with catgut. Next, the external orifice of the cartilaginous meatus is enlarged with a knife, which is made to cut upward and backward from the meatus, through the crus of the helix, so far that the little finger can be pushed through it into the mastoid cavity. The posterior wound is entirely closed with sutures (of course, black silkworm gut), and a wet gauze dressing applied, covered with jaconet, and bandaged. After-Treatment.-On the following day the dressing and plugs are removed and the mastoid cavity cleaned by means of hydrogen peroxide. The excess of this having been mopped up, the cannula is passed through the meatus into the antrum and so into the aditus, and then, as at the operation, air followed by boric lotion is syringed through. The mastoid cavity is then again dried out, loosely packed with bismuth ribbon gauze, and a wet dressing again applied. On the third day the stitches are removed, the wet dressing is replaced by a dry one, and, instead of hydrogen peroxide and syringing, alcohol is instilled for five minutes or more as required, each day followed by drying of the cavity. Instead of passing the cannula, Valsalva's method is now used to inflate the ear. This is merely a rough guide, as every case must be treated on its own merits, but I cannot impress too forcibly on readers the necessity for the use of alcohol. It is undoubtedly painful, but the whole success or otherwise of the after-treatment hangs on its use, as by it granulations are held in restraint, the mastoid cavity quickly dries up, and the perforation more readily heals. The patient need not be in bed longer than three days, and can be discharged at the end of three weeks.

This after-treatment looks simplicity itself, but to its neglect the reported bad results following Heath's operation can in the majority of cases be ascribed. Granulations must never be allowed to form too quickly, and it is absurd to attempt, as some do, to treat a Heath's mastoid like a radical mastoid and still expect good results. Personally I insist upon either dressing my private cases myself or having my

own nurse dress them daily for the first three weeks that is, until discharged and if this was only more generally done. there would cease to be any bad results for Mr. Heath's and my own opponents to publish. Given my own nurse and a first-class anaesthetist, I would guarantee, in 90 per cent, of the cases now subjected to radical operations, or allowed to continue discharging and being treated by drops, granted the absence of labyrinthine or cochlea trouble, to double the hearing power of the patient and leave it so that it was no drawback to him, whatever his occupation, and at the same time cure the mastoid disease. Your radical mastoid supporters cannot say this, but Mr. Heath and myself can say it, and we can back our opinions by results. More, I affirm that in most cases the hearing can be restored absolutely to normal by this operation. One or two more advantages that it has, of many, are that the facial nerve runs no risk of being injured, that the performance of the operation takes only a quarter of the time usually taken by the radical operation, that both ears can be operated on at one sitting, and that there is no disfigurement, and that it is applicable to every case of middle ear suppuration if taken in time.

It is useless my attempting in this paper to go into the various futile and absurd objections that have been raised to the operation, as I have already in a previous paper gone fully into them. Suffice to say that most of them are based on jealousy of the originator, Mr. Heath.

To shortly sum up: I am of opinion that every case of chronic middle ear and so mastoid disease should be operated on by Heath's conservative method as soon as the disease comes under notice. Granted the absence of internal ear trouble, the hearing can in 90 per cent, of cases be restored to almost normal. Up to date it is the only treatment, based on rational grounds, that can offer such a brilliant prognosis, and I do not think a better will be introduced for many years to come, as I cannot see that any improvement is necessary. 49 Catharine Street.

TEA TALK.

BY GEORGE M. NILES, M.D.,

Atlanta.

"The tea, that in the magic of its flow Anoints the tongue to wag of so-and-so, To gabble garbled garrulousness ere

You lay the cup and saucer down and go.

And we that now make madness in the room. Where last week's lion had his little boom, Ourselves must go and leave that flattering din, And let them brew another tea-for whom?" Omar Khayyam, Jr.

TEA, a cup that cheers but not inebriates, possesses an important place in history, literature and dietetics. It has been extolled and cursed, loved and abominated, honored and despised, and, withal, has pursued the even tenor of its way, finding a nook in the homes of the exclusive and the democratic, the blue-blooded and the hoi polloi.

All that can be affirmed regarding the early history of this beverage is that it appears to have been used for ages in China, where it is believed by the natives to be indigenous. It is mentioned by the Portuguese writer Maffei, in his Historiae Indicae, as a product of both China and Japan. The first reference to it by an Englishman is found in a letter written in 1615 by a Mr. Wickham, which is still preserved in the archives of the East India Company. It is noticeable that the Portuguese and English writers used the native cha, though Maffei called it chia.

From this time it became gradually known to the wealthy citizens of London in the form of occasional presents of small parcels from India, obtained from China, or by small lots that found their way into the markets from time to time, but it cost an exorbitant price, being worth in our money from twenty to fifty dollars a pound.

In 1657 a rather large consignment fell into the hands of a thriving and enterprising London merchant, Thomas Garraway, who established a house for selling the prepared beverage; and that house, under the

name of "Garraway's Coffee House," 'is still in existence, enjoying at this time a continued popularity.

During those years there were many tea and coffee houses, more or less fashionable, where men and women of high and low degree met and whiled away the hours over the teacups much the same as in clubs and cafes to-day.

By the early part of the eighteenth century tea became quite general in use, winning for itself warm admirers as well as bitter enemies. Among the former was Dr. Samuel Johnson, who delighted to linger long among his cronies in the various tca houses, and who spoke of himself as "a hardened and shameless tea drinker." About this time, too, John Wesley was in his zenith, and in him the loved beverage found a warm opponent. He thundered against it in and out of season, in his wrath denominating it as "one of the machinations of the devil."

It was in the latter years of this century that the never-to-be-forgotten "Boston Tea Party" occurred, and for a time the tea drinkers of the new world, from patriotic motives, either went without their favorite solace or used various substitutes. Leaves of strawberry plants, currant bushes, sage, and a shrub called ribwort were brought into service and called "liberty tea."

It was not for long, however, that the cheering draught was kept in exile, for, with the advent of better feeling among the English-speaking people, it again came into general use, and at present is drunk in nearly every corner of the globe.

It is not strange that many misconceptions should arise concerning an agent whose qualities vary so widely according to the preparation of either the leaf or the manner of brewing the beverage, and I shall briefly cover some of the points which may be of interest.

Tea leaves were primarily culled from two species of plants-Thea chinensis and Thea assamica-but at present there are numerous hybrids. Teas grown in China, Japan, India and Ceylon vary somewhat in

flavor, owing more to different treatment in curing and marketing than to variations in soil or climate. The finest tea is made from the small tender leaves at the end of new shoots, each succeeding pair of leaves upon the branch furnishing a different and less valuable grade. Three or four pairs of leaves or grades are gathered, the various kinds being classified as green or black, according to the method adopted for curing them. Black tea is made by "withering" the freshly picked leaves in the sun. They are then mashed and rolled, in order to break the fiber and cells of the leaf and liberate their constituents. After this the leaves are gathered together and fermented, during which process a part of the tannic acid in them is made less soluble, and the essential oils are modified in character. They are again exposed to the sun, and finally are "fired" or dried in the oven.

Green teas are withered in pans that are at a temperature of about 160° F.; they are then rolled, withered again, sweated in bags, and finally slowly roasted. By the process of preparation through which it passes, green tea contains more than twice as much of the astringent tannin as black tea, and, consequently, is regarded as less wholesome than the latter. It is also believed to have a somewhat less stimulating effect upon the nervous system, though this can hardly be accounted for by the slight change in the percentage of thein contained therein, this substance being the alkaloid or active principle chiefly responsible for the exhilarating influence of tea upon the nerves.

The thein of tea and caffein of coffee are chemically identical and much alike in action, though not entirely so. Experiments on frogs have shown a marked difference in their effects, for while thein will produce convulsions, caffein will not; also, thein destroys the sense of smell early in the poisoning stage, but caffein does not at all unless in the very last stage.

The peculiar stimulating properties which tea possesses, as well as its color and agreeable flavor, depend on several factors,

among which are the season of the year at which the leaves are gathered, the age of the leaves, and the skill, manual or otherwise, with which they are prepared. The flavor arises from volatile oils which develop during fermentation, and it is in these minor substances that the many differences arise distinguishing good from bad tea..

Both the aroma and flavor of tea are often artificially increased or altered by the addition of such sophistications as the leaves of orange flowers, jasmine or roses. In addition, much depends on the water in which the tea is made, as to whether it is hard or soft. Soft water extracts more of the soluble material of the leaves, yielding a beverage of a darker color. Water containing much iron or lime salts should be boiled with carbonate of soda before it is used for making tea.

There is much art in brewing good teathe art which preserves the delicacy of flavor, the beguiling aroma, and the gently stimulating effect. The best authorities. claim that the water should be poured upon the tea leaves when boiling, and the infusion should not last over three or four minutes, lest by longer infusion materials should be extracted from the leaves which, while making the tea appear stronger, markedly diminish its delicate taste.

The effects of tea naturally depend on the amount drunk, the strength, the quality of the tea, the condition of the digestive tract, and the age of the drinker. Like all other beverages containing a stimulating principle, it tends to produce an habitual craving, so that some individuals suffer from "tea inebriety" as from other stimulants.

When tea disagrees, or when it is taken. to excess, the ill effects are referable to its action on the digestion and nervous system. If taken in large quantities with meals it precipitates the digestive ferments, retards the activity of the stomach juices, occasioning gastric irritation, and in many instances inaugurating a gastric catarrh of indefinite duration. Copious draughts

of black tea, strong in tannin, are productive of constipation, followed by flatulence, which, in turn, is responsible for abdominal distress. The malign effects of too much tea on the nervous system is manifested by alternate exhilaration and depression, restlessness, worry and insomnia, sometimes merging into sensory disturbances, muscular twitching, palpitation, irritability, and a general sense of ill being, unless the nerves are highly strung up by the thein.

The temperament of the individual largely governs these evil results, for those of robust physique, who are out in the open, and who perform manual labor, do not suffer, as do the weak and fragile tea habitues, who sit around the fireside, sipping cup after cup, indulging in endless smalltalk, who depend on "tea and toast" to keep warm their bodily furnaces, instead of good red meat and other wholesome viands

these are the "tea tipplers," who lapse into miserable, sickly slaves to the drink that should be simply cheering and re-. freshing.

Under favorable conditions, and when drunk with judgment, tea has many advantages, rightly filling a niche only secondary to that other universally loved beverage-coffee.

It is mildly stimulating to the nervous system, refreshes the mental machinery, and relieves bodily fatigue. For headache arising from "run-down nerves," it often affords prompt surcease, and during treatment for chronic opium or alcoholic habituation it is most helpful.

Some of the effects of tea are not strictly due to its action on the nerves. It in troduces into the system considerable hot water, when taken hot, flushing the kidneys, encouraging perspiration and aiding in keeping up bodily warmth, if too cold, or aiding in reduction of temperature by increased evaporation from the surface if the body is too warm. Hot tea, also, will augment the action of an early morning aperient, though this may be in the main due simply to the hot water.

satisfying and soothing after reaching a period of life when the functional activity of the stomach is gradually weakened. At this time, when "the shadows are lengthening" and the digestive department finds difficulty in furnishing a sufficiency of heat and energy units, generous libations of tea often cheer up the flagging stomach and intestines, enabling them to better perform their necessary tasks.

The refreshing effects of tea when taken into an empty stomach after bodily fatigue may continue three or four hours, a period considerably longer than that bestowed by coffee, wine or whiskey. In excessively hot weather, nothing is more delightful than tea, ice cold, sweetened to suit, with a few random drops of lemon juice that impart a certain piquancy to the taste.

On the whole, this gently exhilarating beverage has much to commend it, and, unless taken unwisely or to excess, lends a gentle stimulation, bracing up tired nerves, toning relaxed muscles, bestowing good cheer to the strong, renewed energy to the weary, solace to the aged, and comfort to its numberless devotees in every quarter of the globe.

920 Candler Building.

INFANT MORTALITY. BY MR. WILBUR C. PHILLIPS,

Milwaukee, Wis.

THERE is no need, before any socially intelligent audience to-day, to emphasize the fact that there is a problem of infant mortality. Men and women throughout the country, as well as physicians and social workers, are fully aware of the horrible waste of infant life which is going on, and realize that something must be done immediately to prevent it.

especially, as I see it, to the problem of see it, to the problem of saving the lives of the babies right here in Milwaukee.

In any discussion of infant mortality, it is essential at first to show clearly what are the causes of this high death rate. After this has been done, a remedy can be suggested.

Those who first devoted themselves to saving the lives of the babies began by distributing clean milk. Certified milk and pasteurized milk were at that time held to be the great cure-all. Milk stations were established, free tickets were distributed, and much attention was given to this phase of the question.

After a while a few physicians began to wake up to the fact that although babies were fed on the purest bottle milk, they, nevertheless, continued to die in large numbers. Mothers might be ever so exact in the selection of formulae, but if they fed their babies, in addition, on pork or some other highly indigestible food; if they fed them irregularly, or if they did not bathe or dress them properly, the babies, in spite of the correct formulae, would die. Much, therefore, began to be said about "ignorance" and the education of the mother, and prophylaxis, and again it was felt that the final step had been taken of the development of knowledge along this line.

Still, the babies died, and new reasons had to be found. Pure milk and the education of ignorant mothers, it was now claimed, were not enough. After all, breast milk was the thing which was going to reduce infant mortality. A cry of back to nature was raised; for was it not true, as German statistics and statistics of other countries showed, that from 10 to 20 bottle-fed babies died to every one baby fed on the breast, and that 95 per cent. of all mothers could breast-feed their babies if they were only helped to do so?

As is usually the case, the advocates of pure milk, of prevention, education and prophylaxis and of the encouragement of breast feeding, all have right on their side; but the solution of the problem of infant mortality will never be accomplished sing

ly by the advocates of any one of these principles. More and more we are being forced to recognize that clean milk, such as physicians recommend for infants, is an expensive commodity, beyond the reach of those who need it most; that breast milk is even more expensive, because too often it depends upon release from labor which, whether remunerative or unremunerative, is still a necessity for the family; and that the very ignorance of the mothers must be laid at the door of our failure to grasp the highest concept of an educational system which now forces children to learn many things which are distasteful to them and which they speedily forget, while mothers who love their babies are left to kill them daily because no adequate instruction in their proper care is provided.

The burden of infant mortality falls not upon the milkdealer, not upon the physician, not upon the nurse or social worker, not upon the mother or the "little mother," not upon the wage-earner, but upon the state which permits each year the spectacle of the sacrifice of the babies to pass unnoticed, while it gives its attention and advocates large sums of money to street paving, commercial improvements, public buildings and buildings and the prevention of hog cholera.

It is not for philanthropy to trifle with this important municipal problem; it is too vast, too serious, to be approached in the manner of the lady or gentleman bountiful, or to be studied by the amateur.

This problem can only be solved by a municipal plan which takes into full reckoning the efforts of all institutions, hospitals, societies and agencies working with mothers and babies, and which directs an organized movement to prevent the wholesale waste of its future citizens.

Careful study should be made by our cities of the means for the care of sick babies in hospitals and dispensaries; for the adequate confinement of mothers, and for the care of the babies of those unfortunate women who are without husbands or who are prevented by the ruthless hand of society from nursing their own babies,