in two doses of 30 grains each during the day, has often been effectual after all other measures have failed to check them. It is more effectual when given in the form of camphoric acid internally than when applied in the form of camphor or camphorated alcohol externally. Camphorated alcohol rubbed into the skin may assist the effects of camphoric acid given internally, but of the two it is the internal remedy that affords by far the greatest benefit.

Balsam Peru in the Treatment of Wounds. Sickmann reports his experiences with Peru balsam from the surgical clinic in Erlangen, in which it has been employed systematically for a number of years. The balsam proved to be very useful in all cases of accidental wounds. It is necessary, however, that all the recesses of the wound be filled with an excess of the balsam, since it only acts efficiently when any bacteria present are completely enveloped in it. No toxic disturbances need be feared. In cases of infected wounds, discrimination must be observed in its use, and this can only be gained by experience. The balsam appears to have a favorable influence in stimulating granulations.

GENERAL TOPICS.

Pregnancy and Labor of one of the Siamese twins.2-There live in Prague twin sisters, known as the "Siamese twins," who are united to each other by a solid bridge of tissue, with some cartilage and bone enclosed, in the region of the hip-joint and the brim of the iliac bone. Several attempts at separation have been suggested, but refused by the twins because they desired to exhibit themselves for money. One of the twins suffered a few years ago from cholelithiasis, and had to be operated on in the surgical clinic of Prague, where examination revealed that apart from the malformation of the connecting iliac bone, the two persons have separate and independent

'J. Sickmann, M. D., Deut. Zeitschr. f. Chir., Bd. 104.

2Jour. A. M. A., May 14, 1910.

Al

bodies and independent bodily functions. A few days ago the twins, now 36 years of age, again came to the clinic, as the former patient again suffered from colicky pains. The surgeon made a diagnosis of advanced pregnancy or rather incipient labor. though that possibility was absolutely denied by the girls, the patient soon gave birth to a healthy boy, and later, after repeated questioning, confessed. The other sister felt nothing at all of the pain of the mother so closely united to her, and when the next day the temperature of the mother went up two degrees the temperature of the other twin remained normal, showing the absolute separation of the two organisms. as regards function and metabolism.

Lactation in the Blazek United Twins.1— Considerable scientific interest has been aroused over the phenomena of lactation in the united Bohemian twins, the Blazek sisters, one of whom was delivered recently of a boy at Prague (mentioned in the Vienna letter April 28). The father of the child is the manager of the two sisters, who has exhibited them to the public for several years. The Blazek twins form a pygopagus; that is, twins joined at the buttocks; all the organs of the trunk are duplicated, except that the rectum and the introitus vaginæ are in common. Formerly the sisters menstruated for a four to five day period. During pregnancy the menses. ceased in the pregnant woman, while the other sister menstruated regularly until the last two months before the birth. It is remarkable that lactation set in not only in the woman who was delivered but also in her sister. Dr. Basch, who examined the sisters in the Prague hospital, reports this fact and its explanation in the last number of the Deutsche medizinische l'ochenschrift. (Trunececk and Baudouin also discuss the teratologic aspect of the case in the Semaine Médicale, May 18.) Basch regards the influence of the sympathetic nervous system on the secretion of milk as small. The role of the sympathetic is especially shown in the transmission of reflexes in sucking or milking which are necessary to a uniform continuous activity. of the mammary glands. The essential spe

'Jour. A. M. A., July 2, 1910.

, 1910

, Vol. V.,

cific activity of the mammary glands is independent of the nervous system. According to Basch, the growth of the breasts is occasioned by stimulant substances which are present in the ovary after impregnation, while the initiation of the secretion of milk is brought about by stimulating substances which may be obtained from the expelled placenta. According to his opinion the secretion of milk in the nonpregnant twin is to be explained by the fact that we have to do with two individuals living in parabiosis in whom the necessary stimulus to the production of lactation generated by the pregnant sister was carried by the common blood stream to the other sister with positive effect. Whether this idea will be sustained by other investigators remains to be seen.

A Chinese Triumvirate. According to the Medical Record the doctor, dentist, and barber are powerful factors in Chinese civilization. Once a week the Chinaman visits the barber for a general overhauling. First the head and face are shaved; then the ears are scraped and cleansed with a small brush made of duck's hair; third, the upper and lower eyelids are scraped with at dull edged knife, all granulations being smoothed away, after which a salt solution is applied with a duck's hair brush. It is for this latter reason that so much blindness is found in China. No antiseptic precautions whatever are taken; all instruments are held in the operator's hand when not used. Finally the patient's back is massaged; and after paying a fee of three cents (and no tip) he leaves the shop feeling clean outside. He next consults the physician. After undergoing the usual examination (a form of military inspection) the case is diagnosed and treated, unless a devil happens to jump down the patient's throat. For this the only remedy that will serve is the setting off of one hundred firecrackers, and a daily visit to the joss house. This done he receives the usual pills for those vacated by the devil; these may consist of spotted rhinoceros horn-a wonderful cure for intestinal troubles; these horns come from southern China and in the Singapore market a single specimen will bring $25. Tiger bones, ground and mixed

with Chinese wine make a valued blood tonic much used in northern China among all classes; the receipt is held by a Shanghai firm, which has become very wealthy upon it. upon it. Old deer horns are boiled down to make the medicinal glue which binds the fifty ingredients composing the average Chinese pills; in these one may get anything from a pint of gunpowder to cobra tail dust. Of equal medicinal efficiency are three high-grade tiger remedies-the eyeball, liver and blood. The genuine tiger eyeball can be prescribed only for the very wealthy Chinese; similarly the liver, dried and reduced to a powder, is worth its weight in gold; tiger blood, evaporated to a solid at a high temperature is believed by Asiatics to transform a craven into a hero. Finally the dentist is looked up; this professional will be found on any street corner in all large Chinese cities. He is very impressive by reason of his seriousness; always reading and thinking of his collection of some 2,000 teeth on a table, and a few bottles of some secret drugs said to contain the moisture of the inner side of an old coffin collected after a ten years' burial. The dentist in China is called a boxer; for he is suppposed to have great strength in his arms and hands.

A Novel Cure for Obesity. It is obvious that there can be no real cure of obesity unless the habits of life, dietetic and otherwise, undergo a radical change. Now this is what obese persons, generally large eaters, specially resent and in the majority of instances they are unable, or at any rate unwilling, to suffer the pangs of unrequited hunger entailed by the necessary restrictions. Dr. Dubois-Havenith of Brussels relates the curious case of a young

lady afflicted with polysarcia who "enjoyed her food" to such an extent that before she reached 25 years of age she weighed close upon 190 pounds. She found herself quite unable to forego the pleasures of the table, and as her digestion was slack she suffered a good deal of discomfort after dinner. On one occasion she experienced such physical distress that she provoked vomiting by putting her finger down her throat with im'London Lancet, Aug. 6, 1910.

mense relief. She was delighted to find that it was possible to conjure the evil effects of over-indulgence in so simple a manner, and so it degenerated into a habit. To her surprise she found that under this regimen she rapidly lost flesh, so much so that in three months her weight had fallen to 120 pounds. She then called attention to the fact that whereas a moderate quantity of food used to leave her with an unsatisfied craving, after deliberate emesis she was free from hunger between meals. Physiologists may explain this on the assumption that the mere act of eating "decongests" the digestive apparatus and so confers functional peace. In any event, the Romans, who were past-masters in gastronomy, knew all about voluntary vomiting, as is shown by the institution of the vomitorium, which was resorted to presumably very much for the purpose described in Dr. Dubois-Havenith's case. Of course, it is irrational to take more food than one requires, but having done so the provocation of vomiting cannot be described as unphysiological. Nature provides that remedy automatically in suckling infants whose overloaded stomachs are relieved by a timely puke, and even in grownup persons the reflex is not unfrequently called into play to avert the consequences of over-indulgence in food or drink. Whether, however, voluntary vomiting can safely be allowed in any individual to degenerate into a habit is a matter calling for careful consideration. Esthetically objectionable and morally questionable, the method is also physiologically incorrect, and it is not likely to supplant more orthodox treatment which affords a disciplinary training of value.

pitals. In accomplishing her great work which has resulted in revolutionizing field sanitation, Miss Nightingale had not only to contend with disease in the Crimean campaign, but her greatest fight was against the prejudice which existed against a woman engaging in work of that character. At the beginning of the Crimean War not a woman nurse was employed in the military hospitals. It was not until the war was over and the generals and medical men at the front enthusiastically praised her work that public sentiment was turned in her favor and she became a heroine whose fame has endured from 1855 down to the present time. A brief summary such as this cannot adequately present the work which she accomplished, but it has had the greatest possible influence on field hospitals and the treatment of the wounded in all wars that have occurred since that time. When she returned to England the British public raised a fund of $250,000 and presented it to her as a token of the esteem in which they held her. This she accepted, but not for herself. She used it to establish a school for nurses at St. Thomas's Hospital, London. She superintended this school for many years, finally retiring from active work for a much needed rest. In 1907

she received from King Edward the Order of Merit, the statutes being modified to admit of her appointment, and she is supposed to be the only woman who has been so honored. In 1908 she was given the freedom of the city of London. Although her health was never robust after the Crimean War, yet she wrote much that was of value.

The Death of Florence Nightingale.1Florence Nightingale, the heroine of the Crimean War, died at her home in London on Saturday, August 13th, aged ninety years. Her long life was devoted to the cause of saving life and relieving suffering in times of war and pestilence and to the general improvement of hospital service at all times and everywhere. To her we owe the modern system of army field hos'New York Med. Jour., Aug. 20, 1910.

SURGICAL HINTS.

In young children caries of the mastoid. process with abscess formation may occur without involvement of the inner ear, and without fever, pain or other constitutional symptoms.

Rectal feeding can usually be dispensed with after esophagotomy for foreign bodies, the patient being given small amounts of sterilized water for the first twenty-four hours, after which liquid food may be administered.

Complete Series, Vol. XVI., No. 9. New Series, Vol. V., No. 9.

The Carnegie Foundation Report on the status of American medical schools has led to an endless amount of discussion pro and con, and in certain circles at least has stirred up an antagonism that is anything but passive. On the whole the Report presents few facts that were not generally known, and many of its criticisms. and animadversions on the teaching facilities and methods of our average American medical college have been foreshadowed by numerous articles that have appeared from time to time in the medical press during the past decade. For a number of years the Association of American Medical Colleges has been earnestly striving to elevate the standards of medical education, and a record of its meetings would show very conclusively that those charged with the direction and management of the medical colleges of the country have been thoroughly alive to their shortcomings. It would be most unfair to state, or even to convey the impression that honest, faithful efforts have not been put forth to better existing conditions, or to deny that very real and substantial progress has been made in the equipment, methods-and aspirations-of practically every recognized medical school. The state boards of registration have worked consistently to these same ends, and have been particularly successful in raising entrance requirements, a fact well shown by the improved type of medical students.

It is quite apparent, therefore, that the general movement in medical education, including essentially all teaching facilities and methods, has been forward, while the substantial improvements that have been made in not one but many directions are such that graduates of even ten years' standing cannot fail to appreciate them.

If we were to assume to criticize the Carnegie Report from any standpoint whatsoever, it would be on the grounds that the very evident progress of the past ten to fifteen years is entirely disregarded, and comparatively little or no credit is accorded. the medical schools for the efforts they are obviously making to increase their efficiency. Unfortunately nothing handicaps a report or a work of reform as surely as a suspicion of unfairness and we fear the laudable motives and the really excellent, painstaking work embodied in Professor Flexner's report will fail to accomplish the good it should-for a while at least. This situation, the result primarily of the controversies it will surely stimulate, together with the suspicion of an animus against the smaller institutions, bound to result from the apparent failure to give proper credit for the advancement practically every college has made, will pass away, it is to be hoped, when the Report is more carefully studied and understood.

Aside, however, from the foregoing, it will be seen that the Report is epoch mak

ing, that it is fearless and specific in its recommendations, and should give very material aid in placing medical education on a higher plane.

standards of medical education to the highest degrees of efficiency. But what we do desire to emphasize is that the day of the small, comparatively inconsequential, medical college is by no means passed. Equipment and methods as long as the personal equation plays so vital a part, are necessarily of relative importance, and questions of locality, expense (cost of living), and expediency will continue for many a day to give the small medical college a legitimate. place in the scheme of "things as they are."

A real service has been done for the deserving medical colleges of the United States, a service that will take on new significance as the forces at work for the advancement of medicine are better organized.

Medical education, like all other branches. of learning, is largely dependent on the personal equation. In other words, if a person is intent on securing medical knowledge, the question of the institution is purely of secondary consideration. The truth of this is shown by the experiences of countless of America's foremost physicians and surgeons. How little important is

deemed information as to the medical college from which a man graduated! It is the man himself and his individual ability that commands principal interest, and no one is ever handicapped-in the public estimation at any rate-by the fact that he graduated from one of the smaller or mediocre colleges. To show how little importance is attached by even the medical profession to the institution from which the

diploma is obtained, one has only to inquire as to the college data of any of the country's

great medical men, past or present. Unless the person receiving the inquiry has specially posted himself, it is the exception to obtain a single fact concerning a man's college training, however prominent he is or may

have been.

This should not be understood as minimizing the desirability of first class institutions, or the necessity for every college to seek to obtain the best possible equipment. In no way do we wish to intimate that we are not in sympathy with the elevation of the

The most important phase of medical education is that which pertains to entrance requirements. No one who will give the matter sufficient thought will deny that rigid entrance requirements mean a higher

type of students. Better qualified students will exert a powerful influence on each institution, with inevitable tendencies toward greater efficiency. A college must respond to its students' needs, or it will very soon find its classrooms vacant. There can be no question, therefore, that establishing high entrance requirements promptly elevates every standard of a medical college, solving at once not one but many problems, and achieving true progress in a most practical and far-reaching manner. The poorly equipped candidate for a medical degree is eliminated automatically, and likewise the handicap he would assuredly place on the work of any institution he

could enter.

The crux of the medical college situation is obviously the elevation of entrance requirements to the highest possible point compatible with common sense and sound judgment.

Experimental typhoid has been produced in animals by Prof. Metchinkoff and reported to the Paris Academy of Sciences,