tor's calling and work is indeed more enobling, self-sacrificing and with a higher end result than that of the lawyer. While the lawyer struggles over the mere dollars and cents in dispute, the doctor struggles for the life of his patient, besides which the possession of wealth fades into insignificance. The practice of medicine at the present time requires a liberal preliminary and professional education. It requires residence in hospitals without pay, it requires time for post-graduate work. It requires money for expensive equipment, instruments of precision and skill. Improvements in these instruments leads to their disuse and the necessity of buying new paraphenalia from time to time. And again, after a time of hard work in practice, the up-to-date physician needs a rest, a change of scene and a relaxation from labor. At the same time, after a while he needs to visit medical centers of learning, there to refresh himself by attendance with the masters so as to avail himself of all the new methods and advances since the time of his last post-graduate study. All this requires money. This money must be made by a judicious taxation of his patients, according to their means. Mistakes are made by phy. sician as a rule in estimating the size of his patient's pocket-books with a loss on the side of the physician. The layman is too prone to take advantage of the physician in finance. The laity know how we estimate a fee by the means of the patient and some of them know how to accordingly underestimate their financial standing with physicians. More care should be exercised by the physician in this regard. At the same time, the practice of some physicians of remarking that such and such a specialist's fees are "too large, or this or that surgeon's fee list "too high" should be depreciated. Instead there should be a laudable effort made to make the practitioner's clientele understand that the physician must be well paid if he is to give the best that is in him in the saving of human life. This depreciation of another physician by one physician is most pernicious, and only serves to make the rates worse than they are now. When patients are brought to the surgeon for operation, the practitioner should not fix the fee for the surgeon. Let the surgeon attend to that. If he gets a fee of the proper size from the patient, the practitioner who has sent him the patient should not commiserate with the patient afterwards, agreeing with him that the fee was "exorbitant," as is often done. Let him defend the higher standard and let him also elevate his own standard. In no other way can this matter be put in its proper place. He In this place, it is but fitting to speak of the niggardly practice of physicians encouraging the various insurance companies who pay for the first aid treatment for injuries of employes of corporations to cut their rates to the absurd state so largely exposed in the Journal of the American Medical Association. In the issue of March 31, 1906, there is interesting reading concerning the rebuke given by the editor of the Journal to the president of the Maryland Casualty Company for the ridiculously low scale adopted by that company for payment of physicians employed by them. The president of that company denies the right of the medical press to protest against these low rates for service. says it is no man's business to protest against them as long as physicians are content to take the work and take the pay offered_by them for such work. We contend with Dr. Simmons that it is the province of the medical press to protest. We contend that the physician should refuse to give their services for niggardly fees. These accident and casualty companies derive a large part of their revenue from the practicing medical profession. They have at their disposal at all times the honest advice and honest opinions of the medical men who are treating accident cases all over the country. They should be willing to encourage the medical profession in the high character of its work by lifting it out of the commercial field in which they are trying to put it by elevating rather than by depreciating their fee lists. They do not realize that such a depreciation long-continued will work great havoc to their own interests. Suppose for a moment, that a doctor could be "bought" and sold" for the highest bidder; suppose his opinion instead of being candid and honest and straightforward, whether it be good for the patient's pocketbook or for the company's, was always dependent upon the amount of money offered to him, what state of affairs would follow with these accident and casualty companies? Many and many a damage suit is averted, many and many a damage suit is settled out of court through the honest offices of the attending physician, and always with an advantage for the company; many and many a case in court ends with a judgment materially reduced by virtue of the attending doctor's honest expression of opinion concerning his patient's injury. What would happen to the accident and casualty compaines if by their antagonism, their cheap methods, their commercializing tenedencies they so brought it about that medical professional opinions could thus be bartered? There is no reason to fear that this could ever happen, yet these companies should be reminded at this time of their injustice and their narrowness in viewing the matter of payment for medical attention. R. B. H. G. THE past winter has been one of those remarkable seasons when a wave of universal A Lesson from the Wave of Universal Health. To the good health has swept over the entire country, and especially here, in the Mississippi Valley, where climatic conditions have been such as to insure no epidemics, and to prevent even the ordinary diseases of winter in their usual frequency. As a result of this rather unprecedented state of good health, physicians have had comparatively little to do. public, upon whose woes the prosperity of the physician depends, this has been a blessing, but to many physicians it has been a great hardship and trial. The young physician, just entering practice, has felt keenly the idleness which while expected, has been rather beyond the expectations of the most sanguine, while to many thoughtful physicians of established practice it has proven an unmixed blessing, because it has created an opportunity to avail themselves of the postgraduate school privileges, now so thoroughly presented in our many excellent schools in this country. The physicians supply dealers, pharmaceutical houses and physicians' specialty dealers have not had a very prosperous winter, due to the lack of demand for their goods. Now, reviewing conditions as they are all in all, it has been a good season, and physicians should not complain, for after all the public upon whom patonage depends, has been blessed and profited, and after all the public gives due consideration to medicine, when the demand exists, and will always be a friend to progressive medicine. We quite agree with John Burroughs in believing that to share the common lot is good enough for any one, and that "unlucky is the man who is born with great expectations," especially in medicine. Such trying times as this past season give many a physician an opportunity to take account of stock and see what he really has to offer as services to a willing public when the opportunity eventually comes. He should clean up his stock, brush the cobwebs and dust off some of his old ideas, put in new thoughts by reading and study and visiting clinics, and thus make conditions really declare dividends by being better prepared for work when it does come. We have little sympathy with the man who is contented to let such oppor tunities for improvement go by and then bemoan his fate, when according to the law of natural events, this ebb of work is really an opportunity to be ready for the flow when it comes. "Let us then be up and doing, F. P. N. THE City of St. Louis and the profession have recently suffered great loss in the death of Dr. C. A. Snodgras, Health Commissioner of this city. Dr. Dr. Charles A. Snodgras, Health. Charles A. Snodgras Commissioner of St. Louis. was born forty-two years ago on a farm in Jackson county, Mo. His father, William A. Snodgras, and mother are living at an advanced age and reside with his sister, Mrs. Emily B. Mays, at Independence, Mo. Dr. Snodgrass gained his collegiate education at the Missouri State University; after leaving this institution he taught for some years and spent his summers in post-graduate study at the University of Chicago, where he perfected himself in the branch of learning which was to be his life work. In 1898, Dr. Snodgras came to St. Louis and was attached to the Department of Anatomy of Washington University. His indomitable will and close application to the study of medicine while teaching in Washington University enabled him to take the degree of Doctor of Medicine at that university in the year 1900. As a bacteriologist he did some very valuable work in the recent suit of the City of St. Louis regarding the Chicago drainage canal, his investigations being complete and convincing to men of science. In 1903 Dr. Snodgras was appointed city bacteriologist by the Mayor of St. Louis, in which position he worked unremittingly until his promotion to the position, first, of acting health commissioner, and finally-on the removal of the former incumbent-health commisisoner, of the city St. Louis. Dr. Snodgras, while employed in teaching in Marshall, Mo., became acquainted with Miss Anna Gamble, a colaborer along educational lines in this school, and the acquaintance led to their marriage. Two children, Alvin, aged five years, and Dorothy aged three years, together with his wife, remain to mourn his untimely death, which occurred as a result of double pneumonia on Friday, April 6th, 2:30 p.m., at the City Hospital of St. Louis, notwithstanding the ungrudging and sedulous attention of his professional colleagues. Having been intimately associated with Dr. Snodgras for the last three years, and for the last year coming in daily contact with him, perhaps an estimate by me of his sterling worth and singular unity of purpose will not be amiss. Dr. Snodgras was a man whose mind had never been contaminated by any thing small or selfish. The one ambition that possessed him-that shaped his every act was the desire to elevate the professional standing of medicine. He was just and rigorously honest. Simple in his tastes and mode of life-even childlike in his simplicity-yet withal the whole strength of his character seemed encompassed in the idea of stalwart manhood and professional zeal. Had it not been for his tenacity of purpose it would indeed have been difficult for him to attain that degree of scientific knowledge and professional acumen which became his very life, but which was accomplished by slow and patient application in various and tiresome struggles. Upon his promotion to the office of health comissioner his entire energy was devoted to a complete study of the various departments under him, in order that, before attempting any improvement, he might be thoroughly acquainted with every detail. To accomplish this purpose he gave each and every department careful and consistent careful and consistent study, making an extensive tour of the important pathological laboratories of the country, with the result that in a remarkably short time the several departments, their work and divisions, were entirely familiar to him. As a result of many important innovations had been begun. There was in contemplation by him the establishment of a tuberculosis clinic, at which those unfortunates afflicted with this grave disease were not only to be treated but to be educated in the methods which had for their object not only the benefit of the individual but the protection of those who came in contact with him. The idea of having diphtheria antitoxin supplied to all worthy poor and administered by the physicians connected with this department was another of the aims which was shortly to be accomplished. The fight begun by the St. Louis Medical Society against irregular and irresponsible practitioners of medicine found in him a worthy ally and one without whose aid the difficulties of this fight will be greatly increased. In the space of this brief article it is indeed a difficult task to enumerate the many accomplishments and plans that he had in view. He possessed the confidence of each and every one of his subordinates. His simplicity of manner, his open-heartedness, made them, one and all, feel that in him they had a superior officer with whom they could consult and confer, and that ideas or suggestions made to him found always ready and careful attention. In his death the medical profession loses a valuable member, the city an honest, upright, and conscientious servant, and his family a devoted and loving husband and father. Though his public life was indeed short, yet it stands out clearly and boldly. It serves to set up a standard that those who follow him must strive to emulate. If naught but this were left by him as a heritage his life has served a noble purpose. H.J.SHERCK. MEMORIAL MEETING OF THE ST. LOUIS MEDICAL SOCIETY. Exercises in memory of Dr. Charles A. Snodgras, health commissioner, were held by the St. Louis Medical Society in the society's hall, 3525 Pine street, at 4 o'clock Sunday, April 15th. Dr. George Homan, president of the society, presided. The invocation and benediction were pro. nounced by Rev. John W. Day, pastor of the church of the Messiah. Short addresses were delivered by Dr. Homan, Mayor Rolla Wells; Dr. W. G. Moore, Attorney Henry T. Kent, president of the Civic League; Dr. W. J. Miller, president of the Eclectic Medical Society, and John H. Matthews, bookkeeper in the health department. At the close of the addresses, a memorial to Dr. Snodgras, prepared by a committee composed of Dr. Robert Luedeking, Dr. John Joung Brown, Dr. O. H. Elbrecht, Dr. W. G. Moore and Dr. L. H. Behrens was read by Dr. Luedeking and adopted by a rising vote. Dr. Homan spoke of Dr. Snodgras as one who, in the apparent prime of vigor and official usefulness, was called away when great possibilities of worthy achievements seemed about to be realized. Mayor Wells' theme was "The Man as an Official." He referred to Dr. Snodgras as his loyal friend and public fellow-worker; a man imbued with purity of thought and whose whole being had been conservated to the uplifting of mankind. Dr. Moore, on behalf of the medical society, spoke on "Appreciation of the Man by the Medical Profession." He reviewed step by step the life of Dr. Snodgras, beginning with his birth in Lexington, Mo., January 2, 1864, to his connection with the health department. Mr. Kent, on behalf of the Civic League, spoke on "The Appreciation of the Man by the Community at Large.' Mr. Matthews spoke of the kindness and consideration with which Dr. Snodgras reated his subordinates. REPORTS ON PROGRESS Comprising the Regular Contributions of the Fortnightly Department Staff. INTERNAL MEDICINE. O. E. LADEMANN, M. D. Vomit Acute Dilation of the Stomach.-Herrick (Jour. A. M. A., March 31, 1906) speaks of acute gastric dilation as a rare and extremely grave condition. Its recognition is not always easy, yet important, as it is probable that the earlier treatment is begun the better is the outlook. He reports in detail two cases, one of them with a complicated pneumonia ending in recovery, and the other terminating fatally. A comparative study of the symptoms of these cases with those recorded in literature are in most respects quite identical. The onset is sudden. There may be a complaint of abdominal discomfort and pain, the latter may be quite severe. ing large amount, which may be offensive, of a brownish, grayish, greenish or black color is quite characteristic, It almost seems to run out of the patient's mouth rather than to be forcibly ejected. The urine is scanty; the bowels loose or constipated. The temperature is often subnormal, the skin cold and clammy, small and rapid pulse, extreme thirst; in short the picture of collapse. The abdomen, especially the lower half, is distended, though it may be flat if the stomach be well emptied for the time being through free vomiting. A slight peristaltic wave was observed in one case. The per cussion note is drum like over the gas-containing part of the viscus and flat over the fluid. Fluctuation and the succussion sound are clearly made out, the stomach tube with draws a large amount, sometimes several pints, of brownish, greenish or blackish rather thin or gruelly fluid. This fluid generally contains bile, perhaps pancreatic juice and some altered blood. Free HCl, as a rule, is lacking; lactic acid has been found several times. The odor is often offensive, almost never feculent. The gas that escapes through the tube or by belching is often abundant and may be of foul odor. H2S has been found in one or two instances. The stomach, with or without the aid of distension, by air injected through the tube, can be outlined as greatly enlarged, extending to the symphysis. The abdomen flattens in contour as the fluid and gas are withdrawn by the tube. The diagnosis is not as easy as one might think. To be considered are peritonitis, either general or local, intestinal obstruction, pancreatic cyst, uremia, postanesthetic vomiting and acute pancreatis. Of especial value in diagnosis is the succussion sound, and the examination by the stomach tube revealing the characteristic fluid and enormous size of the stomach. The prognosis is grave, an extremely small number of recognized cases have recovered. Types of more moderate severity probably occur and end in recovery so that the prognosis, if these cases were more accurately reognized, would not be so grave as it is generally supposed to be. Some of the instances of late nausea and vomiting after anesthetics may be due to milder forms of acute dilation. Death when it occurs may be within the first forty-eight hours, or it may be delayed for more than a week. In general the disease runs its fatal course within a week. Relapse may occur, and intermissions of several hours with cessation of vomiting and improvement in symptoms have been noted several times. The treatment should consist in frequent gastric lavage, saline solution by the bowel and under the skin, nutrient enemata, strychnin and other stimulants hypodermatically. Change of posture to the right or to the abdominal decubitus should be tried to relieve the possible drag of the mesenteric vessels on the duodenum or the pressure of the overloaded stomach on the same portion of the bowel. It has occurred to the writer that possibly the stomach might be induced to contract by the application of ice to the abdominal wall, or of hot water or even hot air put into the stomach through the tube in the same way that the inert uterus after confinement can be induced to contract through these means. That the stomach wall has not entirely lost it elasticity and contractibility has been shown by its prompt shrinking to the escape of gas when pricked postmortem, as well as by the same contraction in the wall when at operation in a few cases the stomach has been opened and emptied of its gas and fluid. In intractable cases gastrojejunostomy is advocated. As etiologic facors are given trauma, surgical operation, overloading of the stomach, preceding or accompanying diseased conditions. In some cases the condition must be regrarded as idiopathic as no cause whatever is discernible. Concerning the pathogenesis, Herrick says that more careful histologic, chemical and bacteriologic examinations are necessary before this condition shall be made clear, and more attention should be given by the clinician to noting the condition of the stomach as regards location and size before and during operations and at the beginning of infectious diseases. A previously existing gastroptosis might predispose to acute dilation. So, too, the condition of the stools during these attacks might show whether or not the same peculiar blackish material found in the stom ach is present in the lower bowel, and in this way throw some light on the possible presence of duodenal obstruction. Santonin in the Urine.-Neuhaus (Deutsche Medizinische Wochenschrift, No. 12, 1906) suggests the following as a reliable and efficient test for santonin in the urine: A few drops of Fehling's solution are added to several co. of urine, whereupon a dark green color appears which changes to dark violet-red as the amount of copper solution is increased. On adding an acid, preferably acetic acid, the color turns to a light green. Stronger acids render it a darker green. The reaction is exquisite in the urine of children taking the ordinary dose of satonnin, while adults require a correspondingly larger dose of the drug. The only drug causing a similar reaction which the author observed is rhubarb, although differing from the santonin reaction in an absence of the violet-red color on the aditional adding of Fehling's solution, and the light green appearing when an acid is added is of a dirty tint. The Suicide by Means of Veronal.-Ehrlich (Muenchner Medizinische Wochenschrift, No. 12, 1906) had the occasion of observing two cases of suicide by this means. symptoms in each case closely simulated opium poisoning, consisting in cyanosis, unconsciousness, superficial respiration with intervals of cessation, vomiting, cold extremities, pupil contracted to the size of a pin's head without any reaction, and a pulse vary. ing in volume (small) to complete imperceptibility. In the one case, a melancholiac with suicidal tendency, age 57, death ensued thirty hours after the taking of 15 grams and the other twenty hours after 11 grams. A Delicate Reaction for Bilepigment.-Kroküwicz (Muenchner Medizinische Wochenschrift, No. 11, 1906) published this test for the detection of bile in the urine in 1898, and has since given the reaction a thorough trial in testing for bilepigment in other fluids. (stomach contents, etc.). In making the test three reagents are required, namely: (a) one per cent aqueous solution of sulfanilic acid; (b) one per cent watery solution of sodium nitrite; (c) chemically pure concentrated hydrochloric acid. The solutions a and b should be kept in dark bottles. One cc. each of solutions a and b are thoroughly shaken in a test-tube for a short time, when all save a few drops of the contents (one-half co. at the most) are poured out of the tube. To the contents remaining in the tube an equal amount of the fluid to be tested is added (about one-half cc.). This mixture turns a ruby-red color and by adding one or two drops of the concentrated hydrochloric acid, diluting the whole several times with distilled water, an amethyst-violet color appears. Fluids to be tested containing a large amount of bilepigment should be diluted about ten times with distilled water before testing. The writer urgently recommends this reaction as more delicate than the tests of Gmelin, Brucke, Fleischl, Rosenbach, SmithMarechal and Rosin. Aortic-Rupture and Arteriosclerosis in Children.-Oppenheimer (Virchow's Archiv, Bd. clxxi, Heft No. 1, 1906) reports in detail two interesting cases of arteriosclerosis in boys, age 9 and 10 respectively. In the first case the child died from spontaneous rupture of the aorta. Oppenheimer regards the high blood pressure and a possible congenital weakness of the wall of the artery as responsible for the condition, while the cause in the second boy was undoubtedly of toxic origin. The pathologic findings in each instance were identical to those of typical arteriosclerosis. Gastric Mucus.-Schütz (Archiv für Verdanungs's Krankheiten, Bd. xl, Heft 5 and 6, 1906) article embraces an elaborate discourse on pathologic variations in the secretion of mucus in the stomach. His studies consisted in examining the expressed contents of a test meal one hour after its ingestion, an examination of the rising water obtained after the stomach had been emptied, and the stomach contents obtained by expression and lavaging of the fasting stomach. He presents in tabulated form the findings in 110 patients with various gastric affections who had been subjected to these three tests. In 52 per cent of the cases the mucus present was in excessive amount, while in the remaining number of patients it was either scanty or absent altogether. Among the latter there were 9 cases of achylia gastrica, 8 of motor insufficiency, 7 of gastralgia, 9 of gastric neurosis, 4 of anacidity, 3 of hyperacidity, 1 of ectasia, 2 of chronic catarrh, and one each of ulcer, subacidity, cicatricial stenosis of the pyloric end, gastrosucchorrhea, constipation, renal calculi, acute dyspepsia and icterus. In 28 cases of chronic gastric catarrh, 6 cases of cancer of the stomach, one case of hepatic cancer and in one of gastric ulcer the mucus was found excessive at all three tests. In the second and third tests alone, the mucous was found excessive in ten patients, among them one case of ectasia, two of motor insufficiency, one of gastrosucchorrhea, one of chronic nephritis with dyspepsia and in three of gastric neurosis. The mucus was found excessive in only the second test in two cases of moto, insufficiency and in one case of gastri |