Microscope. A good microscope can be purchased from Bausch & Lomb, of Rochester, N. Y., for $75.00, having the following complete equipment; two eye pieces; triple nose piece, carrying three objectives (low power (2/3), high power (1/6 or 1/7), and oil immersion (1/12),) and an Abbe condenser. The oil immersion lens and Abbe condenser are positive necessities.

Centrifuge. A hand centrifuge can be purchased for $10.00. The glass tubes should be graduated and are extra. The centrifuge is a necessity, for often, even after sedimentation, it is hard to secure much deposit. This is apt to be true in interstitial nephritis, the clearness of the urine, or lack of sediment being no guide as to the pathological condition. I have seen clear urines, free from albumin, containing casts.

Stains. The following stains are essential: Carbol-fuchsin (ZiehlNeelson). Methylene blue (Loeffler's). Methylene blue, prepared with acetic acid. Wright's stain for blood smears. Decolorizing agent prepared as follows: Sulphuric acid, 2 c. c.; alcohol (95%) 23 c. c.; water, 75 c. c.

Accessories. These include slides, cover-slips, cover-slip forceps, cedar wood oil, lens paper for removing the oil from the immersion lens, canada balsam, fine filter paper for removing excess of water from cover slips, platinum wire needle in glass holders, and small pipette for removing the urinary sediment.

It is better to purchase the stains in small quantities already prepared, from Bausch & Lomb. Wright's stain can be bought of Hynson, Westcott & Co., Charles & Franklin Sts., Baltimore, Md.

The technic employed in the examinations mentioned is not at all complicated and is as follows:

Urine. Centrifuge without filtering. If specimen contains urates, remove with heat. If phosphates are present, add acetic acid. The phosphates often take the form of casts which disappear after the addition of the acetic acid. Remove carefully with pipette, a bit of the sediment at the bottom of the centrifuge tube, and transfer to a slide and cover with cover-slip. Hunt for casts with the low power lens. When found, examine more carefully with high power. The high power is also necessary when hunting for blood, renal epithelium, and spermatozoa. The centrifuge has another use of practical value; with the graduated tube, accurate percentages of albumin can be quickly made, doing away with the Esbach method which is not as reliable; also the careless and much-to-be-deplored method of estimating the amount of albumin, by stating the percent according to the depth of the albumen in the test tube. The method consists in mixing potas

sium ferrocyanide (10%) 3 c. c., acetic acid (50%) 2 c. c., and urine 10 c. c. Allowing it to stand ten minutes, and centrifuge three minutes. By means of a table in Purdy's Urinary Analysis, the percentage of bulk of albumen can be converted into the number of grains of dry albumen to the oz.

Sputum. The regeants necessary are carbol-fuchsin (Ziehl-Neelson), decolorizing agent (as above) and methylene blue (Loeffler's). The technic is as follows: For a stained preparation, make a thin smear on a cover-slip with the platinum wire, having previously made a loop in the end. When dry, fix in flame of Bunsen burner, or alcohol lamp, by passing it quickly through the flame three or four times. Then cover with carbol,fuchsin, and steam gently for a moment or two over the flame; turn off the carbol-fuchsin, wash in tap water, and remove excess of water with filter paper. Cover with decolorizing agent, allow it to remain until slip becomes a faint pinkish-grey; wash thoroughly with tap water, removing excess with filter paper. Cover with methylene blue a few moments, wash in tap water, dry with filter paper, mount in Canada balsam, and examine with the oil immersion lens.

The tubercle bacillus will be found as delicate red rods slightly curved, on a field of blue, comprised of pus cells, epithelium, and bacteria.

The immediate examination without staining, should not be neglected, for it is by this means that we determine the character of the epithelium, the presence of blood and elastic fibres.

Discharges for Gonococcus: Technic for smear the same as above. Cover with methylene blue a few moments, wash with tap water, dry as before and mount; examine with oil immersion lens. The gonococcui occur in pairs, biscuit-shaped, the flattened surfaces approximating each other, and must be in the protoplasm of the pus cells to be of diagnostic value.

Secretions from the throat for the Kleb's-Loeffler' Bacillus. Technic of preparation as above. Cover the slip with the acetic acid preparation of methylene blue, as this brings out the irregular staining peculiarity of this bacillus better than Loeffler's methylene blue, the bacilli appearing as short rods, dotted in appearance. If the direct examination does not prove satisfactory, the specimen must be sent to the laboratory for culturing, for it would not be practical for the general practitioner to try to make up culture media. The direct method is usually sufficient.

Blood. The general practitioner ought to be able to prepare a blood smear for the benefit of the Pathologist, as well as for himself.

I have had blood sent in various impossible ways for examination. The technic is as follows: Clean the cover slips by washing with soap and water, rinse, immerse in a little water containing a few drops of hydrochloric acid, rinse, and polish with alcohol. A little ether used at the bedside, gives a smooth surface, although alcohol may be used. Take one cover slip in the fingers of the left hand; another cover slip is lifted with forceps, touched to the drop of blood oozing from the finger tip, or lobe of the ear, according to circumstances, and dropped gently, blood side down, upon the cover slip in the left hand. The blood will quickly spread. As soon as this process is complete, quickly and smoothly draw the slips apart without lifting the upper one from the lower. Dry in the air; they are now ready to be stained, which can be done at any time. The slip is covered with Wright's stain, a few drops of distilled water are added until a metallic scum appears; allow it to remain on the smear about two minutes, wash gently with tap water; dry with filter paper, mount in Canada balsam, and examine with the oil-immersion lens.

If the stain is good, the nuclei of the white cells will stain a deep purple, eosinophiles will contain red granules, "mast cells" will contain large purple granules, polynuclear leucocytes will contain fine violet granulations and the malarial parasite will appear in the red cells as a blue organism.

Unless one is thoroughly acquainted with the appearance of the malarial parasite, a diagnosis should not be given without a control slip, known to contain the organism. Other diseases which may be recognized by this method, are: Anemia, splenic myologenous leucæmia, and leucocytosis.

Stomach Contents. The examination is made directly. If it is desired to stain the elements, Loeffler's methylene blue is again available; the technic the same as before given. The staining of starch granules with Lugol's solution of iodine, is unnecessary, as they are easily recognized without staining. The washing out of the stomach, testing for hydrochloric acid and lactic acid, should also be a part of this general knowledge.

This paper has been written to show the feasibility of making these examinations, and the great practical advantage it would be, especially to physicians in country districts, also to younger men in the profession who are not overburdened with practice, to make them.

NOTE. A good book on Clinical Diagnosis, Wood or Simon, is a necessity, but it is not necessary to have a special volume on Blood Examinations, Stomach Diseases, etc., unless one desires it. Purdy's work on Urinary Analysis is recommended. 830 Rose Building.

MEDICAL ETHICS.*

By John C. Sanders, M. D., LL. D., Emeritus Professor of Obstetrics,
Cleveland Homeopathic Medical College.

It is a clear and imperative duty for a medical man to marry as soon as his revenues will warrant-by which I mean, as soon as his revenues will provide means for a comfortable support of himself and wife-a support not in elegance or luxury, but in simple comfort. I say this is a duty, largely because it is a duty promotive of his best physical and moral health, as well as promotive of patronage.

There is a natural hesitancy and shrinking in the employment of a young unmarried medical man, especially if he is a comparative stranger-not so much because of his youthful years, for the trend in these latter days is toward the selection of young men and young women in all the departments of industry, professional or otherwise, but because he is a single man and therefore presumably unsophisticated as to the knowledge of the subject matter of the related sexes or the needs of the delicate necessities of maternity, or the needs of babyhood and of childhood. The married relationship of the young physician is a strong presumption favorable to his or her patronage.

In this matter of marriage there is not only a duty, but a delicacy of duty that fully justifies the most careful consideration and warrants a few remarks in this connection.

From a long and painstaking observation, I have come to the conclusion that in the choice of a wife, there is no calling so imperatively demanding the exercise of so accurate and so broad a wisdom as the medical profession. There opens to the wife of the medical man a broader field of possible helpfulness to him than opens to the married. woman of any other calling. The medical man should marry only the woman whom he loves, but he should not permit himself to love the woman who is not best suited to become his wife-best suited by the possession of those qualities of being which the medical man's lifecompanionship demands. The woman of his choice should possess a good standard health-one with no patent or latent heredity of cancer or tubercle, or syphillis, or tumors, or epilepsy, or insanity. A frail, feeble, sickly wife is a lamentable handicap to any man, but most. egregiously so to the medical man. A sickly wife is an abiding, taunting criticism and embarrassment to the physician for reasons that are patent on a moment's reflection.

Next to this in importance, she should possess in a pronounced degree domesticity-by which I mean, a fondness for home. She should possess, too, beauty of person-beauty not alone in comeliness

*Second Lecture.

of feature and figure, but beauty of character-lacking which, all other beauty is a mockery. Amiability is the next crowning grace of character, to which should be added sweetness and patience of spirit, affability, courteousness, and not least nor not fully defined by these terms, she should possess what is best defined by the term tact-that quality of character, popularly and forcefully defined as gumption.

All these qualities are necessary in the character of the wife of a physician, chiefly because home is our only earthly Eden; there is none outside it. All else in this life is a travesty on earthly happiness. And besides, the doctor, apart from his professional skill and power is always a prominent factor in society-in which his education and culture, continuously improving, if he keeps himself as he should, abreast with the advancing march of his profession, give him a rank exceeded by no other-a rank with which his wife should be ever capable of keeping apace. To do this and to maintain this position, by no means involves the neglect or abandonment of her home duties; but it does involve, that she shall keep her general intelligence as constantly improving as his own shall be, by continued study and reading, by the enlargement and improvement of her accomplishments of whatever nature that may be, by the cultivation of her tastes as best her opportunities permit.

This all will enable her to maintain an honorable companionship with him, not only at home, but in whatever society their lines may be cast. Besides this, the tact she presumably possesses and can put in exercise, may prove more serviceable than you now can think possible in the enlargement and strengthening of his clientele.

The next duty is physical and moral towards himself in the furtherance of his intellectual and moral growth. To this end, the medical man should continue his study life in the literature of his profession. There can be no high excellence of attainments without this! Without this, there will inevitably ensue a retrograde, mentally and morally. Besides his continued medical study, he should take up systematically a reading course in general literature; either in the sciences collateral to medicines, such as Chemistry and Electricity, or in History or Biography or Belle lettres, and this, if only a page is read a day. One page a day carefully read would in the aggregate of only a few years make him learned in whatever department he should choose to pursue. This course of study and reading, apart from what is professional, should be carried on in his family, if he has a family, or in the presence of his wife, who would be a glad participator and equal sharer in its advantages. Household reading aloud is one of the most delightful and profitable of home entertainments.