cent., the ratio of that time. Certainly THE we can do no better to-day with opium Cincinnati Lancet-Clinic: than was done fifteen or twenty years ago. Surgery in the very worst cases of abscess or pus in the peritoneal cavity has a mortality of only 20 per cent., and if these cases of abscess or A WEEKLY JOURNAL OF MEDICINE AND SURGERY. ISSUED EVERY SATURDAY. pus in the peritoneum have the advan- J. C. CULBERTSON, M.D., Editor and Publisher. tage of early surgery the 20 per cent. ought to be cut down to 10 per cent. at least. In reference to the assertion of Schede, that the general results are better without the knife, I can only say that it is doubtful whether Schede has had the operative experience with appendicitis that some of our American surgeons have had, and therefore cannot speak ex cathedra. Hot Water and Ulcer of the The drinking of hot water has become very popular, but it is necessary to sound a warning. Dogs submitted to water about the heat usually prescribed for patients-introduced through a tube into the sthomach-were killed from day to day, and it was found that this treatment induced a hyperemic spot, which in course of time became an ulcer of the stomach. A great many cases of ulcer of the stomach occur in cooks, and it is possible it is induced by tasting hot soups, etc. I was once visited by a cook for whom the drinking of very hot water had been prescribed, which very much aggravated her condition; she was suffering from ulcer of the stomach.-ACHILLES ROSE. Prognosis of Injury at the Elbow- Be very guarded of prognosis in cases of injury at the elbow. A fracture into this joint, treated with the most far-seeing precautions, may be followed by more or less stiffness and disability. Begin passive motion as early as possible, delaying only long enough to allow the first pain and reaction from the injury to subside; in most cases this will allow some manipulation of the joint by the end of the first week.International Journal of Surgery. Annual Subscription Rates. In advance, $2.50; within the year, $3.00. Advertising Rates.-Fifty cents a line of ten words (brevier type). It is this truckling spirit to follow and keep along with popular opinion that lowers the profession in every circle. English and German alienists were astonished that in the trial of Guiteau a large number of leading specialists in this country followed the wave of public indignation, and pronounced the criminal sane. Only two physicians had the courage to assert his real condition. The medical specialist in any branch of science owes a duty to the profession to assert clearly and positively the facts he has ascertained to be true, no matter what the effect may be on the judges, jury or general public. T. D. C. When two men, equally learned, | of the present clash of opinions will differ as to the meaning of a certain set pass away. of facts, they should always be ready to give clearly the reasons for such opposite views. There should be no hesitation in defending their positions, no matter what the sentiment of others may be. The expert witness who wishes to make a good impression on the jury, or who is anxious to have his views of the case accepted, irrespective of all other facts, is a time-server and unsafe man. An author who poses as a great expert in disputed medical cases can always be made on the cross-examination to qualify and neutralize his first statements, so that they can be practically made to support both sides of the case. Another famous expert seems always on the side that can pay the largest fees for his testimony. When pressed by shrewd counsel he falls back on some very unusual ex planation of acts and conduct. NEW WAY OF SELLING BOOKS. A number of Eastern publishers have opened up a new avenue for the book trade, through the secretaries of active medical societies. The plan is to send to the secretary copies of the late medical publications, and he distributes them to the various members for examination and review. They are to be sold at a per cent. off the retail price, within thirty or sixty days, and those unsold are returned to the publisher at his expense. The member who receives a copy for review is highly flattered at this opportunity to exhibit his general knowledge of this special subject, and measure his judgment with the author of the book. He examines the book with great care, and frequently becomes interested, and buys the book for fear his rival will secure it. His review is generally negative and somewhat doubtful, or if he is less cautious it will be warm and fulsome. If he does not care for the book he will disparage it in every way, and this will rouse up a rival to examine it, and, as a rule, to buy the book. Thus all the art of selling a book is brought out uncon Physicians in the witness box who attempt fine distinctions of science, or strained, unnatural conclusions, always fail, and bring discredit upon themselves. The true expert will fully satisfy himself of the correctness of his position and the conclusions from the facts, and defend them until they are disproved by other evidence. In mental cases he will avoid fine distinctions, and adhere to general rational conclusions. Insciously by the rivalry of society memsurgical and other cases the same rule follows, only a more careful study of the facts will indicate whether the case in question belongs to the general order or is an exception to the rule. While the present methods of eliciting medical expert evidence are very objectionable, they will continue until a clearer public sentiment will demand a change. An independent medical commission will in the future determine these disputed facts, and their reports will be authoritative. Then the disgrace bers. Many of the reviewers become attached to the book, and if they can not buy it persuade their friends to do so. New books given for the purpose of reading critically become an attraction to the reviewer, and he purchases what he would not do under other circumstances. Single volumns seem most attractive, and the large encyclopedic works already begin to feel the pressure of this new method of book buying. Wood's "Practice" in one society was sold to the extent of ten copies, on the strong endorsement of one reviewer. Surgical works and monographs on various topics are bought freely. The society meetings were made interesting by all sorts of comments on all sorts of books, and an immense rivalry is roused to show the literary skill and erudition of the reviewers. Some of the reviewers write out their opinions at some length; others mark passages to read and follow it by full comments. curious This new plan has many advantages for the average society member. He is brought into close personal acquaintance with many new books, and is able to judge of both reviewer and book, and if his curiosity goes farther he can have the book to examine for himself. In this way some harsh comment on a work rouses an interest to examine it, and the result is a not unfrequent opposite view and purchase of the book. While this method has some advantages over the glib agent who is so persuasive, it has some drawbacks, in that many works are forced into the library that are never taken down to examine Infusion of sage is again recommended for the treatment of hyperidroagain. The making of books is marvel-sis in tuberculous subjects as well as ous, but the art of selling is far more wonderful, and becoming a psychological study. T. D. C. EDITORIAL NOTES.; Report of the HEALTH DEPART MENT OF CINCINNATI. Following is the statement of infectious and conta gious diseases for week ending February 5, 1897: Diphtheria..... Phthisis Pulmonalis.. Membranous Croup.. Total.. Cases. Deaths, ΙΟ 6 those suffering from leukemia, rheumatic polyarthritis and typhoid fever; in thirtyeight cases where it was tried there were only two failures. Steep forty-five grains of sage leaves in half a pint of water and let the patient take a cupful in the morning, one during the course of the day, and still another before retiring at night-or the tincture of the leaves may be given in the twenty drop doses in the morning, and from twenty to forty drops at night. Salvia officinalis 2 has a proper place in the front ranks of anti-sudorific remedies.-Medical Week. ... 3 15 5 3 26 FOR RENT-Parlors, suitable for physician or dentist, at 524 W. Seventh St. Apply 24 on the premises. Correspondence. THE SAMUEL P. POST CASE. Editor LANCET-CLINIC: In February, 1893, I was called to attend this patient, who had been sick for about a year. He presented the following symptoms: General anasarca affecting the whole body with the exception of the head and upper part of the thorax; pitting everywhere on pressure; difficulty on breathing; pulse rapid but regular, and of fair force; appetite and bowels disturbed, though stools were of good color and quantity; some pain in operations due to hemorrhoidal conditions, which had existed for years; urine free, clouding on the addition of heat and nitric acid, though this would disappear upon the removal of the gen eral effusion. The previous history of the case the case had been good. He was married, aged about sixty, in active business, and gave no statement of any previous serious illness. Under use of active purgatives large watery evacuations were produced, with an attendant reduction of the swelling; attention was also directed to the condition of the skin, so that by hot baths its activity was increased and free perspiration induced. Mercurials in the shape of gray powder, and at times the kali iodidi, were used freely, he tolerating the former better than the latter. Under this treatment he improved, so that he was able to go to his business in about three weeks. A similar course of medication was continued throughout the summer and fall until the end of December, when the swelling recurring and persisting it was determined to tap, drawing off from four to six gallons of clear albuminous fluid. Between that time and his death, January 29, 1897, the tapping was repeated twenty-two times, removing about the same amount each time. The intervals between the tapping varied greatly; sometimes it would only be the space of two weeks, then an interval of four months, and once I only operated once in sixteen months. Why these variations it was a little difficult to determine. Until quite recently he rallied very rapidly from the effects of the operation, being able to go down town to his business the next day. As in all these cases, the scrotum was involved, but in this case there was a peculiarity that was watched with a great deal of interest to determine its exact nature; on the right side, following the course of the cord from the external abdominal ring downwards may be three inches, there would occur a swelling about the size of an orange, larger at its base, that came and went with the abdominal condition. If, as was suspected, it was fluid, connecting with the cavity above, it was an ideal place to put in the trocar; if it was the bowel, then it was well to let alone. The post-mortem solved the question, and I might add caused regrets. we There was another peculiarity in this case most interesting; the cause of the general condition was determined to be hepatic, but in liver disturbances interfering with the circulation expect to and generally find enlargement of the superficial veins of the abdomen, but in this case, though looked for anxiously to confirm the diagnosis, they were never seen. The post-mortem was held about sixteen hours after death, my brother, Dr. William Judkins, and Dr. Belt, of Milford, O., assisting. Upon opening the abdomen the whole peritoneal surface was found covered with shreds of lymph, and at many points beneath the parietal layer were small collections of pus, may be the size of a pea and smaller; discharging freely on incision. The inflammatory condition had bound the various organs of the cavity more or less firmly together, and it was with difficulty that any could be removed for inspection, rupture occuring with the attempt, obliging us, as with the small intestines, which were matted together and to the structures below, to desist. The liver was firmly adherent to the surrounding tissues, its capsule very much thickened, and the organ itself reduced at least one-fourth in size, if not more; nodular; edges rounded and thickened and serrated, resisting inci sion, presenting, when laid open, the cirrhotic picture. The gall-bladder, though smaller, was open and contained no concretions. The capsules of the kidneys were adherent, the organ itself congested, though not enlarged; in the cortical substance of the left kidney were two cysts about the size of a cherry, containing a clear serum. Spleen en. larged and very friable. Stomach normal. At the lower portion of the hypogastric region, at a point opposite the right external abdominal ring, was an opening admitting two fingers extending through the ring and down into the scrotal cavity, lined with peritoneum and containining some fluid; there was no evidence of its being occupied by a knuckle of bowel, at least not recently; it was this pouch, in its filling and emptying, that caused the regret spoken of, in that we have to wait for death to find many things out. CHAS. P. JUDKINS. Nymphomania. Search carefully for local causes, such as may occasion pruritus vulvævaginitis, vegetations, vulvitis, eczema, syphilis, herpes. Investigate especially as to diabetes. Where nervous dis orders are suspected, bromides in medium doses are indicated; when associated with opium, they combat in an effective manner the exaltation of the venereal appetite. Camphor may be added, and when insomnia co-exists chloral is to be given at night. Local applications are useful. Cocaine in lotion or ointment has the preference. Hydrotherapy is indicated in all cases. When scientific douchings are not possible, applications of cold water to the vertebral column at bedtime are beneficial. LUTAUD. Urinary Incontinence. Where the urine is dark in color and concentrated, it may very often be successfully treated by dessertspoonful doses every four hours (in water) of potassium citrate and sweet spirit of nitre, each four drachms, with water added to make the mixture up to a full ounce.-N. Y. Med. Reporter. THE BRACELIN REMEDY FOR DIPHTHERIA. [After all the talk in the newspapers on the subject, and elsewhere, we are sure our readers will gladly know that Dr. Bracelin is still in the ranks of the profession and repudiates the term "secret" as applied to his treatment.] -Editor Journal of the American Medical Association. CHICAGO, ILL., June 29, 1896. To the Editor:-Diphtheria, one of the most common and the most fatal of all acute infectious diseases from which the human family suffers, has been the bete noire of the medical profession. For years investigators have been studying the disease so as to learn the cause which produces it, and, if possible, to discover a remedy which would remove the cause or modify or neutralize its effects, but without any satisfactory results. At length, after years of patient study and observation, two German scientists discovered that a certain kind of bacteria was invariably to be found in the diphtheritic deposit. They made known their discovery and now the Klebs-Löffler bacillus is looked upon as the specific cause of the disease. Since the discovery of microbic cause of the disease different antiseptics known to be destructive to bacteria have been used with varying degrees of success, but on the whole with unsatisfactory results. Medical journals and daily newspapers were filled with reports of wonderful cures effected by the different methods of treatment adopted, yet the average death rate has remained about the same. The last aspirant for professional honors in the treatment of diphtheria, antitoxine, and most generally accepted by the profession as a successful remedy, does not appear to be so useful as it was at first believed it would be. Clinical tests as reported by some are favorable; as reported by others very unfavorable. According to some reports the death rate has been lowered, but others again show that there has been no appreciable lowering of the rate of mortality. So many authentic records of sudden deaths following immediately after it had been injected, and apparently caused by the remedy, as also the constitutional disturbances undoubtedly produced by it have made many of the profession halt in their advocacy of such a dangerous remedy, even if it had proved more successful in curing the disease than it has been, they feeling that it is not safe nor advisable to use such a dangerous remedy. In my opinion diphtheria is a self-limited disease of specific origin. If, after the appearance of the disease, auto-infection can be prevented the efforts of nature will, unaided, effect a cure, but if the products of decomposition containing the specific poison of the disease (whether we believe this to be the Klebs-Löffler bacillus or the ptomaines produced by it) are allowed to the circulation the disease inenter |