from the face. The whole trend of experience is the other way; all I say is that too much treat must not be laid spor the face, for we are apt to deceive ourselves and be deceived by excessive reliance upon the physiognomy. Many attempts have been made to read temperamental traits from the face, and faces have been divided into the square for the bilious and lymphatic, tapering for the sanguine, and for the reflective an 1 introspective the so-called melancholy face; but it hardly need be said this question of expression implies a much more complicated inference than seems to us on the surface, for we have the square jawed midnight marauder the typical "Bill Sykes," and we have the tapering face of this man's tool-viz., the sneak thief, who is content with minor achievements, such as stealing purses and picking ladies' pockets in the intervals of loafing. There is no doubt the physiognomy has been greatly exploited as a field for information in regard to character. As an expression of the emotions it is certainly of value, particularly of those fundamental emotions relating to pleasure and pain, for the face, like the barometer, is a good indicator of existing emotional weather, but too much. confidence must not be placed in the face as the chief interpretative medium of character. In regard to the elements of the physiognomy, the eyes are looked upon as the "pole-star" for those who seek guidance as to the emotions; the eyes of Chatterton had "fire rolling at the bottom of them," and those of Burns were "like coals of living fire," and Sir Walter Scott's "literally glowed"; but the hand is also a valuable guide. Nevertheless, I am inclined to think that the most reliable element in the face is the mouth. Possibly the more fleeting and transient feelings of the moment are better reflected in the eye; whereas the fixed, firm, decisive, and permanent constituents of character are in the mouth. We all know the roving eye which looks

upon everything and sees nothing, and we recognize the inconstancy conveyed by the shifting eye.

As to the general mental disposition, we rightly associate the different emotions-e. g, joy, caprice, anger, fear, and ambition-not with the bony framework of the face, but with the more mobile features controlled by the muscles and nerves of the face. It is the tout ensemble, the whole assemblage of the visage in which we see emotion and which rightly show character. For instance, we know one person to be suffering from melancholia, another from mania, a third from dementia, a fourth from confirmed epilepsy, and a fifth from general paralysis by outward facial characteristics. A sixth, perhaps a summary of all the others, which forms the basis of the insane temperament, gives, on the other hand, no indication by physical signs-i. e., one needs to find out the mental reaction to ascertain the temperament. Neither the highest powers of the microscope nor the most skilled chemist would be able to say that a person possessed the temperament of the paranoiac, who is the most dangerous as well as the most chronic of all the varieties of insanity. For this it is necessary to ascertain the mental reaction.

Classification Based on the Mental
Reaction.

The mental reaction or tendency to act must be taken as the only guide to the temperament or the personality, and mental reaction originates primarily out of the master structure-viz., the brain, which gives to the individual the form of character or the conduct he tends to. The brain of man differs from that of the lower animals, and there is also a racial difference, for the brain of an Englishman differs from that of a Chinaman. There is a diversity in shape, weight, size, quality, and convolutional pattern, and a corresponding diversity is seen in their mental reaction.

APPENDICITIS AND LIFE INSURANCE.

F

AWCETT does not altogether agree with the condition laid down by an American office that an applicant must have been free from an attack of appendicitis for a period of two years ere his application would be considered. Several medical authorities take a similar view. The author makes the following points: (1) The risk of a second attack of appendicitis occurring is a diminishing one. (2) For practical purposes some limit of time must be fixed at which the risk reaches zero, and for that purpose a period of five years is suggested from the termination of the first attack. (3) Some additional rate must be fixed to the premium to cover the risk for these five years. (4) Whatever the rate fixed may be, in the case of an applicant who is going abroad or who will be out of the reach of skilled assistance at least double the fixed rate should be charged. Fawcett proposes to tax those cases in which appendicitis has occurred by an addition to the premium for a period of five years of 1 per cent. on the sum assured. This is thought to be a better plan than to create a debt on the policy; first, the insurer gains thereby the full value of his policy for a comparatively small extra cost considering the risk the company is taking; secondly, there is no dissatisfaction on the part of the beneficiaries, as there would be if after the death of the insured in the first year or two they found they were entitled to only half or three-fourths of the sum for which the deceased was insured on account of the debt on the policy.

In the case of relapsing appendicitis the author suggests postponing the application until after the vermiform appendix has been removed, or else the determination of a rate to cover the risk of

operation. Fawcett thinks such a rate might be recommended as would cover a possible claim of 2 per cent. of all cases in which the vermiform appendix is removed during the quiescent period, and this would be met by a single addition of 2 per cent. on the sum assured.

In the case of an applicant accepting the terms but not undergoing an operation and dying from appendicitis within twelve months Fawcett is of the opinion that the risk of such an attack is so exceedingly small that the company might accept it. In the case of a proposer who at the end of a year, when about to pay his second premium, was found not to have submitted to operation, it is suggested that 2 per cent. be added each year to the premium for the first five years and 1 per cent. for the next five years, unless, in the meantime, a certificate shall have been received that the vermiform appendix had been successfully and completely removed, when no further extra premium would be required.

In the case in which an abscess has been opened and the appendix not removed, if the operation wound has healed and the applicant appears in all ways sound, acceptance might be reasonably granted three months after operation with an addition of 1 per cent. on the sum assured for two years. Twelve months after the operation risks might be taken with 1 per cent. on the sum assured for one year. After eighteen months to two years from the time of complete recovery from the operation ordinary rates may be charged. In case of appendicular abscess in which the appendix was removed at the time of the operation, if all is satisfactory at the end of three months, the applicant might be accepted with an extra 1 per cent, on

the sum assured for one year, and after a year has passed at ordinary rates. In a case of appendicular abscess ruptured spontaneously and not operated upon, no applicant, even in the simplest case, should be accepted until at least six months after complete disappearance of all signs and symptoms of appendicitis or its results. After that an addition of 11⁄2 per cent. on the sum assured for the next two years would be a reasonable one to make to cover the risk involved.

Cases of general peritonitis (a) with or (b) without a localized abscess and removal of the appendix: (a) Νο cases should be accepted at an earlier period than twelve months after the operation wound has soundly healed. If the case is one in which simple drainage has been carried out and the appendix has not been removed, then some such addition as 12 per cent. might be charged for two years and no case accepted earlier than twelve months from date of operation. (b) In severe cases at least two to three years' immunity from symptoms should be required before acceptance is considered, and for the next two or three years, at any rate, some addition would be necessary to cover the risk-possibly 1 per cent. on the sum assured for the period mentioned might suffice.

TREATMENT OF TUBERCULOUS
GLANDS.

Bennett, in the Practitioner, holds that the treatment of the primary adenitis in the case of tuberculous glands is the healing of the focus from which the infection is drawn. Assuming that no focus of infection can be found, and the gland principally involved persists in the rising and falling habit, or continues to increase, and indeed if it does not diminish, its removal is strongly indicated, not only on its own account, but with a view to the prevention of further infection of neighboring glands. Should other glands have already become involved, they

should certainly, when the main gland contains, as it often does, a small abscess, be also removed, as they will frequently be found to contain a suppurating cavity, although they may be insignificant in size.

The primary source of infection having been cured or become non-existent, if an affected gland does not diminish, although it may not for a long time increase, it is very suggestive of invasion by tubercle; this suspicion may or may not be confirmed by the opsonic index or other tests. Assuming for the moment that evidence is forthcoming which would justify a diagnosis of tubercle, the methods available for treatment are for practical purposes the tuberculin method, the open-air and climatic method, an:l the traditional treatment by drugs and specialized nutriment. For working purposes these are in some degree generally combined, but for purposes of discussion it is convenient to consider them separately.

Tuberculin in the author's experience is of little service except in the very early stages of bacillary invasion.

As to the open-air and climatic method of treatment, the author considers continued residence at the seaside, or preferably on board ship, infinitely more beneficial than treatment at high altitudes. It should be noted, however, that children born and living at the seaside developing tuberculosis there benefit vastly by change inland, and in the same way that those who develop tuberculosis inland derive benefit from a change to the seaside or shipboard. It is also true that a child having left its place of birth to reside elsewhere will, if it develops tubercle, derive more benefit by a return to the place of its nativity than any other place, provided of course that its birthplace was not a crowded town or an obviously insanitary locality.

As to local treatment, the less a tuberculous gland is worried by local applications, the better. Painting by iodine is

as useless as unscientific. The production of hyperemia is sometimes beneficial. Arsenic and iron are the drugs of main service given internally. During the stage of softening and suppuration in all cases in which the capsule is intact, the gland should be removed completely by dissection, and when possible whole. When the broken-down contents have perforated the capsule and invade the surrounding parts the matter is different, as in many cases anything like a formal removal by dissection is not feasible, and is generally unnecessary, since a complete cleaning out may be accomplished by the curette. Thereafter a small drainage tube is desirable for twentyfour to forty-eight hours.

CHRONIC GONORRHEA IN WOMEN. Norman P. Geis, writing in the International Journal of Surgery, considers a gonorrhea chronic when in mild cases it lasts beyond four weeks and in severe beyond six weeks, and then always owing to complications. An untreated case is always chronic, for the longer patients go on without treatment the deeper the germs penetrate. Gonorrhea is never chronic from the beginning. The infection at times is very mild, and the woman's attention is not directed to her genitals because the irritation is slight. Mild gonorrhea may be taken for a leucorrhea only, as the latter is common in all women. The gonococci may appear to be absent for a time from a chronic case only to reappear, and this may continue for years. They, in fact, do not disappear, but are few in number and located in the glands of Skene and Bartholin or in the cervix. Irritations of various kinds stir them to activity again. Childbirth is a frequent cause. ered resistance of the body in general will also start them into reinfection.

A low

In treating a chronic gonorrhea or a reinfection from an apparently cured chronic case, build up your patient. Often the failure to cure these chronic cases

is due to overlooking the fact that the gonococci have lowered the resistance powers to a marked degree. Look beyond the local condition; remember that an anemic genital canal cannot resist infection and the deep penetration of the cocci. In several cases, because of lack of proper nutrition, the author was not able to effect a cure in seven to nine months. These women finally, after receiving proper nourishment and with the help of large doses or iron, improved in their resistance power. Two months after the anemia was gone all were cured.

The local treatment is directed to the parts that remain infected. These will be discussed under their respective headings.

Urethral gonorrhea. When chronic, this condition is always due to infection of Skene's glands. The expression of a drop of pus from the gland or of even a watery fluid indicates the source of infection.

Irrigation of the duct with picric solution with a hypodermic syringe and needle with a blunt point will clear most cases. It is at times necessary to lay open the whole duct with the knife. Paint the opened duct with 95 per cent. carbolic acid followed sixty or ninety seconds later by alcohol. Apply a dressing. wet with the picric acid solution, and continue its use till healing takes places. If an abscess forms in the duct, open and treat it as above.

Gee cataways ohtam the picric ad man from the cerix at the next treatment, and dla proses hat the canal from the tampon.

A chronic gonorrhea will take from eight to twelve weeks to get well. Geis does not consider a case cured until all discharge has ceased and the following tests made with negative results:

1. Microscopical test of the expressed 1 kone's glands, three or four smears. 2 Same tests from Bartholin's glands. 3 Micri-copical test from a tampon placed against the cervix and left in place forty eight hours. This is to be removed only by the physician and two slides smeared for examination.

These tests are made two days apart. It, therefore, takes about ten days to complete them. Only then can a cure be claimed.

GYNECOLOGICAL HINTS.

Ralph Waldo, in the International Journal of Surgery, gives the following advice:

them strong and we derelined, after birth to own or three children they id and bareri At me time I treated a large her of women why had been a very short time la par cra try, and in other class have I ever seen so general and extensive uterine disease as the result of partitive.

Don't use vaginal dreches after labor unless there is a special indication for them. If you do, the process of repair that is taking place in small abrasions in the irepneum, vagina and cervix will be materially interfered with.

When indicated. a dull curette as large as can be easily passed through the cervical canal of a puerperal uterus can be safely used, and will accomplish all that is necessary.

The puerperal uterus has been many times severely injured with the sharp curette. There are many instances where a curette has been pushed through a soft uterus; it is impossible to pull one through. Therefore, great care should be used in introducing the instrument into the uterine cavity and all force should be avoided in pulling it out. This little precaution will prevent many a perforation of the uterus.

A large percentage of puerperal infections start as wound infections, and usually originate not far from the vaginal outlet.

Strictest antiseptic precautions at the