Tuberculosis continues to attract a great deal of attention, and considerable advance was made in education and in the promotion of sanatoria. Although there has been much discussion in Canada and elsewhere, no distinct advance has been made except in Edinburgh and a few other places, where notification has been made compulsory. Probably health authorities have hesitated in advocating compulsory notification of tuberculosis owing to the all too great and unreasonable antagonism towards the tuberculous on the part of the laity. There have been encouraging practical results from a new phase introduced lately in sanatorial treatment, namely, that of graduated labour.

Koch's 1901 Announcements are being gradually offset and disbelieved in; and it seems to be becoming generally accepted as a fact that bovine tuberculosis can be produced in animals by certain strains of tuberculous matter of human kind. According to the second report of the Royal Commission on Tuberculosis, no reason can be shown that man is less susceptible to bovine tuberculosis than any animal. In fact, the Commission states definitely that in many cases-as many as 14 out of 60 human strains-the bacilli of human tuberculosis possessed the characteristics of bovine tuberculosis.

Though Sleeping Sickness, or, rather, a knowledge thereof, is of no practical importance to our readers, it is interesting to know that two young Canadian graduates have made a special study of this unique and attractive disease, and published during the past year a review on the subject of combating it. Drs. Allan Kinghorn and John L. Todd have arrived at these conclusions: A drug as specific in its action on sleeping sickness as quinine is on malaria must be supplemented by the same preventive measures as carried out in destroying the mosquito. As there are no means of destroying the tsetse flies in large numbers yet found out or carried out, strict quarantine and isolation measures should be enforced to prevent the further spread of trypanosomiasis; the value of "atoxyl" is problematical, although it is beneficial, but it must be administered continuously and regularly.

Vaccine Therapy has been the subject of many investigations since Sir A. E. Wright brought opsonins to the attention of the medical world. He in conjunction with other investigators and observers has recently shown that the process of auto-intoxication might come under observation in the beginning of a tubercular

infection; and that it is, in fact, a regular accompaniment of the hectic of advanced pulmonary tuberculosis. "They also brought forward evidence to show that in the induction of an auto-inoculation, when this is preceded and followed up by a series of measurements of the opsonic index, there exists a method which can be turned to account for the resolution of some of the diagnostic and therapeutic problems which present themselves for solution in connection with every localized infection which is not accessible to direct bacteriological examination." This will prove valuable in diagnosis in doubtful cases.

These experiments were made with
Their conclusions were that pituit-

The Action of Pituitary Extract has been set forth by two scientists before the Royal Society by Prof. E. A. Schafer and Dr. P. T. Huring, who have made some very interesting experiments and important observations. the extract upon the kidney. ary extract has a greater diuretic activity by far than any substance in the whole pharmacopoeia. By its action on the vascular system it produces an optimity in renal activity. It apparently also exerts a specific stimulation upon the renal epithelum. They regard it that possibly the extract acts as subordinate or auxiliary to the function of the kidney.

Clean Milk is essential to infantile life; and its production and marketing should concern everybody most vitally. Von Behring believes that most of our adult tuberculosis is taken into the human system while we are yet babies in our cradles. But it is not in this fact there is all the danger. It is the most important single article of diet we have; how requisite, then, is every detail in bringing it clean and pure to the consumer! How lax, however, are some of our boards of health in this respect. Halifax and Fredericton have no regulations governing its production. St. John, N.B., seems to have about the best regulations of any city in Canada. Quebec, Montreal, Ottawa, Kingston, Regina, and Vancouver appear to do about as much as St. John. In Toronto the requirements are 3 per cent. butter fat and 12 per cent. total solids; inspection of milk takes place as delivered. In a recent bulletin on milk from the chief analyst of the Department of Inland Revenue, Toronto, shows poorer than any other district.

The Campaign Against Rats has taken practical form in England. A National Society for the Destruction of Vermin is being formed, with Sir Lauder Brunton as President, Sir James CrichtonBrowne, Sir Patrick Manson, Surgeon-General A. F. Bradshaw,

and Prof. W. J. Simpson as Vice-Presidents. When the common brown rat invaded England he gradually killed off the "Old English" black rat; and at this day the latter is only found in small numbers in ports and docks. Everybody knows it has been proven beyond question that the black rat caused thousands of deaths every year in India, through bubonic plague. This ubiquitous rodent was feasted upon and infested with fleas; the fleas deserted his dead carcase, carrying the plague bacillus to the blood of human beings. The brown rat remains mostly now in England, and he is not exempt from the charge of carrying other diseases, such as typhoid fever. This brown rat multiplies very rapidly. The female will litter eleven to twenty young every six weeks; the young doe will bear a family at three months. Thus the National Society for the Destruction of Vermin will have its ́ work cut out for it.

The Re-organization of the Visiting Staff of the Toronto General Hospital is now said to be complete. Elsewhere in these pages will be found the announcement as it appeared in the public press. The whole scheme exhibits one very bad and rather nasty feature. Several men have had their heads pole-axed for simply attending faithfully to their duties, and leaving altogether out of sight politics, pull, etc. Now, this unsavory action on the part of either the Board or the medical advisers to the Board is abominable; and occurring as it does amongst medical men, who are sticklers for ethics, smacks of quackery. If this sort of slaughtering is to be a feature of hospital work every few years-and many of the young men recently appointed will bear in mind that their tenure of office is for a year only-then it is high time reform, thorough and lasting, should be inaugurated in all hospitals which receive governmental and municipal grants. Taxpayers, lay as well as professional, should have something to say as to the manner their money is spent. To deny the right of a practitioner, who is a taxpayer, or whose patient may be a taxpayer, to follow that patient into the wards of any hospital, irrespective of his being or not being on the visiting staff, does not seem just as just to that practitioner and that patient as it may be advantageous to the hospital and the visiting staff. In other words, Boards care more for their hospitals and visiting staffs more for their appointments than either care for the patients. It is only the patient and the patient's doctor who is concerned in the case in hand. Every man who is licensed to practice is entitled to practise upon his patient in his own home. The conscientious doctor when he needs the aid of a confrere or specialist, he so advises. Why are

there men in the medical profession who for a little questionable fame attached to a hospital appointment will deny the right of other of their regularly licensed confreres to practice in hospitals. as well as outside? Why should a poor man, because he has not enough money to pay for his hospital maintenance, have taken from him the right, which he is entitled to as well as any one else, to choose his own medical attendant in any hospital? There are a great many medical men who do not care for hospital appointments. There are others who will pull out tooth and evulse nail to get them. Is their success in life so dependent upon this disgusting wire-pulling? We trow not. It would be just as great, just as distinguished, just as transcendent, if every physician and every surgeon had the privilege, as it is his right, to follow his patient and treat him in any hospital he liked.

Editorial Notes.

Communication from Dr. D. W. Cathell.-Baltimore, Maryland, December 18, 1907. Editors Maryland Medical Journal: When one reflects on the ten-thousand-dollar and the one-thousanddollar and the five-hundred-dollar fees allowed by the new fee table adopted by the Medical and Chirurgical Faculty in May last and published in the December number of the Journal, he naturally concludes that such charges are intended to cover either very extraordinary cases or cases occurring in persons noted for their wealth, and we all know that both such classes of cases do occur; but to know that such fees are actually gotten sometimes makes one feel something in his mind and heart akin to envy.

General practitioners also have highly important cases, and as one of them I would mention a non-fee table plan that I often follow, which enables me to obtain a fee that is a little more just to my pocket and to my reputation than it would be ofttimes under the unfair fee table system.

We will now turn to a money subject that is of direct importance to every general practitioner in America.

Looking back fifty or sixty years, we find that neither the amount of practical knowledge then possessed by the average medical practitioner, nor the worth of services based on knowledge, can at all compare with the wisdom and worth of the average practitioner of medicine to-day, because the great art of medicine itself was then based on much less certain and much less numerous facts than we now possess.

Owing to this lack of development our profession then, and even up to about 30 years ago, was composed almost entirely of all-round men, who were then called "family physicians," but now known as general practitioners, all working under an unjust fee system, thousands of them barely eking out an existence on the pittance their practice brought them.

But since those bygone days medical knowledge and medical practice have undergone great advancement, and this has caused to spring up in all large communities numbers of scholarly and scientific medical men, known as "specialists," who each devotes himself to some one of the various branches of study and practice, and in consequence of their advent our profession now consists of two well-known divisions: Our surgeons gynecologists, laryngologists, oculists, neurologists, alienists, proctologists, etc., in one diviison, known as specialists, and in the other the legion of family physicians, now called general practitioners.

Owing to the good and satisfactory work being done by these specialists and the resulting excellent reputation they have earned for themselves, the size of their charges for services and the time at which their fees are due and payable are no longer governed by the old 1847 fee-table methods, for which they have but little or no respect, but in lieu thereof each of them wisely adopts some more or less definite financial policy of his own, and rightly puts his own valuation on his services to his cases and makes his own terms of payment, naturally taking care to charge this and that patient sums commensurate with his services and large enough to materially aid in giving him and his dependents a comfortable support, with some addition for his own and their needs when he is no longer able to labor; and each rightly leaves every other man to put his own value on his services and to pursue his own methods in collecting.

Money-getting is not the chief object of the worthy physician, yet it always has been, and always must be, one of the objects, because no one can live by his calling without money. Yet in our noble and humane profession everybody, whether specialist or general practitioner, willingly and rightly does, and we hope always will, do his share of "no-charge" work among the worthy poor, and all act as Good Samaritans to any who are in the grasp of physical distress, and each has cases in which he humanely gives to those who appear to deserve it "a poor man's bill," and every practitioner, for one reason or another, often gets but little or nothing from people well able to pay, sometimes not even "Thanks" for very valuable services, occasionally even for saving life itself; and almost everyone also encounters transient, indefinite, chronic,