ing of the exact manner in which atmosphere arrests the progress of the disease is a comparatively recent acquisition.

The opinion at one time obtained that mountainous and elevated districts were beneficial to phthisical subjects on account of the alevation alone. Recent investigations have disproved this theory. It is now an accepted fact that elevation, per se, is of little or no importance. On the contrary, the seashore is oftentimes better adapted to phthisical individuals than regions of a much higher altitude.

While it is true that the higher the altitude the less prevalent is phthisis, the explanation is that atmospheric impurities are less abundant and ozone is more plenteous in such regions than elsewhere. In other words, it is conceded that the absence of atmospheric impurities and the presence of ozone are the chief elements in the cure of phthisis and that any section, high or low, which affords these elements, is advantageous to the phthisical individual.

The benefit derived by consumptives from living in or near pine forests is a matter of common observation. The turpentine exhaled from pine trees converts oxygen into ozone and the atmosphere is thus purified by the process of oxidation.

Having repeatedly proved that the direct inhalation of ozone is of little, if any, benefit, we are forced to the conclusion that it is not ozone which arrests the progress of phthisis, but the systematic oxidation which is brought to the maximum by the inhalation of a perfectly pure atmosphere.

In fine, we are now agreed that if systematic oxidation can, in any manner, be maintained at the proper standard of activity, without exhausting the vital forces of the subject, the progress of phthisis can be checked and very frequently completely cured.

Although the benefits derived by phthisical individuals from an atmosphere that is conducive to a full measure of systematic oxidation are immeasurably great, the fact remains that it is not always within the power of the physician to induce the patient to move to a region affording such an atmosphere. The patient may, through inability to pursue his vocation, be financially unable to make a change of residence, or he may be influenced by the optimism peculiar to phthisical subjects to postpone the change until the disease has progressed too far.

When for any reason whatever it is not possible to change the abode of these subjects it is within the power of the physician to check the progress of the disease by the augmentation of systematic oxidation.

While all forms of iron increase systematic oxidation by converting the oxygen in the economy into ozone, the mucous surface of the alimentary tract of phthisical subjects is usually too enfeebled to absorb iron unless it is presented in the organo-plastic form. For this reason Pepto-Mangan (Gude) affords results which cannot possibly be secured from any other prepartion of iron.

In addition to promoting oxidation to a surprising degree, PeptoMangan (Gude) invigorates the digestive functions and increases the nutritive processes most markedly. The appetite of the patient is improved, the wasting is arrested and the vital resources are greatly enlarged by the continued employment of the preparation.

CONSERVATIVE SURGERY, OR THE USE OF EXTERNAL APPLICATIONS IN CASES OF DOUBTFUL SURGICAL PROCEDURE.*

By F. W. Hander, M. D., Beaumont, Texas.

Without any comment on the conservation with which a surgeon should use the knife in doubtful surgical cases as regards time, symptoms and condition of patient, I shall give you several cases which have been under my own observation.

Mrs. H., age 24, married, had suffered pain in both ovaries, especially the right, shortly before, during and for a short time after menstruation, from the beginning of her menstrual life at the age of 14. This pain gradually increased in severity and time of duration until it had become almost constant and unbearable.

After being advised by several excellent physicians to undergo operative procedure for diagnostic as well as curative purposes, she consented. When the abdomen was opened both ovaries were found to be cystic, the systs being more numerous in the right. The appendix was normal and healthy and gave no evidence of having been in a pathological condition at any previous time. Both ovaries were removed as a curative and preventative measure.

The patient made an uneventful recovery from the operation, but for three years after, when she again sought medical advice, the pain continued as before, with the addition of slight swelling and tension in the right hypocondriac region. The patient passed through the artificial menapause with very little inconvenience or nervous disturbance.

Case 2.-Man, married, age about 27, suffering from acute attack of appendicitis, as diagnosed by the attending physicion, two consulting physicians concurring. Constitutional symptoms present and anatomical appearances, such as tension, redness, swelling and pain at McBurney's point, pronounced. Operation advised, to which patient and wife objected.

In both the above cases Antiphlogistine was repeatedly applied, with the most marked benefit. In case one, although the woman had suffered three years after the operation, through the influence of antiphlogistine, the pain and tension were modified, leaving only a small, soft elevation in the region of the appendix. Pain returned only at long intervals and with diminishing severity, and there is every indication now, after one year's treatment along this line, of permanent relief.

In Case 2 the same treatment was carried out. Tension, redness, swelling and pain diminished with the first application of Antiphlogistine, and disappeared after ten days. With some constitutional treatment the patient entirely recovered in this time. In this case there has been no recurrence of the attack in over three years.

I had another case in which two wire nails were driven through the palm by a falling timber. This was followed by pain and swelling after a few hours (no bleeding), the swelling extending up the forearm.

Another case was one of a deep infected wound following paronychia. This wound was opened to the bone and free drainage established, but it gradually grew worse, involving the whole hand. Amputa

tion of the finger or hand was advised, to which the patient objected, saying he would die first.

In both these cases the local application of phenol and antiphlogistine gave relief and finally cure. In the latter case I cleansed the wound with hydrogen peroxide and applied silver pitrate to the exuberent granulations.

Multiples of these minor cases could be given, where the knife seemingly was indicated, but which rapidly yieded to local applications along the above lines.

I also had an interesting case in a boy 12 years of age who suffered from osteo-myelitis of the femur of several years' standing. The discharge was constant through a fistular opening, and the case showed no evidence of improvement, although at several operations all diseased bone and some healthy bone had been removed. An antiphlogistine dressing was persistenly applied, with the result that several large particles of bone sloughed off, after which the opening rapidly closd. No further pathological process has been observed in this case in ten years, although an enlarged gnee joint and some anyklosis remain as sequelae.

EDITORIAL FROM SAN FRANCISCO NEWS LETTER FOR FEBRUARY 10, 1906.

IS THIS ANOTHER GRAFT?

After the recent election Mayor Schmitz announced his intention of giving San Francisco the best administration she ever had. The clean cut victory of the mayor and his supporters gave him every advantage in this intention. We certainly hope he will carry out his policy, and as we intend to be the first to praise if he does, we do not want to be the first to criticize without cause. Still, we have some plain questions to ask, to which we would like plain answers:

Last year the fake medicine, Liquozone, which has been criticized and exposed all over the country, was condemned by the San Francisco Board of Health. This was evidently condemned under Section 347-A of the Revised Statutes of the State of California, which prohibits the sale of medicines containing sulphuric and sulphurous acids except under the "poison" regulations.

The board's official analysis of Liquozone, published at the time, showed it to contain sulphuric and sulphurous acids, also traces of formaldehyde. Previously formaldehyde had been found by some chemists but others could not detect it. Acting under the above section, which clearly includes Liquozone, the board condemned this remedy. The Liquozone company sued out a temporary writ of injunction, the returning of which has been put off and put off for several months.

On the 8th day of last month the Board of Health passed a resolution removing the ban from Liquozone for the ostensible reason that a recent analysis of the fake shiwed that it did not contain formaldehyde. Formaldehyde is not mentioned in Section 347-A under which the board proceeded. In our issue of November 11th we

published an analysis of Liquozone which we had made for our own information, at our own expense, which agreed with the board's analysis, and with the analyses made in England and all the prominent cities of this country. The trace of formaldehyde, once found by the Board of Health's chemist, was a small part of the evils of Liquozone. Sulphuric and sulphurous acids, commonly known as oil of vitriol, are unlawful to sell except under the regulations contained in Section 347-A.

The questions we desire to ask of the administration, Mayor Schmitz, Dr. Ward, the president of the Board of Health, the other health commissioners, Dr. Ragan, the health officer, and Chief of Police Dinan, are these:

Has Section 347-A of the Revised Statutes been repealed?

Is there any evidence that Liquozone does not now contain sulphuric and sulphurous acids, which have always been its principal ingredients?

Why was the removal of the ban based on the fact that a recent sample did not contain traces of formaldehyde?

If it still contains sulphuric and sulphurous acids, and we believe it does, why was Section 347-A utterly ignored and how can the administration, Mayor Schmitz, President Ward, Dr. Ragan and Chief Dinan reconcile the ignoring of this statute with their duty to uphold the laws?

As stated above, these are plain questions and we would like plain answers to them. We believe in giving the present administration a fair chance, and we do not want to be the first to cry "Graft!" Still, to say the least, the above looks more than suspicious.

THE ROLE OF IRON IN THE NUTRITIVE PROCESS.

It is an established custom of physicians to administer iron whenever a patient with pale, waxy, or sallow complexion complains of extreme exhaustion, muscular feebleness, easily accelerated pulse, aphasia, anorexia and the several symptoms which constitute the characteristic issues of a qualitative or quantitative reduction of the corpuscular elements of the blood.

Such symptoms are unerring indications of anemia, and iron is beyond dispute a cure for that disorder. But while the chief therapeutic property of iron is that of an anti-anemic, the subordinate, or collateral effects of the drug are manifold, and are worthy of far more consideration than they usually receive.

As a hemoglobin-contributor and multiplier of red blood corpuscles, iron will doubtless forever stand supreme, but its utility is by no means restricted to anemic conditions, for one of the chief effects of iron-one quite often lost sight of-is its influence upon nutrition.

The primary effect of iron is a stimulation of the blood supply. This results from invigoration of the blood vessels. As a consequence of a more active blood stream, the digestive capacity is increased and the nutritive processes are correspondingly improved. Subsequently, iron increases the amount of hemoglobin contained in the red corpuscles. This imported hemoglobin converts the systemic oxygen into ozone, and thus wise oxidation, upon which nutrition directly depends, is restored to its proper standard.

It is impossible to emphasize the fact too strongly that it is necessary to do more than increase the appetite to correct nutritive disturbances. A voracious appetite does not necessarily imply an extensive appropriation of nutriment. On the contrary, it is commonly observed that individuals who eat ravenuously suffer, the while, a progressive loss in physical weight and strength, even in the absence of all exertions that might account for such losses. And while it is obviously needful to relieve the existing anorexia in order to arrest a loss of weight, it is likewise essential that the capacity to properly digest food be fully restored before the nutritive processes can proceed in befitting order.

The manner in which iron begets an increase in appetite has only recently been perfectly understood. The earlier observers entertained the belief that an increase in appetite resulted from the mechanical effect of iron, and that this mechanical effect never manifested itself unless the drug was administered in some acid form. Later investigators advanced the theory that this mechanical effect could be secured by rendering the drug either strongly acid or alkaline. Recent observations have completely disproved the accuracy of both of those theories by inviting our attention to the indisputable fact that a neutral preparation of iron will relieve anorexia with greater celerity than will either an acid or an alkaline one. From the information gained from these observations, we are impelled to admit that the increase in appetite attending the employment of iron is due solely to the increased oxidation induced by its entrance into the blood stream. Accepting this as being true, we can readily understand the manner in which iron exerts its happy effect upon the nutritive pro

cesses.

The aforesaid facts compel the admission that that preparation of iron which enters most rapidly into the blood stream is the one capable of producing the best results in all disturbances of nutrition. Acid preparations of iron diminish the alkalinity of the blood, thus depressing thedistribution of nutriment, and alkaline preparations of the drug offend the mucous lining of the alimentary tract. For these reasons it is consistent with logic to extend preferment to that preparation of iron which is neutral in reaction. That preparation is the Pepto-Mangan (Gude).

Pepto-Mangan (Gude) is unquestionably the form or iron most closely resembling that which is native to the economy, and the strik ing affinity for it displayed by the circulating fluid causes us to concede that it possessess desirable attributes not common to any other preparation of the drug. Whence we take it that it is the precise form in which to administer iron when a correction of nutritive deficiencies is the end to be achieved.

In those conditions of weakened digestive power where the func tion is unable properly to take care of the food supply; when to administer the ordinary forms of iron would be but to increase the digestive disturbance, Pepto-Mangan (Gude) may be prescribed without apprehension, as the preparation is tolerated by the weakest stomach. Being practically predigested, Pepto-Mangan is immediately absorbed by the mucous membrane and taken up by the blood without the necessity of the weakened function being called upon to prepare it for assimilation, and therefore the entire system, including the digestive function, is strengthened and reconstructed. As a nutriment tonic in digestive disorders Pepto-Mangan (Gude) has no equal.