pears very much like stretching matters to the breaking point. To say that such a definition "cannot be emphasized too strongly" seems very like saying that an erroneous definition is a definition of supreme merit. It cannot be accepted as either positively or negatively correct. Take, for instance, the case of mottled ice cream. The coloring is not added with any wrong intent. No definition of the word adulterate that ignores motive can be a true one. The coloring matter added to mottled ice cream is neither a food nor a condiment, and yet it is in no reasonable sense an adulterant. The definition of Bulletin 100 makes it an adulterant. An addition whether food, condiment, or anything else, that is made for the purpose of deceiv ing and robbing the customer is an adulterant. An addition having no such motive but aiming at the improving of the article is not, in any reasonable sense, an adulterant. Justice cannot properly be meted out by any law that takes a view that excludes intent. The pure food law that Dr. Wahrer and the Journal of the American Medical Association sought to get, ignored the motive and made the addition an adulteration. The pure food law just passed leaves to judges and juries the chance to ferret out the motive, if inclined to do so.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

SURGICAL SUGGESTIONS. Practical Brevities in "Surgical Diagnosis and Treatment. By Walter M. Brickner, M. D, Chief of Surgical Department, Mount Sinai Hospital Dispensary, New York, and Eli Moschcowitz, M. D., Assistant Physician, Mount Sinai Hospital Dispensary, New York. Duodecimo; 60 pages. New York: Surgery Publishing Co., 19.6. (Cloth, 50 cents.)

This little book is most novel, not only on account of the many original terse and epigrammatic practical suggestions given, but its general appearance and attractive form. It contains 250 suggestions grouped under proper headings and its contents is carefully indexed. While some of the items are familiar to the practical surgeon, they are presented in a manner that will impress them on the reader's memory. The book is bound in heavy cloth, stamped in gold, and the text is printed upon India tint paper with marginal headings in red. This book will be much appreciated by the general practitioner, not alone on account of the value of its contents, but as an artistic bit of book making.

POKER JIM-GENTLEMAN.*-The early appearance is promised from the pen of our

*Poker Jim is published by the Monarch Book Co., 121 Plymouth Place, Chicago. Price $1.00.

This

versatile friend, Dr. G. Frank Lydston, whose stories appeal to the doctors quite as satisfactorily as do his scientific contributions. Each story seems to have a scientific lesson under a coating of very interesting fiction. is a story of the old time Cailfornian mining camps by a native son of the golden West. It depicts in graphic terms the oddities and heroism of the early western pioneers and brings out in bold relief the many-sidedness of their characters. The delineation of these characters is a labor of love on the part of the author, who recalls them from his boyhood's days, and as the most picturesque features of his early life. They indeed belong to "the days when there were giants in the land." In Poker Jim, the high minded, courageous, polished soldier of fortune, the author has depicted a character which was peculiar to the environments afforded by the mining camps of early days. Not even Bret Harte, at his best, had a clearer insight into the individualities of the heterogenous population of the coast mining town than is displayed in this book. The rough and ready, chivalrous, hot tempered, impulsive, hair-triggered Argonauts cf '49 have by no means suffered in the hands of the author of Poker Jim, who recalls them heroic figures of a time which, though not far distant, was very unlike the present.

DR. LOUIS RASSIEUR is another of our foreign delegates to return recently. Dr. Rassieur has spent three years in Germany and Austria; his work being along surgical lines.

MOSQUITO BITES. --The intense irritation that is caused in some persons by mosquito "bites" may be promptly relieved by the application of ipecacuanha, either the "vinum" or the powdered root, made into a paste with water or vinegar, being used.

CURING A COLD.-When a man takes a cold, it is really remarkable the crowd of medical advisers he meets. A friend of the writer who was thus unfortunate, had, in the course of six days, the following, among other infallible remedies recommended to

him: A porous plaster, flannel over chest, gin and soda, laudanum, treacle posset, vinegar and bran, saffron, sweet nitre, electricity, Everton toffee, semoline, suicide, Burton beer, onion broth, oatmeal, and several patent panaceas. He was advised to get drunk, keep off the beer, to eat plenty, to starve himself, to keep quiet, to move around briskly, to lie in bed, to sit up. And yet they say in the mulitude of counsellors there is wisdom! -Health.

HISTORY OF A CASE OF CARCINOMA OF THE TESTICLE AND MESTASTASIS IN HEART.

B. F. KERN, M. D.

ST. LOUIS.

Wм. E., widower, aged 76, was sent to the hospital March 19th, for the relief of a strangulated hernia. The following notes were made at that time. This patient complains of sharp abdominal pains coming on at irregular intervals. Patient has a hernialike mass in left inguinal region, an enlarged left testicle and a hard cylindric mass projecting into the left side of the scrotum apparently connected with the mass above.

Patient states that he has had similar pains at varying intervals for the past six weeks. Bowels open. Has not vomited. No abdominal tenderness or rigidity. Pulse 80; respiration 28; temperature 99.2.

Careful examination of the left inguinal region showed the hernia-like mass to be firm and immovable. Patient stated that he had never been ruptured and the mass had been increasing slowly in size for ten years. impulse could be obtained on coughing.

No

Habits-Denies the use of alcoholics or to

bacco. Eats and sleeps regularly. Appetite poor. Bowels open.

Family History.-Parents died in Germany; causes unknown. Can give practically no family history.

Personal. Widower for twenty years. One child dead. Denies any venereal infection.

Previous Diseases.-Patient states that he has never been seriously ill with the exception of two attacks of malaria.

Patient has been losing strength rapidly and for the past three weeks has been unable to be on his feet more than an hour at a time. Appetite has been failing for six mcnths. Patient thinks he has lost about twenty pounds in the past six months. He suffers from sudden sharp abdominal pains which come on at irregular intervals, and Patient persist for varying lengths of time. has never vomited or had a bloody stool. Has never been jaundiced.

nourished, hair white, cornea hazy, muscles Physical examination.-Male, white, poorly flabby. No edema.

Chest well developed. Left side more prominent than right. No areas of dullness, no rales. Breathing somewhat harsh on left side anteriorly at level of third rib. Heart dullness not made out. No murmurs heard; arteries hard. Pulse weak and irregular. No abdominal tenderness or distension. No dullness in flanks. Liver and spleen not palpable.

In the left inguinal region lying above and over Poupart's ligament is an hernia-like mass about three inches in diameter. This mass is very firm and gives no impulse on coughing. The left side of the scrotum is occupied by a hard cylindric mass some four inches long which projects downward from the mass above. The left testicle is twice its natural size. Is not tender. The spermatic cord very firm and apparently about the size of a man's finger, is easily traced to the external ring. Through the belly wall the cord may be easily paplated, disappears through the internal ring.

Urinary tract O. K. Urine 1022, amber like, clear, no albumen, no casts.

Nervous System.-Knee jerks, poor pupils, react slowly to light. Patient evidently senile.

March 30th.-Left testicle twice the size it was at the time patient entered hospital. Right testicle also enlarged considerably.

Diagnosis. Sarcoma of the testicle and cord. Prognosis bad.

Treatment supportive. Patient grew gradually weaker and died April 6th.

can

St. Louis is getting to the front none deny, the rush of building, the making of streets, the opening of new sections and the hum of activity in all parts of our city witness to the fact. Within a year past 49 new manufacturing plants and 984 new mercantile concerns have been established here. At the present eight sky-scraper office buildings are in the process of construction, and many manufactories and buildings less pretentious. One who would know the St. Louis of today must stay here, a short absence makes evident many and great changes.

In things medical the progress of our city is particularly evident. The St. Louis Medical Society is active as never before, its membership is fast growing, its scientific work is creating enthusiasm, it has completed its new hall and on resuming after the summer's intermission will for the first time be in a home of its own. Our medical schools have strengthened themselves, and are now offering students as good opportunities as can be had in the country. New hospitals and a probable State Post-Graduate School and new buildings for our insane and our sick poor are matters of in part accomplished fact and in part certainty for the immediate future.

Medical and other journalism has gotten into motion. Our medical journals are becoming more scientific in their conduct and appearance, and are inspiring pride at home as never before.

St. Louis is losing her character as an overgrown village and is taking on metropoli

tan airs, and she carries them well. When the American Medical Association comes to St. Louis in 1908 we will be able to show a city second to none other in America except in population.

Lay

Selt-Medication

and CounterPrescribing.

THE recently inaugurated campaign against patent medicines and secret nostrums, has emphasized as the really important factor for danger, not so much the poisonous character of the drug or combination used, as the fact of lay self-medication and counter-prescribing in drug stores. These pernicious customs allow drugs which are perfectly safe in safe hands, to be blindly administered and often in the presence of definite physical contraindications which a qualified physician would determine before prescribing. This has led to the classification as poisons of some of our most useful drugs-drugs which are safe and harmless under normal conditions and in proper doses.

By

The State has safeguarded the public by exacting of those who would treat the sick a demonstration of their ability to safely and scientifically do so. Not alone is a knowledge cf drugs a requisite, but the physician must know the action of same in the presence of any condition the patient may exhibit and be quite as ready to intelligently withhold as to administer. Yet the average corner drug store will prescribe for more patients in a day than will the average qualified physician. The druggist may know drugs, but he does not know patients! what right does he prescribe for even the commonest of bodily ills? Does a license as pharmacist include the right to practice medicine? True, it is only just to state that there are druggists and druggists, and that the evil of counter-prescribing is not universal. Unfortunately, however, it is so general as to be an acknowledged fact. is borne out by the published list of fatalities from acetanilid and compounds containing acetanilid. This list may be very inaccurate and greatly exaggerated, as has been claimed, yet it tells a tale of self- and druggist-medication, and the coal-tar derivatives are suffering where a system is really at fault.

Were it possible to have the co-operation of the druggist, lay self-medication would soon be ended and to the ultimate benefit of the druggist. This is a habit which can but be condemned, as it means the employment of medicines in absolute blindness. The habit is nothing less than pernicious, and criminal where drugs are so administered to infants

and the helpless. In this day of free dispensaries and excessive gratuitous treatment, even the poorest in any section of our country need not lack competent medical advice if they will have it.

Much has been said pro and con to 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 caluminated 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 profession, and this brings us back to censure of the system of self-medication and prescribing by the incompetent. We do not be lieve 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 may soon come when physician, manufacturer and druggist will combine to have the practice of medicine conducted in safe, scientific and legitimate channels, and it is no selfish belief that the best interests of all three, and that of the patient as well, will be promoted by the new regime.

THE season is at hand for physicians to make their plans to attend the next meeting of the

Mississippi
Valley

Medical

Association at Hot Springs.

Mississippi Valley Medical Association, which will be held at Hot Springs, Ark., November 6, 7 and 8, 1906. Those who were fortunate enough to be present at the meeting of the association held at Hot Springs in 1894 will remember that it was one of the most delightful, from both a scientific and social standpoint, that was ever held, and from the indications already at hand the local profession will this year bend every endeavor to make this meeting a record-breaker.

The Address in Medicine will be delivered by Dr. Frank Parsons Norbury, Jacksonville, Ill., and in Surgery by Dr. Florus F. Law. rence, of Columbus, O., the mere mention of whose names is sufficient guarantee of a treat om both a scientific and literary standpoint.

The headquarters will be [the Arlington Hotel, while the sessions will be held in the Eastman, where the exhibit hall will also be located. Reduced rates on all railroads. The Iron Mountain will run a special from St. Louis for the occasion.

Independent Medical Journalism a Necessity for the Profession.

trol its destiny.

DR. KENNETH W. MILLICAN in speaking of the power of the American Medical Association (Med. Rec.) states that it may use its influence for good or for evil. The line which it will follow will depend entirely upon the character of the few men who from time to time must of necessity conEarnestness, honesty and tact on the part of these men will make for good. The lack of any one of these qualities will cause the association to become a menace to the profession and thus to the public. The Journal of the American Medical Association has indubitably right on its side in a demand for a measure of publicity in regard to the composition and of honesty in regard to the claims of proprietary remedies. The writer nakes the plea that physicians lay down for themselves certain definite principles which shall govern the admission or rejection of advertisements in the columns. of medical papers. These should be published and acted upon. He believes that a moderate course will be the most satisfactory. He declares that there is no more dangerous frame of mind than that of the fanatic who thinks his mission is to reform the universe. To permit the establishment of a monopoly in medical journalism would be to sound the knell of medical liberty.

DR. NELSON W. WILSON, associate editor of the Buffalo Medical Journal, has been appointed Lecturer on Genito-Urinary and Venereal Diseases in the University of Buffalo. The appointment is a good one, and will doubtless lead to Dr. Wilson's appointment to a full professorship later.

DR. KAHLO AT FRENCH LICK SPRINGS. — The removal of Dr. Geo. D. Kahlo from Indianapolis to French Lick has been recently announced. announced. Dr. Kahlo has undertaken the medical management of that important health resort, and has already inaugurated an active and scientific regime. No name speaks for more among the notable medical men who hail from Indiana than does that of the present physician-in-charge at Frenck Lick. Our congratulations to that institution,

DR. JAS. S. HOLLAND has lately returned to St. Louis after an extended period spent in the pediatric clinics of London, Berlin and Vienna.

DR. FRANK HINCHEY, who has been doing the medical centers of continental Europe, is again in St. Louis, eager to apply what he has learned abroad.

THE BRITISH MEDICAL ASSOCIATION AT TORONTO.-The British Medical Association will convene in Toronto, Ontario, August 21st, the session lasting to and including the 24th. A considerable number of physicians from St. Louis and tributary territory have signified their intention to attend. The editor of the FORTNIGHTLY has been requested to ascertain as definitely as may be the number who will attend from St. Louis, those contemplating the trip will confer a favor by advising us.

FOREIGN CORRESPONDENCE FROM DR. EcCLES.-It is to be our privilege to publish from time to time a series of letters from Dr. R. G. Eccles, who has recently sailed from New York for an extensive foreign tour. Dr. Eccles sailed on July 19th for Cherbourg. He will spend six or seven weeks in Great Britain and Northern France before proceeding to Spain and Portugal. From Gibraltar he will go to Italy, Sicily, Malta, and perhaps to Tunis, thence to Greece, Turkey, Armenia, Palestine, Egypt, Ceylon, India, Burmah, Straits Settlements, Java, Siam, China, the Philippines, Corea, Japan and

Hawaii. A South African and Australian

tour will follow later. The doctor promises

to tell us of matters which are of interest to our profession as the experience of the tour develops them. We anticipate that the series will prove one of intense interest to all readers of the FORTNIGHTLY.

MEDICAL SOCIETY OF THE MISSOURI VALLEY.-The annual meeting of this association will be held in Council Bluffs, Iowa, on September 6th and 7th. The date of this meeting was changed by amendment to the by-laws, and will no doubt be much more satisfactory to a majority of our members. The meetings in Council Bluffs, the birthplace of the society, are always well attended. Those desiring to present papers will please communicate with the secretary at once to secure a favorable position on the program. Papers on Diagnosis and Treatment especially solicited from internists. If you are not a member of this progressive society, send in your name. Initiation fee, $1.00; annual dues, $1.00, which pays your subscription to the Medical Herald, the official journal. CHAS. WOOD FASSETT, M.D., Secretary, St. Joseph, Mo.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

A Study of the Blood in Lead Poisoning. -Cadwalader's (University of Pennsylvania Med. Bul., April and May, 1906) paper embodies a series of observations on the number and percentages of the white cells as well as the red blood corpuscles. Total and differential blood counts were made on thirtyseven cases of lead poisoning, all of which presented the well known symptoms, as colic, constipation, blue line on gums, etc., with a clear history of having worked with lead for periods of from weeks to many months. The hemoglobin and red blood corpuscles were reduced to about one-fourth of the normal in most cases, giving an average of 65% of hemoglobin and 3,850,000 red cells per 1 In every instances there was a marked increase in the number of granular red blood cells. Macro and microcytes were occasionally met with, but poikilocytes were, as a rule, not marked. One or more normoblasts were found in all but four cases, and megaloblasts in two instances, while in one case 130 normoblasts and 13 megaloblasts were found while counting 500 white cells, notwithstanding the fact that the total number of erythrocytes were scarcely one-fourth less than

cm.

normal. After convalescence was estab

lished the nucleated red cells disappeared from the circulating blood before the granular erythrocytes. The leucocytes showed no morphologic changes. The average number per 1 cm. was 7,568. In the majoirty of cases the number of leucocytes either above or below the normal was very slight. In most instances there was an increase in the percentages of the large mononuclear lymphocytes, the average being 14%, accompanied with a slight diminution in the percentages of either the polymorphonuclear or small lymphocytes. It is evident that lead may cause an anemia in one of the following ways: First, by an excessive destruction of red blood cells in the circulation; second, by an insufficient or defective hemogenesis; or third, by a combina

tion of these factors.

Typhoid Bacilluria.-Brown (Edinburgh Med. Jour., Feb., 1906) summarizes his paper on this subject as follows: 1. The typhoid bacillus exists in the urine of typhoid patients in from 30 to 35% of cases. 2. In most cases they cause no symptoms, and their presence is revealed only by a bacteriological examination. 3. Bacilluria is frequently