hours of the injection of the drug superficial lesions, such as mucous patches, condylomata and primary lesions are freed from living spirocheta. This remarkable effect of the drug on the parasites can be readily demonstrated on the testicular spirochetal lesions of the rabbit, in which the innumerable spirochetæ can be entirly immobilized within twenty-four hours with a single injection of the drug, after which the lesion quickly resolves."

The twelve cases reported by Nichols and Fordyce showed the same brilliant results as are being reported from Europe. They conclude that it may reasonably be hoped that all the lesions dependent upon the presence of the spirocheta pallida will be favorably influenced and the most we can expect in the secondary degenerative changes is that the process may become arrested.

It will not be amiss here to mention that Ehrlich warns against the use of the drug in the presence of advanced cardiovascular disease, or where lesions of the optic nerve exist.

McDonough asserts from his experience that the earlier the syphilis the larger the dose required (0.45 to 0.6 gram) and that 0.3 gram is ample for the late cases. Toxic symptoms were not marked in any of his cases, but, on the other hand, he was impressed by the marked improvement in the general condition of the patient. He thinks the severer the case the quicker the action and his results far outreached his expectations.

Isaac reports twenty-seven cases, all showing markedly beneficial results with no serious by effects, nor has Michaelis observed any threatening ones in his seventy-one cases.

Fraenkel and Grouven conclude from their experience in over 100 cases that the remedy marks a distinct progress in the treatment of syphilis and possibly other diseases, but report one fatality, after the intravenous administration of the drug, which they ascribe to an individual hypersusceptibility to the arsenic. The patient was a waiter of about 25, who had suffered for years from severe speech disturbance, wordblindness, etc., evidently of luetic origin, and had been in the psychiatric clinic for eighteen months on that account. The drug was administered in 15 c.c. of water. Fifteen minFifteen minutes later symptoms of serious arsenic poisoning developed, proving fatal in three and one-half hours. Autopsy showed extensive foci of softening in the left temporal lobe and distinct amounts of arsenic were recovered from the spleen, lungs and liver. They no longer employ the intravenous route. Their other results far surpassed any ever attained by mercury.

Spiethoff states that his experiences with fifty cases were all favorable, although the reaction to the drug was rather severe in a number of patients. For the most part his untoward symptoms consisted of psychic and visual disturbances, although one anemic woman injected in the afternoon was found dead in bed the next morning, but at autopsy showed no signs of arsenic intoxication. Ehrlich attributes this death to shock due to local painfulness at the site of injection.

Herxheimer noted no by-effects of consequence in eighty-three cases. One neurasthenic developed urinary retention which immediately responded to a hot sitz bath. Forty-eight hours after the injection no spirochete were to be found in eighty-two cases, nor has recurrence been observed to date. observed to date. In the other case the spirochetæ did not seem to be affected, and a similar result has been met by A. Glück in two cases, as though certain rare strains of spirochetæ must be insusceptible to the drug, just as some are mercury-fast. The drug proved especially efficacious in malignant syphilis.

Jllinek warns against the two promiscuous heralding of the curative powers of the drug for fear of throwing down the barrier to venereal infection caused by its dread by the laity.

In his sixty cases Iversen declares the Wassermann reaction to have been invariably negative by the twentieth to the fortieth day after the injection. Spirochetæ uniformly present in chancres before injection always disappeared by the third day thereafter.

Taege reports the interesting case of the infant of a syphilitic mother, weighing only some 5 lbs. at birth, apathetic and disinclined to nurse. On the ninth day it developed progressive pemphigus on the soles, and paronychia. The mother was given 0.3 grams of "606" subcutaneously and three days later all the nursling's symptoms began to subside. In two days the infant was transformed into an apparently healthy, hungry and rosy baby. He ascribes the change as due to the production in the mother of antibodies from the sudden destruction of spirochetæ and liberation of their endotoxins. The drug did not pass into the milk.

observable in most cases of pernicious anemia, is wholly a matter of luck, there being no constant findings with any of these conditions.

The diagnosis of arteriosclerosis rested on a general knowledge of pathology rather than on physical examination.

As between a diagnosis of aneurism and one of mitral stenosis, the probability is always of aneurism, and such diagnosis should only be made after all data have been most carefully collected.

Cabot's clinical and post-mortem experience with heart lesions diagnosed as mitral regurgitation (the commonest of all cardiac diagnoses) has convinced him that such diagnosis is not only an unverifiable but a superficial judgment about as definite, he says, as tachycardia. The essential point in the diagnosis of nine-tenths of this class is to know what is back of the mitral leakchronic nephritis, hypertension, cardiac hypertrophy and dilatation, arteriosclerosis, etc.

Of the diseases of the respiratory system many correct diagnoses of lobar pneumonia were made without distinctive physical signs but from symptoms known to have occurred in other cases of a similar type.

When an apparent bronchitis renders the patient too ill for a simple bronchitis, one is warranted in a diagnosis of broncho-pneumonia.

The x-ray has not materially aided Cabot in his diagnosis of incipient tuberculosis.

Experience has taught the author that tuberculous meningitis means miliary tuberculosis.

Of the diseases of the urinary system, the diagnosis of acute nephritis is, at the present time, difficult because of the fact that cases formerly thought to be acute were proved by blood-pressure measurements to be but acute exacerbations of a chronic affair. Most of the cases of acute nephritis encountered could be attributed to infection

by the pneumococcus or the organism of septic endocarditis, or to mercurial poisoning. Chronic glomerular and chronic interstitial nephritides were far more readily diagnosed.

With regard to diseases of the nervous system, one of the interesting features was the frequency with which cases clinically diagnosed apoplexy, on post mortem showed an arteriosclerosis of the cerebral arteries with no evidence of hemorrhage whatsoever.

Although the presence of cerebral tumors was readily diagnosed, attempts at their localization were usually failures.

Tuberculous and septic meningitides were for the most part easily diagnosticated.

Of the lesions of the digestive tract only onehalf as large a percentage of peptic ulcers was recognized as of the malignant cases. Hepatic

cirrhosis was correctly diagnosed in 61 per cent. of the cases.

Typhoid fever and diabetes mellitus, of course,. seldom failed of recognition.

Although the diagnosis of cerebral syphilis is not at all uncommon, yet in the last decade Cabot has failed to see the lesion so diagnosed, confirmed at autopsy a single time.

The study closes with a most interesting summary and list of maxims that would be worthy of a permanent place in the drawer of the busy practitioner's desk, that it might meet with daily use.

EDITORIAL NOTES

REMEMBER that a portion of the Association. dues for 1911 will be set aside as a medical defense fund to be used in defending members of the Association in malpractice suits.

As we have often said before, a few copies of THE JOURNAL go astray in the mails each month. If those subscribers who fail to receive their journals will promptly notify us, duplicate copies will be sent them.

THE dues to the Association are two dollars for 1911, payable on or before January 1 and delinquent on February 1. Why not pay them now and save your county society secretary the trouble of asking you for them later?

THE LaPorte County Medical Society publishes a 4-page bulletin which is a credit to the society, and ought to be copied by other county medical societies. The bulletin contains an

announcement of the regular meetings and programs for the month, and one of the pages is devoted to news notes and comments.

THE promptness with which Dr. Crippen was tried, convicted and sentenced by the English courts is an evidence of justice meted out without the unnecessary and time-consuming technicalities which usually are a part of such trials in this country. And the worst of it is, justice is often defeated in our American courts by technicalities which it seems are not recognized at all in England. No one can doubt that Dr. Crippen had a fair and impartial trial, while at the same time the court prevented the wrangling of lawyers which, in this country, often makes our criminal trials a farce and the entire method of

On May 26, 1910, I received from Dr. Henry C. Marcy, Chairman of the Davis Memorial Committee, checks as follows:

St. Joseph County, Ind., Medical Society, J. W. Hill, Treasurer, $5; Madison County, Ind., Medical Society, E. Charles, Treasurer, $5; Vigo County, Ind., Medical Society, C. N. Combs, Treasurer, $5, and Muncie, Ind., $5. I do not remember by whom the last check was signed, but the contribution amounted to $20 from these various sources. I suppose the Muncie check was the one from the Delaware County Medical Society.

As these checks were from out of town, and as the banks of Chicago charge exchange on all out of town checks, I paid out of my own pocket the 25 cents per check on each of these, so that these various societies would have the full credit of $5 each. Very truly yours,

J. P. MORGAN, the financier, who is noted for his practical manner of looking at things, has given further evidence of rational thinking by expressing disgust, when some of the delegates, at the national Episcopal Convention recently held in Cincinnati, introduced the subject of divine healing and expressed a belief in present day miracles in curing the sick by methods akin to those employed by Christian Scientists. When the discussion, on the healing of the sick by prayer and the application of holy oil, was at its height in the convention Mr. Morgan hastily made his exit, and when asked as to what he thought about the subject he is reported as saying, "It is the most disgusting affair I have ever listened to. I have heard more absurd statements from that platform on this subject than I have ever heard before."

For a long time it has been known that our clerical friends are losing their hold on the people, and they have been making frantic efforts to find something which will once more place them in the high position once occupied. The attempt to inject into religious teaching the

absurd and ridiculous theory that all disease can be cured by divine healing is going a step further than is warranted in efforts to secure something new and attractive to stimulate increased adherence to the church. According to our way of thinking, ministers will serve a higher and nobler purpose if they confine themselves to purely religious teaching, which has as its first principle the intent to make people morally better. The wrangling over dogma and creed is sufficiently distasteful to the outsider without injecting the farcical subject of divine healing into what should be the teaching of right living and right conduct as it pertains to our moral and spiritual betterment.

IT is generally conceded that doctors are poor business men, but why should they be? They may not have been trained in business methods but it is never too late to learn. There is absolutely no reason why a doctor should not keep an accurate record of cases, including specific charges for all services rendered. Failure to make a record of charges for visits and office consultations has resulted in the loss of many hundreds of dollars to busy physicians, but the failure to collect what has already been charged has resulted in greater loss. One of the reasons why many doctors' bills are not collected is because the statements of accounts are not presented, or if presented are too late to effect a settlement that might have been made if the claim had been made soon after the services were rendered. Modern business methods demand the presentation of statements on the first of every month, and there can be no valid reason given for not adopting such practice. Practically no one but the doctor does an extensive credit business. The merchant expects and demands his pay at the end of thirty days, and if accounts run longer he makes an effort to get security or force collection by law. The manufacturer does likewise. The laboring man and mechanic receive their wages weekly or monthly. The farmer never extends credit but demands and receives cash for everything he sells, but he generally expects almost unlimited credit when he buys goods or service. The doctor is not given credit but he generally thinks he must extend credit to others whether there is reason for it or not. It is a matter of habit and it is time that doctors got out of the habit. Bills should be sent out monthly to rich and poor alike. Leniency and charity should be extended to the poor, but there is no reason or justice in waiting beyond the ordinary time limit for the payment of bills by those who are able to pay. It does not add to