be confirmed by further experience it would be a great practical gain, in view of the fact that a great many persons show a strong aversion to all kinds of oil, especially if they are to be taken in large quantities.

Dr. Steward said that he had been using this treatment with success for the past twenty-five years. He employs the spirits of chloroform in combination with olive-oil during the period of attack, and recommends that the oil be continued, in doses of two tablespoonfuls before each meal, for a period of several weeks afterwards.

Dr. J. C. Da Costa had not had as brilliant results from the oil as those reported in the paper. He had obtained good effects from calomel, or better still corrosive sublimate between the attacks. One of his cases was in the habit of taking half a pint to a pint of olive-oil, and is relieved in

twelve to fourteen hours. The oil seems to have a tendency to lengthen the intervals between the attacks.

Dr. M. Price said he was unable to understand how olive-oil could relieve the pain except by lubricating the biliary passages. Many stones are of a soft, non-irritating nature, and if the spasm in the gall-duct is relieved there is no further trouble, the stone passing readily except when the duct is inflamed. In cases where the stone is hard, as in cancer, no benefit could be derived from this treatment, and large doses of morphia are alone able to afford relief. He advocated abdominal section for the removal of large and hard calculi, and in cases of obstruction of the gall duct simulating gall-stones, if medical treatment proves inefficient.

Dr. J. B. Walker believed that the question was not so much what will relieve the attack as what will prevent its recurrence. In his opinion any laxative agent which promotes peristalsis and free biliary discharge will relieve the immediate attack if the stone can escape; then it becomes necessary to relieve the duodenal and hepatic catarrh. He has employed olive-oil in several cases, but with unfavorable results. The best remedy he had found for old, recurring cases where there seems to be an impacted stone, and where even cancer has been suspected from the cachexia, is spirits of chloroform. He uses this in combination with phosphate of sodium or some other sodium salt. A visit to the Carlsbad Springs is also of service.

Dr. Mays in conclusion expressed the view that if we were in search of a cholagogue to relieve attacks of biliary colic and prevent recurrences, chloroform could not be relied upon, because it had no cholagogue properties and acted simply by relieving the spasm of the bile-ducts, and by

I. INTERNATIONAL CLINICS. A Quarterly of Clinical Lectures on Medicine, Surgery, Gynecology, etc. By Professors and Lecturers in the Leading Medical Colleges. Edited by John M. Keating, M.D., and J. P. Crozer Griffiths, M.D., Philadelphia, and J. Mitchell Bruce, M.D., and David W. Finlay, M.D., London, England. Oct., 1891. Philadelphia: J. B. Lippincott Company. Like its predecessors, this goodly volume is filled with able articles upon some of the most interesting points in the entire field of medicine.

The lectures on gynecological subjects are of special practical value.

II. THE PHYSICIAN AS A BUSINESS MAN; or, How to Obtain the Best Financial Results in the Practice of Medicine. By J. J. Taylor, M.D. Philadelphia: The World Publishing Company. 148 pp.

In this practical age the volume before us strikes a keynote which must find response in every physician's mind. The author does not endeavor to inculcate principles that would lower the profession to the level of a trade, but in plain, unvarnished terms reminds the doctor that if he were a little more attentive to the business details of his work his financial results would be more satisfactory. After all, the doctor is a bread-winner. Although he justly ranks above all other men, as Robert Stevenson and many before him have said, in moral tone, he is untrue to himself and those depending upon him if he neglects the ordinary practical rules of life, as he unfortunately too often does.

This little volume should be in the hands of every working physician. It will save him much time, annoyance, and conduce to his satisfaction and happiness.

III. THE SUPREME PASSIONS OF MAN. By Paul Paquin. 150 pp.

This little volume is an honest attempt to demonstrate that the passions of man arise from inherited and acquired appetites, by avoidable stimulation or alteration of certain sensibilities, and are brought forth by environments, which are termed tempting conditions or circumstances. The author earnestly labors to impress the influence of food and drink as the chief elements of inflaming the passions, and argues intelligently for modifications, especially by the abolition or diminution of flesh foods and total abolition of alcoholic drinks. There is much food for reflection and for profitable practice in these modest pages.

THE

confirmation of the therapeutic principles of which the GAZETTE has become the exponent, viz.: Sim

Contributions upon subjects legitimately coming within the scope of THE GAZETTE will be always welcome, and if found to contain useful ideas or practical information, will be accepted for publication. Articles of exceptional value or embodying original research are especially desired, and if found suitable for the pages of THE GAZETTE, ample remuneration will be made to the authors.

All remittances, business communications, books for review, matters relating to the editorial department and to advertising should be addressed THE GAZETTE PUBLISHING CO., 1218 Broadway, New York.

Entered at the post-office, New York City, as secondclass mail matter.

Editorial.

PRECISION IN PRESCRIBING DIET AND EXERCISE.

Just one year ago we emphasized (p. 13) the necessity of careful attention to the details of diet and exercise (p. 33), in the prescriptions of physicians.

Physicians are too lax as a rule in their prescriptions of these. Too much is left to the caprice of the patient and the sympathy of the attendants. That greater precision in our dietetic prescriptions, a precision at least approximating that exercised in the administration of medicinal agents, would surely be rewarded by more positive results, is the frequent observation of men of large clinical experience. It does not suffice to tell the patient: "You must exercise to the point of fatigue; use your judgment " "The dose" of the exercise, the place, the time, the method, all these must receive as scrupulous and minute attention as we are in the habit of giving to the dose, the quality and method of administration of strychnine, arsenic and iron.

A recent able paper by Dr. J. C. Mulhall, in the Medical Record, Dec. 26, offers a practical and clear outline of the value of diet and exercise in chronic inflammations, and furnishes a manifest

complicated modes of treatment.

The author refers to the fact, which we illustrated in an article on milk-diet in hepatic cirrhosis (Jan., 1891), that there is no remedy to equal diet and exercise in the treatment of chronic inflammations. While we are not quite so sceptical regarding drug treatment as the author, we are quite in accord with him in the idea that compared to dietetic and hygienic management, the latter is far superior.

The article offers several striking clinical histories to illustrate the value of this treatment. Coming from a specialist, a member of that class whom the general practitioner commonly regards as blind to all else but the particular organ which he has taken under his protecting wing, this paper is a revelation, and the more instructive since it appears to be the offspring of conviction in the mind of one whose bent would naturally lie in an opposite direction.

When a specialist cites a case of throat trouble (p. 758), which "had disheartened the patient because he had submitted to tri-weekly local applications extending over a period of three months without relief," and ends the history by stating that "he was placed on a frugal diet, given daily severe exercise, lost forty pounds in three months, when every morbid symptom disappeared. No kind of medicinal treatment was pursued," we are justified in attentively regarding what he has to say on the much-neglected subject of diet and exercise.

Why are so many physicians neglectful in the matter of prescribing physical exercise? One reason is, I think, in their manner of recommending it. The usual advice is," You must take more exercise." This usually enters one ear, makes a faint impression on the cerebrum, and departs from the other. Exercise should be prescribed accurately, just as accurately as a drug. If the patient be told that he must walk forty blocks per day, at a certain rate of speed, this is definite advice, and so with whatever exercise is enjoined, its art, manner, duration, degree and persistence: must be explained and insisted on."

Just as with exercise, so with diet. Many physicians are not painstaking and exact in their advice.

"To simply tell a patient to diet himself is usually utterly meaningless to him. He must be informed about every article of diet, and frequently how it should be prepared. This presupposes on the part of the physician knowledge, not only of the nutritive value and digestibility of the various

foods, but also a certain knowledge of the art of cooking; for the method of preparing food creates dyspepsia as well as the nature of food. Many physicians have no time to go into such detail. I I may inform them that the great London physician, Sir Andrew Clark, takes the trouble to write out these things for his patients. He has no printed dietary. Every patient has peculiarities that modify prescriptions of diet and exercise."

The correctness of the strictures and suggestions will at once be realized by every practical physician. We are personally cognizant of the fact referred to with regard to Sir Andrew Clark. In the leading number of the present issue, this subject is fully dwelt upon, being an elaboration of the principles laid down in the editorial of the January and February, 1891, numbers.

There is no one element in the treatment of disease which is more important and yet less attended to. Hence iteration and reiteration are not out of place. Only by constant agitation may these too prevalent errors of omission be removed.

FINANCIAL PROSPECTS OF THE

PHYSICIAN.

Since the divine fiat went forth that man must labor for his maintenance, man has persistently endeavored to lighten this labor and ameliorate his condition.

In those primitive days of the world's history the command applied to labor of the husbandman. As the world progressed, other vocations arose, and the competition between the laborers became active, bitter and fierce.

The trades have long recognized the necessity of protecting their laborers by legislation. Certain rules, by which incompetent men may be kept out of them, not only protect them against unfair competition but also guard the public against wasting its means upon workmen who are unable to give a quid pro quo.

Moreover, the members of the various trades are banded together for the furtherance of mutual interests which are guarded by such wise and beneficent rules as experience has demonstrated to be of value.

The professions, on the contrary, regard themselves as superior in their aims and aspirations. Scorning the methods adopted by the trades, they have striven by all means in their power to further the interests of their chosen work rather than to improve their personal relations to it and to the public.

to the profession of medicine, it would ill become us to say aught in condemnation of this course of action, which has been transmitted to the present generation by hoary tradition.

But tempora mutantur," and shall we not say "et nos illis mutamur"? Shall we stand idle in the slough of despond, while the waves of change and progress rush past us and bid us move on or be engulfed?

This is the serious question of the hour for the medical profession.

The spirit of the times demands a change from honorable and honored tradition to the methods and manners of the active, vivid present. The physician, filled with loftiest aspirations for the welfare of mankind, enthused by the noble possibilities of his calling, must still obey the divine fiat sent forth in those dim primeval days. He has struggled long against its shackles, and he has nobly conquered. No profession can point to such a record of unselfishness, of utter disregard of danger and privation, as that of medicine. Occasionally the world is reminded of it by such utterances as that of Robert Louis Stevenson, who said in one of his recent novels: "There are men and classes of men that stand above the common herd, the soldier, the sailor and the shepherd not unfrequently; the artist rarely; rarer still the clergyman; the physician almost as a rule."

There is perhaps no class of men who suffer more silently, being conscious of the loftiness of their calling and unwilling to besmirch its fair fame. If we may judge from numerous recent utterances, however, a decided antagonism against existing conditions is growing constantly more manifest. There are mutterings of discontent heard everywhere. The time is ripe for a change in the attitude of the profession toward the public. Far be it from us to advocate a recession from the high moral ground now occupied by the medical profession. But it would seem that we might with perfect propriety descend from the lofty level in the clouds for the purpose of approaching nearer to the actualities of life as they present themselves to our daily view.

The "common herd" appreciates the lofty position of the doctor, and it is inclined to yield to him all reverence so long as its "pocket nerve remains untouched. This is testified to by their peculiar attitude regarding compensation for professional services. It is not at all an uncommon experience of the physician to be requested to make reductions from his ordinary fees for all sorts of reasons. Persons who would not dream of asking

table reasons, appeal to the doctor for such a purpose with the utmost nonchalance, evidently regarding him as the only legitimate eleemosynary member of human society.

The consequences of this "noble" status are disastrous to the poor doctor, who must needs provide bread and butter for his family quite as surely as does the tailor or grocer.

There is a muttering of discontent in our ranks, arising in all directions. The Medical Record The Medical Record recently contained a plaintive appeal from a young medical man which doubtless finds an echo in many a recently fledged doctor, and what is far more painful, in the heart of many a doctor whose hair is whitening under the burthen of his illrequited labor.

A recent letter in the Aertzliche Vereinsblatt, No. 254, which seems to be the organ of a large society, demonstrates that in other countries also the financial status of the physician is becoming sorrowful. The article is headed "The Distressing Situation of the Practical Physician." The author states that the lamentable fact that the position of the practical physician with regard to the family to which he ministers, as well as his respectability and his income, in short in his ideal as well as material interests, has suffered materially, and has led the organ of the German physicians' union to repeated investigation of the causes and remedies of the evil, which if they cannot be removed may at least be retarded. This body has endeavored to ascertain if the legislative enrolment of medicine among the trades has injured it; it has endeavored to counteract this as well as the injurious influence of the sick fund unions; it has dissuaded men from studying medicine in order to inhibit overproduction; it has advised a more rigorous examination. Whether this effort to check the decadence of the profession will succeed, says the author, "Videamus!"

One point referred to by this correspondent is rather novel. He claims that specialism is guilty of aiding the decadence of the ideal interests of the medical profession; that to it is due much of the loss of respect which was formerly yielded to the family physician. The latter, if he be not a specialist or teacher, is regarded only as a second-rate physician. Neither the physicians nor the specialists are responsible for this. This injustice is due to a misconception by the lay public of the relative work of the general practitioner and specialist.

We shall revert to this interesting point at some future time. It is mentioned here briefly only as a novel reason of the decadence of the interests of the medical profession. What, then, are the remedies for these evils which stare the doctor in the face at the very threshold of his

career and embitter his life at a time when it should be radiant with promise?

1st. The limitation of the number of new doctors by the only legitimate measure, the rigid examination of all applicants for practice. Men may be allowed to obtain diplomas in this free country ad libitum. Colleges may multiply and send out their hordes of full-fledged doctors. But the medical profession must, for its own interests, but more even for the interest of the gullible public, continue to labor for State examinations. These will, if properly conducted upon some general plan, weed out not only incompetent practitioners, whose numbers are, alas, but too large, but they will also weed out incompetent colleges by holding the latter up to just reprobation in the exhibits of the rating of their students.

2d. The course of instruction in our colleges should be (and as a corollary of the first) would be made more thorough. The exaction of a preliminary education, too, would aid in lengthening the time necessary for the entrance into practice. Thus the oversupply of doctors would be decidedly inhibited, and this would inure not only to the good of the profession, but also to the general good.

A better entente should exist among the members of the profession. We should imitate the trades. unions, who pass general laws for the protection of their members, and who adhere to them to the bitter end. Worthy struggling practitioners should be helped, just as the worthy mechanic is helped, out of a common fund, if his necessities arise, as they often do, from his strict adherence to the rules of the medical guild.

If this were done there would be fewer breaches of the ordinary rules of professional etiquette. As it stands now, the young physician, who regards the latter as sacred, is pressed aside, aye, trampled down by the more eager and unscrupulous colleague. Something should be done to enhance the solidarity of the medical profession; to weld it into a guild with noble aims and aspirations, but with a determined, practical regard for its material interests. In this country especially is such action demanded. Our government does not furnish salaried positions in universities and laboratories, which enable the ardent physician thirsting for deeper knowledge and original work to pursue these in peace, untrammelled by the "divine fiat."

The road to a comfortable income from the pursuit of medicine should be and may be made less stony and impassable, in order that young men and older ones, too, may be willing to devote some of their time to the advancement of knowledge. The lay people should be taught in season

and out of season the illimitable value of the physician's work, and the necessity of compensating him less grudgingly. It cannot be denied that a proper and constant agitation of this subject would lead to much advantage even in this practical, utilitarian, money-hunting age. May the material interests of the physician keep pace with his scientific development is our New Year's wish to our readers.

Annotations.

a day. If any pain-points remain the use of the cautery is often valuable, but is apt to interfere with massage treatment, which is so helpful at this time. At this state Mitchell employs kneading of the muscular masses of the leg, and also a gradually deeper surface rubbing in a downward direction over the nerve-trunk for half an hour twice a day. When the pain has disappeared "it is wiser for a while that at first the patient stand, aided by crutches, and then walk with them, and not sit up long, as this brings pressure on a nerve which may still be sensitive." Often the patients are thin and anæmic, and

AND COLD.

Dr. S. Weir' Mitchell states (International Clinics, Vol. I.) that in cases of sciatic neuralgia rest is a most important agent. After eliminating rheumatism, gout, syphilis, trauma and pelvic growths, and deciding that the case is one of neuritis, he considers the most certain indication is to secure rest; not simply by keeping the patient in bed, but by means of a long splint. An old-fashioned long splint from the axilla to the foot may be used, or a roughly-moulded anterior splint, with a wooden attachment carried up laterally to the waist or axilla. The ankle must be so sustained "that the heel does not carry the weight of the leg." The knee must be gently flexed, and the angle of flexion changed a very little at each dressing. After a few days of undisturbed rest all the joints must be carefully and slowly flexed and extended to a slight extent, to prevent too great stiffness, the common evil which follows the use of a splint. Only sufficient bandage to keep the splint in position ought to be used. If the patient cannot bear a long splint an anterior suspension splint may be of some service.

By this simple treatment many cases of chronic sciatica may be overcome which have defied more elaborate treatments. But if the case be not cured thereby Mitchell recommends the daily use of Paquelin's cautery button at the pain-points. If still obstinate, he employs dry cold. An icebag of caoutchouc is kept on the painful nervetract day and night for two or three weeks; or the leg is placed on a tin or copper gutter, on the under part of which is an ice case three or four inches wide. This method of treatment by dry cold, though described by Mitchell many years ago, has been little used by others. As the pain disappears the use of cold is diminished until it is only applied at night, or for an hour or two twice

ment has been employed for some time; but at first it must be avoided in order that the resting limb may not be disturbed.

As regards general treatment, iron and codliver oil are given, and milk or soups between the meals.

Strong galvanic currents may be of service in the milder forms of sciatic neuritis, but this treatment is as painful and less efficient than the cautery. If the wasted limbs do not gain in size and tone at the close of a treatment the stimulation of the induction current may aid in producing a more rapid result. Mitchell states that he has never met with a case of sciatica in which he was obliged to resort to nerve stretching. He has seen nerve stretching cure sciatica, but prefers to see what medical means will do first, and points out that nerve stretching is liable to fail like all other means. In double sciatica, probably due to caudal disease, he is more willing to think of surgical aid.

The treatment of chronic sciatica by splint-rest and dry cold, as above described, is more apt than other means to effect permanent cures, and Mitchell has many times seen it triumph when all else had failed.

Eye Tuberculosis Cured with Tuberculin.-In a report from the Institute for Infectious Diseases in Berlin, Germany, by Professor W. Doenitz, he gives the results of experimental inoculation of the rabbit's eye with pure culture of the tubercle bacillus and with tubercular tissue, and the effect upon such tubercular eyes of the treatment with Koch's tuberculin.

The report was presented to the Society of Physicians of the Charité Hospital, and a number of the animals experimented upon were shown, manifesting the various stages and results of the treatment, from the first irritative reaction to the complete cure.