Contraindications of the regime are albuminuria, tuberculosis, indigestion and loss of appetite. In all cases it is best to weigh the amount of potato taken each day. The form in which the potato is cooked is of no importance. A short rest was found to overcome an acquired distaste for the potato diet.

EDITORIAL COMMENT.

THE RISE AND FALL OF MEDICAL JOURNALS. THE demise, recently, of an eastern medical weekly after a comparatively brief period of struggling existence, finishes another chapter of the commentary on medical journalism. The publication in question had many advantages to promote its success. It was born in an atmosphere of scientific and professional learning, and was endowed at once with trained editorship, a large professional following, and the determination to succeed. There was lacking, however, a certain very important quality, which is also wanting in some prepossessing and highly-educated individuals-the quality of success. However indefinite this explanation may seem, it is nevertheless as clear as are the reasons for failure offered by the ex-editors of the ill-fated journal.

Neither this incident nor the project of the new medical daily are needed to suggest the thought, but it is a fact, with which everybody is well acquainted, that anybody can start a medical journal. Possibly the founders may sustain the venture for a while. Some good medical journals die, the same as some good people die, but the property of endurance in a medical journal is pretty good evidence of its establishment upon, and management according to, worldly-accepted business principles, notwithstanding the latter may sometimes lack foundation in ethics. An ecclesiastic cannot live on promises of support; neither can a medical journal survive without a business basis; but danger lurks in the desire to achieve fame and fortune at any risk, and consequently we are little surprised when the goal of some ambitions is reached in the determination to perpetuate journalistic existence even at the cost of indulging in ethical obliquity.

A vast deal has been said and written from time to time about mercenary medical journals, and the comments cannot be ascribed to victims of delusion. Journals of this class certainly abound, and their trademark closely corresponds to that which brands quack doctors. The projectors are in the enterprise wholly for dollars and cents, regardless of honor and justice, and the better element of the medical public understands well their motives. A marked distinction is perceptible between the medical journal whose primary purpose is mercenary, and the medical journal whose basic principle contemplates the dissemination of trustworthy knowledge regarding the science of medicine, and therefore, considering the higher educational requirements and the

extended course of study necessary to gain admission to the medical profession, which have been developing gradually for a quarter century, it is indeed a lamentable commentary on the ethics of the craft that physicians are still extant who countenance the mercenary makeshifts.

In January, 1879, according to George P. Rowell & Company, the whole number of medical journals published in the United States was seventy-five, and although many have fallen by the wayside, the output has been augmented from year to year until in April, 1903, quoting the same authority, the number had reached one hundred sixty-two, an average of nearly one journal for every six hundred members of the medical profession. It is probably safe to say that about two-thirds of this number are conducted solely for pecuniary gain by persons who have not a scintilla of interest in medical science beyond the receipts derived from their periodic handbills, each of which has been dignified, for the purpose of insuring an audience with the unsuspecting doctor by the nom de plume of “medical journal.”

Notwithstanding the fact that journals are continually yielding the ghost many new ones have been started within the past few years, presumably to fill long felt wants. Seemingly oblivious of the condition that too many medical journals already exist, there are yet individuals abroad in the land who cherish the erroneous idea that the establishment of additional mouthpieces contributes to the greater honor and glory of the medical profession. The truth of the matter is that the interests of the profession would be better subserved by depleting the ranks of medical journalism, for, the greater the competition the greater the likelihood of the weaklings becoming prey to mercenary influence.

It is amusing to observe the artifice displayed by some journalistic enterprises to hoodwink the physician and the purveyor. Instances. galore might be cited to show the deception practiced upon both constituencies, but suffice it to say that the trickery is not confined exclusively to journals of the so-called inferior class, but is characteristic of some that essay to be paragons of all that is good and great in medicine.

CONTEMPORARY.

DRUG ERUPTIONS.

[SAINT LOUIS Medical review,]

IN refreshing the encyclopedic store of information required by the general practitioner one item is too often neglected-that of drug eruptions. All are familiar with the possibilities of the commoner drugs in the way of producing cutaneous lesions, and in the majority of cases these lesions may be safely ignored. But the growing use of an increasing list of synthetic remedies, many of which often induce skin manifestations, and the fact that delicate diagnoses are sometimes

dependent upon the condition of the skin, make the subject one for profitable investigation.

To the British Medical Journal, George Pernet, of the University College Hospital, contributes an interesting discussion of drug eruptions He classifies them as follows:

(1) Erythematous, urticarial, papular, and desquamating. (2) Vesicular and bullous. (3) Pustular. (4) Furuncular. (5) Purpuric. (6) Gangrenous. (7) Pigmentary and discoloring. (8) Hypertrophic. (9) Tumor-like.

The lesions produced by belladonna are well known. Administration by the mouth, however, seldom induces these rashes. Arsenic, during the Manchester beer-poisoning epidemic, produced a variety of rashes. Mercury, quinin, and iodoform are also familiar examples Chrysarobin at times leads to a diffuse erythema, especially when applied near the face, and is then often accompanied by a smart conjunctivitis.

Copaiba may cause an eruption which at times leads to errors of diagnosis. It may be papular, scarlatiniform, or morbiliform. Usually it is made up of rosy red, slightly elevated patches, chiefly about the backs of the hands, the fronts of the knees, the limbs, and abdomen. A well-defined scarlatiniform rash may develop over the front of the trunk.

Erythematous eruptions may be caused by a number of drugsopium, morphin, potassium chlorate, digitalis, et cetera. The numerous synthetic remedies also act in this way; antipyrin, phenacetin, sulphonal, et cetera. Chloral hydrate deserves special notice. The eruptions from the use of this drug vary, but are usually erythematous in type. They occur, too, as dusky-red papules, or as purplish mottling in the neighborhood of the joints of the extremities. The scarlatiniform rashes may be generalized with flushing of the face, itching and burning, and followed by desquamation.

Diagnosis in the foregoing cases may be easy, at other times difficult. In scarlatiniform rashes the first thing is to exclude scarlatina. Here duration, mode of onset and development, and absence of corroborative symptoms are the points to lean on. Nonscarlatinal rashes do not usually come out in the order observed by scarlatina. may be some rise of temperature and some congestion of the fauces in the former, but this is not the rule. It is scarcely necessary to insist on the importance of examining the urine in suspected scarlatina.

There

Salipyrin (a compound of salicylic acid and antipyrin) has led to a herpes-like eruption about the penis and mucous membranes of the mouth. There were also erythematous areas about the hands and upper limbs in the case of a medical man, who had taken fifteen grains in a little diluted cognac. He found subsequently that a very small dose of antipyrin had the same effect. There is an interesting case of a German student, who for about nine months had recurrent attacks of a bullous exanthem involving various parts of the body, but chiefly the

face. This was accompanied by headache, rigors and pyrexia. The diagnosis of pemphigus chronicus was made, but it turned out subsequently that this rash occurred after drinking bouts, the patient treating the usual Katzenjammer in the morning by taking thirty grains of antipyrin in place of the customary red herring. Here again the combination of beer and drugs may account for the severity of the symp

toms.

Antipyrin may give rise to an erythema multiforme bullosum-like rash. A point about antipyrin is the pigmentation which may be left behind after the subsidence of the buliæ. This pigmentation must not, in the absence of corroborative symptoms, lead to the erroneous diagnosis of syphilis. The recurrent vesiculo-bullous lesions due to iodoform must be specially borne in mind, and direct inquiry be made, especially in the case of medical men, for the cause of these rashes may be easily overlooked and ascribed to constitutional conditions. In fact surgeons, who have suffered in this way themselves, have failed for a long time to realize the cause of their trouble.

The effects of arsenic, bromids, iodids, and quinin sometimes go beyond a mere erythema; papules, furuncles and even gangrene may be produced.

Speaking generally of diagnosis, Pernet says:

"In a general way, whenever an unusual-looking rash comes before you, the possibility of a drug rash should be borne in mind. If the patient has been under your own care, the medication you have prescribed will occur to you. On the other hand, the patient may have taken remedies on his own responsibility, unknown to you, or may consult you for the first time on account of the rash. In all cases it is important to see as much of the eruption as possible. The duration, distribution, and mode of development, together with a general examination of the patient as to the condition of the various functions, are the points which will help you to arrive at a right conclusion. The duration alone will in some cases exclude the acute exanthemata, and variation from the mode of invasion of the latter will also be of great assistance. The urine should always be examined. Inquiry as to a preexisting skin disease should be made."

MEDICAL NEWS.

THE PRINCIPLES OF ETHICS.
[CONTINUED FROM AUGUST NUMBER.]

ARTICLE 4.-DUTIES OF PHYSICIANS IN CASES OF INTERFERENCE. SECTION 1.-Medicine being a liberal profession, those admitted to its ranks should found their expectations of practice especially on the character and the extent of their medical education.

SECTION 2.-The physician, in his intercourse with a patient under

the care of another physician, should observe the strictest caution and reserve; should give no disingenuous hints relative to the nature and treatment of the patient's disorder, nor should the course of conduct of the physician, directly or indirectly, tend to diminish the trust reposed in the attending physician.

SECTION 3.-The same circumspection should be observed when, from motives of business or friendship, a physician is prompted to visit a person who is under the direction of another physician. Indeed, such visits should be avoided, except under peculiar circumstances; and when they are made, no inquiries should be instituted relative to the nature of the disease, or the remedies employed, but the topics of conversation should be as foreign to the case as circumstances will admit.

SECTION 4-A physician ought not to take charge of, or prescribe for, a patient who has recently been under the care of another physician, in the same illness, except in case of sudden emergency, or in consultation with the physician previously in attendance, or when that physician has relinquished the case or has been dismissed in due form.

SECTION 5.-The physician acting in conformity with the preceding section should not make damaging insinuations regarding the practice previously adopted, and, indeed, should justify it if consistent with truth and probity; for it often happens that patients become dissatisfied when they are not immediately relieved, and, as many diseases are naturally protracted, the seeming want of success, in the first stage of treatment, affords no evidence of a lack of professional knowledge or skill.

SECTION 6.-When a physician is called to an urgent case, because the family attendant is not at hand, unless assistance in consultation is desired the former should resign the care of the patient immediately on the arrival of the family physician.

SECTION 7.-It often happens, in cases of sudden illness, and of accidents and injuries, owing to the alarm and anxiety of friends, that several physicians are simultaneously summoned. Under these circumstances, courtesy should assign the patient to the first who arrives and who, if necessary, may invoke the aid of some of those present. In such a case, however, the acting physician should request that the family physician be called, and should withdraw unless requested to continue in attendance.

SECTION 8.-Whenever a physician is called to the patient of another physician during the enforced absence of that physician the case should be relinquished on the return of the latter.

SECTION 9.-A physician, while visiting a sick person in the country, may be asked to see another physician's patient because of a sudden aggravation of the disease. On such an occasion the immediate needs. of the patient should be attended to and the case relinquished on the arrival of the attending physician.

SECTION 10.-When a physician who has been engaged to attend. an obstetric case is absent and another is sent for, delivery being accomplished during the vicarious attendance, the acting physician is entitled