of the loss of flesh. As a working rule Dr. Cohen finds that each daily tablet of five grains of desiccated thyroid may be expected to produce a loss of one pound of bodyweight, in five days, in a patient weighing from 180 to 210 pounds. The loss seems to be less rapid as the abnormal accumulation of fat is reduced, but sufficient data are not yet at hand to warrant the formulation of a more precise statement. In order to cause a loss of 10 or 12 pounds per month in the average case, two tablets daily (one at night and one in the morning) should be prescribed. It appears to make no difference whether the drug be given with meals, or when the stomach is empty.

account of the high situation of the stricture, esophagostomy was decided upon, the incision being made a little below the level of the cricoid cartilage (the anterior edge of the left sterno mastoid muscle acting as the guide). The edges of the esophageal wound were then stitched to the skin, and a No. 12 soft rubber catheter introduced into the stomach and allowed to remain for the introduction of liquid food. A second incision was made into the esophagus, above the seat of constriction, about half an inch higher than the first, a rubber catheter being passed upward into the mouth. The walls of the esophagus between these two openings being largely cicatricial, dilatation was attempted; the

point of the forceps, however, when pushed upwards, instead of remaining in the caliber of the esophagus, passed backward behind the wall of the pharynx. Owing to the patient's condition further operation was postponed. In spite of the administration of food through the catheter the patient gradually weakened and died. At the post-mortem examination three inches of the esophageal wall were found almost entirely destroyed by a suppurative process, the intervertebral cartilages. were loosened and the spaces between them and the bones were filled with a dark, foulsmelling pus. An area of consolidation at the root of the right lung, when incised, gave vent to a similar material. The suppuration found in the posterior mediastinum, although largely due to leakage from the tube, may possibly have been partly caused by the introduction of the filiform bougie, which, instead of passing through the stricture, perforated the esophageal wall at that point and entered the mediastinal space.

On the Treatment of Ununited Fracture by Passive Congestion.-F. M. Caird, F.R. C.S.Ed. (Edinburgh Medical Journal, June, 1895.) A domett roller is carried from the toes or fingers, upwards to a point about three inches below the fracture and, at a similar distance above the fracture, the limb is encircled by a turn of thick elastic tubing. The intervening area then becomes hard, swollen, and of a bluish red hue. For a day or two the elastic band will be irksome and then it ceases to be inconvenient. The object of the treatment is to amass as much blood as possible within a given area so as to obtain the greatest quantity of nourishment possible for the parts. Something more than edema results, as is shown by the fact that even two or three days after the removal of the tubing a firm cartilaginous ring remains, clinging to the bone. Where two bones are involved, the Esmarch bandage may lead to displacement of the fragments and judicious padding has to be substituted. There is the danger of producing gangrene by too tight bandages, and the danger of bruising the tender tissues of young people by the same means. These dangers may be readily avoided by exercising care. The method may be employed where there is faulty union after the excision of the knee-joint.

Selection

NEWSPAPER DOCTORS.

"IT is all wrong that city doctors be permitted to report their cases (real and imaginary) to the daily papers with sensational headlines, such as 'A Terrible Ordeal, 'The Surgeon's Knife,' Dr. Blowhard, Assisted by Drs. Drum and Trumpet, Performs an Unparalelled Operation,' etc., etc, followed by a bom. bastic account of a most wonderful performance, one part fact, forty-nine parts wind, and fifty parts falsehood. And, what is still worse, that such men should be permitted to walk into the medical societies and take front seats.

"But suppose the country doctor should write up some case or operation of his for the local paper, even if it were a matter of neighborhood interest, he would call down upon himself the reproaches of his professional associates for having transgressed the rules of professional dignity and decorum.

"Almost equally reprehensible is the 'interview' dodge and the 'biographical sketch' (with portrait) dodge, that so many are ready to adopt, even men who think themselves great, and whose position might justify the belief. Do they not realize that greatness cannot be manufactured by such methods? Do they not know that such petty and contemptible tricks are fully understood, and that they only detract from greatness and make littleness the more apparent? The first step toward greatness is to cease being little, or, in the words of the notorious Sam Jones, 'quit your meanness." An artificial fame can only be maintained by continuing the same artificial methods, and even then the asses' ears are almost certain to crop out from under the lion's skin.

"Another custom, though not so reprehensible, is certainly of very questionable propriety. This is the flooding the country with reprints of papers read before medical societes. Aside from a question of propriety, this has become verily a weariness of the flesh. If one reads a paper before some society and afterwards sends a copy of it, with his compliments, to his personal friends and acquaintances, it is an act no one would call in question; but when it comes to send ing out editions of ten thousand copies and enclosing one's business card it becomes an abuse of privilege that should be called to order. It is simply an advertising dodge, that would not be tolerated for a moment in a country doctor.

"The relations between the specialist and the general practitioner run parallel with those that exist between the general practitioner and the public-each looks to the other for reputation and support. If the specialist may flood the country with thousands of reprints of papers and case reports addressed to general practitioners, why may not general practitioners with equal propriety flood the public with their papers and reports? Yet such an act would be promptly denounced as unethical.

"It is not uncommon for certain specialists to pub. blish a list of cases for a year and sow them broadcast over the country. How would it look for the general practitioner to publish a list of all his cases for a year

and distribute them among the families in which he desires to be employed? If such a method of advertising is according to refined taste and ethical, why should not the general practitioner enjoy the benefits of it among those from whom he must derive his business? The fact is, such methods are wrong, vulgar, and contrary to the spirit of the Code.

"How, then, shall a specialist build up a business? By waiting patiently till his reputation, founded upon a high order of scientific and practical work, brings it to him, just as the general practitioner must do. If this were the established method it would then become the duty of the general practitioner to watch critically the professional career of the specialists, that he might be able to decide judiciously to whom he should refer his patients needing special treatment. He should exercise that discrimination which we now feel that the public should employ in the selection of a family physician, and which we often feel aggrieved that they do not employ.

"All special work should pass through the hands of the family doctor, and he should direct it to the skillful, conscientious, high-toned specialist, whose character will guarantee the highest professional skill with the most honorable dealings, while the bombastic, the selfish, the mercenary professional sharks should be relegated to the regions of undisguised quackery, for which their peculiar talents pre-eminently fit them."-From the "Rusticus Papers.' The Cincinnati Lancet-Clinic, Dec. 14, 1895.

New Publications

THE JOHNS HOPKINS HOSPITAL REPORTS. Volume IV, No. 9. Report in Pathology, IV. Deciduoma malignum. By J.Whitridge Williams, M.D.

From their first appearance the Johns Hopkins reports have been characterized by their high grade of scientific medical learning, and the present fasciculus maintains the high standard of its predecessors. It is devoted entirely to an exhaustive study of that exceedingly rare and but recently recognized obstetric condition, malignant deciduoma, founded upon an exceedingly interesting case that presented itself in the hospital wards. Dr. Williams has thoroughly reviewed the literature of his subject, and has presented a most readable and truly valuable exposition of the condition.

BOOKS RECEIVED.

AN AMERICAN TEXT-BOOK OF SURGERY FOR PRACTITIONERS AND STUDENTS. Edited by William W. Keen, M.D, LL.D., and J. William White, M.D., Ph.D. Second edition, carefully revised. 8vo, pp. 1248. Philadelphia: W. B. Saunders, 1895.

pallid and often found to be anemic and flabby. The excessive restlessness uses up both nervous energy and blood, hence arise unconscious fatigue and wasteful metabolism. For this the carbohydrates offer better supply than albuminoids, and my custom is to enforce the use of fats. Cod-liver

oil was first used for rheumatic conditions and still stands pre-eminent as a recuperative agent in disorders of this nature. I give it with best success in capsule and often only once or twice a day. Iron is not often needed, especially when arsenic is employed for its specific action-whatever that may be. For the first fortnight, bathing twice daily, with vigorous salt towelings, is enough of tonic to the surface. After that I employ massage to redistribute blood from depths to surface and also for its controlling power over nervous disquietude. For this effect it should be administered somewhat differently from the usual methods (which vary widely enough, heaven knows); slow, steady surface-stroking should be followed by firm, quiet kneading, ending with passive movements of the limbs and over-stretching like that used for spastic conditions. And in children, bear in mind, a shorter seance is required. "Enough is enough and too much may founder," as the Southern saying aptly puts it.

So soon as the prodigality of movements comes under control greater liberty may be allowed both in diet and exercise. Then to be partly dressed and remain up and about the room for most of the day, resuming ordinary occupations, is admissible, not permitting any fatigue production, however, and above all, no excitement or annoyance.

Finally, when the ataxia has been excessive, I find it a most useful measure in restoring clean and accurate co ordination to reeducate the limbs and motor centers by teaching the use of accurate movements at word of command, systematic posings and mild, free exercises. It is well to direct the

action of the eye up, down, to right and left; the fundamental arm and leg attitudes rising gradually to complex acts, as tossing and catching a ball or bean bag. All this in regulated doses and followed by bathing and rest. Do not forget that in all exercises of convalescents, regulated or free, a period of absolute rest should immediately follow.

Of medicines, not a very large variety have gained my confidence. If any trace of rheumatic pain show, it is best to be met by the salicylates, which children bear very well anyhow. I like the ammonium salicylate, and along with it ammonium bromid in liquor ammonii acetatis, or maybe elixir of calisaya in full doses for three or four days. Precede this with a laxative, and follow with the arsenic. I know of nothing better than Fowler's solution, begun at 3 drops, thrice daily, increasing 1 drop a day (which just doubles itself on the tenth day), and continuing up until toxic symptoms are clearly manifested. Then stop for one day, and continue the daily dose just preceding the toxic signs for several days. If this prove too much, stop and begin at the three drops, and go up again. Keep up the arsenic until a week has passed without twitching. In severe cases, arsenic may best be given hypodermatically; moreover, some will receive it better thus than by the mouth. (For this purpose, liquor potassii arsenitis may be made without the lavender.) Always write out the schedule of increments on a card, thus:

First day, 3, 3, 3.
Second day, 3, 3, 4.
Third day, 3, 4, 4.
Fourth day, 4, 4, 4, etc.,

till the tenth day about. Each day, the nurse may check off the figures, showing the exact progress. In dealing with powerful remedies it is of utmost value to write full directions indicating possible complications and toxic symptoms.

Quinin has been claimed by Dr. H. C. Wood as a specific, upon the theory of its central action, reinforcing inhibition. It has not often, but occasionally, done good service at my hands in chorea. The possibilities of malaria being at the bottom of the disorder must not be lost sight of, when, of course, we may expect results from its use. Moreover, quinin has a most happy effect upon spas modic action, as in pertussis. Dr. Morris Lewis pointed out long ago that, in the subsiding stages of bronchitis, when the cough persists, quinin often brings prompt relief. This has proved a boon to me numberless times, especially in dispensary cases from certain localities.

And finally, chorea may pass into a habit spasm, although that mimetic disorder arises in other ways. Habit chorea, however it arises, is a close cousin to the real thing, and is benefited by much the same treatment. Nevertheless, it is often a most intractable condition and requires firm moral means to check. Hypnotism or powerful suggestion or mild fright are all useful. Indeed, I've cured it several times by pointing out clearly to sensible children that it resides with them

to rid themselves of a foolish and entirely controllable state.

Perhaps one illustrative case may be of use. A boy of fourteen was brought to me tumbling about so that he had several times hurt himself severely, and being a sensitive, refined lad, he was mortified beyond speech, refusing at last to appear in public in daylight. The best of medication had been employed in several centers of wisdom and authority, to no avail. I saw him throw a teacup across the room by convulsive action, and while examining him got my own face wofully banged. The diaphragm was involved so that he gave a great yell in the midst of placid speech; and the heart became at times strained almost to bursting by excitement or chagrin. Perhaps some of the valvular troubles arise in these strains. The parents were able and willing to do anything, so I put him to bed and used to the full all the foregoing measures, with the result that in two weeks he could point a small gun accurately at my order, and in three weeks was walking about everywhere and a dozen pounds the heavier, not to speak of his beauty of color or serenity of countenance.

CASE I.-Referred to me by Dr. George Hartmann, of Port Kennedy, Pa.

J. W., aged 20, while harvesting, was struck forcibly in the eye with a cornstalk. The cornea was perforated, the anterior chamber emptied, the capsule torn, and probably the lens injured. I saw the patient I saw the patient a few days after the accident. The cornea showed an irregular cicatrix near the center, the iris was attached in several places to the capsule, the lens was opaque, striæ running backward from the point of densest adhesion, and there was moderate ciliary injection. In six months the eye was free from injection, the synechiæ persistent, and the lens was en

tirely opaque.