There's a Reason-Of course, if it is left to Battle Creek, Mich., coffee will be found to be a non-essential. And there will be the usual explanation"There's a reason."-Kansas City Star.

Venereal Prophylaxis-The subject of venereal prophylaxis is one that should appeal to every physician with especial force at this time, because it demands the attention of every medical man. Venereal prophylaxis is not solely a moral question, nor is it one that can be handled efficiently without the assistance of the doctor. The word "doctor" in its true meaning means teacher, and it is the doctor above all others who has an opportunity to teach his patients not only the danger and disaster that follows venereal disease, but the importance of its prevention. To assist the physician in doing this, some interesting and effective literature dealing with the subject has been prepared and will be sent gratis to any physician, on request to the Sanitube Company, Newport, R. I.

A New Parresine Atomizer-The successful treatment of burns in the war hospitals of France by the hot-wax method has resulted in the adoption of sim-. ilar methods in this country. The first product presented to the medical profession, over here, was Parresine (Abbott), a non-secret combination of wax, resin and Eucalyptol which is very similar in its physical character to the famous French product, so successfully used by Dr. D. E. Sandfort, particularly as regards plasticity, ductibility, pliability and adhesiveness. Parresine was presented to the Coun cil on Pharmacy and Chemistry of the American Medical Association and approved by that body for inclusion in the list of new and non-official remedies. Clinical data and reports from industrial physicians, hospitals and surgeons seem to justify the claims made for Parresine as regards relief from pain, prompt healing, convenience in redressing, and fewer scars and contractions. While Parresine in its liquid state may be applied to burns with a camel's hair brush the most satisfactory method has been found to be by means of a spray or atomizer. The first apparatus brought out for this purpose was expensive and not entirely satisfactory. A new atomizer has now been developed which is not only economical but constructed along scientific principles and very satisfactory. The price of this new Parresine atomizer is only $4.00. It will hold enough melted Parresine to cover any ordinary burn without refilling. The Abbott Laboratories of Chicago are to be congratulated on their progressiveness in being the first firm in this country to present to the medical profession such preparations as Parresine and Dakin's new antiseptics Chlorazene and Dichloramine-T.

Goiter Special Tablets are one of the fine pharmaceutical specialties offered by the Columbus Pharmacal Company, of Columbus, Ohio, one of the oldest manufacturers of pharmaceuticals sold exclusively to physicians. This company has always maintained a high degree of excellence for medicinals. The firm's very conservative policy of insisting on a thorough clinical testing of their specialties lends weight to any claim for consideration which they are willing to make. Sample and literature may be obtained by sending your card and mentioning The Herald.

Resorts for American Soldiers in France-Aix le Bains, the most charming of French Summer resorts, is to be made a recreation center for the U. S. troops, under supervision of the Y. M. C. A. The baths at Aix were first discovered by the Romans, who built an immense establishment there. The barbarians destroyed these works and for six centuries Aix disappeared from history. It was revived under the Merovingians, but it was not until the Sixteenth Century that it approached its former importance. King Victor Armedee of Savoie restored the town after a fire

in 1776, but the revolution and Napoleonic wars soon followed and Aix lost much of its glory. In 1815, however, the new progress began and in the century since the region about Aix has rivaled the Nice and the Riviera as a haunt for pleasure loving Europeans. Strangely, it attracted few visitors from America, although its mineral waters are especially adapted to the treatment of American ailments, such as rheumatism.

The Pneumonia Convalescent-In spite of all of the modern advances in scientific therapy, and the improvements in the general handling and management of acute infectious diseases, acute lobar pneumonia still deserves the title ascribed to it by Osler:" "The Captain of the Men of Death." There are, however, especially during the fall and winter months, many cases of the lobular or irregular pneumonia that so often complicates or follows la grippe. When this condition supervenes it is more than likely to follow a subacute or chronic course and convalescence is frequently long delayed. Under such circumstances, in conjunction with treatment designed to hasten resolution, a general blood tonic and vitalizing agent helps materially to shorten the convalescent period. Pepto-Mangan (Gude) is of much value in this field, because it not only increases the solid elements of the blood, but also acts as a true tono-stimulant to the organism generally. As PeptoMangan is free from irritant properties and constipating action, it is especially serviceable in the reconstructive treatment of the devitalization following the pneumonia of the aged.

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Incorporating the

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FOOD WILL WIN THE WAR DON'T WASTE IT

"SERVICE"

This is a word having a peculiar and patriotic significance in this country just now. All classes and conditions of men, women and children are becoming more familiar with the word in its fullest and truest sense-service to our country-Emery-Bird-Thayer Co., a Kansas City concern, with a record of many years of successful merchandising, make the claim that "service" has been the keynote in the wonderful growth of their business. In this issue of the Herald this enterprising firm has used a full page in which to emphasize this important phrase of its work"service"-which we urge all our readers to peruse.

Kora-Koria-We are pleased to announce the reappearance in our advertising pages of the Mennen announcement setting forth the merits of "KoraKonia," the ideal powder.

Need an Office Assistant?-If you want an assistant in your office, doctor, one that is competent and willing; one that will make money for you from the start, read over carefully the offer of the ThompsonPlaster Co., on adv. page 58, this issue. It is the best thing we know of in the whole realm of office assistants.

Dr. Thomas J. Mays, noted physician and writer, died at his home in Philadelphia of apoplexy on February 14th. He was born in Lebanon County, Pennsylvania, January 10, 1846. Dr. Mays made a special study of tuberculosis for many years and was the author of Pulmonary Consumption, a Nervous Disease.

CAUTION! Whenever the true merit of

a preparation is authoritatively established, imitation is sure to make its pernicious appearance. To counteract the injurious results of another of these fraudulent proceedings-in this instance affecting firm name and reputation-Sander & Sons have been compelled to appeal to law, and in the action tried before the Supreme Court of Victoria, the testimony of a sworn witness revealed the fact that this witness suffered intense irritation from the application to an ulcer of the defendant's product, which was palmed off as "just as good as Sander's Eucalyptol." Sander & Sons had the satisfaction to obtain a verdict with costs against this imitator, who is perpetually restrained from continuing his malpractice. Dr. Owen, in a report to the Medical Society of Victoria, and Dr. J. Benjamin, in the Lancet, London, both denounced, as others did before, on the strength of negative results, the application of unspecified eucalyptus products.

This forms convincing proof that only an authoritatively sanctioned article can be relied on.

SANDER & SONS' EUCALYPTOL
(Ecalypti Extract)

1. Has stood the test of Government investigation.

2. It was proved at the Supreme Court of Victoria by experts to be an absolutely pure and scientifically standardized preparation.

3. It is honored by royal patronage. 4. It always produces definite therapeutic results.

Therefore, to safegaurd the physicians' interest and to protect their patients, we earnestly request you to specify "Sander's Eucalyptol" when prescribing eucalyptus.

The Meyer Bros. Drug Co., St. Louis, Mo., agents, will forward one original package (1 oz.) on receipt on One Dollar.

POND'S

EXTRACT

SORE

THROAT

Vol. XXXVII.

Original Contributions

[EXCLUSIVELY FOR THE MEDICAL HERALD.]

THE LIMITATIONS OF LOCAL ANESTHE-
SIA IN SURGICAL OPERATIONS*

LEIGH F. WATSON, M. D., Chicago.
Introduction.

Local anesthesia has its limitations the same as any other method of anesthesia. It cannot be succesfully employed for every operation nor can it be used on all patients. In some instances it is not suited to the temperament of the patient; in others, the operation is one that should not be attempted by local alone. The variety of major operations that is possible to be completed by local, depend upon a proper selection of cases and the experience of the operator; his patience, his gentleness in handling tissues, and special training in the method.

Essential for Success.

The first requisite for the successful use of the local method is an accurate knowledge of the nerve supply and the ability of the operator to block off completely every sensation of pain. When the nerve supply cannot be entirely controlled general anesthesia should be employed. The sensation of pain is confined to the skin, nerve trunks, parietal peritoneum and synovial membrane of joints. Lennander has demonstrated that all internal organs obtaining their nerve supply from the sympathetic and vagus, below the branching of the recurrent nerve, have no sensation. For this reason the abdominal and pelvic viscera are insensitive to heat, cold, pain and pressure, both in health and disease. There is no sensation of pain in bone substance, bone marrow, cartilage, tendon, articular surface of bone covered with cartilage, brain, lung, liver, heart, kidney, kidney pelvis, ureter, bladder serosa and intestine.

A slight twinge of pain is felt. when blood vessels are cut. Traction on the ligaments of the thoracic, abdominal or pelvic viscera will cause pain; traction on the mesentery, besides roducing pain, will cause epigastric discomfort

"Read before the Medical Society of the Missouri Valey at Lincoln, Neb., Sept. 21, 1917.

No. 4

and nausea. I have frequently noted the pain of ligating the meso-appendix when it has not been previously blocked with local anesthesia. Solution, Syringe, Needles, Etc.

Novocain one-fourth per cent. solution, or cocain one-tenth per cent. solution, is strong enough for any operation. Adrenalin (1:10,000) five minims to the ounce of anesthetic solution is usually employed to give prolonged anesthesia. The drug must be sterile, and dissolved in sterile normal salt solution, being freshly prepared for each operation, and of a definite strength, that the operator may know at any time the exact amount of anesthetic that has been used. Cocain and novocain can be sterilized by heating to 212 degrees Fahrenhiet; a temperature above this, as well as repeated sterilizations, are injurious.

Different operators prefer various syringes. I have found an all metal syringe holding ten c.c. very serviceable. The syringe should take a slip needle to facilitate rapid refilling. The needles must be kept sharp and clean; the smallest size should always be used for the initial infiltration of the skin.

Advantages.

As there is no danger of post operative pulmonic, cardiac or nephritic complications following local methods, many emergency operations can be satisfactorily and safely performed in the patient's home. Either at home, or in the hospital, the patient should be made comfortable on the operating table, which should be well padded with extra blankets or quilts; a hard table will quickly cause him to become tired and restless. As there is no necessity for speed with the patient conscious and comfortable. fewer assistants are required than with general anesthesia.

Many patients will consent to operation under the local method who would not consider it if it involved a general anesthetic; this applies especially to those who have had a stormy and protracted convalescence after taking ether.

Allen sums up the advantages of the local method as follows: Absence of fear of the anesthetic; absence of post-operative disturbances; no danger of post operative dilation of the stomach or tympanities; no post operative backache; no vomiting and straining to weaken