Trendelenberg posture, the abdomen opened by a long incision, and a corkscrew introduced into the fundus. By means of the corkscrew the entire uterus is elevated and the ovarian arteries secured by ligatures introduced as close to the pelvic wall as it is possible to carry them. A couple of catch forceps secure the uterine ends of the arteries, when the ligaments are severed one-quarter of an inch from the ligatures. (Fig. 9.) The peritoneum in front is next turned back, after the method of Kelly, and the intra-ligamentary cellular tissue carefully explored for enlarged glands. Succeeding ligatures secure the remaining portions of the broad ligament, all hugging the pelvic wall as closely as possible, except those passed through the base of the ligaments, when the tissues are divided with

scissors. It is necessary in this locality to observe care not to injure the ureters. Kelly locates the ureters by inserting under cocaine, before the patient is placed on the operating table, bougies into them. If this is impracticable the dissection should be carried upward along the uterine artery with the handle of the scalpel, when the ureter will be exposed as a "glistening cord." (Kelly.) The glands at the bifurcation of the iliac artery are not infrequently involved and should be carefully enucleated, as should any other enlarged glands. After the ureters are located more of the tissue about the uterine arteries can be removed if deemed necessary. The broad ligament stumps are next nicely covered by peritoneum with a running catgut suture, the vaginal mucous membrane being first

stitched to the peritoneum in front and behind. A small opening into the vagina is left for drainage, through which several strips of gauze are carried. The abdomen is closed in the usual way. antisepsis is observed throughout.

Strict

Such, in brief, is the more modern way of operating for carcinoma of the uterus. I have necessarily omitted many of the minor details. I made, according to this method, during the last year, twelve hysterectomies for cancer. One death resulted from hemor

By this

rhage, a catgut ligature slipping from an ovarian artery. method only is it possible to observe the broad surgical principle of extensive ablation of tissue.

I performed my first vaginal hysterectomy on March 7, 1887, which was, I believe, the first vaginal hysterectomy made by a homœopathic surgeon. Since then I have made in all fifty-eight hysterectomies for cancer, with five deaths. One of the deaths resulted from shock, the patient being practically bloodless before the

operation was begun; two died from secondary hemorrhage, one from sepsis and one from ilius. Of the recoveries, not to my knowledge has there been a recurrence of the disease, though it is possible that recurrences have occurred, because I have been unable to obtain any information from ten of the clinical cases. All may be dead, but this is hardly probable. In none of the cases operated upon during the last four years has there been a recurrence. In working through the vaginal route I have always made it a rule to work as far beyond the uterus as possible; and, until Kelly taught us the more radical procedure, I declined to operate when an examination under ether revealed involment of the glands beyond the uterus. This, doubtless, accounts for my per cent. of cures. Although this record gives me a mortality of something over 8 per cent. in hysterectomies for cancer, I desire to call attention to the fact that I was something of a pioneer in this work and that many of my operations were made before the technique was perfected. I have been able to keep my mortality in hysterectomies for all purposes down to 6.2 per cent.

THE TREATMENT OF TETANY WITH THYROID EXTRACT.-LevyDorn (Therapeutische Monatshefte, 1896, No 2, p. 63) reports a case of idiopathic tetany of three years' duration in a Woman 21 years old, which, after resisting varied treatment yielded upon the administration, over a period of nearly four weeks, of four grains of thyroid extract at intervals of one, two, or three days.

BACTERIA IN Water from Deep Wells.—"It has been a widespread popular opinion," says The Engineering Magazine, March, "that the purity of water obtained from deep wells, especially from deep wells of the kind known as driven wells, might be depended upon. Of late, howe ver, there has arisen a doubt of the accuracy of this belief, and scientific investigation has now shown it to be erroneous. Examination of waters from a considerable number of springs and deep wells by the distinguished bacteriologist of the Massachusetts State Board of Health has now shown that bacteria are present in water taken not only from springs and open wells, but from carefully guarded wells of quite extraordinary depth. The results of the investigations conclusively prove that Sternberg, Abott, and other high authorities were in error in believing waters from deep sources to be free from bacteria. Frankland, in his celebrated work, Micro-organisms in Water,' evidently had doubts, but his investigations led him to believe that such waters, altho' perhaps, not free from micro-organisms, possessed a 'high degree of bacterial purity.' . . It is difficult [says the Report of the Board] to find deep wells in uninhabited or country districts, and our results are all derived from populous areas. It is possible that other results might be obtained from wells driven in uninhabitated regions. It is plain, however, that water absolutely free from bacteria is not ordinarily obtained from even deep wells, and that many deep wells contain as numerous bacteria as are found in many surface waters."

EDITORIAL DEPARTMENT.

EUGENE H. PORTER, A. M., M. D.

GEORGE W. ROBERTS, PH. B., M. D.

EDITORS.

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Chicago Office:-Business communications may be sent to 70 State Street.

THE CONSTITUTION AND EXAMINING BOARDS.

T HAS been insisted by the opponents of the examining board system that much of the power exerted by many boards, notably the refusal to recognize licenses from other States, is unconstitutional and if a test case should be had the boards would be stripped of this prerogative and stand rebuked. The argument on

this side is so fairly presented by Dr. W. H. Taylor in a recent letter to the editor of the NORTH AMERICAN that we give it in full. Dr. Taylor writes:

"As a recent graduate and one who has already passed Examining Boards in two States of the Union, I would like to call your attention to Article IV., Sections I and II of the Constitution of the United States. Section II reads: The citizens of each State shall be entitled to all privileges and immunities of citizens of the several States.

Section I reads: Full faith and credit shall be given in each State to the public acts, records and judicial proceedings of every other State. And the Congress may by general laws prescribe the manner in which such acts, records and proceedings shall be proved and the effect thereof.

Now, Mr. Editor, I think from a careful reading of these paragraphs, we can clearly discern that a multitude of State boards, guarding the borders of each and every State in this Union is derogative of the liberties which any regularly registered physician has, as a citizen in any one State, and which thereby renders him immune in the same privileges in other States. If the Superior Court of the State of Georgia registers me as a citizen entitled to practice the healing art, what State or group of States, shall say, 'enter thou not here.' It lies with the Congress of the United

States to regulate commerce between the States, and to prescribe the laws by which full faith and credit shall be given in each State to the public acts of every other State. Clearly no State can deprive a man of his calling, should he locate within its boundaries, for we are not a Confederation but a Union and if a citizen of one, a citizen of all. If a student had the means to make a test case of it, he could easily establish his rights, and the attitude of our State boards in taking advantage of his lack of means, in the last resort, is only a refinement of blackmail.

Let some of our Nestors take this matter to Congress and give us once more reciprocity between the States."

Dr. Taylor's position is a very natural one. The profession justly consider it an unnecessary hardship that each time an educated and reputable physician moves from one State to another, he should be required to pass an examination more or less severe. It is believed that this is unnecessary, unfair and an outrageous, assault upon professional right and dignity. And because this unfortunate condition of affairs exists, and examining boards in many States refuse to recognize licenses issued by the boards of other States, efforts are being made to modify and lessen this serious evil. But these efforts are not made for the purpose of stripping the boards of power, and reducing them to a helpless inefficiency; on the contrary, they tend to strengthen the boards by unifying their work. To propose that the State Boards shall be deprived of any power to reject any license offered is one thing, and to propose that any educated, reputable physician, licensed by due and responsible authority in one State, shall be allowed to practice in any other State without further examination, is quite another thing. The American Institute of Homœopathy at its recent session at Detroit, advocated the latter proposition. It recommended that the various State Examining Boards acknowledge the certificates of each other in their various States in order that the standard of members of the profession may be the same throughout the country and with equal professional rights for all. And this, it seems to us, is the only solution of the problem. The State Boards must come to an agreement as to requirements of candidate and then endorse each others licenses. After a few States have set the example others will the more readily fall in line. If the Boards do not do this, and in the near future, the profession will take the matter into its own hands. This method