jackal is thought the worst. Perhaps this is because the mad jackal usually tries to bite the face. It may also be due to the type of the disease. Such animals bite while in a state bordering on frenzy, and not in the half apathetic or indifferent stage when a dog may bite. My own boy was bitten by a dog which died thirty-six hours later with typical symptoms of rabies. I sent him at once to a Pasteur institute at Kasauli, a thousand miles away from my home. This institute is sustained by the government to care for soldiers who have possibly been infected. It was at that time the only one in the Indian empire, though another has since been established in the Madras presidency.

There is little diphtheria, and so far as I know, no scarlet fever. Only a very few cases of croupous pneumonia came under my observation. I think that only once did I see a characteristic rusty sputum. Bronchial pneumonia is common and frequently complicates other diseases and ushers in the final end.

Though Europeans are prone to have typhoid in India, the disease is rare among the natives. For some reason they seem to be practically immune, though because of their unsanitary habits much more exposed to infection than the Europeans. It may be that their simple vegetarian diet leaves the bowel in better condition to resist the infec

tion of the typhoid germ. It may be that they have an acquired racial immunity. Perhaps both are factors.

Most

The sanitary conditions of Bengal are shocking. If an European should do as the natives do, he would not live six months. Take the matter of water-the usual mode of typhoid infection. of the natives in that section use water from large open tanks excavated at some point convenient to the village. These tanks are filled by the rains and by such surface water as finds its way in. The water of these tanks is used not only

for drinking purposes and cooking, but is also used for bathing and for laundry purposes. These two operations are carried on in the tank. The villagers are very cleanly in their personal habits. One can scarcely be persuaded to take anything, not even medicine, into the mouth before scouring the teeth in the morning, and the whole population of the village bathes (and scours the teeth it may be) and washes its clothes in this same tank. Here also the neat housewife brings the household utensils and cleanses them. There are no frosts, and the green scum that gathers on the surface and is pushed away so the man can get his water jar in is an heirloom, passed on from generation to generation. These tanks are sometimes cleaned out after draining off the water, and the sediment is one of the best fertilizers com

monly obtainable in Bengal. The average country Jake objects to pure well water on the ground that it has no taste. The government is encouraging the digging of wells, and it is probable that when these come into more general use the water-borne diseases will be less prevalent.

Cholera is the one disease more than all the others that I dreaded. With the water supply such as I have indicated, the wonder is not that thousands die, but that any escape. Enough do die every year to throw the United States into spasms, if such things occurred here. In three weeks the City of Midnapore with thirty-five thousand inhabitants lost one thousand from cholera. One doctor had on his books the names of nearly two hundred cholera patients when he himself was stricken and died. When a pestilence like this strikes a city the dead are often merely dragged out and left to the jackals, dogs and vultures to devour. Rev. H. R. Murphy who succeeded me at Bhimpore had a rather unusual experience that still suggests the possibilities. A pilgrim, a Mahommedan,

was stricken with cholera and died in the village. His fellow religionists buried him as Mohammedans do about two feet down into terra firma. The jackals that night dug the body up and held a post-mortem. The next evening as Mr. Murphy sat at his evening meal, his attention was attracted by a fox terrier I had left with him which seemed to be greatly interested in something under the supper table. Investigation disclosed as the object of his interest a bone of the cholera victim of the preceding day. Such observation as I have made leads me to think that the cholera germ is short lived and probably easily killed. It is very possible that the green scum so offending us is inimical to it. I am also led to think that the cholera germ probably cannot get by the stomach, if the stomach juices are normal.

With plague I have personally had no experience. I have suspected two or three cases, but none of them was really typical and probably my suspicions were not well founded. For some reason, not explained, plague has never gained a continuing footing on our side of the Rupnarain river. There have been quite a number of sporadic cases, but nothing even approaching an epidemic. The serum treatment as a prophylactic is increasingly used, and more and more by the natives themselves. An unfortunate catastrophe gave it a bad name on its introduction, but this is gradually being lived down. Owing to some carelessness in a government laboratory, instead of the serum a culture of tetanus was used in the injection and some thirty persons died in quick succession from

tetanus.

Venereal diseases are often met, and as many of them run a course not affected by the medicines given, we see them at their worst. A father with five children came to me one morning. The children, as I remember it all, had other signs of hereditary syphilis, but the re

markable thing was that all five had tibias flattened from side to side and bowed anteriorly. They looked like a new variety of the "genus homo." The root and herb man often salivates these cases with mercury. I often ask a patient if he has "eaten smoke" which is the colloquial expression used to distinguish the mode of taking the mercury, i. e., inhalation of the fumes. One such case was so full of mercury that the slightest dose of potassium iodide would bring out all the symptoms of salivation.

Tuberculosis is prevalent and is on the increase. All classes are affected. What they gain by their open air life they lose by insufficient food and by sleeping without ventilation in the cold season and with the head covered at all times. The advantage the well-to-do man has in less exposure to cold and wet and in having better food, is more than counterbalanced by his lack of exercise and generally enervating life.

Muscular rheumatism and rheumatic fever occur; also, rheumatoid arthritis. The fact that most of these people are vegetarians does not, in my observation, make any difference. Bright's disease is common. There is a great deal of diabetes, especially among the well to do. These cases do badly as it is almost impossible to get them to use a proper diet.

Children suffer a great deal from discases incident to insufficient or poor food. Alimentary troubles arising from eating indigestible matter, are also frequent. Nervous diseases of all sorts, hysteria, tabes, neuritis and the others. are met. Ophthalmia is frequent and severe. One contagious case will bathe in a tank and the whole village will have sore eyes. Ophthalmia neonatorum causes an enormous amount of blindness. The mortality among such unfortunates is very great, on account of neglect. Some such infants are no doubt killed outright to get rid of caring for them.

Ulcers of the cornea are often met, due in part to the too exclusive rice diet of the people.

On account of the caste ideas and social customs I have done comparatively little gynecological and obstetric work. Only the abnormal obstetric cases come to me. I think in eight and one-half years I have only seen three normal cases. The average length of time my patients have been in labor when I am called is about four days. Complications due to the extreme youth of the mother are naturally much more frequent than with us. And conversely complications due to a first child after thirty are correspondingly rare.

Owing to the much less active life of the people fractures and dislocations are not numerous. The same can be said, though without the same reason, of malignant growths. Fatty and fibroid growths are often met. Abscesses in enormous numbers are present. They generally run quite a course before coming to me. I am a last resort. The people are very much afraid of the knife, though they usually stand pain well. I cannot say the same of blood loss. When anything is accomplished by means of surgery it is highly appreciated. As had no hospital I had to confine myself to minor work, except in case of emergencies. The low, mud-walled, thatchroofed, houses with walls smeared with cow dung and all the upper part of the room festooned with soot covered cobwebs prohibit surgery in the homes.

Appendicitis is extremely rare. A confident diagnosis was possible in only two cases that I saw. The reports from others in India are similar. I have jokingly said that a surgeon would be a fool to diagnose appendicitis in a กาan who was only getting four cents a day. The foolishness is not wholly on account of the impossibility of an adequate fee

The necessarily simpler diet and the immediate attention to the demands of nature of those whose habits are more free are also factors.

I never saw a case of hydrocephalus in Bengal. It has been suggested that the exposure to the sun's rays of the uncovered head increases the activity of the internal drainage of the brain and also by promoting sweating draws away the moisture of the brain.

But with all the rest and the multitude of skin diseases that I have not mentioned the doctor's work in Bengal is only touched upon until we mention malaria. Malarial infection brings seventy-five per cent of my patients to me. Plague and cholera and smallpox are more frightful, but by keeping everlastingly at it all over the province malaria destroys many fold more lives than all the others combined. Whole villages and sections are sometimes so stricken that the people all die or flee away. Pernicious anæmia and enlarged spleens are among the more noteworthy sequelae. Almost the whole anterior abdominal cavity clear down to the pubis is not at all infrequently occupied by a massive spleen. Rarely the type temporarily prevalent is extremely pernicious and makes malaria almost as much to be dreaded as cholera or plague. Such a type at times begins in a large rice growing district called Burdwan, and is hence called Burdwan fever. I saw an algid case of this form in which the temperature dropped to 94°, which later recovered. An opinion is prevalent that Europeans and Americans are specially liable to fever in the tropics. Speaking from my experience I should say that they are even less so than the natives. We hear of the death of the foreigners. but the millions of natives who die are unknown and unnoted.

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JANUARY

Editorial

To wrest from nature the secrets which have perplexed the philosophers of all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they may be quickly available for the prevention and eure of disease-these are our ambitions. Το carefully observe the phenomena of life in all its phases, normal and perverted, to make perfeet that most difficult of all arts, the art of observation, to call to aid the science of experimentation, to cultivate the reasoning faculty, so as to be able to know the true from the falsethese are our methods. To prevent disease, to relieve suffering and to heal the sick-this is our work-Osler.

Valediction. With this issue of the JOURNAL, the present editor lays down the work which he began four years ago. It has been a pleasant task, yet withal a difficult one. The amount of thought and labor incident upon preparing for the press fifty or more pages of reading matter, month in and month out, is perhaps greater than one who has not tried the task would think. Yet the agreeable associations which the work has brought and the interesting by-paths into which it has led, have been ample compensation for the hours of midnight oil, burned in the preparation of copy and the reading of proof.

The work was taken up at a propitious time, for the make-up of the JOURNAL, its scope and its policy had been well defined. by the able editor who had preceded. It has been the constant aim of the present incumbent to carry out the work in the same spirit in which it was conceived. He has believed it to be the function of the

torials largely to economic questions affecting cur state membership and to explaining the policies and plans of the State Society, with now and then editorial comments upon items and events in the general field of medicine; to give the readers honest opinions of the new books which have appeared; to publish every scrap of county society news and personal news on which he could lay his hands; to afford a forum for correspondence, a place where any grievance, not purely personal, might be aired by any member; and to furnish abstracts of a few of the advances made in scientific medicine. It has been the constant aim never to descend to the methods of some of the JOURNAL'S contemporaries, for the sake of popularity, to include the medical joke, the vulgar story or the sarcastic and semi-witty article of the "smart writer." The result has been that the JOURNAL has been criticized as being "too straight laced," but we have been satisfied to accept the criticism, for we have believed that it is better so.

At times the work has been discouraging, but looking back on the past four years, your editor can see that good, great good, is being slowly but surely accomplished by our State Socicty and its affiliated local branches. The scientific and literary value. of the average paper now sent in for publication is better than it was four years ago, and infinitely better than when the JOURNAL first appeared. A comparison of the articles of the past year with those published in 1903, will convince the most skeptical of this fact. Any improvement which the JOURNAL may show over the issues of seven years ago is due to the general improvement in knowledge and ability throughout the state, for a journal such as ours, depending entirely upon the local talent for its material, is but the index of the learning and the culture of the profession of the state.

The work of editing the JOURNAL during the past four years could not have been done had it not been for the faithful assistance of the Associate Editor and the loyal and enthusiastic support of the collaborators, all of whom retire with the editor, and to all of whom the editor here expresses his appreciation and gratitude.

At this writing the new editor has not been elected, but whoever he may be, may he have the same loyal support and the ame courteous treatment from the officers, the Council and from the membership at large, which have made the past four years a delightful remembrance to your retiring editor!

BENJAMIN R. SCHENCK.

There is a humorous side to the medical editor's work, which occasionally compensates for the monotony of his plodding routine. Can you not conjure up a smile at a printer's error or a stenographer's blunder or (let us whisper it!) an author's oversight, which allows a ludicrous error to appear on the ink-lined plane? For example, what blame attaches to any one who allows a sheet to arrive at the editor's desk bearing the grave interrogation, "Is the opening of the abdominal wall never to be gamboled upon?" The orthographic mistake is not discernible when the sentence is spoken, but when written, one is inclined. to answer that friendly germs may gambol there, but all others must keep off, else they shall have their wrists slapped.

The essayist who speaks familiarly of the Calmette reaction provokes no smile. whatever, but he who peruses the essay cannot resist a grin to see it dressed up as the Calumet reaction. Loyalty to our state and the possession of copper shares would readily account for this transmogrification.

The printer who turned tonsil into "toc nail," knew not the joy he caused when he made one of our professors recommend excision of the toe-nail for recurring at

The

tacks of rheumatism. It reminds one of the country paper which in speaking of the annual Fourth of July parade mentioned the battle scared veterans. next week the long-suffering editor's apology was made to read, "In our last issue a printer's error caused us to refer to the Grand Army veterans as battle scared. Of course we meant bottle scarred."

It was a bold but fun-loving editor who allowed to pass the following sentence: "The eating of toad stools is a frequent cause of serous stools." It may be found in one of the recent books issued by a wellknown publishing house, whose literary editor doubtless could not resist the temptation to brighten up an otherwise somber text.

When one aspires to rise from familiar nosology into the realms of technical terms and Greek derivatives, the pathway is strewn with pitfalls. It is easy to graduate from saying "pus-tube" to the grandiloquent "pyosalpinx"; surely it can be rendered phonetically, and our ex-President would defend him who persisted in writing it "pyosal-pinks." It looks like some kind of new and non-official remedy. Or if it refers to pelvic trouble, "pinks" is a new one to us, however familiar we are with "whites."

It was momentarily a puzzle when we read that something "had better be shammy." Our professional integrity revolted at the suggestion of any sham whatever, but the text soon led us to preceive that it was "chamois" the writer recommended. With this substitution we were willing to proceed, though it was somewhat astounding later on to read that we could pass the "electrode in the cervix up to the internal ass." It was hard to tell whether the author was trying to make an ass of us or an ass of os.

The writer who'rehabilitates hemorrhoids as "hermorides" is bound to succeed, for he is inventive and resourceful; as also, he who advises "specticals." As for the ed