Wine, beer and spirits to be forbidden, and drink of any kind unless in case of urgent thirst; but fruit, raw or cooked, to be indulged in ad libitum. The general result of such a diet he found to be a remarkable feeling of well-being; the sense of fulness, bearing down, and weariness, thirst and constipation soon disappeared, and the patients have been able to walk many miles up to the eve of confinement. His own wife would leap ditches and climb hills, and even on one occasion ventured on a race for endurance. The ease and rapidity of the deliveries in some 25 consecutive cases, some of whom had previously had tedious or difficult labors, the small amount of liquor amnii, often not more than a teacupful and sometimes almost inappreciable, were striking, and all without exception succeeded in nursing their infants, though some had not been able to do so before. The children were healthy but small, mostly weighing six pounds, and the circumference of the head was under 36 cm. (14 inches), averaging 33 to 34. The restriction of albuminous foods had no injurious effect on the quantity or quality of the milk.

THE COST OF AN EPIDEMIC.-As an illustration of the pecuniary loss to the community arising through the prevalence of infectious diseases, Dr. Campbell Munro, medical officer of health of the county of Renfrew, in his annual report in the British Medical Journal, makes the following interesting state

In the course of an epidemic of enteric fever in 1893 there occurred 859 cases, and 74 people lost their lives. He put aside any reference with respect to the immense amount of bodily pain and suffering, the mental distress and anguish, the misery and wretchedness involved in these figures. He confined himself to the pecuniary aspect of the question. Having before him an approximate statement of the wages earned by each individual wage earner attacked in the course of the epidemic, together with the average period during which he was prevented by illness from pursuing his occupation, he was in a position

to estimate the cost of the epidemic to the community through loss of wages at $16,455. There was next to be considered the expense involved in connection with the treatment of these illnesses, extending, on an average, over seven weeks. He found that the average cost of treatment for each patient received into hospital in the course of the epidemic was about $43.75. He was, therefore, well within the mark in estimating the average cost of treatment of cases, overhead, at $25. It might be taken that, in respect of a large proportion of the cases treated at home, the cost of treatment was limited by the pecuniary capacity of the household. The cost of treatment upon this scale amounted to $21,475. $25 was the accepted estimate of the average amount incurred in connection with funeral expenses; and the expenditure arising in this connection falls to be set down at $1850. Finally, they had to estimate the value to the community of the lives lost in the course of the epidemic. That human life had a distinct pecuniary value was a consideration which had probably never entered the mind of the average citizen. Nevertheless, the matter was one susceptible of actual demonstration. A quotation from the writings of Farr, the greatest authority on the subject, would best illustrate the position of the matter. "As lands, houses, railways, and the other categories in the income tax schedules are of value, because they yield annual returns, so for the same reason and on the same principle, the income of the population derived from pay of every kind for professional or other services, and wages, can be capitalized; not precisely, it is true, unless the income of every person living were returned at least as nearly as incomes subject to income tax; but sufficiently near to the true value to show that the value of the population itself is the most important factor in the wealth of the country. . . The capitalization of personal incomes proceeds upon the determination of the present value, at any rate, of the future annual earnings at that and all future ages."

The value to the community of an in

dividual member was ascertained by deducting the capitalized future cost of subsistence of the individual from his capitalized future income. Proceeding upon these lines Farr arrived at the conclusion that "the minimum value of the population of the United Kingdommen, women and children—was $795 a head; that was the value inherent in them as a productive, money-earning race."

He estimated the value of the population of the United Kingdom at the time he was writing as equivalent to a capital sum of $26,250,000,000, while the "capital" of the country (using the term in its ordinary sense) amounted, according to Mr. Giffen's estimate, to $42,500,000,000.

Adopting Farr's figures as a basis for the calculation, he has made a rough estimate of the value "inherent in " the persons who died in the course of this epidemic, "as a productive, money-earning race. He found that it amounted to the very large sum of $67,700. So that the pecuniary loss to the community of Mid-Renfrewshire, arising in connection with the epidemic, amounted to the enormous total of $107,480. A consideration of these figures, Dr. Munro observes, might well suggest the reflection whether any investment was calculated to yield a better pecuniary return than the expenditure involved in the operations of the Public Health Department, which had for their main object the prevention of epidemics.

LOCAL TREATMENT.-In no department of medicine have methods changed so radically as in gynecology. Dr. J. F. Baldwin has instituted, in the Columbus Medical Journal, an inquiry into the value of local treatment and he formed the following conclusions:

1. Local treatment of the endometrium possesses certain inherent dangers.

2. Acute or sub-acute inflammatory conditions of the uterus, if not specific or septic in character, may be treated, sometimes, with advantage by local stimulating applications; although, if good drainage is secured, the hot water douche and glycerine tampons, com

bined with hygienic measures, will probably bring about as good results with less annoyance, and with less expense.

3. For chronic conditions, these being usually dependent upon either specific or septic infection, local applications will accomplish little or nothing, and may do great harm, either by exciting acute inflammatory complications or by causing the postponement of more radi

cal measures.

4. In cases of adhesions from postpartum inflammatory exudates, properly applied vaginal packing, with some elastic material, such as absorbent wool, will afford more prompt and satisfactory results than will local applications to the vaginal vault and endometrium.

* *

IMPLANTATION OF WOUNDED URETER IN THE Bladder.-Pozzi (American Medico-Surgical Bulletin) accidentally divided the left ureter near its vesical end during the removal of a cyst of the broad ligament, and at once secured it by sutures in a small incision made in the bladder at a higher level. Union was obtained, and during a second laparotomy, nine months later, Pozzi was able to prove that the implanted ureter › was normal, except for a slight dilatation.

ABDOMINAL SECTION BY A COW HORN. -Dr. W. Q. Skilling of Lonaconing, Maryland, reports in the American Journal of Obstetrics a case of abdominal section by a cow horn. The cow had poked the woman in the abdomen just above the symphysis, a little to the right of the median line, taking an oblique curve to the right and making a rent about six inches long. The intestines protruded through the peritoneum. Little blood was lost. The parts were cleansed with hot water, the intestines replaced, the peritoneal wound closed by a continuous silk suture and the abdominal wound by a superficial and deep interrupted suture. The wounds healed by first intention and the patient made a rapid recovery.

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BALTIMORE, AUGUST 10, 1895.

The Dangers of Practice.

DR. CHARLES F. STILLMAN, in his work on Life Insurance Examinations, says that physicians stand below most other professional men as risks and adds that it is because of their irregular lives and exposure to all kinds of weather. The young man who is waiting to step into the shoes of a busy relative or neighbor and wishes to inherit a large practice may think that some physicians will never die. As a rule, however, physicians undergo many risks and some of them are rarely thought of by those outside of the profession.

One not unusual risk is the danger of personal violence from real or fancied wrongs and every now and then there appear in the daily papers startling statements of harm done to a physician by a patient or by friends of this patient.

A case is reported recently from Illinois, not far from Springfield, of a physician who was deliberately waylaid and murdered by a

Here

was a case of insanity probably only temporary in character or possibly a relapse of an old attack which had occurred before husband and wife had met or it may have been a case of prolonged delirium from fever and the physician is murdered in cold blood by a man who has no reason for his actions and no proofs of the doctor's supposed crime.

Another case recorded in the papers more recently happened in Brooklyn. A physician was called suddenly to a house which appeared to be vacant. He was told that the case was upstairs. He groped his way to the top floor and there he was seized upon by several men, bound, robbed and gagged and after his assailants had escaped he managed to free himself and give an alarm.

Few physicians hesitate to go into any house where they think that duty calls them and there is no punishment too severe for the man who would abuse a physician's devotion to duty and his work by decoying him to some lonely place and there by force and numbers overpower and perhaps murder him.

These are some of the risks for which the life insurance companies do not provide and if the physician is a bad risk on account of exposure to weather and irregular life he must be a much worse risk where more serious dangers threaten.

A physician's life is full of anxiety and trouble when he has many cases and is conscientious in his work, and in all instances where there may seem to be danger imminent, as in the first and second cases mentioned, he should not hesitate to prepare himself for these dangers and not rush blindly into any rat hole for a few dollars.

The public rarely appreciates the devotion and heroism of a physician until disease and trouble come and then the doctor is an angel until his bill is presented.

family is told in every case that their doctor is doing all that can be done. This is the sphinx-like remark whether the attendant is a fool or actually on the right track. For if the consultant offends the attendant, who is a good friend, that ends all his consultations in the future with this particular man.

The consultant's position is no sinecure for he will either offend the attendant or the family and in many cases the family will wish to dismiss the regular attendant and have the consultant take charge and they cannot understand why this plan is not feasible and then they rail against medical etiquette. As a matter of fact it does seem hard that the family cannot have just what physician they wish and that they are obliged to stick to one physician when they think another is better.

Medical etiquette is a sealed book to the laity and yet when a judge, in endeavoring to settle a dispute on ethics between two physicians said that he could not make much out of medical etiquette but if the two physicians would go home and behave like gentlemen he thought that the trouble would be cleared up, he probably understood the matter. man is a gentleman in the correct meaning of the word and acts to others as he would have them act towards him he will need no medical etiquette.

If a

That consultants have tricks and use them is certain. Indeed the time may come when a school of consultation is established and men will be taught how to conduct a consultation. The editor of the Journal of Practical Medicine tells the following story of a successful counselor which should be studied by all would-be consultants :

"An acquaintance of ours enjoys a fine reputation as a counselor. He always has something to suggest which has not been tried, and always knows just what to do. Being favored with a call from him recently, we ventured to ask him why he thought he had this reputation, and to what did he attribute his success as a consulting physician. His reply was a surprise, and was to the effect that he thought it was due almost entirely to one thing; and believing this, he certainly cultivated it more and more. This was: Keep well posted on all the new drugs, as fast as they appear. When called in consultation, you can mention one or two with quite a certainty that they had not been tried. This has novelty to recommend it at least."

A PROMINENT daily paper of Baltimore takes the pains to point out three things that Baltimore needs. If time and space would allow not only three, but perhaps three hundred things

The Needs of Baltimore.

could be mentioned that Baltimore and other cities also need, and need very badly. This paper, however, alive to the health and sanitary needs of this city, says the following:

"There are three things that Baltimore, with every other American city, badly needs. They directly concern the health, well-being and prosperity of all the people.

First, and probably foremost, is a sewage system that will abolish the ninety thousand wells that every year become more dangerous to the community. It will cost money, but Baltimore has reached a time and a size when it is abolutely necessary to face the situation and prepare for the future. Paris is spending thirteen millions of dollars to get rid of wells somewhat similar to those in Baltimore. Every year Baltimore postpones the matter increases the expense enormously.

"Of almost equal importance is a better and more expeditious system of garbage collection. At present this is not as promptly done as it should be and the results are both odorous and unhealthy. Colonel Waring says the offscourings of a city should be divided into four classes: Paper and other rubbish, street sweepings, garbage, ashes. If this can be done, he holds that the problem is practically solved. But it will not be solved until the removals are prompt and thorough.

Balti

"The streets must be kept cleaner. more must not depend too much on friendly rains. There must be more and better cleaning, even if more money has to be spent. The best economy in the world is money spent for cleanliness."

It takes money to make the streets of a city clean and to keep them in that condition and Baltimore by its hilly streets and natural drainage methods can have its streets cleaner at a comparatively less cost than most other cities. As a matter of economy it is cheaper to keep a city clean and lessen the amount of illness, and if no higher motives can appeal to a city corporation this fact of economy ought to have some weight. Baltimore still remains unsewered and clings to the old privy wells and these underground defects cannot be remedied too soon.

The heir to the throne of Russia has phthisis.

Medical students annually spend about $750,000 in Edinburgh.

An International Congress of Surgeons, to convene every five years, is proposed,

Tuberculosis, cancer and rheumatism are the three most common diseases in California.

Dr. W. P. Munn of Denver, Colorado, has been appointed Health Commissioner of that city.

The American Academy of Railway Surgeons will meet in Chicago on September 25, 26 and 27.

New York City has a hospital for the colored race, and it will be managed mainly by colored persons.

Among educated Germans no less than sixty-seven per cent., so the statistics say, have imperfect or defective eyesight.

Inspectors of the New Jersey Dairy Commission report an alarming spread of anthrax among cattle, horses and mules in this State.

Professor Gurlt of Berlin has found that in 31,803 cases of chloroform narcosis, 23 deaths occurred, and in 15,712 cases of ether narcosis, 5 deaths.

The Governor of New Mexico has approved the bill providing for the regulation of the practice of medicine and the establishment of a Territorial Board of Health.

Watertown, New York, has been visited by an epidemic of typhoid fever. The water supply is pumped from a river at a point just below where two cemeteries drain into it.

Mr. Christopher Heath has been re-elected President of the Royal College of Surgeons, England. Mr. Reginald Harrison and Mr. Pickering Pick have also been appointed Vice-Presidents.

At an annual meeting of the State Board of Health of Pennsylvania, held July 11, at Marietta, Pa., Dr. S. T. Davis of Lancaster, who for three years has been the President of the Board, was succeeded by Dr. Pemberton Dudley of Philadelphia.

A French gentleman, M. Guzman, has left 50,000 francs ($10,000) to the Assistance Publique, the Paris Municipal Charity Department, to defray the cost of musical entertainments to be given to the sick poor in the hospitals and asylums under its control.

The Astley Cooper Prize of £300 ($1500) will be awarded to the author of the best essay on diseases of the joints produced by syphilis and gonorrhea. Essays, in English or accompanied by an English translation, should be sent to Guy's Hospital, London, before January 1, 1898, accompanied by the usual motto and sealed envelope. For further particulars, address Dr. Hale White, 65 Harley Street, London, W.

The death is announced in New York City of Dr. William C. Jarvis. Dr. Jarvis was graduated from the University of Maryland. in 1877 and after practicing a short time in Baltimore went to New York, where his peculiar talents soon placed him in the first ranks as a laryngologist. He possessed a wonderful mechanical genius which brought to light the well known Jarvis snare and other instruments. Dr. Jarvis was a man of great promise and his loss will be greatly felt.

Three women doctors have been appointed in the summer corps of medical inspectors by the New York City Board of Health. All of them are spinsters: Miss Mitchell, M. D., Miss Deane, M. D., and Miss Weiss, M. D. The other doctors of the body offered no objection to the selection of these three inspectors, all of whom are said to be fully qualified to perform the duties of their office. Their salary is $100 a month, and the Sun has no doubt they will earn it by faithful service.