blades which possess strong teeth for gripping.

想哭

GREEK SURGICAL INSTRUMENTS.

We learn from the London Times, that a set of thirty-seven remarkable ancient Greek surgical instruments has been discovered near the site of Kolophon, in Ionia, and has after being for a considerable time in the possession of the late Mr. Alfred O. Van Lannep, Dutch vice-consul at Smyrna-been brought to England.

The instruments show a type of workmanship unequaled in any other extant specimens and generally reveal the great progress in surgery which the ancients achieved. The date, though somewhat uncertain, is probably the first or second century, A. D. It is possible, however, that it may have been before the Christian era.

With two exceptions all the instruments are of bronze. The blades of the knives were originally of steel, but in each case this metal has been almost completely destroyed by oxidation (rust).

It is an interesting fact that in ancient times knives were made either of stone or bronze. This custom was followed, not because iron was unknown, but because that metal was held in superstitious fear-a fear which lingered into the Christian era. According to Plutarch it was actually unlawful to introduce any iron implement into a Greek temple, and no Roman priest might be shaved by an iron razor or iron scissors.

Surgical knives, however, had steel blades. Nevertheless, even these bore, on the opposite side from the actual blade, a leaflike projection of bronze blade, preserved, apparently, for ceremonial reasons. Each of the six knives (or rather knife handles) in the collection shows a groove for the steel blade which it originally possessed. It is probable that, as in modern instances, the shapes of the blades differed considerably to suit different operations.

Among the five pairs of forceps or grippers in the find is a large and beautifully made instrument the handles of which are shaped to represent two dolphins. This is probably a pair of "polypus" forceps, used for removing growths. The "bite" of the teeth is strong and close. Another interesting pair of forceps is that used for extracting arrow and lance heads from wounds. This pair somewhat closely resembles modern "bone" for

An elevator for raising depressed bone is another interesting exhibit. Its presence in the collection would seem to prove that after battle efforts must have been made to treat surgically even the most serious wounds of the skull.

Modern surgeons are apt to imagine that brain surgery is a recent discovery, and that operations for the elevation of pieces of depressed bone were invented within living memory. The elevator has unfortunately been broken, and only one end of it remains.

Another and still more remarkable brain instrument is the "drill bow" for operating a skull trephine. This instrument proved a great puzzle at first and was supposed to represent some sort of measuring appliance. Research, however, has shown that it is a bow which, when fitted in a string, was used to rotate a bone drill or skull trephine-much as drills and trephines are still occasionally rotated. The British museum possesses the only other specimen of the drill bow extant; until the discovery at Kolophon was made the nature of that instrument was not known.

Far from being a triumph of modern surgery skull trephining or trepanning is an ancient maneuver. Skulls have been discovered again and again showing trephine openings, and the natives of the South Sea islands are actually known to practice the operation. In classic times this was not undertaken, as at present, to relieve the pressure from an abscess or an effusion of blood but to allow exit to the evil spirit supposed to be troubling an insane or epileptic patient.

The collection includes a tenacula, or sharp hook, similar to those in every day use, a number of catheters of beautiful workmanship and shaped like modern instruments of the same type, a scoop or curette for gynæcological and other work [Hippocrates speaks of such an instrument], a cautery for burning wounds, a couple of probes exactly like the modern ones, a couple of spatulæ or spoons, a needle holder, and a bronze box, intended evidently as an instrument case. In addition there is a slab of Egyptian porphyry for mixing ointments upon, and a well constructed pair of scales, still in excellent equipoise.

Some cupping vessels were also discovered. The method of using these was to ignite a piece of dry linen placed inside of them and then apply them to the skin. As the heated air within cooled it contracted and sucked the skin into the neck of the cup, thus exercising counter-irritation. The modern Bier's glass exhibits the same principle. That the Greek and Roman surgeons achieved

ETHICAL ADVERTISING.

That young and cleverly edited medical weekly, the Cincinnati Medical News, has the roguish habit of prodding the sore spots of our leaders— just to see the great ones squirm, we suppose. For instance, it talks about the "ethical" advertiser this month-not the little fellow who buys advertising space by the line, but the big fellow who manages to get columns of it for nothing. Note the following:

"Generally speaking, the writer's observation leads him to believe that the members of the rank and file are 'more on the level' than are the really great in the profession. Of course, there are exceptional physicians who regard a neighboring physician much as a bull does a red rag, but generally the ordinary physician is fair and square— such, at least, has been the writer's experience. These paragraphs on ethical advertising will hardly apply to the general practitioner, because the average newspaper does not hold him in very high regard, and its editors imagine that the size of his practice and social standing of his clientele is a sufficient index of a physician's ability.

"Ethical advertising, then, is a prerogative of the great. The meek (?) and lowly are generally not guilty; they couldn't be if they wanted to. "Professor Bunk, for example, is an eminent surgeon. In his own opinion he is the most eminent surgeon of his time. He has discovered that a hemostat with jaws one and a half inches long will seize more tissue than a hemostat with jaws one inch long. This entitles him to the Nobel Prize. The professor has also made many more discoveries quite as important. He is teacher in a medical college, which is proof that the whole medical profession sits at his feet to gather the wisdom which falls from his lips. Professor Bunk is staff surgeon to a great hospital. His motto is, when in doubt about a diagnosis, cut. He cuts often. Often he can not make a diagnosis after cutting. Professor Bunk admires newspaper reporters. He has often been seen handing them cigars, and occasionally buys a drink (of lemonade) for them, because he admires them. Newspaper reporters make a livelihood by gather

ing news, and they give the professor to understand that a little tip occasionally will be appreciated. Newspaper reporters are invited to attend one of the professor's cutting seances. They attend. The operation from the standpoint of a physician is most commonplace. Bunk, however, gives the reporters to understand otherwise. 'This instrument is of my inventon;' 'My method of procedure is an improvement on other methods;' I find this and I do that,' etc. Newspaper man duly impressed. Scoop! 'Wonderful operation by wonderful man! Professor Bunk's new discovery.' Result, the professor's bank account soon shows the effect of this little ad-writing. Ethics? Sure, that's ethical.

"Professor So and So is another type of the really great. With an abundance of money and a plenitude of political pull the professor secures a position as advisory something in the building of an institution which some people regard necessary and others as wholly unnecessary. Professor So and So's picture could be seen on the screen of moving picture shows some time since, and any physician with an extra nickel had an opportunity to see what a really great man looks like. Professor So and So is an ethical physician, and a great authority on all matters medical. If you don't believe it, go ask him, or his wife, or any of his relatives.

"Then there is another type of an ethical advertiser. This is a brain specialist. Since he studies brain it is obvious to any one that he knows more than other physicians. The brain is the organ of wisdom. Ergo, a brain specialist is the wisest of men. Every time a murder occurs this type of ethical advertiser is on hand with an interview on the mental condition of the criminal. He may have never seen the man; has only the statement of a newspaper reporter, nevertheless, an authoritative opinion on the man's mental condition is published, captioned 'Professor Alienist, Eminent Specialist, gives it as his Opinion,' etc. Of a hundred murders in this country ninety-nine are due to coffin varnish, and one to insanity. The cure for coffin varnish murders is the noose and not temporary confinement in an insane asylum.

"Another type of ethical advertiser is the physician holding a public office. Now, the mere fact that a physician holds a public office is no proof that he knows more about medicine than a physician in private life. The public in general seems to think so. The newspapers are responsible for this, and the medical politician soon believes it himself.

"Occasionally an ordinary practitioner manages to get a little ethical advertising. One

physician visiting a summer resort discovered a case of infectious disease. He immediately had the whole territory quarantined. A most commonplace proceeding. But the newspapers transformed it into a matter of extraordinary interest. 'Brilliant Physician Quarantines Noted Health Resort,' etc. That bit of ethical advertising increased the physician's income by a full twenty-five hundred dollars a year.

"Generally speaking, the rank and file get no chance to exercise the fine art of ethical advertising. As said, it is the prerogative of the great and the near great. And the chances for a member of the rank and file to elevate himself to the front rank in the profession are mighty slim at the present time, and they are getting slimmer every day."

IS THE USE OF IODINE IN SURGERY A PASSING FAD?

With the passing of bichloride of mercury, surgeons all over the world have taken up tincture of iodine. It is the universally accepted

of the epidermis and prevents the spread of the various cocci from the skin into the wound by fixing them. If this be true, the iodine should not be applied beyond the margin of the wound.

"The only real claim that is made for iodine that seems to have merit is that of painting around the border of little cuts, small puncture wounds, etc. But where a large surface is exposed, it can only do harm if applied in the wound itself.

"The medical profession scoffs at the laity for picking up every new thing that is suggested, no matter what the source, but the profession itself, speaking of it as a whole, does the very same thing. By reviewing the methods of the first dressing in the last twenty years, we will find that we have often thought we had the ideal dressing, but in a short time have discarded it for various reasons to take up some more popular fad that was being heralded for some special reason, the majority not knowing

just why. We came down through carbolic acid,

bichloride, iodoform, acetanilid powder, etc. Then the solution used for a time called Har

"The principle underlying all first treatment in urgent work is not to try to kill the bacteria present but to limit their spread and growth. To wash an open wound with water or a watery :solution may bring to it the first and only infection that comes to it, lower the vitality in the border of the wound and retard healing. If the wound be already infected, water or watery solution is the worst thing that can be applied and tincture of iodine or any other solution will not destroy the infection. It can only do injury to the tissue and trying to disinfect the same only coagulates the blood in the wound. Let it bleed, if not too severe, as bleeding may carry out some infection if there

of tincture of iodine.

"We believe that within the next couple of years the profession will have discarded iodine and adopted the views of Prof. A. von Eiselberg, of Vienna, in the first treatment of urgent surgical dressing. He advocates the dry treatment with nothing but absorbent, sterile gauze, and says that if the surgeon is not situated so that he can wash his hands thoroughly, not to wash them at all for the moisture and scrubbing will only get the bacteria loose so that they will more easily get into the wound. Do not touch the wound at all with the hand. Keep all water and solutions away from it.

"Koenig reports that he treated 250 cases of open wounds with no cleansing whatever and only had delayed healing in two and very

material that can be left in the wound. Disinfectants do not belong to the first dressing.

"War records have shown that the best form of treatment to prevent infection is to use no solutions to wash the wound but cover it with dry, absorbent sterile gauze, this replacing all powders of any description or any other material that will become dry on the outside and tend to seal the wound. It is my opinion that. if iodine does any good at all, the benefit is -derived from the tanning or hardening process

iodine. Von Eiselberg says that, after twenty years of observation, the washing of wounds with water or some fancied solution is the cause of the larger percentage of infections. We do know that all infections spread much more rapidly where the wound is moist than when dry. It does seem that so far we have missed the real solution of the problem to prevent infections, for they are certainly as prevalent in the ordinary work as they ever were.

THE ARMY WAR CORRESPONDENT IN

MEXICO.

While not of medical interest, we are sure the readers of the MEDICAL STANDARD will be pleased to know something of the conditions which will surround the war correspondent in Mexico in case war comes, as it promises to do before long. These conditions have already been arranged and are given in the last number of the Fourth Estate.

The newspaper man who desires to be a correspondent with the army must deposit a certified check for $1,000, against which he may draw for subsistence supplies at the commissary or for any part of his equipment, such as blankets, tents, saddles, bridles, clothes, and similar available articles. He must also provide a bond in the sum of $2,000 for his good conduct, which in the case of forfeiture may be transferred to any charity the Secretary of War may designate. The correspondent will also take a military oath of loyalty in the usual form. He must agree to abide by all the regulations laid down for his guidance. Only one correspondent from a newspaper will be permitted to accompany the same field army. Men who have adventure rather than actual service as active journalists in mind will not be received. All who ask to go will be required to show that they are really newspaper men and have had experience.

Foreign correspondents must show that they have seen service in the field with an army, and must present credentials from high officers of the army with which they have been in the field, and letters in each case from their respective diplomatic representatives in the United States. No photographers for the press will be allowed with the army. There will be an official army photographer whose films will be sent to Washington promptly and prints will be furnished to the press at a slight cost.

Moving-picture men will also be barred. Regular correspondents will be allowed to carry small hand-film cameras, but their films must in all cases be censored, the films being sent to Washington to be developed and passed upon.

It is proposed to have a commissioned officer of the army act as censor in Washington and another to act as censor with the army in the field. All letters and dispatches must be submitted to the censor at the field headquarters of each army and receive the stamp of approval.

The regulations forbid that the correspondent may send the names of regiments or commanders, the disposition of troops, the state of the army's transport, the number of sick, the extent of losses in any engagement, or any other matter which

the censor may reject. The commanding general may, however, relax the administration of the regulations when military necessity does not require such strictness.

The correspondent on being duly licensed has the status of a non-commissioned officer so far as privileges are concerned. His pass gives him transportation over all military railways, and he is entitled to draw rations and is allowed tentage. A cook for the correspondents' mess is supplied. The amy wires are open to his use when not occupied by official dispatches. Every correspondent must wear olive drab garb for the field, with a white arm band two and a half inches wide, bearing the letter C in red on the left arm. His messenger, if he has one, must also wear olive drab, and a band with the letter M in red.

Once started as a war correspondent no one may leave the army without the permission of the War Department. If dispatches are distorted in the office of publication, or language or expressions are used conveying a hidden meaning which would tend to mislead or deceive the censor, such an act will be held to be a violation of the regulations, punishable by forfeiture of privileges and the bond filed with the War Department.

Correspondents are to be subject to all medical regulations of the army.

No officer or enlisted man in the army will be permitted to act as correspondent for any publication without the consent of the Secretary of War and the majority of war correspondents attached to the army with which such an officer or enlisted man may be serving.

No censor may write anything for publication about the war while he is acting as censor.

PRESCRIPTION INCOMPATIBILITIES. Dr. Thomas Stephenson, has an interesting article upon this subject in the Prescriber. Among other things, he points out the following:

It is a well known fact in chemistry that salts of a weak acid are decomposed by a stronger acid. That is to say, the stronger acid has a greater affinity for the base, with which it readily combines, setting free the other acid. This happens when a mineral acid, such as nitric or hydrochloric, is added to a benzoate, salicylate or cinnamate. A solution of sodium salicylate or benzoate will, therefore, be decomposed by the addition of a mineral acid; salicylic or benzoic acid, which are only slightly soluble in water, being set free. Sometimes the liberated acid is diffusible in the mixture and easily shaken up, as is the cinnamic acid precipitate in the followng mixture:

Caffein. cit.
Sodii salicyl.
Syr. tolut.
Aq. chlorof.

.gr. lxxx .gr. clx .51 ...ad viii Solutions of iodides are decomposed by certain mineral acids, iodine being set free. Potassium iodide is thus incompatible with dilute nitric or nitrohydrochloric acid, or with tincture of ferric chloride, the liberated iodine forming a brown solution. Spirit of nitrous ether, when kept for any length of time, becomes acid and acts in the same way on potassium iodide. This may be avoided by previous neutralization of the spirit by means of potassium carbonate, or by addition of a suitable quantity of ammonium carbonate to the prescription.

Acetyl-salicylic acid (aspirin) also decomposes potassium iodide, and when the two are ordered in cachets the liberated iodine combines with the starch contained in the envelope, forming an unsightly bluish-black compound. Some essential oils, especially if long kept, have the power of decomposing potassium iodide.

Another instance in which iodine is set free, though not immediately, is when potassium chlorate is prescribed with syrup of ferrous iodide. In this case the chlorate is gradually reduced to chloride, and iodine is liberated from the ferrous iodide.

Glucosides are hydrolyzed in presence of mineral acids or alkalies. Thus salicin is slowly changed into saligenin and glucose, and strophanthin is similarly decomposed.

Reference has been made in a previous article to the decomposition of substances rich in oxygen. Chlorates, nitrates, bichromates, permanganates, etc., decompose with explosive violence when mixed with readily oxidizable substances such as sugar, sulphur, glycerin, reduced iron or essential oils. Solution of potassium permanganate is reduced by ferrous salts, glycerin, alcohol, hydrogen peroxide, phenol and most organic substances.

Chloral hydrate is another substance that is readily decomposed. With carbonates or hydroxides of the alkalies or alkaline earths (potassium, sodium, ammonium or magnesium) chloroform is set free, and a formate of the base is produced. With certain soluble salts, such as bromides and iodides, in the presence of alcohol, an oily layer of chloral alcoholate is formed. It is therefore unwise to prescribe chloral hydrate and potassium bromide along with a tincture. 淡淡

CARDIAC PAINS.

Dr. Samuel West says, in the Clinical Journal, that cases of cardiac pain fall into two categories. In the one the pain is felt, more or less, actually in the heart itself. In the other the pain is radiated or reflected, and, though originating in the heart, is felt as well elsewhere. The heart pain is connected with the distension or over-distension of its cavities. This is obvious, and capable of easy demonstration where the pain develops during or immediately after great exertion, e. g.. after running or rowing in a race.

This may

be called heart-strain or heart-sprain. The heart, once sprained, may, like any other strained muscle, remain weak, and liable to pain, with even slight effort, for a long time after.

No sharp line can be drawn between these slight attacks of discomfort or pain and those more severe paroxysms, which, in an extreme degree, are called angina. Indeed, angina, in its agonizing and paroxysmal character, closely resembles colic, and, as colic is produced by the unsuccessful attempt of an over-distended muscular organ to empty itself against resistance, so angina may be well described as cardiac colic. As the pains of severe colic may not be confined to the distended organ, but be radiated and reflected to other parts, so it is not surprising that the same should occur in angina. Thus we come to the second category of cardiac pain, the reflected or radiated group. Of this the most familiar instance is the pain felt in angina in the root of the neck and left shoulder, or down the left arm.

Why the pain should usually be referred in this direction is not so clear, but it does not always take this course, for it may be felt in both arms alike, or sometimes in the right alone. Usually it is when the left ventricle is the seat of distension that cardiac pain is felt. In mitral disease the pain is rarely so severe, and much more limited in range, not extending far from the cardiac area, and radiating on a more horizontal plane into the axilla, rather than upwards. I have tried to connect the varying distribution of the pain with the distension of the