And later when some popular preparation appears, we find that its merit depends upon the action of some drug that has been known for centuries, probably; but a new light has been thrown on it, and we find it doing service in a hitherto unknown field. Gentlemen, it behooves us to study drugs, and to stand by those that are reliable, and have real merit, and to discard all others. And here is a plea, though feeble as it is, for purer and more reliable preparations, and a better knowledge of these.-The Charlotte Medical Journal.

INDIGESTION.

BY H. H. HELBING, M. D., ST. LOUIS, MO.

This is one of the most frequent wrongs we encounter in general practice. It causes numerous symptoms often far remote from the primary causes of disturbance, especially if flatulency is an accompaniment. The distension causes pain in the region of the heart, and the patient will feel that he has heart trouble, or he will have sharp pains in the chest and in the region of the gall bladder; and not only the patient but his physician is not sure but what the lesion may be gall stones or inflammation of the gall bladder. In most instances of this kind, by careful examination and observation we will finally conclude that it is flatulency that is causing the difficulty.

Now, it is all very well to theorize about hyperacidity and talk about stomach analysis and give a lecture about gastroptosis, giving beautiful X-ray views of the stomach containing bismuth to throw a shadow, but what are you going to do to relieve the patient? Of course we all know that wrongs of the stomach may be produced by three general causes, either a muscular weakness, a wrong of innervation, or a wrong of secretory function; but in how many cases will the general practitioner be able to tell or determine which of the three wrongs predominates? I have not found it necessary to determine this fact in order to treat such cases successfully. If possible to do so in a given case, that is the wise course to pursue; however, it was not my purpose in this brief paper to write a lengthy disquisition on the subject, but to give you two or three formulas that I have found beneficial in nine out of ten of the cases, on an average, that I have treated.

If constipation exist as well as flatulency I give a tablet made according to a special formula as follows: Charcoal, gr 2; Po. ginger, gr.; Phenolphthaleine, gr. ; Po. nux, gr. ; Sacch. lac., Oil menth. pip., q. s.

I usually give a tablet before each meal, and if the constipation is not overcome, a tablet as follows is added to each dose of the charcoal tablets: Phenolphthaleine, gr. 1; Po. irisin., gr. ‡; Po. podophyllin, gr. 1-16; Sacch. lac., Oil anise, q. s.

I find these latter tablets may be gradually dispensed with. You may have to use three or more per day to start with in obstinate cases, but should gradually reduce the quantity per day.

If constipation does not exist we may give stomachic tablets, (Dr. North) which are made by all manufacturing pharmacists, the formula being as follows: Pepsin, gr. ; Nux vomica, gr. ; Charcoal, gr. ; Capsicum, gr. 1.

These should be chocolate coated. Two of these should be taken after each meal. In some instances all three kinds of tablets may be used. The diet, of course, should be regulated and hygienic measures instituted.-American Medical Journal.

SYMPTOMATOLOGY OF GALL-STONES.

BY STUART M'GUIRE, M. D., RICHMOND, VA.

Post-mortem examinations made by pathologists of all patients dying in large hospitals and the examination of the upper abdomen by surgeons as a routine measure in abdominal sections has shown the presence of gall-stones in many cases where they were not suspected to exist. It is stated by several reliable authorities that about one person in ten has gall-stones. If this be true, the condition should constantly be borne in mind when examining a patient with abdominal trouble, and both physician and surgeon should make a thorough study of the symptomatology of the disease in order that he may recognize it early and treat it properly. It sounds like a paradox, but it is a deplorable fact that most cases of gall-stones are treated by the physician for indigestion, and that many cases of supposed gall-stones operated on by surgeons are the victims of some other disease. Mistakes in the diagnosis of gall-stones are due to all the early symptoms being referred to

the stomach and the supposedly pathognomonic symptom of jaundice most frequently due to cancer.

Indigestion is the earliest and most frequent symptom of gallstones. It is not produced by imprudence in eating, comes on without definite relation to take food, and is usually relieved by vomiting. Persistent and intractable indigestion that does not yield to treatment is usually due to some organic lesion in the abdomen, such as appendicitis, ulcer or gall-stones.

Pain located in the epigastrium and radiating to the back is another fairly constant symptom. It is dull-aching in character and varies in intensity. It is increased when the gall-bladder is distended and relieved when it is emptied.

Tenderness over the gall-bladder can generally be elicited by spreading the fingers of the left hand over the patient's ribs and hooking the thumb under the costal margin. When the patient takes a deep inspiration, the diaphragm forces the liver down and the sensitive gall-bladder coming in contact with the examiner's finger causes a sudden catch in the patient's breath.

Colic is a familiar symptom. It is due to the sudden blockage of the duct and the muscular contraction of the gall-bladder to overcome the obstruction. Colic is abrupt in its onset and sudden in its relief. The patient is doubled up in agony, he is white and cold, yet sweats. There is faintness, nausea, and vomiting.

Jaundice is not a very frequent symptom of gall-stones. Murphy states it only occurs once in seven cases. It is due to obstruction of the common duct, which may be due to its being plugged by a stone from within, but also may be due to its being compressed by a growth from without. It is a fact which can not be too strongly impressed that most cases of gall-stones are not attended by jaundice, and most cases of jaundice are not due to gall-stones.

Fever is a frequent symptom of the gall-stone disease, due to an increase in the acuteness of infection. It is marked by its rapid rise and abrupt termination. If the range of temperature be charted, it gives an appearance which Moynihan calls "The Steeple Chart," and Murphy terms "The Temperature Angle of Cholangic Infection."

Tumor or a movable pear-shaped mass which can be palpated in the region of the gall-bladder indicates either obstruction of the cystic duct with a stone and distention of the viscus with

mucus, or the obstruction of the common duct by cancer and the distention of the organ with bile.

The symptoms of gall-stones have been hurriedly and imperfectly reviewed in an effort to interest the reader in the subject. Gall-stones are never innocent. They may be quiescent for years, but sooner or later they will give trouble. Gall-stones always cause symptoms. The reason a diagnosis is not made is because the symptoms are misinterpreted.-The Virginia Medical SemiMonthly.

CONSERVATISM IN GYNECOLOGY.*

BY HOMER I. OSTROM, M. D., NEW YORK.

The most radical procedure in gynecology may become the most conservative method of treatment. Let me illustrate. Ablation of an ovary is a radical operation, but it becomes conservative if a partial removal would not effect a cure. Therefore we must in this connection alter the meaning of these terms and define them with reference to end results. So regarded conservative gynecology may with equal truth be a radical operation, or no operation, the result attained serving as an explanation of the apparent discrepancy.

I will limit the present consideration to work on the uterine appendages, more especially the ovaries. These glands are essentially the organs of femininity, the organs that determine my characters. They are not alone the glands of race reproduction, but the parts that give the physical form, the mental and psychic qualities that distinguish the female in nature. They control the normal and dominate the abnormal female. Until their development the boy and girl are singularly alike, whatever differences exist being traceable to embryonic differentiation and its natural unfolding. But as soon as ovarian activity begins, sex characters appear and continue during life as a more or less permanent impression.

The history of the development of the sex glands leaves no reason for doubting that they elaborate and continue during their activity to supply something-a secretion-that is necessary to

Read before the Section on Gynecology, at the International Homœopathic Congress, London, England, June, 1911.

maintaining sex character. By the time they have reached the period of folding up, the climacteric, the impression has been so powerful that it is stamped upon the individual and she remains a female even though past the period of motherhood. But it is an interesting fact that both men and women after they have past their sexual vigor frequently lose the finer qualities that distinguish one sex from the other, both physical and mental; in other words, they become members of the genus homo, not so characteristically male and female. They seem to tend to revert to the status maintained before puberty.

At the time of life when the gynecologist is of peculiar service every woman needs her ovaries to preserve her equilibrium. The psychoses that frequently develop during the years of ovarian activity, and wreck so many lives, that may appear at puberty when the sex function is trying to establish itself, and that sometimes attend the climacteric when the ovaries are endeavoring to stop work, are due to some defect in the quantity or quality of the ovarian secretion that puts out of joint the delicate feminine machine. Such disturbances are more due to changes in the secretion of the ovary, possibly the liquor folliculi, than to defective ovulation, two quite distinct functions of the sex gland, in which they stand alone among glands. There is little to suggest that the discharge of an ova, with all its complex mechanism, is attended with any noticeable clinical phenomena. Ova are probably thrown off irregularly when ripe and have no other function than race reproduction. Not so with the ovarian secretion which is essential to the preservation of feminine characteristics.

Experience has taught gynecologists several facts, some we have been slow to recognize. One of the most important of these facts is that not all pain and suffering referred to the ovaries, and the ovarian region, and not all neuroses associated with the functional activity of the ovaries, or connected with the menstrual molimen, can be cured by removal of the sex glands. In the early days of abdominal surgery the brilliancy of the purely surgical results of oophorectomy warped our judgment and blinded our eyes to the end sought. We rather felt that a surgical recovery was of necessity the cure of the patient, when as a matter of fact the contrary was often the case, the patient was not only unrelieved, but sometimes made immeasurably worse by our skillful work. Our mistake has been in regarding the ovary in the single