providing the needed education of the public. It should have a standing committee as a central nucleus, charged with the duty of collecting statistics, disseminating literature, furthering legislation, etc., and the State medical societies should have corresponding committees, while the work should be carried further, through the county societies, health boards and officials, boards of education, teachers and church organizations. A whole systematic plan of campaign is sketched out which has been already adopted and carried out by the Michigan State Medical Society. It needs no prophet, he says, to anticipate how fruitful of good results such a systematic and thorough plan of enlightenment will be against this great evil.-Journal A. M. A.

TUBERCULOSIS OF THE MIDDLE EAR AND MASTOID.-E. A. Crockett, Boston, thinks that the routine examination for the tubercle bacillus would reveal a large number of infections which have clinically shown no diagnostic symptoms. They constitute, he says, the majority of the severe mastoid cases seen in infants. In the extreme cases the diagnosis can be certainly made without recourse to cultures by unmistakable clinical signs, and first and most important of these, he reckons the appearance of a small glandular swelling in front of the tragus, either before or coincident with a middle-ear discharge. Later there is parotid and subzygomatic induration with or without local abscess formation and in extreme cases, after weeks or months, the formation of post-aural abscesses and induration of the glands of the neck. In the severe type the process is apt to begin in the middle ear or temporal bone and to be attended by a facial paralysis on the affected side, and later by the formation of large sequestra of the mastoid or petrous or both. These cases are easily diagnosed and their prognosis is absolutely bad if untreated. A more common form is an infection of the middle ear without involvement of other tissues or of the mastoid, evidently proceeding by way of the Eustachian tube and usually a complication of pulmonary tuberculosis. In Crockett's experience, it has been impossible to check one of these cases short of complete destruction of the membrane and partial destruction of the malleus and incus. In the latter, prompt operative treatment checks the local process, and the prognosis is good; otherwise, as already stated, it is bad. Crockett says, indeed, that the tuberculosis process in the neighborhood of the ear is fully as favorable in infants, if not more so, as that of the ordinary septic processes

commonly causing mastoid diseases in children. Of course, general hygienic and other open-air treatment is also indicated, and much good can be obtained in the middle-ear processes by the use of iodoform powder and gauze in all the open wounds. These are the only cases in which, in his experience, marked improvement follows the use of iodoform gauze instead of plain gauze.—Journal A. M. A.

Treatment of Loosened Teeth.

M. L. Rhein, New York City, distinguishes two classes of loosened teeth: (1) Those cases due to infection which has caused the spreading of pus so as to interfere with the pericemental attachment of the root to the alveolus. In these the more or less speedy removal of the infecting focus will usually restore the solidity of the tooth. Infection from dying pulp, difficult eruption, ligatures around the neck of the tooth, ill-advised separation of the teeth and other injudicious dental procedures are the most common cause in this class, and the condition can therefore be considered a strictly localized disease readily cured by the removal of its cause. (2) Cases in which necrotic conditions prevail and the tooth becomes gradually loosened in its socket as it loses more and more of its peridental attachment. The condition here is the result of some form of malnutrition and is less amenable to treatment. The importance of ascertaining the cause in each case, therefore, is plain. Gingival pockets should be looked for and their extent ascertained. If they extend all round the apex of the root the pulp is probably dead and should be removed. If of slight extent, the question is more difficult and the pulp condition must be tested in various ways. The condition of the occlusion of the tooth must also be considered. Rhein speaks highly of the value of the X-ray in the diagnosis, but points out the need of care in the interpretation of the radiographs. In the second class of cases the general opinion is that the pulp has lost its physiologic characteristics, and its thorough removal when feasible is a well-recognized and satisfactory treatment. The X-ray has been suggested in these cases as a therapeutic method, but its real value is yet undetermined. The high frequency current in its various forms has also been used, and has, at least, the advantage of apparently lacking the dangerous qualities of the X-ray. In the treatment of these cases every possible pus focus must be removed, and one that frequently escapes observation is a root of a multirooted tooth that has lost its entire attachment and remains as a necrotic appendage. Such a root must be removed

without fail, and the best results can only be obtained by replacing it with a porcelain substitute, the technic of which Rhein has elsewhere described. About 85 per cent of his cases thus treated have resulted favorably. When all other means have failed there remains the last resource of uniting loosened teeth together, or to healthy teeth. In all cases of loosened teeth of the second class, after the mouth has been brought into a comfortable condition this can only be maintained if it is followed once every month by careful prophylactic treatment by the dentist and dental nurse.-Journal A. M. A.

Abstracts and Selections.

Proprietaries, Physicians and Proprieties.

In an interesting paper with this significant title,* Dr. F. M. Corwin handles a much-discussed topic very cleverly and injects a vein of reason and common sense into a subject that has been misunderstood by the average reader. We are willing to concede that the work undertaken by the Council on Pharmacy and Chemistry of the American Medical Association is a most worthy and laudable mission, and one that will eventually revolutionize the methods of many of those who cater to the medical profession. There is danger, however, of going to extremes in a crusade of this character, and we hope to see a spirit of conservatism in control of the council before the danger line is reached.

A sense of justice, as well as appreciation of the efforts of the honest and painstaking pharmaceutical chemist demand that his secret, if one there be, of compounding his palatable, effective, and stable preparation, be protected, as a safeguard against substitution -that pernicious practice which does more harm than all the other evils combined and against which every doctor would fain be protected. Dr. Corwin deprecates the practice of constantly prescribing nostrums, and believes one should use discrimination in choosing remedies, in order to avoid the humbugs and fakes. He is convinced that there are many meritorious and worthy preparations among the proprietaries, articles which no wide-awake, up-to-date

*Journal of the Medical Society of New Jersey, July, 1906.

NOTE. Our position is that the manufacturer having stated his formula, the prescriber should be satisfied with knowing what the preparation contains, without demanding to know how it is made.

physician can afford to be without, but for every one of these meritorious preparations there are a dozen or more which have no valid claim for consideration. Physicians should familiarize themselves with the Pharmacopeia, he says, but should not adhere to it literally, because to do so would be to block the wheels of progress. The Pharmacopeia is supposed to reflect the needs of the medical profession. Corwin suggests in this connection that if the profession took more interest in the Pharmacopeia it might be made more comprehensive, and hence, perhaps, more useful. He places the blame for much of the facility with which physicians are led into the use of nostrums on a deficient education, lack of knowledge of materia medica, and pharmacology. He suggests that every physician familiarize himself thoroughly with the properties of thirty or forty useful drugs, and their most palatable and convenient preparations, and that he avail himself of the knowledge possessed by some up-to-date pharmacist. Physicians should ignore altogether the preparations of secret compositions and the alleged synthetics put out by some unknown house, which exists solely for the purpose of making and selling a few specialties. These articles of secret composition are no more worthy of confidence and patronage than are the so-called "patent medicines" which are advertised to the laity as cures for every known ailment. He also urges shunning all proprietaries which, while perhaps in themselves unobjectionable, have been exploited or marketed in such a way as to become well known to the general public and to be found in the department stores. The surface of the earth has now been raked over so carefully by the searchers for the useful that it is safe to assume that about all the plants and trees and minerals of any known or supposed therapeutic value have been brought to the pharmacologic laboratory and made to yield up their active principles for medicinal use, so that the profession may well look with suspicion on any alleged preparation of a hitherto unknown plant. With synthetics the case is different.

We are in hearty accord with Dr. C. H. Hughes, when he attributes to the average doctor the ability to discriminate for himself. He says:

"In the use of the aids to our therapeutics, a wise discrimination in the selection of the proprietaries, rather than an indiscriminate and wholesale condemnation is called for in the present-day therapeutic side of the practice of medicine. The essential thing

Alienist and Neurologist, May, 1906.

to a wise and proper therapeutics is to know the exact proportion of and dosage of ingredients. Knowing this, the average physician ought to know when and how to use proprietaries with therapeutic property and clinical correctness, without the commercially-inspired suggestions and instructions as to therapeutic indications so voluminously, enthusiastically and often incautiously given, in some instances, by proprietary promoters."

Dr. Kenneth W. Millican, editor of the Weekly Medical Review, has contributed a series of articles on "Commercialism, Professionalism, and Their Relation to Proprietary Medicine," which cover a wide scope, and constitute a masterly analysis of these various questions the best solutions we have yet seen. Dr. Millican has issued a pamphlet containing these editorials, which we advise our readers to procure and read.

Regarding self-medication and counter-prescribing, Dr. Hopkins has sounded the keynote when he asks the question:§ "By what right does the druggist prescribe even for the commonest of bodily ills? The druggist may know drugs, but he can not know patients! Yet the corner drug store will prescribe for more patients in a day than will the average qualified physician."

Referring to the crusade against acetanilid as a poison, Dr. Hopkins tritely remarks:

"Much has been said pro and con of the coal-tar derivatives and compounds containing acetanilid. It is not our purpose to enter into the controversy deeply. We believe, as we have stated above, that a good and useful agent is being calumniated while the real evil is overlooked. Acetanilid is not a poison in the ordinary acceptance of that term; few doctors believe that it is. It is a good and useful friend which will serve well, if intelligently employed, but it is not intended to be eaten by the teaspoonful or taken in the presence of cardiac disease. These products were never built for the use of any but a learned profes: ion, and this brings us back to censure of the system of self-medication and prescribing by the incompetent. We do not believe that acetanilid can be so combined. as to be a 'safe household remedy.' The exploitation of any compound containing it to this end may well be looked on with serious apprehension. It may be that no harm will result for a long time, but the chance is there, and it is an evil chance.

"Let us hope that the day will soon come when physician, manufacturer and druggist will combine to have the practice of medicine

Medical Fortnightly, July 25, 1906.