a reward out of all proportion to the act itself. Let us all then try to make this year a "Happy New Year" by giving happiness instead of trying to grasp it for ourselves and seeing it constantly elude us.

Medical Advertising.

The financial success of most forms of medical fraud and quackery depends on advertising, as this is the most efficient means of getting in touch with prospective victims.

For this purpose the best medium is the daily press, which goes into the homes of all classes of people. When the postoffice authorities refuse to admit publications containing fraudulent advertising to the mails, such advertisements promptly cease and the business advertised soon dwindles away. When newspapers or magazines voluntarily refuse such advertisements similar reults follow.

Medical fraud and quackery has, for a long time, been a source of prosperity to various so-called doctors in Omaha and other Nebraska cities, who have used the daily press as a means of enticing the ignorant and unwary to seek their aid for some real or fancied ailment. It is a hopeful sign of the times that a number of prominent publications have not only refused to accept this kind of advertising, but have used their editorial columns to expose the fraud and dishonesty of these fakirs. The Omaha Bee recently exposed the frauds of one of the most successful quacks that ever came to the city and as a result he was forced to seek other fields of operation.

The Western Medical Review wishes to express its thanks and appreciation to the Bee for the service it has rendered suffring humanity (not the medical profession) in ridding Omaha of the wonderful Vino. We hope other papers, daily and weekly, may soon take a similar position in regard to fraudulent advertising and thus rid Nebraska of these undesirable practitioners.

Why is advertising considered unethical by the medical profession? This question is often asked by the laity and

sometimes by physicians themselves. The chief reason is that a phyician cannot "cure" disease. The best he can do is to render conditions favorable or remove obstacles in the way of recovery. Nature really effects the cure. When an advertisement promises a cure, even for a simple ailment, it is misleading and untruthful. A tailor may honestly promise to make a coat, a carpenter may advertise his ability to build a house, but when a doctor advertises that he can cure the sick he is going beyond his certain knowledge, for he cannot foretell results. He may truthfully state what the probabilities of recovery are. He may advertise to the public that he is limiting his efforts to certain lines of medical work. He may mention his place of business and the hours when he may be consulted, but to make definite promises of cure is rightly considered unethical.

It is not only the advertising fraud who offends this rule. The regular practitioner who guarantees a cure, the unscrupulous one who says "I can cure you for $100," belong to the same class. And though such methods may bring a little temporary gain, they destroy the feeling of confidence and reliability which is the basis of all permanent success in the practice of medicine.

Refilling Prescriptions.

The National Association of Retail Druggists, at its meeting at Niagara Falls in September, 1911, discussed this subject at length and finally decided to honor a written order not to refill a prescription, but to pay no attention to instructions to this effect, printed upon a prescription blank.

In our opinion the only thoroughly satisfactory conception of a prescription is in analogy with a bank check; namely, that it is an order to pass out to a certain individual or his authorized representative a definite amount at a given time. We do not see why a patient should keep a prescription and have it refilled whenever he chooses or pass it on to his friends, in the original or by copy, and have them collect it, whenever they choose, any more than a check should be similarly treated. It

certainly is convenient-and cheap-to refill a prescription indefinitely. It would be exceedingly convenient if we could use checks in the same way. Nor do we see why it should be necessary to mark a prscription not to be repeated any more than a check.

However, it is some satisfaction to know that some definite action has been taken by the pharmaceutic profession and, after all, it often is convenient to order a prescription repeated verbally. And we must not forget that, from the business standpoint, the free access of the laity to drugs, singly or combined, does the physician about as much harm as the artist would suffer if the public could get hold of his paints and brushes and thus compete with the professional painter.-Buffalo Medical Journal.

A twelve-year-old girl from the slums of New York was invited to a garden party given by an aristocratic lady to a group of poor girls.

The little girl, as she drank her tea and ate her cake on a velvet lawn under a white blooming cherry tree, said to her hostess:

"Does your husband drink?"

"Why—er—no," was the astonished reply.

"How much does he make?"

"He doesn't work," said the lady. "He's a capitalist."

"You keep out of debt, I hope?"

"Of course, child. What on earth

"Your color looks natural-I trust you don't paint."

"Why, child," exclaimed the amazed hostess, "what do you mean by such questions? Don't you know they are impudent?"

"Impudent?" said the little girl. "Why, ma'am, Mother told me to be sure and behave like a lady, and when ladies call at our rooms they always ask Mother those questions!"

"Some of your hurts you have cured,

And the sharpest you still have survived,
But what torment of grief you endured
From evils that never arrived."

ORIGINAL ARTICLES.

The Operation in Acute Mastoiditis.

*By D. C. BRYANT, M. D., Omaha.

To one fairly well acquainted with the anatomy of the middle ear and the mastoid process, with the intimate, direct and open connection between the middle ear and the antrum, it is a source of constant wonder that a larger per cent of the suppurative processes occurring in the tympanum do not extend directly to the antrum and the other outlying large cells of the mastoid. When the patient is in a recumbent position and especially while lying on the back, gravity itself is sufficient to carry the purulent material over into the antrum. That this is done many times without starting up a purulent inflammation in that cavity, I cannot doubt. Nature in some way protects her own, hence the small number of cases of suppurative mastoiditis compared with the large number of cases of purulent otitis media.

The location of the antrum, the direct connection with the middle ear makes one almost think that Nature intended it as a sort of drip cup for that cavity, whenever there is an accumulation of fluid in it and yet, as every general practitioner knows, nearly all of his cases of acute purulent otitis media get along without any apparent involvement of the antrum, or mastoid cells. Occasionally however, Nature does not seem to be able to offer sufficient protection to the mastoid to guard it against the invasion of pyogenic germs, and it becomes involved in the suppurative process.

In the acute cases the pyogenic inflammatory process, being once fairly established in the antrum, goes on with marked rapidity, so that it is usually a matter of a few days only when operative measures are called for to assist Nature in her efforts to check the inroads of what has now become a destructive and dangerous disease. Left to itself now, more and more territory will daily become involved, and more and more tissue. destroyed. The question that now confronts the physician is what shall the operation be, that is, what proceedure is safest for the life of the patient and which, at the same time, will leave the middle ear and the adjacent tissues in the best possible condition after the suppurative process has disappeared and the damage done by both disease and operation have, by the healing process, been as nearly repaired as possible.

Read before the Nebraska State Medical Association, Omaha, May 2, 3 and 4, 1911.

For the past ten or fifteen years so much has been said and written about the radical operations in mastoiditis, that many operators I fear, have been led into the mistake of doing too extensive an operation in these acute cases, causing unnecessary damage and in some cases bringing about deplorable results that might have been avoided had a more conservative method been adopted.

Remember that the subject under discussion now has reference to cases of acute mastoiditis only, where the disease has existed for a short time, where much of the tissue involved is not entirely destroyed, some of it not having reached the stage where it is beyond recall. As many of the surgical operations, in acute cases, i. e., appendectomies, ovariotomies, etc., were a short time ago done in too radical a manner, so are mastoid operations being done now, I fear, in much the same way. The surgeon soon learned that, in his acute cases of suppurative appendicitis where Nature had had time to throw up a rather feeble barrier to protect its adjacent parts from the inroads of pyogenic germs, the more careful he was not to interfere with Nature's protective wall, the lower became his death rate. The same is true to as great, if not a greater extent, in cases of acute mastoiditis.

Here as in all other suppurative processes, Nature endeavors to head off the extension of the disease, restrict its invasion to as small an amount of territory as possible and limit the damage done to the minimum. Here perhaps more than in any other part of the human body,, on account of the porous condition of the greater part of the mastoid process itself and the posterior end of the zygoma, the close relationship existing between the antrum, mastoid cells, the lateral sinus and cranial cavity, any operation which interferes with Nature's protective work and opens up an avenue for infection of new territory is decidedly dangerous.

Another point worthy of serious consideration is the fact that a great amount of tissue involved in the inflammatory process, and dangerously near the point of necrosis from pressure caused by the pent up pus and inflammatory exudates, is not entirely beyond repair and will, in great part, be restored to normal condition if free drainage is given before the affected tissues are actually necrosed. Understanding that the dangers in these cases are from the suppurative inflammatory process and from pressure necrosis, the line of treatment called for seems plain and simple, that is: evacuation of the purulent material, relief of pressure from the pent-up inflammatory