The great men in medicine were not born to greatness, but they had great problems to solve and solved them by their energy and devotion. There is still a great field for advancement in medicine and improvement in our practice, and the world has a right to expect it from us. Only in the department of major surgery is the medical art following closely in the footsteps of science, because its results are constantly reviewed and criticized by the profession, because it commands a fee that supplies the means for good work, and because of its limited field which can be cultivated. The same is true also in a certain extent in the other specialties, and while a broad general knowledge is always necessary, the times demand even more insistently that, while the physician broadens his general vision, he should narrow his field of work. Every physician should do some specializing. The whole field is too broad for any one man to cover. He ought to serve his patients in every case to the best of his ability, but he can do best if he will also devote a portion of his study to special subjects. Consultations ought to be more frequent, and they would be if each physician would take up some line in which to be the neighborhood expert. The greatest opportunities are awaiting for the general practitioner who first sees 95 per cent. of all the patients. Only let him not try to grasp everything or lessen his efficiency by trying to do too much. Where his knowledge and skill are not up to the needed standard, let him call in consultation his fellow-practitioner best qualified in that line.

TONSILLECTOMY.

J. C. Beck, Chicago (Journal A. M. A., January 27), enumerates the different plans of excising the tonsils and describes his own method, which is performed with an instrument-the tonsillectome. This is a Pierce-Miller snare, modified by having a small but heavy fenestrum at the end, very much like the ordinary Vedder tip, through which the tonsil is pushed and everted. The wire loop is hidden in the slit of the fenestrum and is contained as a twisted stylet through the cannula, fixed and operated in the usual manner of the snare. He credits to Dr. Sluder of St. Louis the development of the technic of tonsillectomy without previously dissecting the pillars from the tonsil. After general preparation of the patient and 1/200 of a grain of atropin sulphate half an hour before the operation, his method is described as follows: "The anesthetist holds the head firmly. The tonsillectome is passed behind the tonsil, going across the tongue from the opposite angle of the mouth, scooping up the tonsil until it appears in the oral cavity in the form of a 1ound tumor behind the anterior pillar. Holding the instrument firmly in this position, by gentle, steady pressure the operator feeds the tonsil through the fenestrum until it disappears under the finger. The snare is unlocked and the wire drawn down until the tonsil is seen on the inner side of

the fenestrum, everted, forming a cauliflower-like mass. The tonsil is now seized with a Volsellum forceps to prevent it from dropping into the throat when the crushing is completed. If the patient is now awaking he should be reanesthetized while the tonsillectome is in position and the tonsil slowly crushed under the mask while etherization is going on. The tonsil is removed and the capsule is found turned on itself. The same procedure is repeated on the opposite side. The same wire loop may be used for the second tonsil by pushing it back into the slit of the fenestrum." In most cases there is no bleeding. He has practically given up local anesthesia for the operation, as

more complete relaxation is required than it will afford. Two other instruments used by him in the method are also described and figured-a mouth-gag constructed so as to be always out of the way of the operator and a tonsil clamping hemostat to control hemorrhage should it occur.

EXPERIMENTAL THERAPEUTICS.

The treatment of every patient, says Torald Sollmann, Cleveland, Ohio (Journal A. M. A., January 27), is more or less an experiment, and all therapeutics might therefore be termed experimental. There is, however, a great difference between experiments between loose and inaccurate observation and wild deduction on the one hand, and close scientific reasoning and study on the other. The essential conditions are not in the material, but in the mental equipment of the investigator and his ability to avoid superficial impressions and hasty conclusions. The other requirements are a problem, a plan to direct observations, accurate records and the comparison, analysis and synthesis of the results with logical and critical deduction. The scientific pharmacologist is crippled by the paucity of exact scientific records of the effects of drugs on the human subject, which is the most important thing in experimental therapeutics. This must be supplied by the clinician, but the pharmacologist may, as has been shown by Cushny, aid him by valuable suggestions. Both clinical and laboratory studies are necessary, however, for the fullest results. Observations on the human subject cannot be as fully controlled and the problems analyzed as they can be in the animal. It is not a new subject. It is essentially the study of the effects of drugs under abnormal conditions, which is one of the ancient problems of pharmacology which has come lately more to the front. While pharmacology has its own fundamental problems, the immediate practical bearing of which is not always so evident, its principal practical task is to help in the solution of the practical problems of therapeutics. Let the clinician set forth real facts and the pharmacologist can investigate them and give practical aids of direct value to the practitioner. He may make too free deductions as well as the clinician. This is a natural human failing. Every scientific worker recognizes the difficulty in transferring the experience in one field to another, even to a similar one, but the progress of science depends on our ability to do this, and the advance of experimental therapeutics depends on the cooperation of pharmacologic and clinical experimentation. The clinician should furnish the practical problems and also finally test them, following the methods of scientific experimentation. Otherwise the results will be dubious, if not worthless.

THE ACTION OF DRUGS.

The action of drugs in pathologic conditions and the contributions of modern pharmacologic investigations to therapeutics form the subject of a rather detailed paper by W. Salant, Washington, D. C. (Journal A. M. A., January 27). He points out that the discovery that the reaction of the cell to chemical substances may be modified or even completely reversed by a change in one or more elements or radicals of the molecule, is one of the leading advances influencing modern therapeutics. Experimental evidence of late years indicates that the reaction of the cells to foreign substances may

be quantitatively and even qualitatively different under changed conditions of environment or morphologic, chemical, or physical alterations, and these may bring about corresponding variations in pharmacologic action. Facts are quoted showing that the selective action of drugs may be at least quantitatively modified by morbid changes. The effect of disturbances of metabolism produced by removal of the organs of internal secretion on the behavior of drugs is noticed and the complex physical and chemical processes of febrile conditions and the changes they produce in the action of therapeutic agents are extensively noted and the results of the work of various experimental investigators and observers noticed in detail. The same is true with respect to the effects of changes and restrictions of diet and of fatigue, and numerous investigations are referred to which indicate this fact. Abnormalities in the circulatory system, produced experimentally or occurring otherwise, also afford instances of modified quantitative and qualitative pharmacologic action. These show us that a substance introduced into the body will not produce the same effect under all conditions and to assume that such is the case is unjustifiable and might lead to disastrous effects in the treatment of disease. Further investigagations are needed in this line as we are far from understanding all the processes called into existence by experimental procedures or by disease. While we should not underrate the value of theoretical anticipation of results, facts show us that it is sometimes misleading. The greatest and only real value, however, is to stimulate investigation, for experimental evidence is the only safe and reliable test of the validity of a theory.

A LOCAL ISOLATION HOSPITAL.

A. C. Haven, Lake Forest, Ill. (Journal A. M. A., January 27), says that every community should provide a hospital for contagious diseases, as treatment of such cases in private houses is very unsatisfactory. The location should be secluded and the building planned for the purpose, one story and fireproof, adapted for isolating not only the sexes but different diseases, simultaneously, with accommodations for exchanging clothes for physicians, for disinfecting, cleansing, etc. The caretaker should occupy a separate cottage, which should contain in its basement the heating plant for the entire hospital and every ward separately. Each ward should have its own dishes and outfit. The grounds should be attractively laid out, allowing for convalescents such outdoor privileges as can be permitted. The term "contagious" or "pest" house should be replaced by more euphonious terms. These are the ideals in substance which have inspired the trustees and architect of the Lake Forest Isolation Hospital, the elevations and plans of which are illustrated. It is the only hospital in the north shore suburbs of Chicago exclusively for contagious diseases.

be quantitatively and even qualitatively different under changed conditions of environment or morphologic, chemical, or physical alterations, and these may bring about corresponding variations in pharmacologic action. Facts are quoted showing that the selective action of drugs may be at least quantitatively modified by morbid changes. The effect of disturbances of metabolism produced by removal of the organs of internal secretion on the behavior of drugs is noticed and the complex physical and chemical processes of febrile conditions and the changes they produce in the action of therapeutic agents are extensively noted and the results of the work of various experimental investigators and observers noticed in detail. The same is true with respect to the effects of changes and restrictions of diet and of fatigue, and numerous investigations are referred to which indicate this fact. Abnormalities in the circulatory system, produced experimentally or occurring otherwise, also afford instances of modified quantitative and qualitative pharmacologic action. These show us that a substance introduced into the body will not produce the same effect under all conditions and to assume that such is the case is unjustifiable and might lead to disastrous effects in the treatment of disease. Further investigagations are needed in this line as we are far from understanding all the processes called into existence by experimental procedures or by disease. While we should not underrate the value of theoretical anticipation of results, facts show us that it is sometimes misleading. The greatest and only real value, however, is to stimulate investigation, for experimental evidence is the only safe and reliable test of the validity of a theory.

A LOCAL ISOLATION HOSPITAL.

A. C. Haven, Lake Forest, Ill. (Journal A. M. A., January 27), says that every community should provide a hospital for contagious diseases, as treatment of such cases in private houses is very unsatisfactory. The location should be secluded and the building planned for the purpose, one story and fireproof, adapted for isolating not only the sexes but different diseases, simultaneously, with accommodations for exchanging clothes for physicians, for disinfecting, cleansing, etc. The caretaker should occupy a separate cottage, which should contain in its basement the heating plant for the entire hospital and every ward separately. Each ward should have its own dishes and outfit. The grounds should be attractively laid out, allowing for convalescents such outdoor privileges as can be permitted. The term "contagious" or "pest" house should be replaced by more euphonious terms. These are the ideals in substance which have inspired the trustees and architect of the Lake Forest Isolation Hospital, the elevations and plans of which are illustrated. It is the only hospital in the north shore suburbs of Chicago exclusively for contagious diseases.