matism are not apt to be victims of true rheumatism.

In the meantime, the cases present themselves steadily and we must do our best in attempting to cope successfully with them. The treatment found nearest satisfactory by Anders (Practise of Medicin, W. B. Saunders, 1900), is as follows: "Sodium or ammonium salicylate up to 14 drams in 24 hours; this mitigates the fever, relieves the pain, and shortens the time in bed by a few days, but does not curtail convalescence. The alkalin treatment operates potently to obviate the occurrence of heart complications and shortens the period of convalescence, but exerts slight, if any, influence upon the fever and pain. I therefore combine the salicylates with an alkalin remedy such as potassium citrate or soda bicarbonate. Potassium iodid and the preparations of colchicum are efficacious, and should be tried. The joints are wrapt in cotton batting or flannel. If the pain is severe despite the use of the salicylates internally, hot cloths lightly wrung out of Fuller's lotion are beneficial.

"Methyl salicylate, by local application, is of service. It is put on the skin over the affected joints drop by drop, and the joint is then envelopt in a wrapping of gutta percha tissue and bandaged with flannel. Cold compresses and the ice bag to the joint have been strongly advised, particularly by German authors. Blisters near the joints, or the light application of the cautery are sometimes serviceable. Currents of hot air have been successfully used. The affected joints should be kept at perfect rest, and this is best accomplisht by padded splints and a roller bandage. During convalescence the patient should not be allowed to get out of bed too early. My rule has been to keep him in bed for a week after the temperature has returned to normal and after the pain has disappeared, except it be during the hot season. After the patient goes into the open air he should be told to avoid cold, and wet in particular. For the stiffness and swelling that sometimes persist or disappear very slowly after the

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acute attack, massage and the application of hot water or warm baths seem to yield the best results."

Chronic Rheumatism.

Chronic rheumatism, like debt and poverty, is always with us, and too often the three go together. The weary ponderings and the therapeutic assaults of centies of medicin have availed but little against it. We hoped for much when the alkalin treatment was promulgated as a sure and certain cure; and when the salicylates were first lauded as a specific, we smiled and lookt upward; to day we sadly remember those disappointments, and still hope.

We have little confidence in any agent or method ever being discovered which will eradicate the damage done to muscles, ligaments, and articular surfaces, thru a protracted series of attacks and over months or years of time. We would better meet the disease in its acute form, and try to avoid the deformity and permanent injury to tissue which the chronic form. entails. Yet we can do much for the chronic sufferer, if we but employ the meagre knowledge we now possess.

It is well to begin with a given case by appreciating that chronic rheumatism is never an entity. Whatever the actual cause of chronic rheumatism may be, it is certain that it has never been conclusivly demonstrated or proven, and that, since we well know that modern medicin is not an exact science, we must meet and treat

individual cases according to the indications. We must consider that our pain rackt and deformed patient has many organs which are not functionally competent. Until we know more, we must hold the stomach, liver and kidneys accountable. It is always safe to get these organs working satisfactorily, and to see that all the emunctories are doing their full duty. It is not well to promise annihilation of old deformities, but competent treatment will surely prevent the development of

often useful by building up the strength of the patient. Guaiacum is a drug which still maintains some reputation in the treatment of chronic rheumatism; it is usually given in the form of tincture or ammoniated tincture, five to thirty minims, four times a day, preferably in milk.

"Local treatment is more important

than internal medicin. Counterirritation by iodin or blisters persistently kept up is sometimes useful. Encasing the joints in red flannel bandages occasionally gives relief and is a useful adjuvant. Massage is undoubtedly an efficient measure, tho its effects are not always apparent. It is especially useful when there is atrophy of muscles, in which event it may be combined with electricity and passiv motion. Hot baths, which should always be taken at night, give temporary relief, but in my experience it is not permanent. Even the systemic baths at the various hot springs, which are undoubtedly serviceable, are apt to be followed by relapses. More satisfactory is permanent residence in a warm climate for those who can afford it." (Tyson; Practise of Medicin, 1900. P. Blakiston, Son & Co.)

Renal Insufficiency.

Many persons who are seemingly healthy have defectiv renal action. There may be no actual disease, but the kidneys are not doing their work. Such a condition persists for years, overlookt by both doctor and patient. The end sometimes comes suddenly, and we stupidly wonder why so many people die of Bright's disease. Were all doctors better diagnosticians such a state of affairs could not long maintain. Given two men equally brained, and trained by the same masters, the hardest and most conscientious worker will be the better diagnostician. Better and more carefully made diagnoses would detect cases of kidney insufficiency in their very incipiency, while there was yet hope.

Always inquire after the condition of the urin. If it be high colored, irritating, excessiv in amount, deficient in quantity, or foul smelling, it is certain that the functional activity of the kidneys needs. to be investigated. Often such conditions.

may be present, and yet the patient may be so indifferent as to have failed to notice them or be so ignorant as to think the matter of no importance. No physician who takes charge of a case can acquit himself of neglect if he fail to know just how the kidthat high colored or scanty urin is not neys are acting. It is well to remember necessarily a sign of kidney insufficiency; the patient may have indulged freely in alcoholic drinks or have habitually ingested too little water. Even albumin in the urin is, in itself, no absolute sign of actual kidney disease. actual kidney disease. Many causes will act to bring about temporary albuminuria. Those diseases of the stomach which are accompanied by supersecretion and phosphaturia will cause albumin to appear in the urin. The point to be settled is

whether the albuminuria is functional or organic. Gastric ferments, and albumoses, circulating in the blood are carried thru the kidneys and injure them to a greater or less extent. The greater harm is said to come about by the injury they inflict upon the blood and cardio-vascular system, the liver, and the general state of nutrition of the body; and thus in addition to the irritation from the unassimilable albumin, damage is done the glomeruli and tubules of the kidney. Such damage may be congestiv, inflammatory or actually degenerativ. May we not believe that such an irritation, beginning as a congestion, passes to an inflammation and in turn becomes degenerativ? If this be plausible, then it is certain that stomach disease will cause actual "Bright's disease," under certain conditions. Chronic nephritis is not amenable to treatment, but supersecretion and phosphaturia are, and the chances seem that if such a case had been properly treated for the stomachic trouble, the nephritis might never have existed. It is equally certain that when the phosphaturia began, if the urin had been examined, evidence of kidney insufficiency would have been found.

We might carry the illustration further,

Operation for Producing Sterility in the Male.

Editor MEDICAL WORLD:-I beg space to again refer to the subject of obstruction of the vas deferens. Why I did those operations reported in January WORLD, page 10, or rather, what caused me to do them, seems to be of interest to the many inquiring friends. I suppose they want to know what caused me to think of it. For six or seven years I have noted the interest manifested thruout the civilized world in the subject of limiting the production of undesirable human beings, as among the criminal, diseased and defectiv classes. I have seen a great many remedies given to prevent conception, but none without serious objections. It occurred to me that there might be a simple operation on the male sex which would sterilize without the loss of sexual power.

By referring to some cases of sterility without the loss of sexual power, due no doubt to plugging of the vas deferens by gonorrheal inflammation, I decided that the obliteration of the vas would be the

ideal operation. After making myself thoroly familiar with the anatomy of the sexual organs of both sexes, I decided to try it.

Sterility in man without the loss of sexual power is of worldwide interest. As I claim to be the first to invent an operation to meet this end, I will give as best I can a technic of the two operations which I consider of most interest. I have done two others, but they are of less interest, altho they were more or less successful. I give the technic of these two operations for the benefit of my many inquiring friends. I have had letters of inquiry from a great many parts of the United States. And if any information other

than is herein contained is wanted I will cheerfully give it either by letter or thru the columns of THE WORLD.

Technic of the injection method: Take an ordinary hypodermic syringe and suck up six min. of c. p. carbolic acid. If the scrotum is not relaxt, apply warm water till it is (of course you want to clean the field of operation also). At the back part of the spermatic cord you will feel a hard, cord like tube a few lines in diameter, which is the vas deferens. Grasp just where the vas leaves the epididymis and takes a straight course toward the pubes, which is about half way between the bottom of the testicle and the pubic bone. Thru the scrotum catch up the vas; it is best to draw it toward the outer side because the scrotum is thinner there and it is handier to the operator, and will give less trouble after the operation. Tighten the scrotum over the vas (be sure you have nothing but the vas), then with your hypodermic needle pierce the vas thru the scrotum till you have entered the lumen of the tube, then turn your needle up or down, push it a little further, to be sure you have the needle in the tube, then inject, and the operation is done. Before you pierce the skin be sure you have all the acid off the outside of your needle or you will make a sore; with this precaution a man may go about his every day avocation. This operation is simple, attended with but little pain, little inconvenience, and I think free from danger.

Technic of the incision method: Catch up the vas as in operation No. 1, inject a few minims of cocain solution to anesthetize the parts, make a longitudinal incision about three-fourths of an inch long down to the vas, pick up the vas with a tenaculum, stitch it to the lower end of the wound, then with scissors divide the vas; dislocate the upper end by pushing it back in the scrotal cavity, then stitch up the wound with the testicle end of the vas outside. This wound heals quickly without much pain. Of course, aseptic precautions should be taken. This is the operation which I especially recommend for criminals, epileptics, syphilitics, consumptives, etc., from the fact that it is positiv in its effect, and I think it is attended with but little if any danger. If a man should perish from as trifling an operation as this, it would certainly be the fault of the surgeon.

My experience is quite limited, but I