ruined by success in practice, and need to pray the prayer of the Litany against the evils of prosperity. It is only too true, as you know well, that a most successful-as the term goesdoctor may practice with a clinical slovenliness that makes it impossible for that kind old friend, Dame Nature, to cover his mistakes. A wellconducted society may be of the greatest help in stimulating the practitioner to keep up habits of scientific study. It seems a shocking thing to say, but you all know it to be a fact that many, very many men in large practice never use a stethoscope, and as for a microscope, they have long forgotten what a leucocyte or a tube cast looks like. This in some cases may be fortunate, as imperfect or half knowledge might only lead to mistakes, but the secret of this neglect of means of incalculable help is the fact that he has not attained the full and enduring knowledge which should have been given to him in the medical school. It is astonishing with how little outside aid a large practice may be conducted, but it is not astonishing that in it cruel and unpardonable mistakes are made. At whose door so often lies the responsibility for death in cases of empyema but at that of the busy doctor, who has not time to make routine examinations, or who is "so driven" that the urine of his scarlet fever or puerperal patients is not examined until the storm has broken?

"But I hear it sometimes said you cannot expect the general practitioner, particularly in country districts, to use the microscope and the stethoscope these are refinements of diagnosis. They are not. They are the essential means which can be used and should be used by every intelligent practitioner. In our miserable, antiquated system of teaching we send our graduates out wholly unprepared to make a rational diagnosis, but a man who is in earnest-and, thank heaven! most of the young men today in the profession are in earnest-can supply the defects in his education by careful study of his cases, and can supplement the deficiency by a post-graduate course. A room fitted as a small laboratory, with the necessary chemicals and a microscope, will prove a better investment in the long run than a static machine or a new-fangled air-pressure spray apparatus."

A MEDICAL "MERGER."

An excellent arrangement which might be profitably emulated in other towns is described in the Minneapolis Homeopathic Magazine:

"There is in existence at Hastings, Minn., a condition of affairs calculated to cause many physicians to stare in amazement. Hastings is a city of some three thousand people, and harbors within its limits five physicians-four "oldtimers' and one who has settled there within the past few months. In such towns there usually are bickerings and jealousies, petty quarrels and rivalries between the medical brethren, and so common has this been the condition, that the inhabitants get suspicious if there is no quarreling. And today some of the Hastings people are suspicious.

"Some weeks ago one of Hastings' M. D.'s

studied the local situation over and noted the following facts regarding the four ‘old-timers:' "1. They were of about the same age.

"2. They were doing about the same amount of business.

"3. They had all been in practice about the same length of time.

"4. They were all graduates of reputable medical colleges, and licensed practitioners. "5. They were all of good moral, social and business repute in the community.

"It was evident that these four physicians were on an equal footing in the city, and the idea was at once promulgated of merging the business of the four into one common institution; of establishing a community of interests to supplant the existing antagonism. Several informal meetings were held; the matter was thoroughly discussed pro and con, and as a result the merger became an established fact, with the following result:

"I. The business is centralized in one building. The second floor, eight rooms, of a prominent business block, was leased, remodeled, decorated and equipped for the purpose. Each doctor has his separate consultation room, his own hours and sees his own patients as of old. Should one of them be absent, his cares are attended to by one of the other physicians-just as would have happened before the merger, and the absent physician gets the fee-just as would not have happened before the merger, Patients understand this and are not so apt to suffer from delay in waiting the return of 'their doctor.'

The merger has increased the equipment of the physicians four fold. Whereas in olden times four copies of one book were necessary to supply four separate physicians, one copy now supplies the four mergers and the money so saved is expended in purchasing additional books which previously none of the mergers felt individually able to afford. The same is true of instruments and appliances. Today, instead of the scanty office outfit of last summer, they have a complete electrical outfit, X-Ray machines, Betz hot air apparatus for knee, limbs and body, and fully equipped laboratories and operating

rooms.

"3. It is now possible for each member to in dulge in post-graduate study. In fact it is made compulsory upon each physician to take a six weeks' course in post-graduate work every year. During his absence his business is attended to by the three remaining at home and he gets his income just as though he were at home. The expenses of the post-graduate work are paid out of the common funds of the merger. The specialties are divided so as not to conflict.

"4. A decided help to each individual in the merger in his every day work without putting patients to unusual expense for consultations or exposing the physician to the insinuations of ignorance and incompetence.

"Besides these palpable advantages there are many others in a business and professional way which are of undoubted benefit to the physicians, their patients and the community at large. In fact so commendable does the idea seem that to those situated similarly to our Hastings brethren we say: 'Go thou and do likewise.'"

THE DOCTOR IN THE NAVY. In an entertaining article in the Boston Medical and Surgical Journal for April 9, Dr. A. J. Nute, of Winthrop, Mass., describes the ordeal to which every candidate for a commission as a medical officer in the U. S. Navy must submit. In view of the fact that Congress has provided for a large increase in the medical corps of the Navy this may be interesting to some of our younger readers.

After securing permission from the Secretary of the Navy, upon formal written application, the candidate repairs to Washington, where the examinations are held. First comes the physical one. The candidate must strip to the skin and is examined from head to foot, is measured, weighed, hearing and vision are tested, and in addition he must swear that so far as he knows he has no disqualifying constitutional disease. If this examination is successful he writes a letter to the board, giving a sketch of his life and education, also a thesis on a subject assigned him. This merely begins the examination, which lasts for ten days, and embraces not only medicine, but every subject the board cares to ask about. The routine is as follows:

"First day: Physical examination and letters of reference placed before the board.

"Second day: Letter to the board describing candidate's life and education. Thesis. Three written questions in anatomy and physiology.

"Third day: Oral examination in anatomy and physiology; number of questions not limited. Three written questions in surgery. Oral examination in surgery.

"Fourth day: Three written questions in medicine followed by an oral in medicine.

"Fifth day: Eight surgical operations are usually done in a dissecting room, counts as practical surgery examination.

Sixth day: Pathology and microscopy; one written question in each. Obstetrics and legal medicine; one written question in each. Oral examination in above subjects.

"Seventh day: Materia medica and action of drugs; two written questions followed by an oral quiz. Chemistry and physics; three written questions followed by an oral.

"Eighth day: Hygiene and quarantine; one written question in each followed by a series of oral questions. Two patients are assigned to be reported on, one surgical, one medical when possible. Recognition of instruments; cases of medical and surgical instruments are displayed, and candidate is required to name and describe the use of those asked for by the board. "Ninth day: Bandaging. Use of microscope. Examination in general subjects begun.

"Tenth day: Examination concluded.

"A general average of 75 per cent must be obtained and in some subjects 80 per cent and 85 per cent. [The last grade is required in anatomy, physiology, medicine, and surgery.]

"General education covers grammar, arithmetic, geography, languages, history, general literature, elementary botany, geology and zoology. Aptitude is important, and can be enough cause for rejection. The look, bearing. ability and manner of the man as he comes in contact with the board is the basis on which

the per cent is given.

"Appointments are made as fast as vacancies occur, and in order of merit as reported by the board, but a qualified candidate not appointed within a year from date must take a second examination. For years back there have always been plenty of vacancies, but in the last year the vacancies have been filled and some acting appointments made as a waiting list. The question has often been asked as to what caused the lack of candidates. I think principally the examination, as it is rather peculiar, theoretical, and the system of the board makes it difficult; it tends to probe a man to see if there is something he does not know. The practical part of the examination is fair and in the reach of any good practical man, but that and the man's previous record has not counted as much as theory.

"Now the young man having passed, he is ordered to procure an outfit of uniforms that cost about $520, and report at the Navy Medical School at Washington for a six months' course of instruction in the duties of a medical officer. his place on board ship, naval etiquette, diseases peculiar to the service, and the various clerical returns and reports that he is supposed to fill out for record at the Bureau of Medicine and Surgery. When the course is over he usually is ordered to some ship or station."

Dr. Nute explains that the rank of the naval surgeon is not positive but relative, and he is considered a staff officer. He enters the navy as an assistant surgeon, and wears nearly the same uniform as a lieutenant (junior grade). After serving three years he takes his examination for promotion, and if successful becomes a passed assistant surgeon, ranking as lieutenant. Promotions are made in the order of seniority, the next higher rank being surgeon, corresponding to lieutenant-commander in the line, then come the grades of medical inspector and medical director.

"The pay is first class; an officer perhaps never would get wealthy on it, but he always has a comfortable income and far more than he would obtain in civil life for the same amount of work, and at the age of sixty-two he retires. on three-fourths of his highest sea pay, thus being furnished a comfortable income for the rest of his life. Sometimes complaints are heard from officers about their pay, but if the United States was to offer one-half of the entrance salary, they would have all the men they wanted and as competent surgeons. In Europe the young officers receive a much smaller salary, and among them Uncle Sam is noted for his liberay pay table.

'An assistant surgeon at sea, on a receiving ship, or in colonies like Porto Rico, receives $1,650 per year, with $9 per month for ration allowance; on shore duty he receives $1,402.50 per year and partially furnished quarters-ice, light, heat, messenger and laborer service. Junior surgeons have quarters usually in a hospital, while the senior has a fine large house to himself. Past assistants receive after five years at sea in the service $1,800, on shore $1,530; after five years with the rank of lieutenant, at sea $2.160, on shore $1,836. Surgeons receive from $2.360 to $2,520 at sea, and $1,989 to $2,142 on

light is almost entirely limited to the blue, the violet, and the ultra-violet rays (the green, yellow, and red being practically useless), and that this action is greatly intensified by focusing the light through lenses. Thus Finsen found that while unfocused light from a July sun in Copenhagen would kill plate cultures of the bacillus prodigiosus in an hour and a half, the same light concentrated through lenses, with the useless rays filtered out, would kill similar cultures in two or three seconds, and the same was true of other bacteria-they were almost instantly destroyed if exposed to concentrated actinic rays.

"Now, evidently you can cure any bacterial disease if you can destroy the bacteria that cause it, so the essential thing to know next was how far into the body these chemical rays could be made to penetrate for this business of

CHATIN-BROCA LAMP FOR CURE OF LUPUS.

"Finsen took note also of a curious experiment with the chameleon, which consists in placing this little animal so that half of its body is under blue glass and the other half under red glass, the result being that one half of the chameleon turns almost black under the blue light, while the other half remains almost white un-. der the red light. Which means, explained Finsen, that the chameleon uses its movable pigment cells to protect itself against the disagreeable effects of blue light."

The conclusion of Finsen, as a result of these experiments, was that only the violet or actinic rays have any decided physiological effect upon animal life. At this point in his researches he came across a pamphlet published in 1832 by Dr. Picton, of New Orleans, in which it is noted that some soldiers who suffered from smallpox, while confined in a dungeon, escaped without suppuration or scarring. It at once occurred to him that this immunity was due to the exclusion of the actinic rays of light. As a practical conclusion he suggested that smallpox patients be treated in rooms in which all but the red rays of light are excluded. This method was soon tried in Norway and Sweden and found very successful. With so much accomplished he continued his experiments in another direction.

"It was well known at this time that ordinary sunlight will destroy bacteria if these are long enough exposed to its action. Finsen now proceeded to show that this bactericidal action of

LAMP GIVEN THE LONDON HOSPITAL BY QUEEN ALEXANDRA.

bacteria-killing. If they could be sent through and through the body (as some credulous newspapers have imagined) then all diseases of bacterial origin, tuberculosis and the rest, must certainly be cured, but it was soon found that any such considerable penetration is impossible with the present resources of science. The depth of the radial action into the tissues is very shallow -a few millimeters at the most. It is true that the actinic rays will penetrate farther when concentrated by lenses, but not far enough to make them available against any but superficial diseases."

Dr. Finsen also found that electric light was more efficient than sunlight because richer in ultra-violet rays and that a part from which the blood has been pressed is more easily influenced, because the red color of the blood hinders the passage of the violet rays.

"Gradually a girdle of limitations was established about the new field of investigation. For instance, there is a variety of baldness due to bacteria which, it was reasonable to think, might be cured by the chemical rays. And there is a form of superficial cancer due to bacteria which also fitted the conditions. And there are various diseases (some due to bacteria and some not) which seemed to call the experimenter with his healing electric lamp. What would the chemical rays do for measles or acne or lupus? These were questions that could only be answered after months of tests.

"Finsen began with lupus, a dreadful disfiguring disease, usually of the face, that comes when the bacteria of tuberculosis attack the surfaces of the body instead of the lungs or deeper parts. There was no cure for lupus, and thousands of sufferers over the world (there were some 1,500 in Denmark alone) were condemned without hope to endure its slow ravages. Surgeons might cut away the affected parts, but some of the bacteria were almost sure to remain, so that the knife gave only temporary relief.

"Finsen's first patient was an engineer of Copenhagen, Niels Morgensen, who for eight years since the lupus declared itself had vainly tried whatever science could suggest for his relief. No less than twenty-five times, he told me, his face had been operated on, the right side being cut, scraped, burned with acids, seared with hot irons, and all to no avail. In the fall of 1895 the phototherapeutic treatment on Morgensen was begun. At first everything was very crude; a hand lens was used to concentrate the rays from an ordinary arc lamp, the red and ultra red being filtered out through blue water. For an hour or two hours, every day, this concentrated blue light was directed against the afflicted right cheek, Finsen himself holding the lens, aided by a medical student.

"The result came up to the fullest expectations. After the first treatment there was no more spread of the disease, but a steady closing in of the lupus patches and a lessening of the angry redness as healthy tissue formed. Within six months Niels Morgensen was free from his disease.

"Needless to say Finsen has made many advances in the use of the light. He soon discovered, for instance, that the ultra-violet or invisible rays at the blue end of the spectrum are much more efficacious in killing bacteria, say ten times more so, than are the visible violet rays, and this fact led him to abolish the bluewater filter which prevents the ultra-violet rays from passing, and to use instead clear water which sufficiently absorbs the red and ultra-red rays that would otherwise burn the skin. He also substituted a lens of rock crystal for the one of ordinary glass used at first, since he found that rock crystal allows the ultra-violet rays to pass freely, while ordinary glass almost stops them. And he gradually increased the power of his electric lamp from twenty-five amperes up to fifty, to seventy, to eighty amperes, as in the lamps used now. Of course the more powerful the arc light is the more abundant is the supply of actinic rays and the greater their penetration. And the only reason why Finsen has stopped at lamps of eighty amperes (that is about three times the intensity of ordinary street arc lamps) is because above that point it is impossible, as yet, to cool down the light so that a patient can bear it."

Mr. Moffett gives an interesting sketch of the Fuisen Institute at Copenhagen and other writers in the same journal describe the use of the "light" in England and America. The following is said regarding its use and limitations:

"Already the Finsen lamps have been used with success for cancer in its small surface form (Epithelioma cutaneum), the records of

twenty-two such cases showing ten cures, four still under treatment, and eight where the treatment was discontinued. Also, obstinate cases of acne have been cured, as well as the kind of bacterial baldness (Alopecia areata) mentioned above. Excellent results have been obtained in erysipelas and minor eruptions, and there is opening a wide and promising field of investigation as to the benefits of electric-light baths and sun-baths in various nervous diseases and in insanity. At the Finsen Institute there is a large room where naked patients walk around for a prescribed length of time under a powerful electric light. And the roof is built flat, with rows of little dressing-houses for sun-bath patients. Of precise results here, however, it is still too soon to speak-Finsen's attitude toward possibilities of the future being to say nothing until he is sure. But the work of phototherapy is marching on in many laboratories.'

THE FEEDING OF INFANTS.

An article in the Medical Record for March 7, by Dr. Joseph E. Winters, of New York, is replete with valuable suggestions concerning infant feeding and the modification of milk for the use of young children. The article itself contains tables which cannot be reproduced here, but which are worthy of preservation. We hope it may be read entire by many of the readers of the Standard.

Dr. Winters refers to the difficulty of providing a satisfactory substitute for mother's milk, yet shows the necessity for intelligence in dealing with the problem. The ideal plan, of course, is for the woman to nurse her child. This is not only of extreme value to the child, but also to the mother herself, since the stimulation of nursing causes reflex contraction of the muscular tissue of the uterus, thereby promoting the process of involution. Continuing, he says:

"With proper regulation of diet before confinement, and during lying-in period, every mother can nurse successfully during the weeks when it is of so much moment to herself and her child that lactation should be stimulated.

"There is much positively erroneous belief regarding inability of mothers to nurse, and much mistaken practice founded on it.

"Weaning at the actual commencement of lactation, through misapprehension, is not uncommon. A child has frequent green stools; without reflecting that richness in salts of first secretion of the breasts is for clearing out meconium, it is concluded that the milk disagrees, and the child is weaned. An infant has discomfort from one cause or another, often from superficial soreness and tenderness, consequent on having been forced through a narrow, bony outlet. This is misinterpreted colic, and hot water given. It next cries from hunger, but refuses to nurse. Nursing is laborious and fatiguing. As long as a child can get anything, even water, from a bottle, it will not nurse.

"A muscular cushion exists in the cheek for drawing the breast. This is a large, well-developed, strong muscle at birth. How marvelous is Nature! A child nurses for a few moments and becomes fatigued; it stops to rest fatigued muscles and falls asleep, or closes its eyes to