity in medicine by creating a special session for its consideration. This was a distinct achievement for the men who have been working along this line, but had it not been for the broad and open mind of Dr. Henry Davy, President of the British Medical Association, it could not have been brought about. He recognized the scientific manner in which the subject had been approached in the last ten years, and realized that such work could not go unnoticed. The result cannot but be felt in this country, and sooner or later such a step must be taken by the American Medical Association.

The work presented at the British Medical Association was of a high class. It was a notable fact that the X-rays held the centre of attention, although much of value besides was presented. A short review of some of the papers was given in the Archives of the Roentgen Ray for September as follows:

"The discussions of the electro-therapeutic section were rendered exceptionally interesting by the presence of our foreign brethren. The opening address by Prof. Leduc was delivered with that mastery of detail and charm of manner which renders him inimitable as an exponent of our art. Professor Wertheim Salomonson communicated a most interesting paper on his adaptation of Einthoven's galvanometer, an instrument which will doubtless prove a most powerful weapon of research in the analysis of current curves and in the interpretation of physiological reaction.

"A discussion on X-rays and sensitive plates was opened by Mr. Mackenzie Davidson, who gave the results of his long and varied experience in the technique of Roentgen photography. This paper dealt principally with the quality of the X-ray tube necessary for the production of a good skiagram, and the plate best suited to X-rays. In the discussion which followed there seemed to be a general consensus of opinion that the stereographic method of X-ray photography was of the greatest utility, and should be adopted where considerations of expense need not be taken into account. A comparison of the different X-ray plates on the market showed

that the Lumière plate still holds an important position.

The discussion on dosage of X-rays was opened by Dr. Sequeira, in a paper based on the experience of many years in the radiotherapeutic treatment of skin diseases at the London Hospital. In his opinion the Sabouraud and Noiré disc still remains the best direct instrument of measurement at our disposal, although it admittedly leaves much to be desired. A record of many thousand exposures made under its control shows that, with the conditions obtainable at the London Hospital, this method is fairly reliable. Dr. Lewis Jones drew attention to the new 'Fallungs radiometer,' which is based on the precipitation of calomel from a solution of corrosive sublimate. This method promises to be a useful, one, as it is simple, easily read, and independent of the climatic conditions, which militate so greatly against the reliability of platino-cyanide discs. The new form of voltameter introduced by Dr. Howard Pirie bids fair to furnish reliable means for the estimation of X-rays, and will be of use more especially when we desire to give a fractional portion of the Sabouraud and Noiré dose.

"We are glad to welcome an atlas of skiagraphy by an English author, Dr. Ironside Bruce, who has brought out 'An Atlas of Systematic Radiography.' Up to the present time, we have been greatly behindhand in the reproduction of the exceedingly good work done by English skiagraphers. The plates represent the appearance in health of the various joints, with the focus-tube in the optimum position for bringing out the anatomical details. The work is indispensable to workers in practical skiagraphy.

"Dr. Reginald Morton drew attention to a new method of treatment he had introduced at the London Hospital. This consists of the use of slowly alternating continuous currents in lieu of currents of high frequency. The former are found to be particularly useful in the treatment of atonic conditions of muscular organs, especially those containing unstriped muscle.

"There was a good demonstration of lantern-slides, among which were some beatiful skiagrams of the hip-joint taken by Dr. Shenton. Dr. Lewis Jones showed tracings of the currents of an ordinary medical coil taken with Duddell's oscillograph. Dr. Wertheim Salomonson showed the current curves of the primary of a large induction coil taken with Einthoven's galvanometer. He also showed a most interesting series of cardiograms, both normal and pathological, taken by his modification of the same instrument.'