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To the Editor:— In spite of limited exposure, the anogenital region can be affected by a number of irritants,1some of which may lead to contact dermatitis.2These act either as allergens or primary irritants. Causative agents frequently noted are dyes in underclothing, condoms, douches, contraceptive jellies, sanitary napkins, substances carried by the hands, systemic antibiotics, rubber products included in supporters and elastic girdles, soaps, and perfumes. The clinical manifestations of these dermatoses vary with the inciting agent, the affected site, and the individual's allergic responsiveness. In recent months we have noted another interesting variation of this entity; contact dermatitis caused by perfumed toilet papers. The presenting complaint was the acute onset of mild to severe pruritus. The periurethral area and the vagina were involved in the females and the perianal area in both males and females. Local signs of inflammation were noted with occasional evidences of excoriation.

St. Louis, Mo., May 15, 1897. To the Editor: — I herewith send you a few crumbs in answer to your call for a discussion of the paper on which theJournalshould be printed, because I am convinced that it will be calculated to do good service by directing attention to very important questions, which must be of great practical interest to the human race both in this and future generations. The question of the size and form of printing type, and the color of the material for background, is not only of great importance to the comfort of adults, but it is of far greater importance to children and those who quite naturally look to the typographical and mechanical features of theJournalfor a model. What constitutes readable print? The most readable print is that by which one may obtain the maximum of reading, with the minimum

As a preface to my paper, I wish to acknowledge my indebtedness to the President of this Society, to our last ex-President, to the ex-President of the Ohio State Medical Society present, to Dr. Thomas, Dr. Barnes, Dr. Dickson and all others who have confirmed my diagnoses, watched the results of treatment, or in any way have aided me in my work; and to thank them for their very complimentary remarks in the discussion of my previous papers. Having my work characterized as the greatest discovery of the age by one member, my name associated with that of Jenner by another, and another give expression to his pride that a member of this Society had done what I have; would be exceedingly gratifying to me at any time, but especially just now when I am promulgating ideas which must arouse the indignation of every great medical professor in the world

To the Editor.— Treating acute psychogenic hyperventilation by rebreathing into a paper bag restores arterial carbon dioxide pressure (PCO2) to normal, and leads to relief of symptoms. We compared the retention of CO2during rebreathing in three different types of bags to determine their clinical usefulness. A plain paper bag, a paraffin-treated ("oily") paper bag, and a clear plastic bag of the same size (No. 12) were tested. Bag gas was sampled continuously through a small catheter, and CO2concentration was measured with an infrared CO2analyzer. With the bag held tightly over the mouth and nose, a subject hyperventilated at a constant rate, and the rise in bag CO2was recorded. When the plain paper bag was used, CO2reached a plateau of 43±7 (mean±SD) mm Hg after 15 to 20 breaths. In contrast, CO2rose slightly faster in the "oily" paper

To the Editor:— The reviewer of scientific articles has a great obligation to the readership of the journal, to the author of the paper, and to the journal itself. Obviously, the reviewer needs to be competent in the subject under discussion. With the rapid advances in science, only a reviewer directly engaged in the area he is to review can adequately undertake the task. His critique should concern itself with the clarity of the text, the methods employed, statistical tests that may or should have been carried out, rationale of the interpretations as well as a careful assessment of the references. An article should not be accepted for publication unless all pertinent views have been cited and proper credit is given to previously published work. Personal bias should obviously not affect a reviewer's critique. The task of the reviewer would be facilitated if authors would transmit their papers for review

South Bethlehem, Pa., Dec. 18, 1895. To the Editor: —As Secretary of the Surgical Section of theAssociation, I am now engaged in arranging a program for the Atlanta meeting. We have selected " The Surgery of the Cerebro-spinal Axis and its Bony Encasement," as the special subject for discussion. I am anxious to obtain as full and as representative a discussion on this important subject as practicable. Will you permit me through theJournalto call the attention of our surgical members to this subject, and to request from them a liberal contribution of papers, and careful preparation for discussing the subject. Besides this special subject there will be room on the program for papers on other subjects. I solicit the active assistance and contribution of the members. Members who desire to contribute papers to the Surgical Section will please notify me and send the title of their papers to

San Jose, Cal., July 8, 1897. To the Editor: —Since I penned a few thoughts in the April 24 issue of theJournal, on the subject of glossy paper for periodical and bookmaking purposes, I have been thinking more on the subject, and the more I think the more I am convinced that the matter needs thorough agitation all round. If one will call to mind the large number of periodicals and books now printed on paper of high glossy finish he will conclude that this style of paper is becoming a " fad." A journal published in St. Louis entitled The American Medical Journalist , notices my former article and makes the following comments: "Dr. Simonton of San Jose, Cal., objects to the high finish of the paper upon which theJournal of the American Medical Associationis being printed, and claims that the 'gloss,' as he terms it, is injurious

The word "eclecticism" appears only twice in this volume of 14 papers and four discussions. Both times it is used to characterize the activities of the society whose nine founders were general practitioners who ventured into neurological and psychiatric practices before World War I. Yet the entire collection is a testament to the concepts of eclecticism or heterodoxy in psychiatry today. H. W. Brosin offers a solid basis for identifying the complex problems and multiple opportunities in current psychotherapeutic work. His scholarly review supports the proposition that man can change psychosocial evolution. Articles on memory process (Magoun), on psychoanalytic education and research (Lewin), on psychopharmacology (Marrazzi), on social psychiatry (Rees), and on the use of drugs (Capparell and Meyers) may be utilized by the young doctor interested in psychiatry as a field of specialization. Astley's highly original and provocative paper on the conflict between psychiatry and religion opens a lively

To the Editor: —Comment on the article on paraffin paper for surgical dressings by Dr. Charles M. Harpster, Toledo, Ohio, inThe Journalfor June 8: I tried this method of dressing wounds in 1908 and discarded it because of the imperforate character and allowing poor drainage. I found, however, that if this wax paper was perforated every quarter of an inch with a No. 4 eyelet punch (which can be bought very cheap in any hardware store and some twenty thicknesses of paper can be perforated at one punch) it served the purpose admirably. I reported my experience at the meeting of the American Association of Railway Surgeons in October, 1910. This perforated paper has been used very extensively in the Youngstown Hospital and is a cheap and durable dressing. It allows ample drainage and ample protection to granulation and is not removed from the wound until the wound

San Jose, Cal., April 20, 1897. To the Editor: —It is not often that one will complain of receiving something that is too good, but I do wish to thus complain at present. While the matter and make up, generally, of theJournal of the Associationhave improved to a high point of excellence, the paper-maker has been endeavoring not to be left in the rear; and he has brought up the excellence of the paper on which theJournalis printed to a degree of perfection altogether too high to be acceptable to many readers of theJournal. As sanitarians and hygienists we ought to practice what we preach. There is not a medical man who will not say at once, when his attention is called to it, that printed matter intended to be read by human eyes—and it is mostly thus intended— should not be impressed on paper

To the Editor.— In the letter "The 'Oily' Paper Bag and Hyperventilation" (229:638: 1974), Dr. Riley mentioned that the increased carbon dioxide pressure when rebreathing from the bag held tightly over the mouth and nose lasts for three to four minutes. During this time, the oxygen concentration must fall to quite low levels, inducing a hazard in patients with coronary artery disease, and probably also in others. It would be of interest to know whether the oxygen pressure was measured.

This volume consists of 30 papers which were presented in December, 1960, at a symposium sponsored jointly by the American Association for the Advancement of Science, the American Physiological Society, and the Society of General Physiologists. Primary emphasis is given to current concepts of the electrical and ionic events associated with nerve and muscle excitability. Active transport and membrane selectivity in elementary systems such as red blood cells are discussed first; the more complex problems presented by nerves, voluntary striated muscle, cardiac muscle, and smooth muscle are then dealt with successively. Junctional transmission and the contractile mechanism in muscle receive special attention and the probable energy supply for the various activity processes is discussed. The mechanism of action of certain pharmacologic agents is considered in terms of their effect on membranes. Numerous models, conceived in the light of recent experimental data, are presented. Throughout, the illustrations are of good quality.

The title of this paper may seem rather an ambitious one, since the study of vital and social statistics, and their application to the comparative study of races and nations, is almost too new to furnish many principles that may serve as bases of induction. However, I purpose to state in a fragmentary way a few notes and observations bearing on the subject. More than usual experience as a traveller has brought me in contact with various races of men under different mesological conditions. Experience and observation in this line show that, in spite of physical and moral varieties, there exists practically, for the physician, but one people, since there are no wide differences, biologically or medically speaking, in the human species; and the infirmities of men, notwithstanding their physical inequalities and the extensive range of the nosological table, are much the same the world over, no matter whether they

Ridgway, Pa., Sept. 20, 1902. To the Editor: —This last summer I drafted and presented to the official board of the First M. E. Church of this place, being a member of the board, a set of resolutions, drawing attention to the falseness of statements and dishonesty of purpose of various advertisers of "patent" medicines, and condemning the publication of such advertisements by the publishers of our church periodicals. The resolutions were passed, but two members of the official board voting against them. I took the ground that it was detrimental to the interests of the church that the papers should receive a profit from so false a business. Copies of the resolutions were sent to the various church publications circulating in this district. If necessary this move can be followed up to the annual and general conferences.

Mr. President and Gentlemen of the Association of Medical Colleges:—The paper of Dr. Vaughan, which has interested us so much, suggests great changes in medical education. During the past year my attention has been called to some of the details of laboratory work which must be faced by every one of you. Allow me to very briefly speak of some of the results of my thoughts and studies.Laboratory rooms must be light and roomy. Forty square feet of floor is the least amount which will accommodate a single student, and then only in the chemical laboratory. In all other laboratories at least sixty square feet of floor space, not including aisles, must be allowed each student. In the chemical laboratory students' desks may be placed twenty feet from the windows; in laboratories in which microscopes are to be used, fourteen feet is a maximum.The ordinary medical class in

Aseptic technic in the dressing of wounds is of prime importance, and is often poorly executed. For use in a surgical clinic, office or where sterile instruments and dressings are kept in bulk, the use of an "individual service sterile towel" is an excellent method. The employment of the usual linen towel is expensive, and demands considerable laundry work and renewal from the constant washing. The ordinary paper towels of rather coarse fiber are excellent and inexpensive substitutes. They can be separated from one another and stacked with one corner of the closed side folded, so as to form an easy method for extraction later. The towels are then put in a hospital towel envelop and sterilized under steam pressure. When they are needed, one end of the envelop is unpinned and opened, as shown in the illustration. Each sterile towel may then be withdrawn, opened, and the sterile dressings

The rationale for this book appears to be the editor's conviction that medicine should "rediscover" therapeutic uses of marihuana. In an attempt to buttress this thesis, he compiled 25 of the "better professional journal articles" from the past 133 years that pertain to various medicinal or scientific aspects of the drug. Most articles describe personal experiences, therapeutic applications with patients, acute clinical studies, or chemical and pharmacological endeavors. Only Musto's excellent review of the 1937 Marihuana Tax Act is not directly concerned with medical or pharmacological effects of cannabis. After O'Shaughnessy introduced marihuana into the Western pharmacopoeia in 1839 (his report is the first in this book), the drug was promptly recommended for an utterly endless list of disorders. Despite utopian claims, however, wide acceptance never evolved. The editor's primary explanation for this is that recent "recreational" use and the "resultant restrictive federal legislation" functionally ended medical applications of marihuana.

In presenting the subject of non-absorbent gauze for your consideration I am not offering a new topic for discussion; non-absorbent gauze takes its origin contemporaneously with the antiseptic dressings of Lister. Lister's 1 earlier dressings were distinctly non-absorbent; the manner of their production secured it, for muslin was soaked in a heated mixture of paraffin 16 parts, resin 4 parts and carbolic acid crystal 1 part; while still warm the excess of the compound was wrung out. Lister 2 shortly thereafter even suggested an 8 per cent. carbolic gauze made in the same manner. The paraffin counteracted the adhesiveness of the resin, and together they precluded a capillarity in gauzes thus treated. The faults of this carbolized gauze were early recognized and were its non-absorbence and its tendency to cake into a solid mass. In turn, Lister 2 experimented with corrosive sublimate and cyanid of mercury; the former, he found, combined

Mr. President and Fellow-members of the Ohio State Medical Society: The subject of fever—in its general aspect—has been deemed worthy of so much labor and study on the part of the physiologist, the pathologist and the clinician, and is of such practical import to all who practice our art in any of its branches, that no apology is necessary, I trust, for bringing one of its numerous phases before this society for consideration. Looking at its most constant and evident symptom—the pyrexia—the physiologist points out, and the pathologist, and clinician confirm the probable •existence of heat-producing, heat controlling and heat dissipating areas, situated in the central nervous system, and influencing by their abnormal action the production of this particular symptom. That the pyrexia, however, does not constitute the disease is quite evident, since, it may be absent, controlled or even eliminated, and yet the patient be far from well. While

Chronic catarrhal laryngitis is a continuous passive inflammation of the laryngeal mucous membrane. Its etiology is multifarious. The most influential causes are nasal stenosis, liquor drinking, tobacco smoking, vitiated air, and an intemperate use of the vocal organs. Nasal stenosis necessitates mouth breathing—an abnormal respiration, by which we have carried into the laryngeal cavity an air pregnant with dust, that soon begets an inflammatory process. Chronic alcoholism produces an abnormal activity of the mucous glands of the mouth and fauces, which, during sleep, drops depraved excretions into the larynx, thereby producing a permanent inflammation. Tobacco smoking causes to be deposited daily in the air passages the liquid alkaloid nicotina, which produces partial paralysis of the vasomotor nerves of this locality, and a resultant permanent injury to the mucous texture. Vitiated air, in illy ventilated apartments, is one of the commonest causes of chronic laryngitis. Air reeking with noxious vapors poisons

Somerset Maugham once remarked that he could think of no better training for an aspiring writer than to spend a few years in medicine. Nowadays, more and more voices are heard claiming that a medical education and a few years in practice are certain to squelch, or more likely to ruin, any creative talent, particularly the talent to write. Medicine, preoccupied as it has become with science and technology, may no longer be the same territory where Maugham found human nature without disguise and was creatively stimulated by the experience. Yet with its strict demands for observation and precise description, medicine is still a profession uniquely suited for cultivating the skills fundamental to the art of self-expression. Contemporary scientific literature is not lacking in the exceptional piece that reflects the art of medicine without being short on science and that shows that smoothness of style, depth of perception, and elegance

[Your attention is invited to a subject which from the humanitarian standpoint is of the greatest importance and of practical value to us as surgeons. Much of the effort of our profession is directed toward the relief or prevention of pain. Distinct advances in our art followed the introduction of the various narcotics, and the science of surgery took a long step forward when the use of sulphuric ether for anesthesia was discovered Sept. 30, 1846, by Dr. Wm. T. G. Morton, of Wellesley, Mass., and chloroform by Sir James Simpson, of Edinburgh, on Nov. 4, 1847; and these names will ever live in our memory. But the great boon of narcosis is not unalloyed. Thousands have died from the effects of the volatile anesthetics, and every time we administer them we take upon ourselves the responsibility of a human life. Ether kills once in 15,000 administrations; chloroform once in

The subject of fibroid tumor of the uterus is too broad to be considered in all its aspects, in the time allotted, before this Society. I have therefore thought it advisable to speak of but two phases of the subject: 1, what cases require operation; 2, methods of operating. Clinical experience demonstrates that only a small percentage of those suffering from fibroids require operative interference for relief. This is so well known that the profession at large have come to regard them as purely innocent growths. This is true in the majority of cases. My experience, based upon more than two hundred carefully recorded cases, justifies me in saying that the majority of women from thirty-six to forty-five years of age suffering from fibroid tumors, do not require operative interference; but this fact increases our responsibility in determining early the cases really requiring operation. A great many women who are

Ludwig Edelstein was one of the great modern scholars of Greek medicine. The first part of his life he spent in Germany, the latter part in the United States, chiefly at Johns Hopkins and the Rockefeller University. A man of great personal integrity and profound scholarship, he achieved scholarly renown in philology, philosophy, and history of medicine. He is perhaps most widely known for his definitive work on Asclepius, published with Mrs. Edelstein. Much of his work had originally been published in German and was not readily available to English readers. Before his untimely death he planned to collect some of his writings, including translations of certain German articles. Now the work has been brought to completion and edited by his long-time friends, Owsei and Lilian Temkin. The translations, by Lilian Temkin, are excellently done, and the whole is splendidly edited. The essays fall into four groups. The first deals

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To the Editor:— Numerous reports of gastric and intestinal bezoars appear in the medical literature. Bezoars of the colon unassociated with obstructing foreign bodies, tumors, or areas of diverticulitis are rarely documented. Wilson et al 1 reported one case in a 54-year-old man with an obstructing phytobezoar in the transverse colon. These authors believed this bezoar to be "at least aggravated by carboxymethyl cellulose ingestion" used in the relief of chronic constipation. The roentgenographic findings were those of large-bowel obstruction as seen in the illustration following. Report of a Case:— A 26-year-old woman was seen on April 11, 1966, with the chief complaint of abdominal cramps of three days' duration. There was mild nausea, and the patient had vomited once prior to admission. She had several watery bowel movements associated with tenesmus. Abnormal physical findings included abdominal distension and a palpable tender mass in the middle part of the abdomen

A number of methods have been designed for recording roentgen-ray findings, particularly in cases of fracture. These methods vary from a simple tracing to an elaborate colored photograph. During the war, the French had a very good idea in which colored chalk was used; but while this method is excellent and graphic, it requires considerable time and experience. At the Post-Graduate and Beekman Street hospitals I have recently been using a modification of this French plan; our roentgen-ray records are now in black and white, and for want of a better name, I call them silhouettes. An ordinary tracing is first made ( A ) on architect's tracing paper (sometimes called vellum), and then the interosseous and extra-osseous parts are painted solid black ( B ) with a small brush, a dull black paint, such as black japan, being used. The parchment-like tracing paper is quite absorptive, and the paint will not run. An

Thirty years ago as a college sophomore intending to study medicine, I enrolled in a course on the English drama. For the inevitable term paper, I found "Medicine in the Modern Drama" a fascinating and rewarding subject. I explored the works of such then well-known playwrights as Ibsen, Shaw, Guitry, Romains, Schnitzler, Kingsley, and Howard. Since there was enough material for a book, I could prune and refine my paper rather than struggle to attain adequate length. That essay constituted my first publication. 1 I still regard that first publication with affection. The judgements still seem sound, and there is little that I would change as the result of greater maturity. However, now I can see more clearly that the plays I discussed fall into five distinct categories. Plays for the stage, movies, and television utilize medicine as part of social criticism, or satire, or history, or medical tract, or

If the short paper which I present to you to-day is productive of any good results, personally, I look for them not so much from the paper itself as from the discussion which I hope it will inaugurate—"many men, many minds." I do not expect that all my hearers will agree with the opinions which I have formed after some years' experience, and I trust that to-day the views of not a few will be freely expressed in order that the subject may be thoroughly thrashed out. In short it would seem advisable for us to hold what may be termed an "experience meeting" and my remarks may simply be looked upon as prefatory to what I hope may be a full and fruitful discussion. I shall speak briefly of work done by others and by myself sometime ago, and shall supplement this by my own experience in two series

The recent advocacy of chlorine in the treatment of respiratory infections has tended to create the belief that industrial poisoning from low concentrations of this gas is improbable. The concentration of chlorine recommended for therapeutic purposes approximates 0.015 mg. per liter of air. This concentration is fairly close to that present in the bleach rooms in paper mills, laundries and textile mills. Barring accidents, it is believed that chlorine concentrations in such industries range downward from 0.03 mg. per liter of air. Apart from minor inconveniences, such low concentrations will not produce any acute harmful effects. When, however, exposure is continued over a period of years, an occasional worker may be expected to become severely harmed. Such an instance is cited below. REPORT OF CASE History. —L. R., white laborer, began employment in a paper mill in 1920. His work, family and personal history up to that time were without

In presenting my paper on the surgical treatment of acute peritonitis I have not thought it necessary to review my experimental work, or to report all my cases operated upon. Neither is it possible in a short paper to enter into a discussion of the anatomy, etiology, pathology and the various clinical phases found in this formidable disease, because inflammation of this membrane may have so many different causes and assume such varied clinical aspects that it is difficult to formulate a uniform and satisfactory classification. Suffice it to say that, anatomically and physiologically considered, the peritoneal cavity may be said to be a large lymph-sac, and noted for its capacity of absorption. This capacity is not surprising when we take into consideration that in its parietal and visceral enfoldings, it presents nearly as large a surface as the entire integumentary covering of the body. Idiopathic peritonitis is considered doubtful by most modern pathologists, and it has become an established practice to search for a local cause in all cases of peritonitis. I believe in every instance, micro-organisms from some source or other have gained access to the

For several years, those associated with the profession of pharmacy have become increasingly aware that the graduating pharmacist is overtrained for the usual duties he performs in the drugstore or hospital pharmacy. This development has resulted from a variety of influences, among which are an extra year of study for the Bachelor of Science degree, more sophisticated and technical classes in the pharmacy curriculum, and increased efforts by drug manufacturers to improve the ease of drug dispensing, which practically eliminates the compounding of prescriptions. Both local and national pharmacy organizations, recognizing the problem, have proposed new roles for the pharmacist in an effort to make better utilization of his considerable knowledge. One such proposal adopted by the American Pharmaceutical Association (APhA) was presented to organized medicine in the form of a white paper entitledThe Pharmacist's Role In Product Selection. This paper contains the premise that the pharmacist is best

While studying the specificity of opsonins last summer in Professor Wright's laboratory I sought for a method of quickly separating organisms from the liquid in which they are suspended, centrifugating alone requiring from thirty minutes to one hour. The following device was used with splendid success: A constriction (A) is made in a piece of small-caliber glass tubing; the tubing is then bent on itself (B), terminating in an opening (C). Moist filter paper fiber (D) (conveniently made by scraping filter paper with the edge of a knife) is placed against the constriction and packed firmly. Into the long arm is placed the liquid (E) to be filtered and the device is placed in the centrifuge. Working with staphylococci, I obtained practically bacteria-free filtrates (F) in ten to fifteen minutes from thick suspensions of staphylococci in normal sera. The filtrates showed scarcely any opsonin, and stained specimens practically no organisms.

To the Editor: —InThe Journal, July 15, is a current comment in which the statement is made that, "contrary to the theory of 'desensitization' by internal administration of tincture of rhus, it appears that the susceptibility may be increased with successive intoxications." The question of desensitization by internal administration of the tincture of the drug is unrelated to the question of increasing susceptibility to successive external exposure to the plant. It is to be regretted that destructive criticism of the treatment by desensitization should be published without adequate clinical testimony, for many patients may, as a result, be deprived of the value of this treatment. In October, 1919, I published a short paper inThe Journalon "Desensitization of Persons Against Ivy Poison." Since that time I have treated in the neighborhood of fifty patients who were susceptible to ivy poison, and most of whom were subject to yearly

Four patients had evidence of acute pancreatitis occurring during infectious hepatitis. Paper electrophoresis of serum and urine of one patient revealed migration patterns of amylolytic activity identical to those of saline extracts of human pancreas. Definite gross and histologic pancreatitis was seen at autopsy in two patients who died of acute fulminant hepatitis. The fourth patient had only mild increases in the level of urine amylase but a classical "reversed 3 sign" on roentgenograms of the uppergastrointestinal tract, that largely disappeared in eight days.

"We will not anticipate the past, our retrospection will be all of the future." It is my purpose in this short paper to take a hasty retrospective glance at the history of dental education in the United State, that I may hold before you for a moment a picture of progress that has seldom been equaled in the history of educational advancement, and then to change the view and hold before you another picture, a prospective view, the realization of which will be no more difficult to us and our children than was that of the first picture to our fathers and ourselves. "Past and to come seems best; things present worse." Shakespeare never wrote a truer line than this, for, if we were satisfied with the present, there would be no progress in the future. Satisfaction with the present brought decay and ruin on the ancient Egyptians and on

Electricity, while not old in medicine, can not be considered new. One of the first advocates of static electricity as a medical agent, I believe, was John Wesley. While endeavoring to educate the people to his ideas of a religious life he spent some time writing and teaching how to apply static electricity for the relief of pain and the cure of certain diseased conditions. He must have given the subject considerable thought and study for much of his advice is as good as that of any of the writings we have at the present time. While there is no doubt in my mind that static electricity may be used to advantage in nearly all forms of neurotic troubles, I shall confine myself in this short paper to its use in the treatment of morphinism. There is no royal road to the cure of drug addictions. There are no specifics, so

Read in the Section of Surgery and Anatomy of American Medical Association, May, 1884. When in July of last year I had the pleasure of taking the distinguished President of the American Medical Association, and Professor Dennis, over the wards of the London Temperance Hospital, Dr. Flint extorted from me a promise to send a short paper to the Washington meeting of the American Medical Association, containing some account of my surgical experience at that hospital. It is therefore in redemption of that pledge that I venture to lay this brief communication before this distinguished audience. In 1873 a house was taken in Gower street, London, and converted into a hospital for "the medical and surgical treatment of the sick, without the ordinary administration of alcoholic compounds;" and in 1882 the institution was removed to its present well-found and commodious building in the Hampstead Road. At first only 52 beds

[Read at the meeting the of Section on Medicine of the British Medical Association, in Liverpool, August 2, 1883.] Mr. President and Gentlemen: The subject which I have selected for a short paper cannot, perhaps, be said to belong in the higher regions of pathology and practice, but it is one which, as it seems to me, has considerable material importance. Most writers on practical medicine at the present time, as in the past, recommend tapping, in cases of ascites, as a last resort, to be employed only when the dropsical accumulation has occasioned an alarming interference with respiration, and after other measures of treatment have proved ineffectual. The practice of most physicians now, as hitherto, I suppose to be in accordance with this recommendation. Many years ago I was led by reasoning and by clinical observation to advocate tapping early in cases of that affection. In 1863 I communicated

The subjects of "adenoids" is such a well-worn one that I would not venture to bring it before the society, had I not been encouraged in my doubts as to the proper way of operating on these growths, by a recent discussion of this very question at a meeting of the London Laryngological Society. It appeared there, too, how wide is the diversity which exists as to the choice of the anesthetic, the posture of the patient, etc. Since conditions are different with us, especially resulting from the preference given ether over chloroform by the profession at large, and the popular distrust in which the latter drug is held; since, furthermore, this mode of operation with ethyl bromid has not been described in American literature, I am in hopes that the discussion called forth by this short paper will prove to be out of proportion to its length. While it

To the Editor:— It is often a distinct advantage to have statistical or other textual material typed or printed on small transparencies to be used as projection slides for large medical meetings and even for small conferences in most hospitals. A major obstacle to preparation of such slides in the latter instance is the cost involved, especially when the slides are to be used only once or very infrequently. Most slides are composed of a cellophane transparency, on each side of which lines are inscribed by means of carbon paper, usually red. These transparencies then are enclosed between two 3- × 4-in. glass squares, and the edges are sealed with opaque cellophane tape, usually red or black. For 2 years I have been making slides with 3- × 4-in. squares of old unused film substituted for the glass squares. This began out of necessity when the glass was unavailable, and

Notwithstanding the free use of drugs, such as ergot, cannabis indica, etc., in various ways, and notwithstanding the persistent use of electricity with all of the modern appliances, there are many uterine fibroids that are but slowly or slightly altered for the better; and a large number continue to grow with increasing deleterious results, despite the use of these agents. This leaves a large and, as I have found from experience, a difficult field for surgical work. This short paper is devoted exclusively to the practical surgical side of some methods of removing the uterus to get rid of these perplexing growths. These methods in their different phases I will illustrate briefly with cases, that I may show more clearly why we adopt different lines of procedure in operating upon this class of patients, and also to demonstrate that it is difficult or impossible to formulate a definite plan of

Read in the Section on Practice of Medicine and Materia Medica of American Medical Association, May, 1884. It has been the writer's intention to bring into this short paper, the results of observations extending over some time concerning certain limitations which must be placed upon signs which are considered, when present in certain states, more or less pathognomonic of a definite morbid condition. The word pathognomonic is not used in a strict sense, but somewhat as the word diagnostic. The writer has so frequently witnessed erroneous opinions as to the nature of disease, arising from the reception of some one sign as absolutely determining, that he has been impelled to write this article to impress more forcibly the necessity of studying all the phenomena present in cases of disease. Those diagnoses which are rightly denominated snap, may at times be brilliant, but he who indulges in them frequently, no matter

To the Editor: —In one of your valuable series of articles on the care and feeding of infants (The Journal, Jan. 13, 1923, p. 109) the author says "Schick ( Ztschr. f. Kinderh. 27 :57, 1920) has found that he can prevent most of this initial weight loss by the feeding of sugar solutions during these first days, giving as high as 1 ounce (30 gm.) of sucrose during the twenty-four hours." In a short paper ( New York M. J ., Jan. 9, 1915) I reported briefly the results which I had obtained by giving 200 newborn infants 1½ ounces of a 10 per cent. lactose solution every three hours, and was able to show that the initial weight loss could be reduced one half; that nearly twice as many infants regained their birth weight at the end of ten days, and that the so-called inanition fever could be prevented Further investigation

To the Editor:— In the short paper on "The Treatment of Poliomyelitis from the Neurologist's Point of View" published inThe JournalOctober 22, Dr. B. Sachs says: "Muscular exercise is the chief aim in the treatment, and for that reason one must follow the simple rule that in treating the paralyzed muscles that form of current is to be used which gives the best contraction with currents of moderate strength." I believe that all who have paid attention to this matter will agree with this statement of Dr. Sachs. But in many cases of poliomyelitis no contraction whatever can be produced by "currents of moderate strength." And indeed in many cases no contraction, or only a feeble one, can be produced by even painful currents. No good can be accomplished by using electricity unless the current produces muscular contraction. And in many cases muscular contraction can be produced only

To the Editor: —Referring to the article on "Repair of Dural and Brain Defects" by Drs. Halstead and Caylor (The Journal, April 26), permit me to call attention to the value of sheet mica (stove isinglass) for this purpose. I once published an article on the subject pointing out the superiority of this (mineral glass) to others as a covering for exposed and damaged brain tissue. Sheet mica can be obtained at any hardware store or, in emergency, removed from the glass windows of heating stoves. It can be split to any amount of thickness from a solid block to that of the thinnest tissue paper. It is smoother than glass; absolutely nonirritant, indestructible, nonadherent to the tissues: a window for observation of the part on which it is applied; is elastic and difficult to break, and can be cut with scissors into whatever size or shape required. Not least

Sweating was induced in 56 patients for the purpose of predicting the results of lumbar sympathectomy. Nitrazine paper was applied to the skin as an indicator of the appearance of perspiration. The limb affected by vascular disease was then compared with the contralateral limb. A prediction formulated on the basis of this test was recorded before each of 68 sympathectomies performed in these patients, and the findings after operation were then compared. Among 41 nondiabetic patients, the good results that had been predicted in 39 cases, and the poor results predicted in two, were realized. Among 15 diabetic patients, however, there were five prediction-failures. If a patient with ischemic extremities is free from diabetes, the sweating test should help in planning the treatment.

Paris, Ill., March 10, 1905. To the Editor: —A few days ago I received a pamphlet gotten out by a proprietary medicine firm, containing an editorial from theVermont Medical Monthly, attempting to justify the use of secret remedies. We are not surprised to find such articles in some so-called medical journals, but expect better things from the official organ of a state medical society. Some physicians throw secret remedy circulars into the waste paper basket at once, but I examine them, because some are well written, and because I enjoy separating the true from the false statements which they contain. After giving the subject a good deal of thought I have come to the conclusion that any physician who prescribes a secret remedy is not only very foolish, but does great harm to the community in which he pretends to practice medicine. He is like the physician who, when

To the Editor: —Since the work of W. M. Millar (The Use of Wires in Blood Vessel Surgery,Proc. Soc. Exper. Biol.&Med.28:193 [Nov.] 1930), who showed experimentally that zinc wire causes a quicker clotting than any other wire when placed in the thoracic aorta, I have had occasion to wire in patients two aneurysms of the ascending and transverse arch. One of the greatest difficulties was to find a source of supply for this wire, but finally I was referred to the Hudson Wire Company, Ossining, N. Y., which furnished me with zinc wire, electrically prepared, and virtually pure, testing 99.99 pure zinc. The wire we used was number 23, B. and S. gage. It was thoroughly cleaned first and then roughened by abrading with coarse emery paper so that the circulating blood would strike these roughened surfaces and thus form the nucleus for a clot.