of great danger in the case of suppurative middle ears. A patient with chronic middle ear discharge may or may not have any premonitory symptoms except somnolence, or there may be certain paralytic symptoms which would give evidence of pressure. Often no symptoms except those of general sepsis. Frequently a subnormal temperature exists. Many cases of this kind the surgeon sees for the first time in a condition of complete coma, and little data on which to base a diagnosis, except the fact of preëxisting purulent discharge from the middle ear. Often this can not be established and frequently no discharge has existed for weeks. Whenever a discharge can be proven to have existed in a middle ear and within a reasonable time thereafter a patient complains of any localized pain in the head, or any loss of muscular power or localized paralysis, especially if accompanied by sepsis as proven by the temperature, pulse rate, etc., it behooves that patient to have a very thorough and critical examination made, as the chances of infection are more than probable.

Even if abscess does not exist, the chances of a pachymeningits or infective meiningitis, a leptomeningitis or an infective thrombosis of some sinus are so possible, that a suppurative middle ear should never be neglected, but always looked upon as a danger. Macewin, in his classical work on "Diseases of the Brain and Spinal Cord," says: "Since the majority of pyogenic affections of the brain arise from neglected otitis media, they ought to be regarded as preventable diseases and their prophylaxis scrupulously attended to." It is not necessary to dwell on this; but the practical point I desire to make prominent is that all suppuration from a middle ear is dangerous, and that proper surgical interference is not meddlesome but absolutely necessary for the safety of the patient.

HOSPITAL AND CLINICAL
MEMORANDA.

AN UNUSUAL CASE OF PERFORATING
ULCER OF THE STOMACH*

Lungs: There was slight dullness at the right apex.

The abdominal symptoms were relieved and blood count improved to 1,700,000. Two weeks after admission he died quite suddenly, without the occurrence of any new symptoms, the immediate cause of death being oedema of the lungs.

Clinical Diagnosis: Pernicious anæmia. Thorax: There was a good deal of yellow stained fat over the pericardium. There was slight hypertrophy of the left ventricle. No valvular or muscular lesions. The lungs were congested and oedematous; no other lesions.

Abdomen: Both kidneys showed chronic diffuse nephritis, being small, hard, with adherent capsules, loss of cortical markings and numerous cortical cysts. One cyst in the rignt kidney was one and one-half inches in diameter, the others small. The other viscera were normal, except the stomach, which was markedly dilated, the dilatation being entirely et tne expense of the anterior wall. On the posterior wall was a peptic ulcer three inches by one and onehalf inches, almost midway between the pylorus and oesophagus and having contracted the lesser curvature so that it measured about five inches.

The stomach wall had been completely perforated, but nature had preserved the stomach cavity by sealing the perforation by the body of the pancreas, which lay denuded in the floor of the ulcer.

The large size of this perforation and the absence of clinical symptoms in the history pointing to its presence, together with the frequently observed occurrence of the complex of symptoms and physical signs which we designate as pernicious anæmia, with unrecognized ulcer of the stomach is my excuse for presenting this specimen.

According to Welch there are a number of clinical types:

I.

3. Acute hemorrhagic ulcers, with or without preceding gastric disturbances.

4. Gastralgic-dyspeptic: The common form, gastralgic, dyspeptic and vomiting form. 5. Chronic hemorrhagic form with dyspeptic symptoms.

6. Cachectic form; usually a late stage and may resemble cancer.

7. Recurrent form.

8. Stenotic form. At pylorus.

Situation of 793 cases by Welch: 235 on posterior wall, 299 were on lesser curvature, 95 at pylorus, 69 on anterior wall, 50 at the cardia, 29 on fundus, 27 on greater curvature.

Size varies greatly. Largest reported by Peabody, of New York, 19x10 c. m., which was non-perforating. J. CLARK STEWART, M.D.

Minneapolis.

DIET OF PROSPECTIVE MOTHERS.-This subject of diet is very often brought to the attention of the physician. Without doubt, some of the discomforts of pregnancy and child-bearing are greatly aggravated by improper diet. The following suggestions found in a French journal may be of use to some one:

An excess of water and albuminous food should be avoided-water, on account of its tendency to produce hydroamnion, and albumen, because it favors excessive growth of the child.

The following is the diet prescribed, which has been tried in a number of cases:

Meat once a day, green vegetables and potatoes, avoid eggs, peas and beans, as they are too rich in albumen. The advantages claimed for this regimen are:

1. The patients are active until the eve of their accouchement; they do not suffer from a sensation of fulness, excessive formation of fat, thirst or constipation.

2. Rapid and easy delivery, even in those cases in which the previous labors have been prolonged and difficult.

An editorial in Pediatrics, says there are many varieties of coughs which do not proceed from pulmonary complications. Emil Mayer has recently published a pamphlet dealing with this not generally recognized fact. Some of these coughs which Thompson designates as useless are common both to adult and child, while one or two are peculiar to the age of childhood. These coughs, which are reflex in origin, are often the cause of much thought to the physician, and are by no means easy to diagnose correctly. The hacking night coughs of children fall into this category. According to Dr. MacCoy, of Philadelphia, these coughs are mostly due to naso-pharyngeal obstruction, and the reason that they are only troublesome at night is because when the child is in an erect position during the day gravity lends its force to facilitate the escape of the secretions from the nasal passages; but at night, when the child is lying down, this secretion cannot escape by these means, and the cough is brought on by mechanical irritation. Again, there is the paroxysmal hacking cough of children described by Dr. Francis Warner, of London. cough occurs in children who, although emaciated and unable to eat, have a normal temperature and the physical signs of healthy lungs. Dr. Warner attributes this condition not to peripheral irritation, intestinal worms, affection of tonsils or pharynx, but to unbalanced central nerve action, and as his conclusions were based on the examination of 22,000 children in schools, he is in a position qualifying him to speak with authority. Lastly, there is the hysterical cough which is common alike to adults and children. -Medicine.

This

THE MEDICAL PRACTICE ACT. Within a few weeks prosecutions have been brought in the District Court of Ramsey County against two men for practising medicine illegally; in both cases the prosecution has failed, and there have come to light weak points in the law which make it a feeble bulwark indeed against the incompetent and unqualified who may attempt to practise medicine in this state.

In the first of the two cases the accusation was the practice of medicine without a license. Section 3, Chapter IX, of the Laws of 1887, amended April 22, 1895, says: "It shall be unlawful for any person to practise medicine in this state without a license from said board, or without having filed with the secretary of said board an affidavit setting forth the times and places in which he or she has practised medicine within the state prior to the passage of this law." The court held that under this statute any person who had practised medicine in Minnesota prior to April 22, 1895, could practice legally by merely filing the affidavit described above. This opens the way to most of those who were refused license between 1887 and the approval of the law in April, 1895, making a gap in the state's defenses that it will not do to leave unrepaired.

* **

The second case was a so-called divine healer," who was prosecuted under Section 6 of the law, which says: * "Any person shall be regarded as practising within the meaning of this act who shall append the letters 'M. D.' or 'M. B.' to his or her name, or for a fee prescribe, direct or recommend for the use of any person any drugs or medicine, or other agency for the treatment, care or relief of any wound, fracture or bodily injury, infirmity or disease; provided, however, this act shall not apply to dentists." The trial judge is quoted as of the opinion that by the words "other agency for treatment" the law meant agencies similar to drugs or medicine, and that to construe it otherwise might be to bring under its prohibition "Turkish baths, massage, osteopathy, and other useful methods of treatment."

What the medical profession wants is a law that shall protect the people against imposition by providing that no physician shall be allowed to come into the state and practise medicine without passing an examination that shall prove him competent for the work, an examination such as that set forth in the present law. The examination should be flexible, as it is manifestly unfair to expect the physician of twenty years' standing to have as intimate a knowledge of such branches as anatomy and chemistry as would be looked for from the man just out of the medical school, while on the other hand, the older practitioner would be expected to have the better practical knowledge of general medicine, surgery, obstetrics and therapeutics. A law is wanted that shall effectually restrain those who without license, and for a fee, usurp the functions of the medical practitioner, that is, assume to know the nature of the patient's complaint and prescribe for it any kind of a remedy whether external or internal, palpable or impalpable. No one wants to prevent people from going to the barber to have their heads shampooed for dandruff, from taking a Turkish bath to break up a cold, nor from putting a rheumatic shoulder into the hands of a massagist. The law has not attempted to prevent the druggist from recommending and selling Dr. Bull's cough syrup to the man complaining of a cough, although there are probably cases where the druggist oversteps the line that should divide him from the doctor.

The necessary changes in the law should be made at the coming session of the legislature, and the best legal talent should be employed to so amend the law that it will hold water. The legislative committee of the State Medical Society should take the matter in hand in coöperation with the State Board of Medical Examiners. This legislative committee was provided for by a resolution passed in 1896, requiring that the president of the Society should appoint a committee of twenty-five every two years to look after needed medical legislation. An appropriation of one hundred and fifty dollars is made from the funds of the Society to go with each committee.

On this page will be found a letter from a correspondent who complains of the inefficiency of the medical practice act to prevent the operation of notorious quacks and medical pretenders within the state. That there is illegal practice cannot be denied. Where the fault lies is not so easy to settle. The physicians call upon the Board of Medical Examiners to drive out the offenders. The Board replies that this is not one of its functions, that it has no funds for the purpose, and that it is for the local physicians to make complaint and see to it that the county attorney prosecutes violations of the Medical Practice Act, a duty which the law imposes upon him. In this manner there is a deadlock, and if the framers of the improved law can find a remedy the medical profession will be grateful, and a service will have been rendered to the public.

CORRESPONDENCE.

THE MINNESOTA MEDICAL PRACTICE ACT. Editor of Northwestern Lancet:

Sir: I was interested in your editorial article of June 15, entitled "A Short Cut to a Degree," but feel disposed to make some critical comment upon it.

As she has done in many other directions, Minnesota has certainly manifested a tendency. to progression in her Medical Practice Act, but I do not think we are quite ready to exclaim with the Pharisee: "Lord I thank Thee that I am not as other men are," etc., for while our Medical Practice Act has undoubtedly resulted in much good, it is still so defective that the state still abounds with charlatans and is overrun with medical mountebanks.

When the status of affairs is such that a man who is practising unlicensed writes insulting letters to the State Board of Medical Examiners and defies them to prosecute him; when a sprig of a boy, who a year ago was canvassing for the sale of awnings and who never saw a medical college, goes about from town to town advertising to treat diseases of the eye with his improved electrical method and administers such treatment so far as he can obtain patients to do it; when a graduated practitioner travels all over the state and publishes his marvelous cures and puffs himself up as being a graduate of several medical colleges, and also takes pains to inform the people that he stands in with all of the best practitioners of the state, adding as a relish to their prurient ears that he is at the head of one of the greatest medical institutes of the country-I say when all of this happens and has happened many times in this state during the past year, then it is high time that we stopped and cleared out both the motes and beams from our own eyes before suggesting a prescription for our sinning brethren.

Just how to apply the remedy is not the object of this communication.

That there is a remedy there is not a particle of question, and it should be the province of our State Medical Society, through its committee on medical legislation, to apply the remedy and apply it so that it will be effective. Fraternally yours,

THEO. L. HATCH.

Owatonna, June 28, 1898.

REPORTS OF SOCIETIES.

HENNEPIN COUNTY MEDICAL SOCIETY. W. B. Pineo, M. D., Secretary.

Annual meeting held at Public Library Building, Minneapolis, on June 6, 1898, at 8 o'clock. President Dr. J. C. Cockburn in the chair.

The Board of Censors having reported favorably on the following physicians they were Drs. W. G. W. duly elected to membership: Tupper, Seth E. Howard, M. C. Johnston, D. G. Beebe, John S. McNeil, A. A. Noyes, G. Deziel, J. A. Crosby, C. A. Lapiere, A. Hirschfield, Robt. A. Campbell, Thos. B. Hartzell, G. W. Moore, C. E. Bachman, J. C. Farmer, E. O. Cosma and C. H. Bradley.

The President then read his annual address, entitled

THE TREATMENT OF TYPHOID FEVER,

which on its conclusion was discussed by Drs. Brown, Haggard, Chapman, Cotton, Donaldson, Little, Kelley, Crosby and Driesbach.

The following officers were lected for the ensuing year:

President-Dr. L. A. Nippert.
Vice-President-Dr. R. E. Cutts.
Secretary-Dr. T. A. Knights.
Treasurer-Dr. Henry Cotton.
Librarian-Dr. R. O. Beard.

Censors-Drs. J. H. Stuart, R. J. Hill, G. D. Haggard, C. G. Weston, C. K. Bartlett.

Executive Committee-Drs. J. W. Little, C. H. Hunter, M. L. Staples.

NEW INSTRUMENTS.

A New Self-Retaining Vaginal Speculum.
By A. W. Abbott, M. D., Minneapolis.

This speculum is self-retaining and is equally useful in all positions. It should be introduced closed, the large blade toward the posterior vaginal wall. The forefinger is then introduced between the blades and by making counter pressure by the thumb on the bar the requisite divergence is obtained and fixed by the nut on the retaining screw. The blades are then spread to the required degree by sliding the posterior blade on the bar.

To remove the speculum simply reverse the process. With this instrument and without assistance, curettage, trachelorrhaphy, vesico-vaginal operations and uterine and vaginal dressings have been made.

This instrument was made for me by Crolius, Tucker & Allen Company of Minneapolis, Minn. A. W. Abbott, M. D.

NOTES.

Coca Erythroxylon.

We need not enter into a full description of the history of the Erythroxylon Coca, as we believe that most medical men are fully acquainted with the principal facts concerning the plant. We may, however, recall to mind that the leaf is the only part of the plant used. Very much depends, therefore, upon the plucking of the leaf, and the time at which it is plucked; the subsequent care of the leaf being a matter of considerable importance, and affecting very materially the preparations made from it. M. Mariani was the first in Europe who took up the study of the plant, and over thirty years ago commenced manufacturing for the medical profession the various specialties associated with his name, viz., "Vin Mariani," "Elixir Mariani," "Pâte Mariani," "Thé Mariani," "Pastilles Mariani," etc., preparations which are known all over the world, and which have acquired their well-known reputation by their purity and efficacy. The stimulating and strengthening property of the leaf in its natural state has been tested by experienced travelers and botanists during several centuries, and it is this invigorating property which the physician wishes to bring into use, and which he is enabled to do in a palatable form by means of "Vin Mariani," this wine being indicated where there is great depression, long continued exhaustion, and where Mariani" is agreeable, palatable, imparting by its diffusibility an agreeable warmth over the whole body, and exciting functional activity of the cerebro-spinal nerve centers. We have frequently prescribed this wine, and we can, from practical experience, recommend it.-The Provincial Medical Journal, London, Eng.

To Increase the Oxygen-Carrying Powers of the Blood.

J. A. Stoutenburgh, M. D., late resident physician Columbia Hospital, Washington, D. C., says: "We need a remedy or combination of them that will increase the oxygen-carrying power of the blood, increase the appetite and stimulate the stomach and intestines to renewed activity. Many so-called blood-makers attempt to do too much for us by supplying predigested and artificial food. It is better to give nature a chance, by coaxing her to resume her work, and then furnishing a nutritious and easily digestible diet. 'Gray's Glycerine Tonic Comp.' is a preparation which has done me excellent service in many cases. I am well satisfied that we have in this tonic a most valuable medium, one sure to grow in favor as its merits become better known." It is manufactured by The Purdue Frederick Co., New York, No. 15 Murray St.