ptomain developt depends directly upon the variety of bacteria present. So we approach the theory of some investigators, that all diseases are germ diseases.

Some bacteria, we know, alter their habits and characteristics according to their environment and pabulum. In no other part of the body are micro-organisms so constantly present, and in such great numbers as they are in the intestin. In no other region of the body are they accorded such a variety of media and pabulum as in the intestin. It is in the intestin that our food is prepared for conversion into the particles which go to make up the various tissues and organs of the body. It is thru the intestin that our body gets rid of much of the destroyed cellular elements which the blood and brain and organs no longer require. It is in the intestin that the multiform and mysterious processes which we call digestion take place. It is in this process that these wonderfully complex compounds, the ptomain, the toxin, and the leucomain, are formed. One may be harmless; the other may set in action factors which may prove fatal. Certainly all of them have an influence upon the health and vitality of the individual. Certain micro-organisms produce a condition or a compound unfavorable to their own future existence, hence immunity arises. A very little study, indeed, brings one face to face with the profoundest mysteries of life and of death. Life is nothing more than a constant death. This cell serves its purpose, dies, and is cast off; another cell is elaborated, takes up the work, and life continues; and in each and every part of all these complex processes, the bacterium and the ptomain are in evidence.

Man is born free from microbes; in a few hours they infest him, and remain. with him, busy in the elaboration of the ptomains with which his economy must deal so long as he breathes. Bouchard, in his "Auto-intoxication," indicates that "man is constantly standing, as it were, on the brink of a precipice; he is constantly on the threshold of disease." Any moment his immunity (?) may be overthrown, and he may succumb to poisons generated within his body during the process of assimilation of his food. The kidney is continually busy excreting all the

poisons it is capable of handling; the liver stands guard at the portal vein. As Oliver well says: "The patient and his disease are too often found living under identical conditions.'

Essential as is all the knowledge obtainable regarding the life of bacteria which work in the intestin, fully as important is the knowledge we may glean of the products of their life, and the manner and result of their death, for "the evil which they do lives after them" in the ferments and enzymes which act under conditions fatal to the germs themselves. To such an extent is this true that Sir Lauder Brunton, in the "Introduction to Modern Therapeutics," considers that "disease depends upon the products of putrefaction and fermentation, rather than upon the direct action of the microbes upon the tissues."

If it were possible to cause conditions within the alimentary tract to revert to those maintaining at birth-in other words, if we could secure and maintain intestinal asepsis-we would have done nuch to solve the manifold problems of auto-intoxication. But, alas, no drug yet known has this power. We have, however, certain drugs which we can administer up to a certain point, and which, when so ingested, have some power in limiting the products of bacterial activity. Notably among them are betanapthol, carbolic acid, the sulfocarbolates, salol and other phenols. Until such time as some innocuous drug will be found to possess decided antiseptic power in the conditions present in the intestin, we must combat intestinal toxemia to a large extent by diet and purgation. To appreciate the conditions present, and to understand how to take measures to limit the absorption of the toxins we know are being constantly elaborated, is the undeniable duty of every practising physician.

The Treatment of Burns.

In treating burns, it is essential to remember that in all severe cases, both internal and local treatment is demanded. The first attention is to be devoted to relief of pain, sedation of the excited nervous system, and to securing reaction from shock; secondly, the local lesion is to be properly drest. The degree of shock is most accurately estimat

ed by the general character of the pulse. An attempt should be made, also, to estimate the probable involvement of the air passages and larynx.

In all severe cases, relief of pain and sedation of the nerves are most quickly and satisfactorily accomplisht by the hypodermic injection of grain of morphin combined. with 1-100 grain atropin; in the more robust, or in cases of the gravest type, 1⁄2 grain of morphin may be none too much. The patient should be kept well rolled in blankets while the dressings are being prepared, in order that as much body heat be retained as possible. When facilities are at hand, it is good practise to immerse the burned portions (even the entire body, if necessary) in a bath slightly warmer than the body temperature. While in the bath, it is often easy to cleanse the lesion and remove the tags of crisp skin or particles of clothing or dirt that may adhere.

If the patient goes quickly into profound shock, it is imperativ that stimulants be employed, until the pulse responds. Whiskey by the mouth and strychnin hypodermically are the most approved agents. Intravenous infusion of normal saline solution, to which a dram of a 1 to 1000 adrenalin solution has been added to a pint, may be employed. In these cases the warm bath is one of the best measures to aid the therapeutics suggested.

For the local dressing, the old reliable carron oil may be employed, either plain or with the addition of I part of carbolic acid to 20 parts of oil. Many prefer it to all other dressings, and it undoubtedly gives good results, tho disagreeable to apply properly and very apt to keep patient and bed thoroly soakt with grease. Picric acid is a newer remedy, the solution of which is prepared as follows: 85 grains of picric acid are added to two and a half ounces of alcohol, and this mixture to two pints of distilled water. After thoro cleansing of the lesions, strips of gauze are dipt in this solution and laid on the parts; this is covered with absorbent cotton and held in place by a few turns of a bandage. It dries quickly and is not removed for several days. When about to remove it, soak dressing in the solution and it will come off readily. The new dressing is then applied as before. The use of rubber gloves while applying the dressing will prevent the unsightly yel

Soak the gelatin in the water until soft, then heat it on a water bath till melted. Add the glycerin and continue heating until a firm skin forms on the surface in intervals of stirring, then add the carbolic acid and mix all well together. Keep in well stoppered glass containers. When wanted for use, it is heated on a water bath till melted, then applied with a soft brush. It forms a strong but flexible skin.

Some practicians prefer the dry dressing of burns; it is very convenient and results in grave cases have been satisfactory. The burnt area is cleansed as thoroly as possible and all loose tissue is removed; xeroform is then dusted freely over the surface and covered with gauze, cotton, and bandage; the dressing only requires renewal at the end of four to six days. This dressing is removed in a bath.

The kidney action must be watcht carefully in all extensiv burns, and if the urin become cloudy or high colored, sweet spirit of nitre and potassium citrate are to be given in generous doses.

Pernicious Vomiting of Pregnancy.

The dividing line between the physiological vomiting of pregnancy, which occurs in the majority of all cases, and the pernicious form, with its attendent mortality of between 30 and 60 per cent., is not definitly fixt. Indeed, the matter seems to be more a matter of degree than of variance in disorder. No diagnostician, when first a pregnant woman begins to vomit, can say positivly that it will prove to be merely physiological, or will develop into a pathological condition. Even in cases where the pathological condition is undisputed, authorities differ as to the etiology of the affection. This is not strange when we consider that any explanation involves a demonstration of the condition and stability of the nerve centers, and also of the degree and cause of the peripheral irritation. Some declare the condition to be the result of the reflex

stomachic irritation consequent upon the excitability of the sympathetics induced by the enlarging uterin walls. Others are emphatic in their assertion that an auto-toxemia underlies the severe symptoms, and cite the beneficial results which often follow treatment directed towards a betterment of such conditions, as proof. The basis of diagnosis, we believe, must rest upon a determination as to whether the vomiting is intimately related to and entirely consequent upon the pregnant condition, or whether the vomiting is independent of the pregnant condition, or but slightly related to it.

Since it is not possible, clinically, to separate vomiting in the pregnant state into two varieties, much of the treatment which burdens the text-books may be considered useless, because much of it is specifically commended for one or the other variety.

ne whole object of any and of all "methods of treatment" may be summed up in the following few words: Exclude existence of complications; remove sources of per pheral irritation; lessen irritability of the nerve centers. Such a view of the matter must impress upon any one the comparativ uselessness of many drugs and methods advised.

It is very

No routine treatment can be advised for any case. Every attempt at alleviation must consider the inclusion of dietetic, hygienic, medical and surgical measures. important, in view of the high mortality attending severe cases, that the surgical features are not kept too long in the background. The life of the mother, by all values estimated by man, is of more importance than the life of the fetus; yet if operativ interference be too long delayed, the maternal life is jeopardized and both lives may pay forfeit to the temporizing.

The dietetic treatment includes the exclusion of unsuitable articles of food, and, in some cases, rectal alimentation. An absolute diet, permitting water only, and covering a period of one to several days, at the outset of any severe case, may do much good. Rectal feeding is seldom well borne, often provoking a severe diarrhea which is more exhausting than any deprivation of food could be. In the milder cases, benefit often follows a light lunch of a cracker, toast, and tea or milk just after wakening and before raising the head from the pillow, the patient lying flat on the back for

15 or 20 minutes afterwards before making any effort to rise.

The hygienic efforts include absolute interdiction of sexual intercourse; lavage of the bowel, and in occasional cases, of the stomach; a mild electrical current applied over the neck and epigastrium; and, in the worst cases, confinement to bed, in a quiet and darkened room. It is a peculiar fact that moral control over the patient has often a salubrious effect; the emphatic assertion that a certain medicin will stop the vomiting often results in a complete cessation. Even a vaginal examination, accompanied by elaborate preparations and precautions, is in many cases sufficient to produce a decided beneficial effect on the symptom. Due attention is paid, of course, to the emunctories.

In the way of medicinal treatment, it is enuf to say that drugs, except those which aid in maintaining perfect functional activity of the skin, kidneys, and bowels, or which aid in elimination or lessening of irritation, are frequently useless. Spraying the fauces with a weak cocain solution before taking food often prevents the vomiting in mild cases. As a rule, the inexperienced practician addresses his efforts along the lines of drug therapy to the stomach, and this is "beginning at the wrong end of the trouble, a fact attested by the interminable lists of drugs given in the books and handed down thru force of habit" (Jewett). If the irritation in the stomach proceed to development of a true gastric catarrh, the drug stricture is removed, for it is then necessary to treat the catarrhal condition, Any complication, as for instance, nephritis, may at once render the use of drugs imperativ; it is the uncomplicated, severe case which seldom does well under drugs alone.

The surgical treatment, ordinarily, is understood to refer to the induction of abortion; but we think it preferable to include all manual intervention. This would include topical applications to a diseased cervix or os uteri; depletion of Nabothian cysts by puncture; insertion of vaginal tampons; when necessary, replacing of a displaced uterus; and when necessary, the insertion of a pessary to maintain the proper position. In severe cases, dilation of the cervix (and, as recommended by some, tho we consider it adds to the dangers of the procedure, the stripping loose of the mem

branes a little way from the cervix), tho it is to be remembered that this often results in the induction of an abortion. Finally, if emaciation become extreme, or if feeble pulse indicate flagging heart power, or if epigastric pain is not relievable, or if the vomited matter becomes "coffee-ground" in character, and if the eliminating of urea sinks to a low ebb, then abortion must be induced to save the mother's life. Abortion should never be undertaken without a consultation of several brothers in practise, and should be delayed until the symptoms above outlined warn that no further temporizing will be tolerated by an exhausted system, and yet it must be undertaken while the mother possesses a sufficient reserve strength and vitality to stand the operation itself and to rally afterwards.

Probably few other emergencies arise in practise where cooler heads and more mature judgment are in such great demand. We have written this article at the request of a subscriber in Canada who has reacht the age of 73, and who has lost faith in drugs and text-books. In another column we are giving a list of drugs and beside them the names of the acknowledged authorities who have commended them, just for the perusal of the many who will persist in dosing patients with drugs without having taken any thought. We do this only because many of the medicaments advised comply with our suggestions to lessen irritation and to promote elimination.

Practise of Medicin Defined.

The prosecution of quacks and pretenders under our various and comparativly recent medical laws has placed it upon the judiciary to define the practise of medicin as occurring in these laws. As a consequence, many definitions have been promulgated by various judges. The latest and best one we have seen is by Judge Green, of New York. It is as follows:

"The practice of medicin is the exercise or performance of any act, by or thru the use of any thing or matter, or by things done, given or applied, whether with or without the use of drugs or medicin, and whether with or without fee therefor, by a person holding himself or herself out as able to cure disease, with a view to relieve, heal or cure, and having for its object the prevention, healing, remedying, cure or alleviation of disease."

Upon this the Phila. Ledger comments as follows:

"The person who undertakes to do the work of the doctor, which is the curing of diseases, does not evade responsibility by any trick or method. Whether there be administration of drugs, the laying on of hands, resort to bread pills, baths, dieting, blue glass, incantations or hypnotism, the operation is the practise of medicin, in the spirit of the statute. This statute is for protection of the public health, as well as to guard the credulous invalid from the rapacity of swindlers. Judge Green's view will be accepted as the popular view, not only because it upholds a benign law, but because it is the expression of plain common sense."

Establishing a Standard.

The average doctor doesn't take much interest in what appears in the advertising pages of medical journals-not near as much interest as he ought to take; on the other hand, a few advertising critics are arising in the profession who go into hysterics over nearly every advertisement of a therapeutical nature, without consistency, rule or reason. If any therapeutic advertisement escapes criticism by one critic, it is condemned by others; and so it goes until all advertisements are condemned, even to Reed and Carnrick's trophonine, a liquid food of the highest standing, and not a drug at all. The critics are entirely at sea as to agreement on a standard, each critic having a standard of his own, if prejudice, lack of investigation and absence of rule or reason can establish anything worthy of being called a standard. We know whereof we speak, for in our talks with critics who are deservedly leaders in the profession in some ways, they seem to disregard logic, and consider information or investigation superfluous when they touch this topic. Many of them seem to adopt the Irishman's policy in the Tipperary campaign, "when you see a head, hit it," with regard to therapeutical advertisements in medical journals.

In the midst of this confusion and chaos, some one should at least begin the establishing of a standard; drawing a line which all should recognize, and then advance the standard as rapidly as general agreement can be accomplisht. We have long ago drawn the line against all speculativ advertisements. Some journals still print advertisements of mining stocks, oil stocks, plantation stocks, etc., but we never did and never will. Also the line should be drawn on advertisements which are palpably quackish, sale of formulas, and other efforts to "work" the profession. Many such advertisements come

to us, which, of course, we refuse. We establisht the above standard for ourselves long ago, and we hope the profession will force every other medical publication to adopt it.

The above being accepted, we approach the many proprietary preparations which are advertised in even the best medical journals, and we stop to consider how we can advance the standard beyond what is mentioned above, so that all respectable medical publications will accept it. Let us try going slowly, even if it is the consideration of one preparation at a time, and see if we can advance the line so carefully that all legitimate medical journals will accept it. The most conspicuous and the most vulnerable of the proprietaries under consideration is undoubtedly antikamnia. There was a time when it seemed to be acceptable, and we, together with perhaps all the other medical journals of the country, accepted it. Long ago it became known that it was an acetanilid mixture; and other similar preparations have appeared, advertised only to the medical profession; and still other acetanilid mixtures (as orangeine, Koehler's headache powders, bromo-seltzer, etc.) have appeared advertised freely to the laity. We all know the evil of placing such a dangerous drug as an acetanilid mixture into the hands of the laity; and no respectable medical journal would think of granting advertising space to orangeine, Koehler's headache powders, bromo-seltzer, etc. While still advertising largely in medical journals, a few years ago the antikamnia people began to advertise directly to the laity, insidiously thru circular letters, addressed to certain classes, as clergymen, lawyers, merchants, ladies, etc. We have often printed samples of these letters. Here is one:

St. Louis, U. S. A., Feb. 10, 1906. Mr. Taylor: We are pleased to enclose a sample of "Antikamnia Tablets" for pain. A sample of something good for pain, is a "good thing" to keep about the house, or for convenience, in your pocket or purse.

Antikamnia Tablets will relieve all headaches, muscular pains, neuralgias, la grippe, insomnia and women's aches and ills. The enclosed booklet tells when and how many, and druggists everywhere sell them in any quantity or in our regular "Vest-Pocket-Boxes" as below. Sincerely yours,

The Antikamnia Chemical Co. FRANK A. RUF, President and Treasurer. The above was addressed to me as "Mr.

C. F. Taylor." I edit and publish "Equity Series," and in that capacity I am (and properly) known as "Mr." I suppose in this way the antikamnia clerks got me on the laity list. And I received the antikamnia calendar addressed in the same way. The printing on the letter-head is distinctly intended for the laity, and not for the profession; the twenty-five cent vest pocket package is specially exploited, of course, for the laity. Similar letters have been sent to the laity all over the country, and the calendars, with liberal advertising on both front and back, have, each year, been liberally sent out by mail, and distributed to the laity thru druggists. These facts are so well known that no wide-awake medical editor can plead ignorance. Antikamnia is a secret preparation as far as the proprietors can keep it secret. Here is its composition as given by the Council on Pharmacy and Chemistry of the A. M. A.:

ΑΝΤΙΚΑΜΝΙΑ.

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture and to contain the following ingredients approximately in the proportions given: Acetanilid, 68; caffein, 5; citric acid, 5; sodium bicarb., 20.

The Bulletin of the Arkansas Medical So

ciety for February 15 (page 7) says:

The Antikamnia people, our would-be friends heretofore, who have posed in our medical journals, who have sampled us and supplied us with their little morocco cases, their physician's visiting list, their calendars, drawn espccially by our departed medical friend of St. Louis, they seem to have forgotten the ways of ethics and have aligned themselves with the sharks of mercenary greed and gain. How the members of the medical profession can repose confidence in them at this time, when they know that these people are now sampling the laity and going direct to the public is more than we

can see.

The question is, should a dangerous remedy like an acetanilid mixture, exploited to the laity as antikamnia is, be granted advertising space in a legitimate medical journal? We have decided that question in the negativ as far as "The Medical World" is concerned, and we have done what we could to expose the above methods as being unfair to the medical profession and dangerous to the laity. Since we have done this, it seems that the antikamnia people have sought to "throw dust into the profession's eyes" by largely increasing their advertising in medical journals, apparently patronizing every