liberation of the toxins from the blood. Saline infusions are indicated after hemorrhages, as after ritual circumcision or in typhoid; they are helpful in oliguria, chronic nephritis, infantile atrophy, severe forms of summer diarrhea, infants in cholera infantum, with profuse and exhausting evacuations and vomiting, with slow circulation and threatening thrombosis. Here hypodermoclysis plays an important rôle. Heubner injects daily in these cases of cholera infantum 150 c. c. He says that he has made as many as sixteen to twenty injections in one infant, often with the best results. The fluid for the injection may be a sterile 1% salt water solution; or, instead, natron chlorat 5, natron bicarbonic 5, aqua 1,000.

Congenital Idiopathic Dilatation of the Colon.

J. M. T. Finney (Surgery, Gynecology and Obstetrics, June, 1908) discusses the subject of congenital idiopathic dilatation of the colon (Hirschsprung's disease). This disease was first described by Parry in 1825, and Billard in 1829; later, by Von Ammon in 1842; Oulmont in 1843; Banks, Bunfer and Favalli in 1846; Little and Galloway in 1850; Gay in 1854; Henoch in 1861; first time in this country by Lewitt in 1867; Jacobi in 1870. Then followed the reports of Barth, Peacock, Gee, Bristow, Morris, Fuetterer, Middeldorf, Cheadle, Gaume and others. It remained for Hirschsprung, after whom the disease is frequently called, to give a most classical description of the disease before the Berlin Congress for Children's Diseases in the year 1886, bringing it into general recognition as a disease entity. The disease has been variously called "Megacolon congenitum" (Mya), and "Congenital Idiopathic Dilatation of the Colon" (Hirschsprung). The term "Giant Colon" has been used by Formad, Osler, Futcher, etc.

There are many explanations given for the existence of the disease, but it all seems to resolve itself into a congenital fault, arising in utero, the real cause remaining unknown. The term "idiopathic," therefore, is but a cloak for our ignorance, and must be rejected as soon as a more perfect knowledge of the true nature of the affection warrants it. The affection is essentially a dilatation, and has to do in the majority of cases with the colon, especially the sigmoid flexure. Cases occur in infancy (true megacolon) and others occur in adult life (pseudo megacolon). Some claim that that form occurring in adult life is not a true megacolon, but is simply due to aggravated constipation, a coprostasis pure and simple. The other observers, maintaining the congenital character of all cases, claim that the form occurring in adult life is but the delayed manifestation of a congenital defect, and has been brought out by atony of the bowels incident to the time of life.

Finney reports a complete history of one case, which may well serve as a type of the disease and illustrates the essential points about Hirsch

sprung's disease. This was a boy of 9 years, with immensely distended abdomen, ribs prominent, the costal angle very wide, chest much larger at the base than at the apex. Pleural cavity was encroached upon by the diaphragm, due to the abdominal distension. The superficial abdominal veins very prominent; at times, marked peristaltic waves were seen traversing the abdomen. There was a history of chronic constipation; in fact, his bowels had never moved normally, a cathartic or enema always being necessary. At times of extreme constipation, he had severe pains in the abdomen. An exploratory incision was made and the diagnosis of idiopathic dilatation of the colon confirmed; the enormous dilatation of colon filled up the entire abdomen, with the exception of the right iliac fossa. The dilatation began abruptly at the hepatic flexure, involving the transverse and descending portion of the colon, and the entire sigmoid, with the exception of the last two or three inches, where it as abruptly ended. The rest of the tract was normal. The greatest dilatation was in the region of the sigmoid, amounting to fourteen cm. in diameter. The walls of the intestine were thickened with pigmentation of the hypertrophic portions. The mesosigmoid was elongated and enormously thickened, in plates as much as two to three cm. The vessels were much larger than normal, as were the lymphatic structures, especially the lymphatic glands, some of which were as large as almonds. A colostomy was performed and the colon at the hepatic flexure was sutured to the parietes. The colon was frequently irrigated after the operation and a great deal of feces washed out. Great improvement in the boy's condition followed. Owing to some accumulation of fecal matter in the dilated colon, some five months later it was decided to short-circuit the bowel. The abdomen was opened and it was found that the dilatation had shrunken to some extent. Lateral anastomosis was performed between the ascending portion of the colon and the lower portion of the sigmoid flexure, postponing the resection of the dilated portion until a later operation, owing to the patient's condition. Some six months after this operation, the abdomen was again opened and the dilated portion resected. The previous colostomy was found in excellent condition. The raw surface of the mesocolon was left undisturbed. The artificial anus at the hepatic flexure which was originally made as a safety valve was later closed under local anesthesia. The boy is now, one year after, in excellent condition, apparently a normal boy in all respects excepting the widening of the costal angle.

In short, this is the clinical picture of the disease: Obstinate constipation and an enlarged abdomen in a patient otherwise in perfect health. This constipation usually sets in at the time of birth. Extreme difficulty in evacuation of the bowels is characteristic of this disease. Unusual postures, assumed by the patient during the act of defecation or passing of gas, are reported by a number of authors, such as leaning over the back

of a chair, standing on the head, knee-chest position, etc. Just as abnormal as the dilatation of the abdomen, is the length of time during which in many patients there is no stool-frequently there is a history of no stool for a week, a period of five weeks (Johanessen), six weeks (Roth), nine weeks (Rolleston and Hayward), and three months (Gay). Then this constipation may alternate with diarrhea. The facies is dull, apathetic, skin dry, harsh, leathery, except over the abdomen, where it is tense and shiny. The abdominal walls are thinned out and peristaltic waves may be seen. The abdominal distension is not always uniform, the intestinal coils sometimes being piled up upon one side, especially upon the left side. Fecal masses may be felt upon palpation. At times, the entire mass may be soft, and there is a singular absence of pain. The borborygmi may sometimes be heard in an adjoining room. The fecal matter is characteristic, sometimes dry and inspissated, sometimes puttylike, yellowish green and with a peculiarly offensive odor. Edema of the lower extremities is common. Owing to pressure, encroachment upon other organs, we may have symptoms of dyspnea, interference with heart or lung action. Kidney functions do not seem to be influenced by this encroachment.

The prognosis is influenced by age; the younger the patient, the more unfavorable the prognosis. Intercurrent affections, owing to the debilitated state, often carry off these patients.

The treatment is medical and surgical. Medical treatment consists in giving the remedies usually given in chronic constipation, cathartics, enemata, rectal tube, massage, electricity, exercise, regulation of diet, etc. The surgical treatment varies with different operators, colotomy, colostomy, colopexy, all being successful in individual cases.

Entero-anastomosis have given good results in most cases. In the case reported by Finney, the entero-anastomosis, even with a persisting fecal fistula, failed to prevent the continued accumulation of feces in the distended loop. Finney's procedure differs from the technique commonly practiced in that the preliminary fecal fistula was made in healthy bowel above the distended loop. The series of later operations proved eminently successful.

THE SALICYLATES IN DIAGNOSIS AND TREATMENT.

A. Haig (Med. Record, December, 1907) says that in many local troubles, such as fractures of bone or old scars in fibrous tissues which generally react to changes of weather and season by some increase of local irritation or pain, the application of a little oil of wintergreen will often suffice to relieve the patient and give a key to diagnosis.

EDITORIAL

SHOULD DOCTORS PATENT THEIR ORIGINAL DEVICES?

The code of ethics declares that "It is derogatory to professional character for physicians to hold patents for any surgical instruments or medicine." (Chapter II, Article I, Section 8). Until this prohibition is removed, it stands to reason that no member of the so-called "organized" profession will have the temerity to patent any instrument devised by him, for to be declared "unethical" is equivalent to expulsion from his home medical society and ostracism at the hands of his professional friends, with all the disadvantages resulting from the same. While this iron-clad law of the profession effectually prevents the securing of letters patent by any medical man in good standing for as long a time as the code of ethics shall rule, nevertheless so far as we know the code has not yet prohibited the right of free speech, and therefore, we trust, without giving offence, we may be permitted to express the opinion that this prohibition against the securing of patents for surgical devices is illogical and is operating as a hindrance to the good of humanity.

Upon the closest investigation and analysis, we find that the sole objection to the patenting of medical and surgical appliances rests upon the idea that ownership in patent rights by physicians would mean individual monetary gain for the particular inventors, which, by some hocus-pocus method of reasoning on the part of the original draftsmen of the code medical, is objectionable and not consistent with uprighteousness in professional conduct. Without attempting to analyze the process of logic which led these framers of the code to this strange conclusion, let us closely examine the intent of the law and the law itself upon the subject of patent rights. Under the Constitution of the United States, patents are conferred for "the promotion of the progress of science and the useful arts by securing for limited periods of time to authors and inventors the exclusive rights to their writings and discoveries." That is to say, the sole purpose of the enactment of patent laws is to promote the progress of the liberal arts and sciences to the end that humanity may be thereby the better enabled to keep up the fight for existence. There is no possibility of misconstruing the plain purpose of the law; there is no intent at conferring particular monopolies upon individuals for the purpose of individual gain, like the practice in England in olden times of rewarding favorites of the Crown with exclusive supervision and control of certain branches of trade. The only intent in the patent law is to help humanity by stimulating those with inventive minds to devise and originate appli

ances and contrivances which will promote the welfare of the nation by helping the progress of the useful arts and sciences. This thought should be constantly kept in mind in the debate upon this question. With this thought in mind, let us inquire if there is any objection to the patenting of a piece of machinery which will be used in the manufacture, say, of flour? The answer is, of course, no. Is there any objection to a doctor securing such a patent upon such a piece of machinery? No. Is there any objection in the ethical code for the copyrighting of a medical book? No. Is there any objection in the ethical code to a surgical instrument manufacturer (a non-medical man) protecting certain electrical apparatus for therapeutic usage by letters patent? No. Is it unethical for a medical man in good standing to use such a patented article? No. This leaves the position of the exponents of the code in a "shaky" condition; they admit that it is right and proper for certain lay individuals to secure patents upon articles intended for professional use-conceding that such patent rights are for the benefit of humanity-and yet they deny to their own brethren the privilege which they freely accord to others. The objection, as we have said in the beginning, rests entirely upon the question of individual gain. In order to be consistent upon this point, every medical man should practice his profession free, he should make no charge for service, or, if say "half-way" consistent, he should accept an "honararium" and never render a bill for services. He should hark back to the days of old when the mention of sordid "money" to a physician was equivalent to dishonor. Now, who nowadays, even the most fanatical of the "codebelievers" would advise this Utopian gratuitous practice of medicine? And yet, there is no more valid objection to the gaining of money through the ownership of a surgical instrument patent than in the ownership of money obtained from the performance of a surgical operation. If in the one case the money is "tainted," it is equally "tainted" in the other. The position of the profession on this point is out of tune with modern progress.

The position of the medical profession in supporting and maintaining that part of the code of ethics relating to the patenting of medical and surgical appliances is illogical, not altruistic and is operating in a manner detrimental to the public welfare. It is illogical for the reason just stated. It is not altruistic because this very prohibition at patenting medical and surgical appliances has made the medical profession apathetic, except in a few cases, concerning the designing and modeling of new ideas and thoughts. There can be no justification in any ethical code, whether medical or that of any other profession, which operates against the public good. Those who created the constitutional privilege of patent existence and ownership were better exponents of economic considerations than those ancient and honorable draftsmen of the code medical. Considera