remarks as to the real utility of the new-fangled idea is met frequently with an incredulous smile from his younger brother, and even mild protest does n't always prevail against revolutionary practice. Of course, among very many new things, a few remain because they are good-and, of course, to get good wheat, chaff must be winnowed or sifted.

I take it that the essential rôle of every new generation of workers is to be enthusiasts, and rightly so. But I take it also, that the conservative views of the old and experienced men are most valuable and important in pointing out lines which observation has shown time and again to be true. This is often admitted in argument, but not followed in practice. Up-to-date in my own knowledge and experience, the following are a few important statements among many:

In throat disorders of acute nature freshly powdered cubebs, taken frequently and in moderate amount dry on the tongue, has been of more service to me than any other drug.

The local application of tincture of chloride of iron, diluted with glycerin, is a most valuable astringent and disinfectant in tonsilitis and diphtheria.

Creosote, inhalations, and moderate blood-letting, especially with leeches, are extremely useful in the treatment of croupous pneumonia. Indeed, the application of a few leeches, locally, can not be replaced by any other agent in many acute, painful inflammatory affections of different organs.

Rhubarb and soda, or rhubarb and magnesia, either in Mist. Rhei et Soda or in Gregory's powder, are two most useful combinations, whenever there are stomachal disorders with fermentation, or hyperacidity.

Of all stomachal remedies none is equal, in general terms, to certain salts of bismuth-the best of which are the oxide and carbonate the former now used in the so-called milk of bismuth.

Warm, moist applications after the application of leeches, or, frequently, when no leeches have been applied, are more soothing and more useful locally in appendicitis, pneumonia, pleuritis, and endocarditis, than the now fashionable icebag.

Castor oil is of infinite value in many instances of intestinal disorder pain, diarrhea, constipation, etc.-accompanied, or preceded, by a moderate dose of blue pill, or mercury with chalk, and does no harm, or "hardly ever."

The best and safest agents to abort a cold are aromatic spirit of ammonia and sweet spirit of nitre.

No case of obstinate malaria is treated most wisely until Huxham's tincture of bark, or Warburg's tincture, has been faithfully tried. Many obscure cases of fever, with or without recurrent chills, will yield to their use.

The best combination for mild counter irritation over chest or abdomen is obtained with turpentine and soap liniment, equal parts, sprinkled on warm flannel-with, or without, oil silk, or thin rubber tissue covering.

Trousseau's diuretic wine is the best combination for old failing heart and kidneys-in chronic Bright's disease and mitral regurgitation. It will reduce edema and prolong life-preceded by a few leeches over the precordium, when nothing else will. If it fail, our final resort is hypodermics of atropine and morphine, in small or moderate amounts—to allay pain, nervousness, distress of mind—and indeed, to give a fillip to a condition otherwise hopeless.

In edema of lungs, bronchitis, asthma, pleurisy, pneumonia, when bleeding with leeches is declined or eliminated, dry cuppingabundantly and repeatedly-is sovereign.

Compound tincture of iodine locally over chronically inflamed joints and all old adhesions elsewhere is most valuable because of its special resolutive action-Iodide of iron internally in pill form is also without a rival as a resolutive, or absorbent, in old adhesions, or to render effusions less threatening, notably subacute or chronic ones of the pleura, and where no tuberculosis is proven.

To acutely inflamed joints-to contusions, sprains, even to open wounds-nothing equals alcohol, or spirit of camphor and water, unless it be tincture of iodine of suitable strength, properly applied.

Sulphate of quinine in moderate doses is of more value and does less harm than any other agent in prevention and helpfulness as regards obscure febrile disorders where there is suspicion of septicemia.

Locally, to subdue pain where the skin is intact,-lanolin, menthol and methyl salicylate combined, and covered with absorbent cotton and a gauze bandage, are invaluable.

The electrotherm is often also very valuable and serviceable and a good substitute for the hot water bag when pain is a prominent symptom locally.

Fixation of joints with a light splint, properly padded and applied, is essential at times to lessen pain and promote cure in joint affections—especially if they become at all obstinate.

Rest in bed in acute and chronic disorders, especially of heart and lungs when fever is present-is invaluable at times, for a shorter or longer period, which may be measured by hours, days, or weeks.

The modern use of vaccines in different directions is now hopeful, but they must still be employed with great good judgment and discrimination, so as not to be soon and unduly discredited.

To what is written much might be added, but, as given, I trust it may prove of service to my juniors.-Critic and Guide.

APPENDICITIS IN WOMEN.

BY H. S. LOTT, M. D., WINSTON-SALEM, N. C.

That appendicitis is a surgical disease has been established. Failing to recognize this fact to-day, the practitioner is either willfully robbing his patient of the best that the profession can give, or culpably ignorant of the light that has been shed on the pathology, with its immediate and remote possibilities.

The presence of a certain group of symptoms greatly simplifies the problem of diagnosis in a large number of cases. They consist in colicky pain of either sudden or insidious onset, progressive and continuous, at first diffuse, but gradually localized on the right side, with nausea and vomiting at most times, and nearly always a constipated bowel. The nausea and vomiting may not be marked and the lower bowel may be easily emptied, but this should not mislead us.

This clinical picture portrays a very large percentage of the cases of appendicitis in first, or perhaps in second, attacks, and they may occur and subside without gangrene or rupture. These accidents being added, the picture becomes even more typical, with its sudden and agonizing pain, subnormal temperature, and rapid and weakened pulse.

Such cases constitute the rule, and in males a given number of them, with some slight deviation, will be very much alike; but there are marked exceptions, and these occur most frequently in young women, and this difference, with its importance, is the point most worthy of emphasis.

""T is true, 't is pity; pity 't is, 't is true" that tubal and ovarian pain is a very common thing, and especially in young women; but when we bear in mind the delicate structure of these organs and the functions they perform, it is not really so much a cause for surprise.

Let us for a moment consider the tubes and ovaries and their ⚫ close relationship to the appendix. Their normal functions, in common with those of the entire female generative organs, are accomplished in cycles of turgescence and of retrocession. Like the tidal wave of the ocean, the currents come and go. Furthermore, the muscular fibers entering largely into their structure endow them with expulsive power, recurrent, rhythmic, and without volition, to throw off an additional burden when it has reached the limit of endurance.

The arterial supply to those organs furnishes, "at times" (Deaver), a branch from the ovarian, direct to the appendix. In periods of congestion, whether occurring at the height of the menstrual wave or during the interval of retrocession, this anatomic arrangement of blood supply insures a bond of sympathy between the uterine appendages and the vermiform appendix, accounting for the obscure blend of symptoms, and also, to my mind, for the kinked or pug dog tail appendix so often found in women.

Now, this type of appendix, which seems to be peculiar to women, is distinctly pathologic and should always be removed. The attacks are recurrent, independent of menstruation, and seemingly at shorter intervals than in other forms; each one "tiding over" without the more alarming symptoms of gangrene and rupture. When we examine an appendix of this pug dog tail type, we will generally find that the lumen has been obliterated; and it would seem that we may attribute to the additional blood supply from the ovarian artery both the sharp kink in the organ and the continued vitality of its tissues through successive and recurrent attacks.

If the symptom-complex in different patients, even with a similar pathology, was always just alike, diagnosis would never be difficult or obscure. But, unfortunately, it is not, and very few cases come up to the text-book standard of symptomatology. In appendicitis, however, I really believe that the symptoms come as near to being uniform as in any condition with which we have to deal.

To recapitulate: Pain is the most important symptom of all, because its character will shed most light on the organ or organs involved. It may be of either sudden or gradual onset, often following a hearty meal; perhaps diffuse at first, but gradually becoming most intense in the lower right quadrant of the abdomen. Continuous, mark you, may be with slight remissions of severity, but continuous and accompanied with nausea and often with vomiting.

Now, these two symptoms, pain and nausea, being the cardinal ones which guide us in early cases before the occurrence of gangrene or perforation (these accidents presenting a picture of their own), let us study them a little and compare them with the pain and nausea which so frequently accompany disturbance of the procreative organs in young women. This disturbance may be either normal or pathologic, but in either case the character of its most prominent symptoms is determined by the anatomic structure and dominant functions of the organs concerned.

At the menstrual epoch, which means the height of the menstrual wave, and also signifies congestion of the uterus and its appendages, most young women have some pain, and many of them have a good deal, attended with nausea. This pain is not continuous, but, like all pain accompanying expulsive crises on the part of these organs, be it full-term labor, abortion, ectopic gestation, or an effort at expulsion from the uterine cavity of a submucous fibroid or polypus, it is recurrent and rhythmic, distinctly intermittent. The nausea also differs somewhat from that of appendicitis, in that it comes just as the pain is at its height and lasts perhaps throughout the interval.

In addition to these distinctive characteristics of the pain and nausea which accompany appendicitis in women, much help has come to me through a recognition of Morris's "Pair of Points." His conception of this reflex, sympathetic phenomenon is very beautiful, and his description of it very plain and very simple indeed. And it is that, just to the right and just to the left of the umbilicus, at a distance of about an inch to an inch and a half and deep down, lie sympathetic ganglia, sending nerves of communication both to the pelvic organs and to the appendix. Now, pain produced by pressure at both of these points with the ends of the fingers would indicate that the tubes and ovaries are most likely the main sites of its origin; while if pressure on the left is