make, and possibly the most important, is that more of our patients are damaged than helped by the promiscuous drugging which is still too prevalent. I believe if fewer drugs were given in pneumonia a very much larger number of uncomplicated cases would recover with no medical treatment beyond an occasional laxative. The mortality to-day in the various hospitals seems to me unusually high. In the four New York hospitals which I have investigated, the mortality varies from thirty-five to forty per cent. At the Presbyterian Hospital, in six hundred cases, the mortality was 34.8 per cent.; at the Roosevelt Hospital, from 1903 to 1905, the mortality was about 40 per cent.; at the New York Hospital, from 1893 to 1894, 38 per cent.Therapeutic Gazette.

THE DUAL LIFE.

[Extract from an address to Arkansas State Medical Society by Dr. Joseph M. Matthews, of Louisville.]

You will permit me to cite you to certain traits of character of men in our profession, which should dub them Mr. Hyde, rather than a Doctor Jekyll, whose character we should try to emulate :

Deceit and hypocrisy. Envy and jealousy.

Slander.

Back-biting.

Sarcasm.

Lying.

Bearer of tales.

Flattery.

Neglect of patients.

Surgical operations for self-reputation. Seeking popularity at the expense of honor. The telling of secrets.

As doctors, are we honestly and ardently striving for a better condition of society? Have we any jealousies? Are we envious of one another? Sometimes this is true, and it is a shame that it should be so. Is it

true that any of us are fickle and backbiting? Do we perform our duty in a halfhearted way? Do we ever indulge in sarcasm? Are we ever guilty of deception? Do we sometimes flatter? Do we neglect the patients entrusted to us? Do we perform surgical operations for pelf or reputation? Are we telling secrets or giving out information that might do harm? Do we

by "wink or nod" or supercilious look, damn with faint praise meritorious work?

Let us rather supplant these with the characteristics of Dr. Jekyll; viz. truth, faithfulness, pity, kind words, covering slander, duty, charity, honesty, secretiveness. Let us know ourselves. Without this information we will be mere shuttlecocks, swayed by every wind. The doctor's life makes a man, a real man. Quiet, of even spirit, trained heart and educated mind, he

is invulnerable. Idleness and ease never produced a great man; but instead ends in ing, slander, hate, dissipation, despair, envy, worry, bluster, fretting, fault-finding, hurry

malice and revenge.

Adverse criticism is a stimulant to action. Don't court it, but accept it in silence with a determination to prove it false. Calmness is the greatest attribute that we can possess. First "know ourselves" and then "govern ourselves." The boisterous, tempestuous nature never accomplishes anything. It does not inspire confidence, and without this on the part of our patients, all our efforts will be in vain. If at any time the attributes of Mr. Hyde which may lurk in our nature show their presence, we should conquer them before they come to the surface. Let us be calm and tranquil in all our undertakings. To the man who is calm, revenge is so far beneath him that he cannot reach it, even by stooping. When injured he does not retaliate, but waits for time and truth to rectify the wrong. He wraps around him the royal robes of calmness, and envy and injustice sneak away.

Where the gray heron is pursued by its enemy, the eagle, it does not run to escape; it remains calm, takes a dignified stand and waits, quietly facing the enemy, unmoved. With the terrific force with which the eagle makes its attack, the boasted king of birds is often impaled and run through on the quiet bill of the heron. The means that man takes to kill another's character becomes the destroyer of his own. Don't let us misjudge our fellow man and thereby do him an injustice. You can no more judge a character by outside appearances than by the kind of clothes one wears.

There is an old Latin maxim which reads: "Nothing concerning the dead unless it be good." Why not let it apply to the living? A bouquet to the live man is worth bushels of flowers to a dead one! (Applause.)

Many a warm and tender heart beats beneath a rough exterior.

WHEN JIM WAS DEAD.

"Hit sarved him right," the nabers said,
An' 'bused him for the life he'd led;
An' him a-lyin' thar at rest,
With not a rose upon his breast!
Ah! many cruel words they sed

When Jim was dead.

"Jes' killed hisself;" "To mean ter live;" They didn't have one word to give

Of comfort, as they hovered near

An' gazed on Jim a-lyin' there!

"There ain't no use to talk," they sed,
"He's better dead."

But suddenly the room growed still,
While God's white sunshine seemed ter fill
The dark place with a gleam of light,
An' o'er the dead she bent-Jim's wife!
An' with her lips close, close to his,

As though he knew an' felt the kiss.
She sobbed,—a touchin' sight to see,
"Ah, Jim was always good ter me."
I tell you when that cum ter light,
It kinder set the dead man right;
An' round the weepin' woman they
Throwed kindly arms of love that day,
And mingled with her own, they shed
The tenderest tears,
When Jim was dead!

-Jour. Ark. Med Soc.

TYPHOID PERFORATION-RECOVERY WITHOUT OPERATION.

Pa

Dr. J. H. Musser reports this case. tient, aged 30, with typical typhoid, recovered, and “after a lapse of seven days fever recurred and, with other symptoms, it was soon evident a well defined relapse of the original disease had occurred. On the third day of the relapse the patient had some abdominal pain; on the fourth day (June 4th) a chill. I saw him with his attending physician on the fifth day of relapse, the third day after abdominal symptoms developed. The view that localized peritonitis was present was supported in that pain, the characteristic vomiting, the facies, the dorsal position with legs drawn up and the local abdominal signs prevailed. There was extreme rigidity of the abdominal muscles with a marked flatness of the abdomen. The urination was frequent and painful and suggested a pelvic peritonitis, a suspicion verified later by an autopsy. A pelvic examination failed to disclose any appendicular inflammation and no signs of effusion. The vesical pain could only be prevented by fre

quent catheterization. The slightest distention of the bladder caused pain. The physical signs of bronchitis prevailed although masked by an evident increase of hypostasis, due to imminent collapse. The patient bore all the features of collapse, which, with the antecedent symptoms, further indicated that intestinal perforation had taken place.

With the conclusion that perforation and peritonitis were present, it was important to decide whether operative measures were justifiable.

It was decided not to operate because of the past pulmonic condition, while the persistent bronchitis and the overwhelming hypostasis were of such degree as to invite a pneumonia from anesthesia. It seemed unwise to operate and add another death, which to the laity is always considered operative. Moreover, and of as great importance, the patient had undoubtedly rallied. from the time perforation apparently took place four hours before, and the hour of consultation. On the second day of perforation the features of collapse disappeared, the peritonitis was undoubtedly local and not spreading. Hence, further careful watching and operative delay were advised.

On the ninth day the patient had a hemorrhage. I saw him again on the tenth day in collapse from loss of blood. Death took place the evening of the eleventh.

The autopsy was made by Dr. Muller. The lesion that interests us was an ulceration of the ileum which had perforated the intestinal wall and was adherent at this point to the posterior wall of the bladder near the fundus. The adhesions were firm and sufficient to prevent extravasation. The decision not to operate was justified by the autopsy.-Penn. Medical Journal.

Restlessness, increasing pallor, increasing air-hunger, increasing weakness of the pulse, falling temperature (subnormal), and the ephemeral effect of stimulation, all point to hemorrhage rather than shock. In addition, there is often some local sign or symptom.-American Journal of Surgery.

Before operating for sarcoma examine the lungs carefully. Do not operate if the patient has persistent cough and bloodstained sputum (not due to tuberculosis), even though no definite signs are found in the lungs a' metastasis has developed.American Journal of Surgery.

All communications to this Journal must be made to it exclusively. Communications and items of general interest to the profession are invited from all over the State. Notices of deaths, removals from the State, changes of location, etc., are requested.

Our readers are requested to send us marked copies of local newspapers containing matters of interest to members of the medical profession. Name of sender should be given.

CONTRIBUTIONS TYPEWRITTEN.

It will be satisfactory to all concerned if authors will have their contributions typewritten before submitting them for publication. The expense is small to the author-the satisfaction is great to the editor and printer.

Any of our contributors desiring reprints, will please write to our publishers, The News Lithograph Co., Wheeling.

TO OUR READERS.

The committee of Publication, to whom the conduct of this Journal has been committed, sent out a large number of complimentary copies of the first issue. It has been the aim to reach in this manner, every physician in the state. Earnest effort has been made to secure their names and addresses. The committee is aware that there are a great many whom it has not yet been

tion that eventually its efforts will be rewarded with practically a complete list. To the same addresses and to such additional ones as have since been obtained a still larger number of the present issue is sent. It is the hope of the committee to enlist the interest and aid of the whole profession of the state in this enterprise. All can see that it will be of the greatest advantage to the profession to have a journal of their own rise to a position of power and influence in their state. This end is assured provided the profession rally as a unit in its support. The committee hopes, therefore, that everyone who receives a copy of the Journal, who is not already a subscriber, will consider himself personally solicited to enlist in the cause, and to bring in as many recruits as he can influence. To brethren residing in other states, may we not also look for an encouraging word and a helping hand? Let us then have your names and your dollars, so that you may receive the next and subsequent issues, and further, that you may have the consciousness that you are identified with a movement so important to the welfare of your profession.

"I DIDN'T KNOW THINGS LOOKED THIS WAY."

The importance of a better understanding on the part of parents and teachers of the subject of visual defects in children, is once more given emphasis by the opening of another school year. It is doubtful if the ignorance and neglect shown toward a condition so vital to the comfort and welldoing of children so afflicted could be more complete. Not alone the progress of the child in school, but its whole after life may be, and almost certainly will be, profoundly influenced for weal or woe, accordingly as the condition is intelligently or ignorantly dealt with. The meagre information upon the subject possessed by the public at large makes the task of arousing an active and

potential interest in remedial measures very difficult. In the first place, the idea is general that the eye is a wonderfully perfect organ, which it most emphatically is not. In the second place, the efforts that have not infrequently been made to enlist public interest in the matter have usually been regarded as the outgrowth of a not overly well regulated imagination-crazy whims, unworthy of serious consideration; or schemes prompted by selfish motives. To illustrate our subject, let us suppose the case of a school-boy with eyes affected by one or more of the usual defects of refraction and accommodation. If he be myopic, or markedly astigmatic, and especially, if, with the latter, he be hypermetropic with failing power of accommodation, it will range all the way from difficult, to impossible, for him to get much satisfactory instruction from a teacher's blackboard exercises or from charts. At the distance these are usually placed from him, he can see nothing clearly; there are no sharp outlines, everything seems in a haze or mist; what to his classmates is clear is to him indistinct, and he cannot avoid confusing lines and letters and figures whose finer details are not perceived at all. For nearer work, as in reading or writing, things may or may not be better. But if, on top of all this, his accommodation happens to be overworked, the effort to use the eyes for these purposes produces such a feeling of discomfort and strain, that he has constantly to keep looking away from the page to get a momentary relief, and besides, he is apt to acquire a habit of squinting, blinking, and rubbing of the eyes that bring him into unpleasant notice. Such a condition is simply unbearable. He cannot study, so gets to be classed as indolent. Reprimands, penalties and mortifications numberless, are his portion. He is rated as dull, stupid, non-receptive. He gets discouraged and later indifferent. If he keeps along with his class at all, he is at the foot of it. This burden he will carry all through his school days, and from there

into his business life, and all the while he will be thinking that he sees just as his fellows do. In a knowledge of these conditions, the training of the average teacher is very defective. Very few are aware of the frequency and results of these defects, and fewer still know how to look for them. It should be made a part of every teacher's qualifications to know how to use the ordinary tests for their detection. It is easy to do, and takes but little time. Each teacher, or better, each school, could easily be supplied with a set of elementary test cards. They cost but a trifle, and with a little training in their use any teacher could quickly discover whether or not a pupil was suffering from such defects to any injurious degree. Normal schools, and all other schools that engage in the training of teachers, should give a course of instruction in their use sufficiently thorough to equip their students for such examinations. Furthermore, teacher's institutes and teacher's examining boards should keep this matter in view, and every teacher's certificate ought to be evidence that among other qualifications, a practical knowledge of these means and methods is possessed. It is not at all. intended that this instruction of teachers be thorough enough to fit them for treating such cases. This should always be turned over to someone especially trained for such work, and whenever a pupil is found to be in need of it, he or she should, as soon as practicable, be put in the way of receiving the proper care. Once, a little boy was trying, for the first time, glasses that had been prescribed for a defect in his vision. As soon as they were adjusted, he ran to the door, and for a few moments looked intently up and down the street, then, turning around, his face radiant with delighted surprise, he gave vent to his joy in the exclamation which has been chosen as the text for these remarks. Long years ago he passed out from our mortal ken, but his little sermon has never been forgotten. These simple words touch the heart of this

whole matter. These sufferers do not know or even suspect their own condition. They do not even know that such defects could exist, owing, no doubt, to the fact previously stated, that eyes are generally believed to be organs without structural imperfections. Hence, they assume, naturally, that things "look" to them just like they "look" to others, and they go on day by day, and year by year, acquiring incorrect and imperfect ideas and conceptions of all the natural objects that surround them, while the finer lineaments of the fair face of nature are completely veiled from them. Let every dull, or backward, or inattentive pupil be subjected to a little investigation of the state of his visual apparatus, to see if his unsatisfactory conduct and progress may not be due to something other than perversity or stupidity. It surely would be a source of extreme gratification to any parent or teacher by so doing to rescue a child from such a disabling condition. It is urged upon them, and not less also upon the school authorities and the medical men of every neighborhood, to give this matter earnest and enlightened attention, and to do what is in their power to remedy a serious defect in our educational machinery.

L. D. W.

DOES MEDICAL ORGANIZATION

PAY?

In this issue we print several articles setting forth the benefits of organization. They will repay thoughtful perusal, and should stimulate action in counties as yet unorganized. Medical socities have existed for a very long time, but until quite recently almost their sole purpose seemed to be to promote medical knowledge by the presentation of papers and the reports of cases, and the discussion. of these. And indeed this should continue to be their chief purpose. In the writer's thirty-five years' connection with medical societies, he has observed that those who

have been the most faithful in attendance were as a rule the advanced men of the profession, who, it may be said, least needed to attend, and the progressive younger men, anxious to gain information in every possible way.

No man who remains outside medical societies, or, if a member, habitually absents himself from the meetings, can be expected to advance in knowledge as rapidly as do those who are regular in attendance. The frequent discussion of familiar topics even will frequently bring out new points; and new medicines, new methods of treatment and cases with interesting features are frequently presented, so that the members absorb ideas, everyone receiving benefit, even though taking no active part. The society thus becomes truly "a post-graduate school," in which all may be students, and teachers as well. We know of a patient who was treated for four months losing forty pounds in weight, without the kidneys ever being interrogated. This gross error could scarcely have been committed had the attending physician been a member of the county society, for on a number of occasions the importance of early urinary examinations had been discussed in the society. This patient later consulted a society member, who immediately diagnosed diabetes mellitus. In the two weeks following 17 pounds weight was gained.

Again, every physician needs to mingle with his fellows occasionally, and to hear and join in discussion, to keep him out or get him out of the rut. The daily round of practice, with little or no fellowship, will tend to make even the best men narrow routinists. Everyone must come into close contact with his brethren, exchange ideas, talk over cases, relate trials, if he would broaden his mind and get the most out of life. Such contact certainly widens our horizon, adds zest to practice and at the same time gives us a better opinion of each other. And thus we may banish for a time the cares of our vocation, while cultivating the