showed any evidence of it. This would appear to indicate the rectal administration of salicylates in diseases of the pelvic organs, its effect being first noted in the adjacent tissues.

As soon as normal doses of salicylate have been absorbed and taken into the circulation there is noticed a relaxation of the vessels and tissues in general, and every form of pressure is diminished to a corresponding degree.

Most notable is the change which may be found in a pelvic or perityphlytic abcess. Here we can readily notice a lessening of the tension of the walls, the gradual relaxation of the tissues and consequent lessening of absorption of septic material shown by the fall of temperature and diminution of pain.

Those who have used it in rheumatism, pleurisy and diseases of other serous membranes will fully appreciate its action, but its field of usefulness is far greater.

So excellent were the results obtained by salicylate as a preoperative procedure that the former members of the Red Cross Hospital made it a rule to first treat with salicylate of soda every case of peritonitis, whether originating at the gall bladder, the appendix or the pelvic organs, and only in severe pain is it to be preceded by one dose of codeine.

The relief afforded was so universal that it very seldom became necessary to operate in the acute stage of perityphlitis or salpingitis, particularly the latter, and the ice bag was entirely dispensed with.

In painful endometritis, and often in painful menstruation, the efficiency of the salicylate is demonstrated. In connection with this one must not overlook the fact that the use of this drug may relax the tissues to such an extent that it will cause hæmorrhage from the uterus or else

where, and its use, therefore, in submucous fibroids or during pregnancy should be with caution.

In renal and billiary calculi one can often observe the free passage of small stones after three or four one-gramme doses of this drug at two-hour intervals. It evidently relaxes the channels and enhances the passage of the stones. However, the pain in these cases is often so great that a special anodyne may also be needed. The action has well been demonstrated when a patient received a number of doses of opiates with only temporary relief and the addition or even the substitution of salicylate would immediately lead toward favorable progress.

The drug is of decided value in cystitis of all forms and inflammatory conditions of the prostate gland, also in orchitis and epididimo-orchitis. The relief afforded in these cases is certain.

Postoperatively the uses of salicylates are similar, and their efficacy was demon-. strated for 10 years at this hospital. No doubt members of the staff now connected with this institution who have performed or attended surgical operations must have observed and recognized the favorable results obtained.

It has long been a routine practice in the Red Cross Hospital to administer salicylate of soda after every surgical operation. I grm. dissolved in 125 c.c. of warm saline solution is given per rectum as soon as the patient is placed in bed, and subsequent doses of 0.6 are repeated in the same manner every three hours.

Owing to the comparatively slow action of salicylates for the relief of severe pain, it is considered advisable to precede the treatment with one dose of codeine sulphate. A dose of 0.015 (about 14 grain) is given hypodermatically, and only in ex

cruciating pain a second dose is given in three hours. Most frequently one or two doses are ample, but in no instance were more than four required, the salicylates, of course, being continued.

Whenever, through operative procedure at the rectum, the injection cannot be given, it is well to administer it in 60.0 of ginger ale. The efficacy of this drug in surgical operations and traumatic cases of the meninges, including the internal ear, has been questioned by some authors; but suffice it to say that in certain forms of pressure neuralgia excellent results have been obtained.

It may be of interest to mention a case, diagnosed as otitis media, and upon which an eminent specialist was to perform paracenticis; here upon the administration of salicylate of soda complete relief was obtained, and it was a question of correct diagnosis or efficiency of the drug.

In acute septic cellulitis of the extremities extending upward it will often surprise the practitioner to see the progress of the disease slowly but effectually checked, the inflammation becoming gradually localized and the constitutional effect proportionately diminishing by the administration of salicylate of soda.

In connection with this treatment, however, it may be of use to state that it has been our practice to make local applications of an ointment consisting of magnesium-carbonate, resorcin and lanum. It is prepared and has been much used in this hospital, and for the sake of brevity is known here as marisol. It is well, however, to understand that no claim is made for this treatment to take the place of the scalpel; but, as expressly stated, it will control and localize the infection. Indeed, if the surgeon is not too hasty and will not expect a too rapid result, the ad

ministration of the drug will render the work of the scalpel far safer and more simple.

The case presented this evening was treated in the aforesaid manner. The infiltration extended over the entire hand, wrist, and made its way upward. The axillary glands were painful and swollen. The patient came to the hospital with a temperature of 38.8 (102.4). The treatment as described was carried on for three days before the swelling above the wrist had entirely disappeared. Then only one incision over the thumb was made, and recovery under the same continued treatment was rapid.

The drug is also of considerable value in pain caused by fractures, dislocations and contusions. In fact, in every form of trauma much relief is afforded by the use of salicylate of soda without the disadvantages caused by opiates and other sedatives. In certain conditions of depression in which salicylate of soda might be feared, the addition of a double salt of caffeine, such as caffeine soda salicylate or caffeine soda benzoate 0.2, internally improves its action, and whenever salicylate of soda is administered internally the addition of half the quantity of soda bicarbonate aids in its action.

Cystitis and acute prostatitis are much improved by the rectal administration of 1.0 of salicylate repeated every three hours.

The tinnitus aurium produced by this drug is an indication to discontinue for the time being. Furthermore, it must be administered to nursing mothers in small quantities only, as the mammæ secrete large quantities of it, and several cases of purpura in the nursing infant. have been observed after the administration of salicylate of soda to the mother.

In conclusion, I wish to emphasize that

the sedative effect of salicylates does not seem to depend upon a central hypnotic action, but upon its power to relieve tension, relaxing the tissues, dilating the blood vessels and allowing a freer circula

tion, it being readily carried to the congested parts. This places salicylate of soda among the efficient and valuable remedies for the purposes mentioned in this paper.

Lord Kelvin's Influence Upon Physiology. The advances which have been made in physical science, and the practical applications of its laws to commercial and everyday requirements, have been so numerous of late years that it is difficult to realize how much we owe to the man who has been the pioneer and leader of scientific thought during the last half century.

Lord Kelvin's work is so great and far-reaching that there is hardly any branch of science which has not experienced the benefit of his influence. Helmholtz was a great physicist who devoted his ability largely to the solution of problems in physiology. Lord Kelvin's talLord Kelvin's talents were employed in wider fields, but he alone rendered possible the building up of that great and growing subject of electro-physiology. The difficulty of detecting the feeble electric currents at the end of the Atlantic cable in 1857 was overcome by the invention and perfection of the mirror galvanometer. A similar difficulty confronted the physiologist. in the investigation of the currents produced by living tissues. The barrier was removed by Lord Kelvin. The mirror galvanometer furnished the means of detecting and measuring the most minute electric currents, and has been the favorite instrument of physiologists for the last 50 years. Lippmann's capillary electrometer, and more recently the string

galvanometer in the hands of Einthoven, have also played a part in electro-physiology, but Lord Kelvin's galvanometer retains its place of honor. Its details and mode of employment form the basis of the study of that part of physiology; a knowledge of it is absolutely essential to the student before he can understand the problems it unfolds. The electrical changes accompanying vital activity, whether manifested in the passage along a nerve of a nerve impulse, in the contraction of muscle, or in the process of secretion by glands, have alike been investigated by the use of the mirror galvanometer, and the nature of the processes involved in these phenomena has thereby been greatly elucidated. been greatly elucidated. The whole domain of electricity and magnetism has been brought by him into the position of a science, subject to mathematical calculation of its forces.

The law of the conservation of energy and the relations between heat and work were placed upon a sound footing by Lord Kelvin; his conceptions have in this respect influenced workers on the physiology of muscle. Thermo-electricity was also better understood from his researches, while spectrum analysis engaged his attention at an early date, and many discoveries attributed to Bunsen and Kirchoff were anticipated by him.

It is impossible to find any subject in

which physical laws are brought into relation with physiology that has not been more or less influenced by Lord Kelvin's work, and the scientific world loses in him one of its greatest exponents.-(Editorial, Edinburgh Medical Journal.)

Ideas and Ideals in Medicine. The value of thinking of ideas and ideals in medicine is pointed out by S. J. Meltzer (Journal A. M. A., May 16), who shows by striking illustrations the absurdity of basing the practice of medicine on crude. empiricism, and that the success of the purely practical man in medicine is a negligible factor in a serious discussion of the value of ideas in medicine. But while pleading for a place for ideas in medicine. he points out how their dominance, that is of theories, in medicine is as little desirable as that of crude empiricism, and perhaps even less so. The great advance in all branches of science that began with the incoming of the inductive methods also affected medicine, but the present era in medicine began practically only about the middle of the last century. Considering some of the principles which have made research in modern medicine effective, Meltzer says that the first step is to uncover the gaps in our knowledge. It is better to admit ignorance than to be misled by unbased theories or erroneous observations. An honest, healthy skepticism that leads to watchfulness and reexaminations is, therefore, of great practical value. The investigations must be carried on by a diligent unbiased observation of facts, but care must be taken not to confuse facts with conclusions. Many statements which are recorded as facts are nothing more than biased subconscious conclusions. It requires a critical mind to observe a pure fact, and the critical faculty is still more needed when it

comes to the correlation of collected facts. Here is where the idea becomes the important factor in the creation of knowledge. To illustrate the value of an idea in research, Meltzer uses the history of our acquisition in regard to the functions of the thyroid glands and the associated epithelial bodies or parathyroids, in which only a few facts were gained by pure observations, the balance was yielded by hypothesis tested and clarified by experiment. Even some ideas which proved to be erroneous were fruitful in ultimately bringing about the correct conclusions. There is only one indispensable requirement for a hypothesis; it must be provided with a safety guard-the experimental

test. For the creation of new knowledge we need well-observed facts, ideas and the experimental test. Meltzer considers the idea as the most important, but without the facts it is nothing. An idea, according to his definition, is a hypothesis that is capable of proof, an unprovable one he calls an ideal. Such, while not scientific theories, may yet be useful guides and stimulants to thought. Accepting the practice of medicine as for the sole purpose of curing and alleviating disease, the habit of thinking on the part of physicians will best tend to its practical success. Every case of disease is a subject for research, the facts must be observed and the proper hypothesis deduced for the treatment. Short cuts froin symptoms to treatment are often dangerous for the patient. Meltzer thinks that modern methods are not altogether favorable to the cultivation of thinking in the practice of medicine; there is too much tendency to pathognomonicity in diagnosis. Even the most pathognomonic tests, like the finding of the tubercle bacillus or the malarial plasmodium, may possibly lead us astray, and what shall we say of the less im

portant ones, which are often considered as conclusive? He, therefore, pleads for more thinking in the practice of medicine; the art of observation must be learned, but we must not forget that the correlating idea is the main thing, and should learn to use it properly. In conclusion, Meltzer asks for more workers in scientific medical investigation, on which the future of the practice of medicine depends, men having the knowledge and training. for research and who are possessed by the enthusiasm and idealism that prefers scientific to gilded success, who will be the leaders of the profession into new paths of progress, for the benefit of the suffering as well as of science and the public welfare.

New Medical Practice Law in Alabama. Dr. W. H. Sanders, chairman State Board of Examiners, has issued the following circular of information:

A new law regulating the practice of medicine in this State is now in operation.

The branches upon which applicants will be examined are: Anatomy, chemistry, physiology, the etiology, pathology and symptomatology of diseases, surgery, obstetrics and obstetrical operations, gynecology, physical diagnosis, hygiene

and medical jurisprudence, diseases of the eye, ear, nose and throat.

A diploma will not be required as a prerequisite for examination.

Formal application for examination will be made after the applicant arrives.

All persons who desire to practice medicine in this State must be examined, irrespective of any certificates of qualification obtained elsewhere they may hold. Reciprocity betwixt this State and any other State has not been established. At least four days will be required to complete the examination.

The next examination will begin on Tuesday, the 16th of June, prox., at 9 o'clock A. M. in the Capitol at Montgomery. Persons contemplating presenting themselves for examination at that time will please give notice of such intention.

The fee for examination will be $10, payable on making application after ar rival.

All applications, whether regulars or irregulars, must undergo the same examination. Materia medica and the administration of drugs in diseases are omitted from the examination.

Temporary license cannot be given. Samples of questions given in previous examinations will not be furnished.

Phthisis.

Phthisis at the bases of the lungs is not uncommon, but its existence is sometimes overlooked because the apices alone have been examined. In any case of phthisis the disease is more extensive than the physical signs would seem to indicate.

Almost every chronic affection of the apex of the lung is tubercular in origin. Most cases of confirmed phthisis progress more rapidly and terminate sooner than is expected. If physical signs are pres

ent the probabilities are against complete recovery; but if the disease is detected before this, there is hope that it may be cured.

Never give a definite opinion as to how long a patient suffering from phthisis will live, for the only certainty is that if you do you will be wrong.

The diagnosis of phthisis is peculiarly difficult in young children, because their expectoration can seldom be obtained.Clinical Aphorisms, Samuel Gee.