a case of laryngeal tuberculosis. It records the results of treatment in over 300 cases. Internal medication is left to general works on practise, and only local treatment is toucht upon. Nearly five pages are devoted to prescriptions for intratracheal injections. The work is a gem. The colored plates are superb. The book contains 60 pages, with an index. The author omits nasal troubles, since "my experience is that the nose must be left alone as long as the patient shows signs of phthisis." The text is not voluminous, but is ample for the field the book seeks to cover. It is suited to the specialist, but the general practitioner who assumes charge of such cases cannot well dispense with it.

A. L. R.

International Clinics, Vol. IV., Tenth Series, 1901. Edited by Henry W. Cattell, A.M., M.D. Publisht by J. B. Lippincott Company.

Contains an interesting article on The U. S. P., by H. C. Wood, M.D., LL.D. Mosquitos and the Prophylaxis of Malaria, is treated by Prof. Grassi, of the University of Rome. The Symposium on Genito-Urinary Diseases is completed. There is an interesting article on The Role of the Blastomycetes in the Etiology of Cancer, by Prof. Roncali, of the University of Rome. Numerous abstracts are made from the clinics of John B. Deaver, on various subjects. The International Clinics need no laudation. It is now a question whether any one volume is better than its predecessors. This volume is a very practical one.-A. L. R.

A Text-Book of Ophthalmology. By John W. Wright, A. M., M.D., Professor of Ophthalmology and Clinical Ophthalmol. ogy in the Ohio Medical University; Ophthalmologist to the Protestant Hospital, Columbus, Ohio; Member Ohio State Medical Society: Member American Medical Association. Second Edition, thoroly revised. With 117 illustrations. Publisht by P. Blakiston's Son & Co., 1012 Walnut street, Philadelphia, Pa. Price, $3.00.

Three hundred and seventy pages, with an index. Originally written for the student for class work, this edition has been remodeled to meet the requirements of the general practitioner. The more common eye complaints have due consideration, and the rudimentary tests are given in detail. A chapter is devoted to color discrimination in examinations for railroad service. The book appeals more particularly to the general practitioner, and is well suited for ordinary needs. Six pages are taken up by illustrations of instruments used in ophthalmic operations. A 27-page glossary will dispense with a dictionary. Seven of the old reliable formulas for common complaints are given. Good authorities are freely quoted. The book is well adapted for the purposes intended; not too pretentious, yet sufficiently complete. We can commend it heartily to such practitioners as may not have the more voluminous works.-A. L. R.

The Treatment of Fractures. By Chas, L. Scudder, M.D., Assistant in Clinical and Operative Surgery, Harvard Medical School. Second edition, revised and enlarged. Octavo, 433 pages, with nearly 600 original illustrations. Philadel phia and London. W. B. Saunders & Co., 1901. Polished Buckram, $4.50 net.

The reader is induced to be self-reliant in emergencies; and this is the secret in treating fractures. Details are given minutely, and all the newer methods are clearly illustrated; there are nearly 600 cuts. The work has been accorded more than the customary enthusiasm tendered exceptionally good books, because the value was evident. Careful revision is evident. The greatest change in this edition has been in the reproduction of x-ray plates. We have some doubt as to their actual value, when presented in this form; but no other work puts out better. There is no better work on fractures. This edition has been somewhat enlarged. We are certain that it has been improved. There is no physician who can afford to be without it. We tried to induce our readers to buy the first edition, and we can proudly repeat our commendation.

-A. L. R.

Diseases of the Nose and Throat. By D. Braden Kyle, M.D., Clinical Professor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia; Consulting Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital. Second edition, revised. Octavo, 646 pages; over 150 illustrations and 6 lithographic plates. Philadelphia and London, W. B. Saunders & Co., 1901. Cloth, $4.00 net.

The first edition of this work was exhausted in less than a year. The author has accordingly taken the opportunity of thoroly revising the book and bringing the subject matter absolutely down to date. The work presents the subject of Diseases of the Nose and Throat in as concise a manner as is consistent with clearness, keeping in mind the needs of the student and general practitioner as well as those of the specialist. The illustrations are particularly fine, being chiefly original. With the practical purpose of the book in mind, extended consideration has been given to details of treatment, each disease being considered in full, and definit courses being laid down to meet special conditions and symptoms. We commended the book highly in its first issue, and take this occasion to again praise the concise yet clear and complete method of preparation. It will continue to have a large sale. It is well suited to the needs of the general practitioner, yet most specialists may use it with advantage.-A. L. R.

Our Monthly Talk.

Concerning the capture of Aguinaldo by Gen. Funston, the N. Y. Evening Post says that "if there are those who regret that deceit and trickery and the use of traitors were necessary to the capture of Aguinaldo, we must point out to them that this is a legitimate part of warfare, which legalizes nearly every practise that is regarded with abhorrence among civilized men in time of peace." The destruction of morals is perhaps the greatest of the many evils that accompany war. If only the heroic were fostered, and if only high standards of honor and integrity were practised in war, we could look upon the physical destruction and distress with much less horror. But when we think of how deceit, cunning, treachery, forgery, lying, etc., are lauded to the skies when they result in the (Continued over next leaf.)

be a very poor and unsuccessful doctor who could not influence 20 votes; and two million votes would do anything. Five hundred votes per doctor could he counted on if every physician workt. But before the voting comes the "wire pulling." We have the strength here, too, if we but use it. Note how the doctors defeated a candidate for the United States Senate in one of our western states; only because he had abused them.

We may well afford to follow the plan evolved in Germany. The doctors of the United States can do it without perspiration, if they will. Let every physician write to his assemblymen and State senator; let him get ten of his friends to do the same; let him repeat the dose at least three times in each session, and each state will soon have such a law. Such a united effort will defeat the lobbying of the nostrum vendor.

Random Polypharmacy.

"Shot gun prescribing" is not only crude and unscientific, but is in many cases undoubtedly harmful. Many good physicians are guilty of it occasionally, and many poor physicians never prescribe in any other way. The recent graduate who has been thoroly grounded in materia medica and therapeutics is usually a much better all around therapeutist than the practitioner of years' experience. A distinguisht professor of therapeutics (at the time he was a quiz-master) told his students before examination, "Boys, yon know more therapeutics to day than you ever will in your life again." His assertion was greeted with roars of derisiv laughter, but the majority of his class that day know now that he spoke the truth.

Such a condition should not exist. That those who live in the practise of therapeutics, and by such practise, should allow themselves to abandon their only weapon, seems incomprehensible. No doctor ever knew too much about therapeutics; the fine shades of difference between the action

of different members of the same class of drugs may mean the difference between life and death. All expectorants are not alike; heart stimulants differ in more ways than in time of action and duration of effect; any cathartic that will move the bowels will not always act with the proper effect on the liver, rectum, duodenum, kidney, or stomach. No man can be a really capable physician, who does not know all that is known of the action of each drug which he uses, upon every organ and function of the body. Using a drug of which he is in partial ignorance, only for the purpose of securing a certain effect, he may do infinitly more harm to some other organ than the good he does along the line on which he aims. Shall medicin never advance beyond the powers and limitations of cathartics, anodynes, and stimulants? The doctor who relies upon calomel, quinin, opium, strychnin, and ammonia, is practising in the twilight of a past century; the doctor who throws a lot of the newer drugs into a combination "for something," and of the action of the individual constituents of which he knows but little, is practising without much light of any age, and absolutely without reason.

Such formulas as the original Warburg's tincture are now but a joke among educated medical men; yet that same notorious example of senseless polypharmacy has accomplisht great good and saved many lives. The doctor who never used anything but calomel, salts, opium, ammonia, and quinin, and did not know anything about the actual action of any of them, is often held up by the laity as a marvelous master of medicin who could accomplish all things possible. The brainless quack, devoid of skill, has accidentally thrown together drugs of whose action he knew practically nothing, and evolved a combination which skilled and educated science has never excelled. The formula for the favorit embrocation of one of the greatest hospitals in the U. S. was given

by a quack to a patient with instructions to "write the ingredients down, himself;" the "doctor" could not write! Noting such facts, we can only subscribe to the fact that "The Almighty is kind to fools." But in such subscribing we can find no shield or excuse for random polypharmacy on our own part. It is our plain duty to study, and keep studying, every drug which we habitually use. It might be that when we know enuf about it we may abandon it altogether.

It is not the prerogativ of any practitioner to use a drug when he wants a patient purged, unless he has full knowledge of the action which that drug will have upon all the organs. It is neither rational, right, nor reasonable to combine a lot of expectorants in a "cough mixture," before estimating the influence which each drug will have upon the various organs. Nor is it sane or sensible to use a cathartic which irritates the colon, in a case of proctitis. Digitalis is far Digitalis is far from being any better than is strychnin as a routine drug in "heart trouble." It is important to make full use of all the knowledge and brain power one may possess when prescribing.

It were better if the physician knew thoroly a few drugs, than to have heard of the reputed virtues of a multitude. "If one misses, another may hit" is but the assertion of the ignoramus or imbecile. The ones that "miss" will certainly hit somewhere else. The drugs ordinarily employed are not inert; they are used because we know that they will certainly produce an effect. We know, too, that the same drugs used in cases where they were not indicated, or where they were strictly contraindicated, would be certain to produce untoward effects. Keenly edged tools are to be handled with care. Random polypharmacy is irrational and wrong; let us first learn to know our steel, and then use it most skilfully.

Please write immediately, for July issue, concerning your usual practise during July.

Insomnia.

There are few more distressing cases than those of obstinate insomnia. The patient who suffers pain is less to be pitied than the patient who suffers from protracted insomnia. It is not in any sense a disease, and is not to be treated as such. This is where many physicians err; they "give something to get the patient sleep." What should have been done, was to have searcht for the cause why the patient did not sleep naturally. This cause is often hard to find; it may be concealed in organic disease, or it may be only result of digestiv indiscretion. It is, however, certain that no treatment of insomnia can ever be satisfactory to either patient or physician, which does not rest on the treatment of the foundation cause. hypnotic is yet known which will certainly bring sleep, and yet leave no bad after effects. We have many good hypnotics which can be depended on in emergencies, but the cases which drag out over weeks and months can not take any one of these with satisfaction for any length of time.

No

Among the more common causes of insomnia in those not severely ill, may be mentioned the use of tea or coffee to excess at the evening meal, retiring soon after eating a hearty meal, excessiv use of tobacco, mental exertion prolonged into the night hours, excessiv bodily fatigue, etc. On the other hand, some cases of insomnia sleep better after a cup of coffee or tea, or a light lunch before retiring; tobacco has a lethargic effect on certain persons, and mental or bodily exercise will conduce to sleep in other cases. Thoroly study the patient, and use tact and judgment as much as you use drugs. Those who work with the brain rather than with the body are often kept awake by poor circulation, cold feet, etc.; bathing the feet with strong mustard water just before retiring, will dispose of these, or a hot water bottle may be kept to the feet thru the night. This class of cases should be encouraged to take gymnastics or some

other form of physical exercise. A glass of hot milk before retiring will help such cases. Those who are overworkt mentally should rest an hour before retiring. Should stomachic acidity or constipation be deemed a factor, the case is readily met by alkalies and laxativs. If sleeplessness depend upon worry or excitement, the bromides are indicated, and may be used freely without fear of instigating a habit. They can be intermitted, and discontinued as soon as possible; ammonium or strontium bromid are to be preferred to the potassium salt. Chloral and opium are best reserved for such cases as suffer pain of such nature that their use may not likely long be required, or of hopeless cases, such as cancer. Sulfonal acts well in cases which will only require its use for a few times; it is especially efficacious in the aged. A peculiar fact about this drug is that the dose may be gradually reduced, and the full effect remain. Occasionally in obstinate cases it will be found that a combination of drugs, even tho given in small doses, acts better than any one of them given singly.

case.

We would impress upon all the importance of the following rules in treating insomnia (1) Find the cause, if possible. (2) Use as few drugs as possible, and never use an enslaving drug in an acute (3) If drugs are used, withdraw as soon as possible. (4) Direct your efforts toward checking the habit of wakefulness, tho free dosage may be the only way to do it. (5) If baffled, while using hygienic measures, give some safe and reliable hypnotic in sufficient dosage to satisfy the patient, and gain time to study and think.

Shall Our Sons Study Medicin?

The Esculapian oath is quoted from as follows:-"I will reckon him who taught me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required, to look upon his offspring in the same footing as

my own brothers and to teach them this art if they shall wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons and those of my teachers." Beautiful sentiments, but they are no longer followed by the profession. stead of dealing with fathers or brothers' the doctor too often finds bitter and unscrupulous enemies among his colleagues. His professional associations are never uniformly pleasant.

The doctor's life is hard, even under the most favorable circumstances. The general practitioner is never sure of rest or meals, or if he makes them certain, loses his clientele; the specialist has short hours and pretty regular sleep, but is generally under intense mental strain while at work. The doctor must be prepared to go anywhere at any time; the surgeon is expected to do the same, and can generally obtain but little more delay. The life is exacting upon the strongest brains and most rugged bodies.

The compensation is inadequate. It is said that the average income of the doctors of the U. S., is but $1000 annually. The general practitioner with an income of $2000 is considered to have a "large and lucrativ practise." The doctor must dress better and live more expensivly than other men. The men who get over $10,000 a year might be easily counted. After expenses are paid, but little is left. It will not likely ever be much better; it is now certainly growing rapidly

worse.

It takes more brains and application to be a really good and successful physician than to win laurels in any other profession. If your boy is mentally capable of gaining prominence in medicin, he would probably do as much in any other profession, and would likely do much better. If you give the matter mature thought and consideration, you will recall your early ideals and aspirations; you will remember your