more up-to-date medical journals, and we believe that the public is being awakened to a realization that the best physician is the one who reads and keeps fresh his knowledge of medicine, his kaleidoscopic mother.

THE LADIES' HOME JOURNAL AS AN AID

TO THE PHYSICIAN.

Nor a little levity is leveled at the Ladies' Home Journal by the so-called funny papers and the paragraphers, on account of its attempted mission of instruction in many branches of household and physical economy to its readers. But physicians, who recognize how difficult it is to impart instruction on medical subjects to their patrons, will appreciate the value of this medium in conveying useful information to its large circle of readers. That the ipse dixit of the Ladies' Home Journal should have more weight than the assertions of the practitioner is perfectly natural, because it comes in the capacity of an enlightened lay instructor, while the family physician is regarded by his clientele as more or less narrow and prejudiced with regard to his views as to patent medicines, fake cures, etc. The recent crusade of the Ladies' Home Journal against alcohol containing patent medicines is bound to have far reaching and good results, because the good sisters and brothers who are told by their family physician that they are indulging in moderate alcoholism when they take their favorite spring tonic or blood purifier usually regard him as narrow and prejudiced and continue to imbibe their sustaining emotion from a black bottle labeled "good for all diseases of the kidneys, nerves, blood, skin, heart, liver, etc." Yet, when the Ladies' Home Journal exposes this to them, they will sit down and discuss the matter and perhaps finally conclude that after all they are not such teetotalers as they are wont to claim.

But among the best results brought about by the teachings of the Ladies' Home Journal are those produced by the excellent medical articles which from time to time appear in the columns of that journal. To a recent one which described that very prevalent condition which we call "adenoids," many practitioners will be able to ascribe the willingness of parents to

have their children submitted to the exceedingly beneficial operation for the removal of this pathological state. In our own experience we recently had a child brought to us whose mother stated that she had read this article in the Ladies' Home Journal, and from it had been enabled to fully appreciate the evil consequences brought about by the adenoids, and had determined to have her child operated upon. If one intelligent mother read this article, hundreds and thousands of mothers have done likewise, and thus have been reached a great number of parents who otherwise would not receive this information. They will notice their children and observe that they are mouth breathers, remark the other symptoms described as peculiar to the adenoid state, and will seek proper advice in time to give their children the benefits which they derive from early operation. This is one good mission accomplished by the Ladies' Home Journal, and this is but one instance illustrative of much valuable teaching that it is imparting. It should be encouraged.

IS MEMBRANOUS CROUP DIPHTHERIA?

WHILE every text-book on medicine of which we have knowledge, and practically every board of health in the country, recognizes the identity of membranous croup and laryngeal diphtheria, there still exists, particularly in the rural districts, a doubt among many practitioners as to these diseases being of the same nature. The consultant on pronouncing a case membranous croup frequently is met with the inquiry "But, doctor, is it diphtheritic croup?" To this, reply is made that membranous croup and laryngeal diphtheria are recognized as having similar genesis-the Löffler bacillus. Then the practitioner of years' experience shakes his head and expresses himself to the effect that bacteriologists may find the same germ in these conditions, but they certainly present different clinical manifestations, and one practically is non-contagious, while the other is very contagious.

This all has an element of truth in it which even the most widely experienced of us must admit. Text-books, under the heading membranous croup, will have in parenthesis "See

laryngeal diphtheria," but this won't satisfy the old practitioner who sees a child suddenly develop hoarseness, progressive dyspnea and stridulous breathing, and in a very large majority of his cases die within forty-eight to fifty-six hours after inception, where there have been absolutely no premonitory symptoms, no faucial manifestations or other evidence of diphtheritic infection, and where without isolation of any kind, not another child in the family will be attacked with the same disease. Yet he knows from his experience with faucial diphtheria, which may have a later secondary extension to the larynx, with somewhat similar symptoms as the previously described condition, that the danger of contagion is very marked, and also that the mortality is not by any means as high as where it commences in the larnyx without previous manifestations.

To these facts we must subscribe, but that the conditions are of the same etiology cannot be doubted in the view of bacteriological findings. True, the Löffler bacillus is not usually so abundantly found in the primary laryngeal form of diphtheria, called membranous croup, as in the secondary form which begins in the fauces, but careful investigation by competent men has shown that the diseases are identical in origin, and must be treated alike. Doubtless in the fulminating form beginning in the larynx, there is a larger degree of streptococcic invasion which contributes to its fatality, but since the opinion of science practically universally allies the conditions as one, practitioners should accept them thus and treat them after accepted methods.

It is apparent to any one who has to deal with these conditions that if anything is to be accomplished by antitoxin and intubation, which combined have so materially reduced the mortality from this disease, the nature of the disease must be recognized very early in its development. To wait until the child is moribund before administering antitoxin, in the light of the present knowledge as to the benefit of this treatment, is very reprehensible, and the best results from intubation certainly are obtained when the tube is introduced before the membrane has extended beyond its reach and the child is threatened with death from asphyxiation. Clinical experi

ence has long since taught us that antitoxin is harmless of itself, and the best general rule to be observed in these cases where there is the faintest suspicion of diphtheria, is to inject antitoxin at once and make a diagnosis afterward. And furthermore, it is unnecessary to be content with the administration of small doses of antitoxin, and we would advise and urge that the initial dose should not be less than two thousand units. Seven or eight hours afterward, if there is no decided improvement in the symptoms, two thousand or three thousand units more should be given. It is unwise to be lulled into a sense of false security by slight improvement in these cases, for they are very irregular in their course, being better one moment and worse the next. No case of this character should be dismissed until every symptom has passed away, and even then they should be carefully watched for several days, as heart failure is likely to supervene at any moment. The lesson the writer of this editorial desires to convey from his own large experience is, however, for the practitioner to be ever on his guard where children manifest suspicious laryngeal symptoms, to inject large doses of antitoxin at an early period and call the intubationist before the patient has reached a point where carbon dioxide poisoning from lack of oxygenation has produced a lethal state.

IS A FEE FOR SURGICAL WORK EVER EXCESSIVE?

It

THE suit recently instituted by an American in Paris against Doyen, the French surgeon, for the recovery of a fee paid the latter which the patient claimed was excessive, gives rise to the question as to what is a proper fee for surgical work. is customary for surgeons to charge for their services according largely to the circumstances of the patient and the degree of responsibility demanded in the case. Some contend that fees should not be graded according to the financial status of the patient, but this undoubtedly always will be done, because in a large majority of operations the fee charged is far less than is proportionate to the benefit derived from the operation and the mental and physical tax to which the surgeon is subjected. We contend that never yet has there been charged

a fee for surgical work that was in excess of what it should have been when is taken into consideration the great skill and resourceful courage required in the successful operator, and the immense mental strain under which the responsibility of the case makes him labor. We believe the fee in surgical operations invariably should be determined by the character of the operation, its value to the patient, and the patient's ability to pay. Surgeons as a rule give equally of their time to charity, and the pauper is as carefully operated upon as the millionaire, but the latter would not care to value his life, nor would the community be willing to do so, on the same basis as the former. Just as we live differently in degree according to our financial ability, so likewise should we expect everything else in life. The man who pays a hundred and fifty dollars for an appendicitis operation gets more than his money's worth, and so also does the one who pays twenty-five hundred dollars for the same operation. If he were run over by a railroad train the courts would value his life at not less than five thousand dollars. If a surgeon saves his life by an operation is he not worth at least that sum alive? It would. seem that a good many people don't think so.

EDITOR'S NOTES.

THE MEMPHIS HOSPITAL MEDICAL COLLEGE opened for its annual session, October 1st, with a large attendance of students. The school doubtless will have one of the best years of its history this season.

THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION will meet at the Grand Hotel, Cincinnati, October 11th, 12th and 13th. The preliminary program is unusually well filled, and indicates that the meeting will be exceedingly successful.

MESSRS. BATTLE & COMPANY, of St. Louis, have just issued the third series of twelve illustrations of intestinal parasites, and will be glad to send them free to physicians on application. These illustrations are cleverly executed, and should prove interesting and useful to every physician.