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' The Journal of the 


American Medical Association 

Published under the Auspices of the Board of Trustees. 


CHICAGO, ILLINOIS, MAY 17, 1902. No. 20. 
_———— — 
Original Articles. To my mind there was but one way out of the difficulty 
the application of an evolutionary law, so familiar 
— Saray can ey cree prewTr ' _..,, and simple that it is a matter of surprise that it should 
HE EVOLUTIONARY ASPECT OF INFEC-  j, necessary to mention it in connection with germ 


Professor of the Surgical Diseases of the Gonito-Urinary Organs, 
“Medical Department, State University of Illinois; Professor 

of Surgery, Chicago Clinical School; Surgeon 
to St. Mary's Llospital. 


The evidence of evolution in general and of infectious 
micro-organisms in particular, has been so overwhelin- 
ny during the last decade that it is surprising that 
teachers of science who renounce the doctrine of evolu- 
tion can still be found. A few weeks since, however, | 
heard a distinguished teacher of physiology say that 
the theory of evolution was untenable and unscientific, 
and that Darwin was not a scientist. This despite the 
facty that manifold and indubitable proofs of organic 
evolution exist, and that evolutionary law controls and 
binds together all the natural sciences and is the very 
ornerstone of sociology, and indeed, all else of human 
interest. But the experimental and laboratory craze 
is ipon us and we are worshipping the new gods instead 
of weighing their potentialities and assigning to each 
is proper place in scientific medicine. Experimental 
acts are valuable in so far as they lead to a more ra- 
ional: philosophy and method in medicine. In the ab- 
stract they are well-nigh valueless. It is not to be denied 
hat the great man in medicine to-day is often he who 
discovers a lot of things which, as Josh Billings says, 
| A single intelligent working theory is worth 
i lushel of useless or misapplied “facts.” Facts, both 
experimental and clinical, have often been stumbling 
blocks in the way of progress. Faets which are fruitful 
in philosophy are the guiding stars of science. Barren 
facts are unprofitable and available chiefly as curiosities. 

The view of infection which I assumed twenty years 
igo and have since published from time to time.' 
had as its basis the belief that infectious diseases 
nay arise spontaneously---a view old-fashioned enough 
‘ocommand respect. Inasmuch as the specific germ en- 
lity had then come to the fore and the theory of spon- 
'aneous generation had long since been apparently over- 
‘thrown, the generation of infectious diseases de novo 
eemed impossible—and it was so ordered by my critics. 


a bb] 
aint so. 

* Lecture delivered by invitation before the Buffalo Academy of 
Medici: Jan, 21, 1902, and Creighton Medical College, Omaha, 
Neb. March 5, 1902. 

1. |'volution of the Local Venereal Diseases, Western Med. Re- 
Porter, vol, 1889, and vol. xii. 1890. Lecture before the St. 
Louis ademy of Medicine, 1889. Vaper read before the Chicago 
Academy of Medicine, 1892. 

diseases. This law is, that all living organisms must 
adapt themselves to their environment. With such 
adaptation necessarily comes differentiation of type and 
species. Pari passu with such differentiation a modi- 
fication of properties develops. Such modification of 
properties may be favorable or unfavorable to the germ ; 
favorable or unfavorable to the animal or vegetable or- 
ganism which it infests. The law and its effects thus 
bears not alone upon the germ, but also upon the victim 
upon which it feeds. There are not separate laws for 
parasite and host—one great omnipotent law governs 
the organic history of both. The life history of the 
germ is but an epitome of all things organic. The al- 
ternative of this view of disease is obvious—primordial 
specific creation. 

It;was with some difficulty that I was able to make 
some of my critics understand that I was not upholding 
the theory of spontaneous generation of germs, but the 
spontaneous generation of new and virulent properties 
in hitherto innocuous germs, and a natural variation of 
tvpe and pathogenic effect of germs supposed to be in- 
variably specific. 

The laboratory investigator has been witnessing the 
operations of the law of germ adaptation vear by vear, 
but the profession has just ‘begun to grasp it. and the 
average laboratory worker has been unable to “see the 
woods for the trees.” Did the earlier, and for that mat- 
ter do some of the latter-day laboratory workers be- 
lieve that man can add to or subtract from the phen- 
omena of nature? They have been very much in the 
position of the fly on the chariot wheel in the ancient 
fable, who exclaimed: “See what a dust we raise.” 
Anything which can be accomplished in the laboratory 
must needs depend upon the operations of a law many 
times more potent in the life history of the germ in its 
normal habitat than in the laboratory. 

The theory of the spontaneous development of infee- 
tion has been combated, through ignorance of evolution- 
ary law, on the ground that the theory of spontaneous 
generation was long ago upset—which had nothing to 
do with the case. Now I do not wish to be understood 
as supporting that apparently exploded theory, nor is 
expatiation upon it essential to the treatment of my sub- 
ject, but I nevertheless wish to make a few remarks 
upon it as showing that even it is a question which is 
not susceptible to dogmatism. Harvey’s law, “Omne 
rivum ex ovo,” or its modification, “Omne vivum 
ex vivo,” established by the labors of Spallanzani, 
Schulze, Schwann, Schréder, Dusch, Hoffmann, Chev- 
reul, Bonnet, Cohn, Tyndall. and most conclusively by 


Pasteur, is generally believed to have closed the question 
of spontaneous generation. ‘Tyndall, e. g., showed that 
living organisms in decomposing fluids are explained 
either by pre-existence of similar forms in the fluid, or 
access of air containing them. Pasteur’s experiments 
later confirmed Tyndall’s position. But, what have we 
to say of Huxley, who, with true scientific agnosticism, 
says in effect, “We know nothing of the beginnings of 
jife, and are not justified in assuming premises which 
demand for their support and rational formulation a 
foreknowledge of such beginnings:” It is hardly scien- 
tific for us to assert that, inasmuch as we have no posi- 
tive evidences of spontaneous generation either in the 
past or at the present day, it does not occur and never 
could have occurred in the history of the world. As 
Huxley says, “we know nothing of the beginnings of 
life.” ‘Time was when the stellar system was limited. 
With telescopes of increased power came a broadening 
out and amplification of the maps of the heavens. Per- 
chance microscopy is as crude to-day as was telescopy 
in its earlier years. Improvements in optical apparatus 
and teachings may one day open up to study biologic 
worlds yet unconquered, analogous to the recent obser- 
vations of the formation of stars and suns from nebule ; 
a substantiation of La Place’s views which at least places 
them upon a higher plane than mere theory. 

Accepting the nebular hypothesis of the origin of 
the solar-system it is evident that life first appeared 
upon our earth under conditions differing widely from 
those now existing, differing more especially as respects 
atmospheric oxygen, light and heat. It is noteworthy 
that some species of bacteria are at present capable of 
existing in the absence of free oxygen, without light 
and at a temperature relatively high. No other organ- 
ism can duplicate this life history, and this fact alone 
should shed some light upon the beginnings of life. 
Taking into consideration the fact that the primal ter- 
restrial conditions must have been peculiar as compared 
with those now existing, who shall say that the inorganic 
might not have become organic. We certainly are not 
justified in formulating biologic laws to fit aforetime, or, 
rather, we are presumptious in putting limits upon pri- 
mal evolutionary possibilities, especially in view of the 
inexorable law that the rapidity and degree of differen- 
tiation of living organisms are inversely to their com- 
plexity of organization. The higher the type the less 
the organism is swayed by evolutionary law, and vice 

I will assume, then, that the evolutionary history of 
certain germs may have begun far back in the history 
of the earth, at a period so remote that we can not even 
guess at their environmental conditions. Such germs 
might well be as insensitive to existing influences as is 
the host upon which they prey. It is by no means im- 
possible that the environmental conditions necessary to 
the spontaneous generation of living entities exist and 
are operating about us even now. That definite germ 
types as we observe them are interchangeable along 
evolutionary lines is susceptible of proof. The fact that 
typically specific micro-organisms are not immediately 
interchangeable is no evidence against the operations of 
evolutionary law, any more than is the unchangeable- 
ness of highly differentiated organic types. As already 
remarked, the rapidity and extent of progression along 
evolutionary lines is inversely to the degree of differen- 
tiation already attained. 

Evolution in its relation to disease is of necessity a 
double-purposed law. It controls and modifies the host 
and must have at least an equal influence upon the para- 


Jour. A. M. 4 

site. If the law already formulated be correct, eyojy, 
tion influences some parasites even more profoundly 
than it does the host. The influence of evolution Upon 
disease so far as the host is concerned has long poy 
recognized. The history of measles is an illustration 
You are all familiar with the history of this diseas 
among the Sandwich Islanders. A disease which, with 
the whites, is usually a trivial affair, proved extremely 
fatal among the Kanakas. Among the whites, eyoly. 
tionary adaptation and heredity have had full sway 
The Kanakas, however, were not so protected. Small. 
pox is a very fatal disease among the negroes as com. 
pared with the whites. Both measles and smallpox 
among the whites, however, are occasionally very severe, 
I venture the suggestion that such cases are atavistic. 
I have elsewhere* expressed the opinion that the pn. 
gressive decrease in the virulency of syphilis is sus. 
ceptible of an evolutionary explanation. The human 
race has become fairly well syphilized by this time, and 
hereditary immunity should count for something in q 
disease which in its active period so seldom kills as to 
permit the race to secure the full benefit of hereditary 
immunity, if such there be. Precocious, or malignant, 
syphilis I believe to be evidence of atavism of micro- 
organisms combined with atavism of susceptibility. 

The influence of evolution on the host has been so 
long understood among progressive medical thinker 
that it is remarkable that its influence upon the para- 
site should have attracted so little attention. Heredi- 
tary immunity is met with in vegetable life. The cot- 
ton plant is subject to a parasitic disease known as 
wilt. Certain plants are not susceptible to it, others 
attacked by it, survive. The primary immunity of the 
former and the acquired immunity of the latter are 
transmitted to their descendants. Advantage has been 
taken of this and, ere long,-wilt will no longer menace 
the cotton planter. 

Disease is incident to the life of every animal. Dis. 
ease is largely dependent upon living micro-organisms. 
As we study the evolution of the animal so should we 
study the evolution of the disease germs that affect it. 
Every phase of organic evolution is subject to adverse 
as well as favorable elements of various kinds. Lach 
organism is relentlessly pursued by foes of a higher or 
lower order of evolutionary development and differentia- 
tion. Even the germs of disease themselves are, 1n some 
cases, pursued by other germs which destroy them. How 
much of this phase of organic evolution is manifest 
in infectious diseases of a mixed type science has not 
yet determined. We know that some germs prepare 4 
favorable field for other germs. The converse seems 
also to be true. The paucity of the bacillus icteroides 
and the presence of innumerable colon bacilli and pus 
cocci in many fatal cases of yellow fever may mean more 
than we at present realize, and are no argument against 
the accuracy of Sanarelli’s views. It is unfortunate 
that the human system should be the battle ground of 
the warring micro-organic factions. Man, with his su- 
perior power born of the forbidden fruit—knowledge— 
has been able to contend pretty successfully against 
most of the elements unfavorable to him. He has not 
acquitted himself so brilliantly as regards those ap- 
parently insignificant little foes, the germs of disease. 
Evolutionary law he may not abrogate, though he may 
sometimes direct and modify its operation. 

As man himself has become differentiated through 
environmental influences, so have his foes become di{fer- 

2. Lectures on Syphilis (Monograph), 1884. 

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May 17, 1902. 

eptiated. As a consequence of adaptation upon both 
ides, man has become more susceptible to the attacks 
of some disease germs and more resistant to others. 
It may well be that certain varieties have become ex- 
tinct, Whilst others have sprung up by virtue of vicious 
evolution of primarily innocuous germs, becoming so 
modified as to bear no resemblance to the parent stock. 
py careful research . along these lines we may 
eventually find that many diseases, at this epoch mark- 
edly dissimilar, may have become so through germ 
jiferentiation. Perehance also we may discover and 
control the ecireumstanees upon which such differen- 
tiation depends. Herein may be the seed from which 
the medical science of the future will spring. 

As bearing upon the question of the upspringing of 
hitherto unrecognized infectious diseases the history of 
epidemic cerebrospinal meningitis is very interesting. 
Practically, if not entirely, unknown until within the 
last hundred years, its character and ravages have come 
to be only too well recognized. The recognition of an 
identical epidemie disease in horses is of especial inter- 
est as suggestive of evolutionary possibilities. 

Early in 1884, in the course of a correspondence with 
Dr. De Gorrequer Griffith of London, my attention was 
called by him to what he termed “The Unity of Poisons 
in Disease.” He subsequently sent me his pamphlet on 
the subject and was good enough to associate with me 
in an article published several months later.* As show- 
ing his position I will quote briefly : 

“In the year 1875, I first observed that what is termed 
scarlatina in the puerperium is frequently not really 
scarlatina. I believe that there are two forms of scar- 
latina: the orthodox, viz., that contracted from a per- 
son infected by scarlatina, and the septicemic, or tox- 
emic, viz., that evoluted or generated de novo, by auto- 
genetic blood-poisoning, such as occurs in puerperal 
cases, Or as a consequence of heterogenetic blood- 
poisoning, such as arises (where no scarlatina had ex- 
isted before) from drains, sewers, imbibition or inges- 
tion of deleterious articles of food; and from decom- 
nosing animal or vegetable substances. 

“While carrying on this investigation, I was struck 
with the unity of origin in certain cases of puerperal 
fever and typhoid. Pursuing the inquiry I found that 
from the same source would spring erysipelas, scarla- 
tina, typhoid and puerperal fever, diphtheria, sore um- 
bilicus in infants, sore eyes, sore mouth and sore throats, 

embracing a very wide area of inflammation and inflam- 

matory conditions of palate, tonsils and pharynx; pass- 
ing still further on in the respiratory tract, the larynx, 
the bronchi, the pleura and even the lung would be 
involved ; so that toxemic or septicemic laryngitis, bron- 
chitis, pleurisy, pneumonia, and pleuropneumonia, at- 
tacking a variety of persons, all, as in the cases of the 
other forenamed ailments, viz., toxemic, typhoid. ete., 
as I call them to distinguish them from the orthodox, 
may be traced to the same causes. The same is true 
of hepatitis, diarrhea. dysentery, cholera, enteritis, and 
i large number of affections hitherto considered to be 
utterly distinct and independent diseases. Hence I for- 
mulated the view of unity (as regards origin) of poison 
in the diseases enumerated and in many others usually 
considered to be separate and entirely distinct. 
“Interenrrent symptoms occurring in the course of 
i affection such as scarlatina—-symptoms ordinarily 
termed complications—-may become primary motors of 
disease, originating a fresh epidemic; it may be fresh 

3. JouRNAL A. M. A., vol 1. 


inasmuch as it would differ from that in the course of 
which it was itself evolved. For example, diphtheria 
not unfrequently is met as a complication of scarlatina 
(I would say it was part and parcel of the scarlatina), 
which, in this instance, would be spoken of as the pri- 
mary disease, the other as being secondary. The diph- 
theria might be conveyed to a number of persons, even 
to such a number as to constitute a fast-spreading epi- 
demic. Then this diphtheria would cease to propagate 
itself. or would cause something quite different to be 
evolved in the person exposed, or in the course of these 
evolutions it would revert to that which set it going, 
viz., scarlatina. There often originate or evolute in a 
number of the exposed, certain other symptoms, usually 
considered sequele, but not actually part of the scaria- 
tina. Here an outburst of something apparently alto- 
gether different from scarlatina and diphtheria takes 
place. This sometimes causes another new evolution ; 
or again, reverts to scarlatina or diphtheria or both com- 
bined. Were it to leap forward it would cause to be 
evolved, in a certain number of cases, a very ulterior 
sequela of scarlatina—say rheumatism or rheumatic 
f-ver, and heart or pericardiac affections. Nephritis 
(the scarlatina] form) may be evolved without any other 
intermediate symptoms being noticed. 

“By unity of poison I mean, not that the poison is 
always the same, but that the one poison—whatever it 
may be—often originates several so-called different 
affections, apparently so widely different as to be con- 
sidered in every respect specific.” 

In the joint article mentioned I took the liberty of 
suggesting that the mass of clinical facts as collected 
bv Dr. Griffith was incoherent and had no tangible bond 
of continuity. I suggested. moreover, that his theory 
had an untenable, entirely chemical basis which served 
to make confusion worse confounded. I then expressed 
the view that if he had taken the living disease germ as 
his starting-point, following it through its evolutionary 
phases and taking into consideration the varying sus- 
ceptibility of the host, some tangible view of the co- 
relation of the infectious diseases might have been 
developed. Both Dr. Griffith and myself were ignorant 
of the now well-recognized possibilities of mixed infec- 
tion, whilst he apparently adjured the germ altogether. 
Our joint article, however, was the foundation of the 
more mature conception of germ evolution which I 
published shortly afterwards, and which has served as 
the basis of the present lecture. 

The frequent difficulty of differentiating etiologically 
processes which clinically seem unequivocally specific 
has long been familiar to the profession. Note, for 
example, the varying phases of septic infection, phleg- 
mon. erysipelas, septicemia, puerperal fever, pyemia— 
who can tell always where the etiologic line of demarca- 
tion begins or ends? The apparent identity of origin 
of these processes, the type forms of which are so dis- 
similar clinically, is a matter of common experience, 
despite varying bacteriologic observations. The precise 
relative weight of the putrefactive toxi-proteid and 
micro-organic elements in such conditions is very diffi- 
cult of determination. The microscope has done us 
yeoman service, but has it explained all? Is there not a 
great beyond which has thus far defied our present op- 
tical resources? Is not the truth to be found rather 
in the direction of bio-chemical research and observa- 
tion along evolutionary lines rather than in the study of 
specific microscopic forms alone? 

A beautiful illustration of the confusion that exists 
as to the germ etiology of supposedly different diseases 


is hemorrhagic septicemia. Hueppe groups under this 
heading a number of diseases once supposed to be sep- 
arate pathologic entities, such as the rabbit septicemia 
of Koch,* the wildseuche and rinderseuche of Bollinger 
and others, and the schweineseuche of Lofiler. It is just 
beginning to dawn upon some of these observers that 
they have perhaps been studying and classifying the 
varying evolutionary phases of the same disease germ. 

The views expressed in this present paper necessarily 
conflict with the dominant school of germ pathology, 
of which Koch is the acknowledged leader. The theory 
of specific constancy of germs owes its popularity 
to the atavistic tendency of the human mind _ to 
revert to the primitive conceptions of savages and 
children, who explain phenomena by the domin- 
ance of a living entity. The savage with his gods 
and demons and the child with his Santa Claus and 
fairy tales are on a psychic parity. Such explanations 
are simple and once advanced are fondly clung to. 
When renounced it is with all the pain incidental to the 

renunciation of an easy-going pet idea. It may savor 
of boldness, not to say presumption. yet I am _ con- 
strained to-say that Pasteur, and following him, Koch 

and his school, while they have done much for the ma- 
terial accuracy of medicine, have nevertheless played 
an active part in deranging the substratum of rational 
philosophy upon which rests the entire superstructure 
of medical science. 

The results obtained in our laboratory modification of 
infections germs depend largely upon degenerative 
changes in the micro-organism, the species growing not 

only less virulent but more feeble. In certain instances, 
~ however, the micro-organisms lose their pathogenicity 
while remaining as vigorous or more vigorous than ever. 

The loss of pathogenic properties and a transformation | 

into mere saprophytes have been observed. Careful ob- 
servation has shown that the properties of pigment for- 
mation. development of toxins and fermentive power in 
micro-organisms are dependent upon the quality of 
adaptation. The micro-organism is versatile because 
swayed by evolutionary law. Koch’s doctrine of the im- 
mutability of specificity in pathogenic micro-organisms 
is no longer tenable. Accepted ten years ago, his dic- 
tum has not borne the cross-fire of laboratory observa- 
tion. Personally, I have never believed in the primal 
specific creation of micro-organisms any more than of 
any organism, and of necessity have always been skepti- 
cal as to their immutability. 

The theory of specific constancy of infectious 
micro-organisms at first gave rise to the most op- 
timistic views of therapeutic possibilities. Having 
discovered the germ, the sole remaining require- 
ment was to find a remedy which would kill it 

and thus cure the disease. The lay mind is even now 
dominated by this fallacious belief. As time went on, 
however, the profession began to appreciate the insuper- 
ablé obstacles often found in the way ‘of specific thera- 
peutics. This I will formulate as the law that the re- 
sistancy of organisms, like their rapidity of multiplica- 
tion and development, is inversely to their degree of 
differentiation. The operations of this law are at once 
obvious. The cells of the host. more complexly organ- 
ized and more highly differentiated than the parasitic 
microbe, yield to destructive influences which are re- 
sisted by the latter. Herein was our first defeat. Not 
until the life history of the microbes of disease began 
to be better understood was there any marked improve- 

4. Hueppe: 

“Pr rine iple s : of Bacteriology. 


Jour. A. M. 3 
ment in therapy as an outcome of our knowledge of the 
specific properties of germs. And then came serun. 
therapy, -the rationale of which is explicabl along 
strictly evolutionary lines. Even our views of local 
antisepsis have been so modified that the supplying of 
conditions unfavorable to germ development, rather 
than an attempt to destroy the germ, dominates :overy 
surgery—evolutionary principles again. 

The believer in the specific creation of micro-orgap. 
isms or even in the present existence of unvarying micro. 
organic entities has, of course, demanded the Missing 

link. He, like his anti-Darwinian. prototype, can not 
be convinced without it. I+ must be remembered, how- 
ever. that the visible complete physical transformation 

of even a single species is not necessary to prove the 
evolutionary progression and differentiation of microbes, 
nor is it consistent with evolutionary law in general, 
Unicellular organisms probably hew as closely to the 
line as do the more highly differentiated and more com. 
plex organisms, in which the cell is not the whole but 
merely the unit, albeit the basic element. The germ 
shows progression along evolutionary lines within its 

own biologic range, and adheres to its own physical 
tvpe—so far as our present methods enable us to deter- 

mine—whatever the variation in‘its properties may be. 
Its properties of specific pathogenesis, culture, color re- 
actions and varying degrees of virulency, may be the 
result, on the one hand of atavism, and on the other 
of environmental adaptation. but it is always a variation 
of tvpe, not of species. The fact that microbes of cer- 
tain specific diseases are unvarying in kind in their path- 
ogenic properties does not controvert the evolutionary 
view of infectious.diseases. Per contra, it is evidence 
of the strongest kind that microbes are subservient to 
evolutionary law. The type in such cases has become so 
fixed that, while a variation in degree of pathogenesis 
may occur, there can be no variation in kind. Far 
back in their life history, however, a number of specific 
germs may have had a common root stock. ‘Just here 
the co-relation of vaccinia and variola is strongly sug- 
gestive. Along the same lines does not the possibility 
of a remote relationship between la dowrine—so-called 
animal syphilis—and lues suggest itself? To be sure 
there is a wider difference between the human and ani- 
mal syphilis than exists between vaccinia and variola, 
but experimental inoculation and serum-therapy with 
human syphilis and maladie du coit might lessen this 
difference. Besides, the period of time past covered 
by the evolution of syphilis and /a dourine may be im- 
mensely greater than the period of existence of variola 
and vaccinia. Then, too, we should not expect precisely 
similar evolutionary results of disease germs in dissim- 
ilar animal species. Apropos of the possible animal ori- 
gin of human syphilis it might be well to recall the 
fact that Martineau, nearly a quarter of a century ago, 
claimed to have syphilized a monkey. The case was 
presented to the Parisian Academy of Medicine and ap- 
peared to be quite clearly defined. It was, however, re- 
jected by the Academy as a demonstration of animal 
susceptibility to syphilis. The extraordinary suscepti- 
bility to the Stmiade to tuberculosis is suggestive along 
these lines. TI will also again refer you to the co-rela- 
tion of human and equine cerebrospinal meningitis. 
So far as the influence of évolutionary Jaw is ©on- 
cerned, it is of little importance whether micro-organ- 
isms in general, and pathogenic germs in particular. be- 
long to the animal or to the vegetable kingdom. ‘The 
operations of the law are the same. The practica! im- 
portance of the question lies in the fact that if micro- 



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M. 3 BB yay 17, 1902. 
nisms are neither animal nor vegetable, but of a 
‘er, more indeterminate type than either. they are 
‘| more susceptible than either to evolutionary law, 
the rapidity and degree of evolutionary variation is 
versely to the degree of differentiation already at- 

© Of the 

. along 
Of local 
IN INg of 

if the evolutionary relation of the most primitive 
imal and vegetable organisms be proven, the primal 
ot stock must of necessity be of a lower, indeterminate 
ye. ‘Those whose fame rests upon classification may 
otest if they will; this is the law. Overthrow or con- 
svert it, and the warp and woof of evolutionary doc- 
ne falls to the ground, for the theory can show no be- 
ming. The beginning or primary impulse must op- 
nate along evolutionary lines, else we must needs either 
«ume a position of complete scientific agnosticism or 
cept the mosaic cosmogony as a basis for biology. The 
iw of the intermediary position of bacteria between 
yimals and plants was held and taught by me to my 
asses twenty years ago. It is gratifying to me to note 
je confirmation of that somewhat immature view by 
» eminent a teacher as Hueppe.® who says, “Bacteria 
be able to construct their body substance out of vari- 
is kinds of nutrient materials, and also to produce 
ay be. fpwanic pigments, fermentation products or poison char- 
lor re- feteristic of individual species, and are able to do this 
x the Mfnalytically or synthetically with almost equal ease. 
his ambidextrous metabolic power exists among bac- 
ria as among no other living things. These organ- 


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f cer- fis consequently occupy morphologically, and, still 
path- fmore, physiologically, a place intermediate between ani- 

onary mals and plants.” 
dence # | am still more pleased with Hueppe’s summing up 
nt to fbf the question of specificity: “Koch’s belief that the 
ne so Heonstancy of specific disease-producing bacteria re- 
‘Nesis #mounces at the outset a scientific explanation. With the 
Far Habandonment of Koch’s position—which has been made 
ecific Hinevitable by the discoveries of the last ten years—bac- 
here Htcriology has progressed beyond the natural history 
“ug- BMstage and become scientific.” The interchangeability of 
vility Hthe properties of distinctly vegetable non-pathogenic 
alled Himicro-organisms and those of a distinctly pathogenic 
sure Mitvpe is worthy of consideration along evolutionary lines. 
anl- The vegetable molds, which are not ordinarily capable 
lola, Hof producing infection, but produce superficial surface 
with Hdiseases, may become saprophytic and produce. internal 
this HMinfection. A case was recorded by Wagner where. the 
ered MMoidium albicans of thrush entered the circulation vid a 
Im- #vounded vein, and produced fatal cerebral mycosis. 
iola MM Several varieties of mucor and aspergillus—usually non- 
sely HM pathogenic organisms—have been shown to be trans- 
Im- Zi formable into saprophytic infectious parasites by 
orl- Bi adaptation. 
the Laboratory proofs of bacterial evolution are not want- 
(20, Mine. The life conditions of micro-organisms have been 
Was BM experimentally changed. Obligatory anaérobic parasites 
ap BM have been adapted to aérial life and obligatory aérobes 
re BB a anaérobie environment. Hueppe has cultivated 
nal as an aérobe the spirillum rubrum, which normally pro- 
0- BM duces its red pigment in the absence of oxygen. He has 
Ne BM also compelled the comma bacillus—a strict aérobe—to 
Ja- adopt anaérobiosis, and has altered the life conditions of 
the actinomyeosis fungus. Kitt has cultivated aérobic- 
MBB ally the obligatory anaérobic bacillus of symptomatic 
“i anthrax. Both Hueppe and Scholl have shown that the 
he Comma bacillus develops more toxicity in the absence of 
a ‘ir than in its presence and that.the poisons produced 
‘0- » Ilueppe: Op. cit. 


‘by oxidation. 


by anaérobic saprophytic micro-organisms are destroyed 
Hueppe produced typie choleraic diar- 
rhea in animals, with artificially bred anaérobic comma 
bacilli. Cholera germs that have become anaérobic by 
culture lose their virulency rapidly when exposed to the 
Cultures of the pneumonia coccus take the same 

course. Cholera germs have been found to change 
spontaneously. When young they are virulent. Ex- 

posure to the air and advancing age render them im- 
potent. Although aérobic they do not have time or the 
proper medium to enable them to become adapted to or- 
dinary atmospheric conditions. The adaptation of path- 
ogenic germs to environment is shown in pure cultures 
of certain anaérobic types upon gelatin and agar. They 
become accustomed to metabolism of oxidation, and the 
pathogenic products are oxidized as fast as formed. 
Virulency is thus lost. 
(To be continued.) 




William Hamilton Gibson, the naturalist and artist, 
called attention to a troublesome parasite of the house- 
fly, the microscopic, red, false scorpion. A careful 
scrutiny of a sheet of adhesive fly-paper in use will 
show many victims of this inconvenient little handicap, 
which, once anchored to the fly’s leg, remains there, an 
animated and persistent tag. 

A more serious and fatal enemy is the fly fungus, 
which “silences more house-flies than all the traps and 
poisons devoted to their extermination.” This germ- 
scourge of flies kills them swiftly, and continues to 
grow with such rapidity that it perforates the body of 
its host and spreads around him on the wall or window- 
glass a white shroud of mold, from which spores are 
wafted, to the peril of next year’s flies. That the house- 
fly acts as host to this fungus is apparent to any one 
who will examine with a hand lens one of the suspended 
and inanimate forms seen often during the fall months. 

The habit of affording house room, whether willingly 
or unwillingly, to all comers, brought Musca domestica 
prominently before the profession in the last decade, 
when he fell under suspicion as a carrier of infection 
in acute intestinal diseases. 

The investigation of the Army Medical Commission 
during the Spanish-American war practically estab- 
lished the fact that the fly is an important factor in the 
dissemination of typhoid fever. 

Victor Vaughan, a member of that commission, 
stated that flies undoubtedly served as carriers of 
typhoid infection, giving as reasons for his belief: 
“They swarmed over fecal matter in the latrines. They 
visited and fed on food prepared for the soldiers in the 
mess tents. In some instances, when lime had been 
recently sprinkled over the contents of latrines, flies, 
with their feet whitened with lime, were seen walkine 
over the food. Officers, whose mess tents were protected 
by means of screens, suffered less proportionately from 
tvphoid fever than those whose tents were not so pro- 
tected. Typhoid fever gradually disappeared in the fall 
of 1898, with the approach of cold weather and the con- 
sequent disabling of the fly.” 

This possibility had been foreseen, for Surgeon-Gen- 
eral Dr. Sternberg issued a circular in April, 1898, 


giving careful directions concerning hygiene, stating: 
“No doubt typhoid fever, camp diarrhea and. probably 
yellow fever are frequently communicated. to. soldiers 
in camps through the agency of flies, which swarm 
about fecal matter, and directly convey in- 
fectious material attached to their feet, or contained 
in their excreta, to the food which is “exposed while 
being prepared at the common kitchen, or while being 
served in the mess tent.” 

An Italian scientist, Celli, demonstrated in 1888 
that flies fed on the pure cultures of bacillus typhi 
abdominalis were able to transmit virulent bacilli into 
their excrement; and the agency of flies in the trans- 
mission of the spirillum of Asiatic cholera has been 
observed by many scientists. 

Dr. L. O. Howard, of the U. 8S. Board of Agriculture,. 

recently published the results of experimental ‘work with 
the house-fly and other diptera extending over a period 
of five years. He considered that from a scientific and 
practical viewpoint there was needed a careful investi- 
gation of the insect fauna of human excrement, and 
especially of the flies that breed in human excrement, or 
are attracted to it. Of the 71 species of diptera that 
were found breeding in, or frequenting human excre- 
ment, the common house- fly (Musca domestica) is re- 
ported “abundant ;” as also its near relatives, the little 
house-fly (Homalo-myia canicularis) “moderately abun- 
dant.” and the stable- fly (Muscina stabulans). To 
ascertain the practical bearing of this fact, numerous 
collections were made of the diptera frequenting 
kitchens and pantries. “In all, 23,087 flies were exam- 
ined which had been caught in rooms in which food 
supplies were ordinarily exposed, and which may safely 
be said to have been attracted by the presence of these 
food supplies.” Of this number 98.8 per cent. were the 
common house-fly, while the little house-fly and the sta- 
ble-fly composed one-half of the remainder. 

Dr. Howard gives an opinion: “That Musca domes- 
tica, in such cities and towns, or in such por- 
tions of cities, as are well cared for and inhabited by a 
cleanly and respectable population, may not be consid- 
ered an imminent source of danger; it is un- 
der other conditions, a factor of the greatest import- 
ance in the spread of intestinal diseases.” 

Of the biting fly (Stomoxys caicitrans) Dr. Howard 
states: “They resemble the house-fly very closely. The 
fact that they enter houses before storms gives rise to 
the common expression, ‘Flies begin to bite before a 
rain.’ From their biting and blood-sucking habits, this 
insect has been suspected, in common with the true 
horse-flies, of carrying the bacillus of anthrax, or malig- 
nant pustule, and there is no reason why it should not 
transfer any blood-inhabiting micro-organism from 
domestic animals to man, or from one man to another.” 

Of another very minute fly (Hippelates flavipes) Dr. 
Howard says: “The flies are very abundant, especially 
in the South, where they are found swarming about the 
eyes of animals and human beings. They are said by 
Hubbard to be responsible for the transmission of the 
disease known as ‘pinkeye,’ occasionally prevalent, espe- 
cially among school children in Florida. The 
species is perhaps often responsible for the carriage of 
putrefactive germs to open wounds, and is indirectly the 

cause of blood poisoning.” 

From the foregoing statements may we not expect to 
find the ever-present house-fly a direct factor in the 
transmission of the micro-organisms of wound infec- 
tion ? 


Jour. \ Moy 

It has been said that the mosquito carries with } he 
the most perfectly constructed of inoculators, ang the 
house-fly has, in the specialized structure of each to, 

minal tarsus, a well-adapted brush for the transmissigy 
of adhering germs. The pads, suction dis 
on each foot, are rayed with minute hairs, which agaiy 

terminate in more minute discs; and Chambe TS. state 
that. the last named “exude a liquid substance whic 
probably serves to make adhesion more perfect.” |) 
experimenting it was found that every footprint of y 
infected fly on sterile culture media was followed bya 
discreet colony of the germ; 30 to 40 distinct colonia 
sometimes appearing after one journey of the fly acrg 
the surface of the culture media. 

In the experiments that follow common house-flig 
were used. They were caught in the kitchen of a dwel. 
ing-house, in a physician’s office, and in one instance jy 
a lying-in chamber. They were confined separately 
under reversed tumblers placed on note paper. A wate) 
glass containing a small portion of the infected material 
was thrust under the tumbler, and when curiosity ha 
taken the fly across the material, he was seized with; 
sterile forceps wrapped with cotton, and liberated jug 
at the mouth of a tube of sterile blood serum. Ox 
stroll across the culture media and the tube was ip 
verted over the flame of an alcohol lamp, which inci. 
erated the fly and sterilized mouth of tube. The 
cotton plug and rubber cap of the tube being adjusted, 
it was placed in an incubator at 37 C. for twelve hours, 

The tubes of sterile culture media were obtained pr- 
pared for use, froma well-known laboratory. 

On September 7 the dressings from an infected hand 
were obtained, the dressings were soaked with blood 
serum, there were several areas of greenish and bright 
green pus, and an offensive odor diffused on opening 
them. The surgeon stated the wound had shown an 
obstinate phlegmonous extension, with localized edema. 
A portion of the dressing was placed under an inverted 
tumbler and two flies confined with it. They imme. 
diately lighted on the dressing, crossing it repeatedly 
before preparations were completed for removing them 
In a few moments they moved slowly and appeared quite 

Fly A was assisted into a tube of sterile blood serum 
with sterile forceps. 

Fly B walked into a second tube through a perfor- 
tion in the note paper over a tumbler. 

In each case, after the fly crossed the surface 0 
medium, the tube was inverted over an alcohol flame, 
destroying the fly; the mouth of tube and cotton plug 
were flame sterilized, the plug and rvbber cap adjusted, 
and the tubes placed in incubator. 
these tubes were removed from the incubator and pre- 
sented practically the same appearance; the surface 0! 
medium was freely dotted with small brown colonies 
the upper surface of medium presented a pale-greenish 
tint. Three days later inspection showed the ‘colonies 
entirely coalesced. the upper one-half of media in each 
tube was a deep bluish-green, the lower one-half a dul! 
orange; liquefaction of “the media had begun at lower 
end of slant. Cover spreads made from these culture 
and stained with Loeffler’s alkaline methylene blue 
showed a pure culture of a small bacillus with rounded 

In following out the necessary cultures on different 
media for ‘diagnosis, in every instance the pure culture, 
as transmitted by the original flies, was obtained. 

A slant culture on glycerin agar-agar and one 0 
nutrient agar-agar, made on September 9, deve! »ped 


After eighteen hour’ 



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M. A. 

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WAY ] ie 1902. 

typical colonies in twenty-four hours and showed the 
juorescent stain of the media, which later developed to 
a deep bluish-black. 

\ stab culture in blue litmus gelatin gave an acid 
reaction in forty-eight hours, the lower portion of the 
medium turning pink, while at the same time the 
upper portion became the pleasing translucent green. 

A stab culture in nutrient gelatin, in four days, 
showed liquefaction in funnel form, with fluorescence 
of upper portion of medium. 

All of the cultures, when opened, emitted an offensive 
and purulent odor. From all of these characteristics 

the germs were identified as the bacilli of green pus. 
The bacillus of green pus, Gessard’s micrococcus pyo- 
evaneus, or the bacillus des griin-blauen Eiters, is a 
widely distributed germ, found in purulent and serous 
wounds, and in the viscera of human cadavers. It is 
an aérobic, facultative anaérobic, liquefactive, motile, 
chromogenic and pathogenic germ; in its chromogenic 
function two pigments are formed, one fluorescent green, 
the other blue pyocyanin. 

The satisfaction felt on coming into possession of a 
germ, so easily identified and tenacious of existence, 
has increased each week, as other experiments much less 
satisfactory were undertaken. 

September 25 two flies were segregated with pus from 
a case of salpingitis; a cover-slip spread of the pus 
showed many streptococci and a few large, fat bacilli. 
Each fly was induced to walk across a tube of blood 
serum, and then one of nutrient agar-agar, and the 
tubes were incubated twelve ‘hours. An interruption 
of ten days followed, during which time the tubes were 
left in cold storage. On examination. October 7, one 
blood serum and one agar tube were fuzzy with many 
colored molds; the second tube of nutrient agar showed 
nine colonies of a viscid, discrete, whitish growth. 'The 
blood serum tube showed many larger colonies, and 
three communities of the orange sarcine. 

From the colonies on agar, cultures were made on all 
the various diagnostic media. 

A stab culture,in glucose gelatin presented large 
slanting bubbles of gas along the line of growth in three 
days. There was no liquefaction of media in any of the 
gelatin cultures. 

A stab culture in blue litmus gelatin gradually turned 
the blue color of the media to a clear claret red. Cover- 
slip preparations made and stained showed an almost 
pure culture of a fat bacillus, which, from its appearance 
~ manner of growth, was identified as the colon bacil- 

Welch states that “one of the leading réles of this 
germ is to invade territory already occupied by other 
bacteria, or previously damaged ;” and by its vigorous 
growth it had almost exterminated the streptococci that 
were numerous in the infective material. 

On October 7 three flies were confined with a watch- 
glass containing a small amount of typhoid stool, from a 
typhoid whose temperature had just dropped to normal. 
Each fly was introduced separately into sterile tubes of 
blood serum, and promptly dispatched after crossing 
media. At the end of seventy-two hours two of the 
tubes presented many small round. moist, grayish colo- 
nies, while the third one was fuzzy with gray mold. A 
cover-glass spread from cultures showed many small 
bacilli with rounded ‘ends, and a few faintly staining 
cocci. In a hanging drop preparation from the blood 
serum culture, the bacilli were seen to be actively motile, 
spinning and shooting about in a surprising manner. 
When grown in blue litmus gelatin there was no change 


in the color of the media; and in glucose gelatin there 
was no production of gas. There was no liquefaction of 
media in the various cultures in gelatin. The clump 
reaction was not tried, but the growth responded ‘to all 
the other tests for identification of the bacillus typhi 

On September 20 ten tubes of sterile blood serum 
were used. In each tube a common house-fly which had 
no known acquaintance with infectious material, was 
introduced and left in tube one minute, or until it had 
crossed surface of medium. After twelve hours in the 
incubator five of the tubes showed many minute colonies 
while five showed no growth. At the end of seventy-two 
hours eight of the tubes showed diffuse and varied 
growths, while two of the tubes were apparently sterile. 
Of the eight infected tubes three presented a noticeable 
appearance. No. 10 (1) showed over 100 colonies dot- 
ting the blood serum at irregular distances, the colonies 
were minute, discreet. raised, moist, color of medium. 
No. 10 (2) presented thirty-three colonies, irregular in 
outline, crenated edges, depressed centers, a light brown- 
ish yellow. In No. 10 (3) the surface of medium was 
covered with a moist, irregular, creamy-appearing 

I regret to say that these experiments were not car- 
ried on to the determination of the germs present. 
They will be repeated with an investigation of the 
pathogenic qualities of the bacteria present, at an early 

On November 2 a fly was confined with some sputum 
from a case of bronchitis in its fourth week. A cover- 
glass spread of the sputum showed diplococci, tetrads, 
and many stapylococci and streptococci. ‘Two tubes of 
blood serum were infected by the fly, and after forty- 
eight hours’ incubation showed manifold and surprising 
erowths. Prominent among the colonies were several 
of a golden-yellow color and glistening surface. From 
these colonies cultures were made on the various diag- 
nostic media. A streak culture on Loeffler’s blood serum 
made a rapid growth, the growth elevated with wavy 
edges, and a shining golden surface. A streak cultume 
on Koch’s blood serum developed less color and sunk 
into the medium, channeling a bed for itself, otherwise 
the medium did not liquefy. On nutrient agar the 
growth was rapid, of a creamny-white color, with yellow 
at margin of growth. A gelatin stab culture showed a 
cloudy liquefaction following stab. Stained cover-glass 
spreads of the blood serum cultures showed masses of 
small cocci, which were identified as the staphylococci 
pyogenes aureus. 

Two tubes inoculated with flies taken from a lying-in 
chamber early in September, showed after incubation, 
one sterile tube and one tube containing many colonies 
of orange and white sarcine; these germs are non-patho- 
genic and appeared sooner or later in a majority of 
the cultures produced by fly infection. 

On one of the tubes—fly infected from the case of 
salpingitis, a single colony of bacillus prodigiosus ap- 
peared. This germ grows with the production of a 
brilliant orange-red pigment ‘and is the origin of the 
miracle of the supposed bleeding wafers. It is non- 
pathogenic, but its chemical products are toxic and form 
a part of the Coley sarcoma mixture. 

Molds grew so rapidly on many of the fly-infected 
tubes that only a few are presentable for inspec- 
tion, suggesting the probability that flies are often 
fungus-ridden whether transmitting pathogenic germs 
or not. 


oy See 



The molds appeared more rapidly and certainly the 
last month than the first, and also during the past four 
weeks the flies have walked less brisklv across the sur- 
face of media, but dragging across; the colonies were 
not discreetly rounded. 

During the experimentation 44 culture tubes have 
been subjected to fly infection ; of this number 41 tubes 
showed colonization at the end of 48 hours, 3 tubes re- 
maining apparently sterile. 

The following germs have been transmitted by fly 
infection, isolated and pure cultures obtained: Patho- 
genic germs—bacillus pyocyaneus, staphylococe! pyog- 

enes aureus, bacillus typhi abdominalis, bacillus coli 
communis. Non-pathogenic—bacillus prodigiosus, sar- 

cine aurantia, sarcine alba, molds and fungi. 


On account of the great rarity of floating or movable 
livers, I have looked over the literature and have had 
others help me at it. I find that only about 98 cases 
have been reported, from which we are able to draw 
some conclusion in the etiology. symptoms and man- 
agement of this class of As far as I have been 
able to find the record of cases is as follows: 

A. Catini’ reports a case with severe nervous symp- 
toms, in a patient aged 54. The organ could be replaced. 

R. Piatelli? reports a case of a woman aged 56. A 
bandage could not be worn. 

E. A. Meissner*® gives a case of a married woman of 
39, a displaced liver apparently following pregnancy. 


She was much improved by wearing bandage. . 
« | on) Q 

G. Barbotta* states a case of a woman aged 37, also 
caused by parturition. 

F. Vogelsang® reports a case in a very quarrelsome 
woman, middle-aged, of a floating, movable liver, which 
was caused by tight lacing. 

F. N. Winkler® reports a case of a woman of 2 
There was general ptosis, following the lifting 
heavy burden, and stabbing pain in “the right side. lt 
could be moved to the left side. 

P. Muller’ states a case of a woman aged 57, with a 
movable liver complicated with an ovarian tumor. It 
was verified by autopsy. 

Salomone-Marino*® gives a case of a woman aged 50, 
who had pain only on turning on left side. He also: 
reports a second case in a woman aged 48. of movable 
liver, the result of a fall. 

G. Leopold® states a case in a woman aged 
was poorly nourished. It never could be replaced. 

C. Vicoli’® gives a case of a woman aged %0, with the 
cause given as excessive lacing. 

W. Sutugin™ reports a case of a married woman at 
the age of which was much relieved by wearing 

G. Tempini’* states a case of a woman aged 72, ac- 
companied by heart lesion; the kidney could be replaced 
and kept there by hands. 

N. P. Wassiljew™ gives a case, aged where the 
spleen was very movable and a movable kidney on the 
right side. He also reports a second case, a coachman 
aged. 31, who was taken with a violent pain on the right 
side after great exertion. A third case of a carpenter, 
aged 47, seemed to be caused by severe cough. 

L. Concato™ tells of a case. woman, aged 60, who had 
pain. She was a very tight lacer and was relieved by 



Jour. A. \. A. 


F. Chovstek’*® gives a case of a married woman of 33 
mother of 12 children. Labors were always very diff 
cult. She was ordered to wear bandage. 

L. W. Blet'® reports two cases without giving 
histories. Both died from heart lesion. 

F. Koehler’ states a case. Married woman of 54 hai 
falling of the womb, which was relieved by a pessary 
Liver could be replaced and held with the hand. §}, 
had no pain. 

W. Pepper’® states a case in a married woman, 4j, 
occurring after childbirth; it was accompanied by flaty. 

J. W. Legg’® reports a case of a man aged 36, wit! 
decision apparently due to coughing. It was verifiej 
by autopsy. 

F. Chovstek*® reports a case in a woman aged 68, a. 
companied by dropsy and swelling of the lower extrem. 

She finally died, but there was no Autopsy 

age of 


Hochhalt?! gives a case of a man who had raise 
a i sack, then sank down senseless. Elastic ap. 

dage and pad were given as relief. 

H. Rodsewitch*®? reports a case of a woman of 18 
Tight lacing during pregnancy caused movable liver, 

F. Chovstek** gives a case in a man of 45, who was 4 
great beer- -drinker and led a sedentary life. After gyn. 
nastic exercise he found floating liver. He had litt 
trouble from it. ° 

_ I. W. Runeberg** reports a case. In session of May 

, 1881, Runeberg showed a woman with floating liver 
and also spoke of another case reported by him. Pp. 
pingskold spoke of a case of liver dislocated observe 
by him many years since in a woman of 50 years. which 
was brought on after severe puerperal peritonitis; she 
died afterwards of carcinoma of the uterus and the dis 
location was confirmed at the postmortem. 

F. Schott®® gives a case of a married woman of 4) 
Jaundice existed for five or six years; during this time 
she had repeated attacks of vomiting, diarrhea, consti- 
pation, general weakness and was greatly emaciated. 
She had catarrh of the stomach, bronchitis, ete. A float- 
ing liver was found and a bandage with a pad was or- 
dered. After ten months patient was much improved 
and stronger. 

J. Trush?* reports a 
able liver followed 

Nicola de Dominicis** reports that he observed som 
years ago a woman who had a wandering liver, in whom, 
having married and then become pregnant, the liver 
was returned to the normal place by the pregnancy an 
was not again displaced. 

F. Schwartz?" gives a case of a man aged 38, wit! 
fever and chills occasioned by jaundice. He returned 
the hospital a number of times. 

Julius Kranols*® reports a case in a married womal 
of 38, accompanied with dropsy. Postmortem showed 
cancerous liver. 

J. Penna, diagnosed by J. B. Arini.*® reports a young 

ase of a widow aged 68. Mov- 

severe fall. 

girl. Her clothes were too small around the bod\ 
Floating liver was diagnosed and confirmed by Arin 
It was relieved by special corset. 

J. Maack*! gives a case of a single woman of 35, Hai 

a tumor in the right side in the ileo-cecal region, whic) 
was found to be a liver and could not be relieved }\ 
bandage. , 

G. Kispert®* states a case in a married woman o! 4. 

who had severe labors followed by fever. 


It was verified by ° 


of | 
of 1 
a ci 



» autopsy 

lan of 53 

very diff. 
NS age of 

of D4 had 
nd. Shy 

man, 4] 
by flaty. 

2 ) 
ob, wit] 

1 68, ac. 

tie han. 

1 of 18 

1O Was 4 
er ov 
id littl 

of May 
1g liver 

. which 

AS; she 

of 40 
is time 
\. float- 
Vas or- 


ied by’ 

| some 

v and 

ied ti 




| by 

f 43, 

May 17, 1902. THE FIXATION OF 


found; in fact, two, with an hourglass con- 

tumor Wis 

s, Salome-Marino** reports a case. Single woman, 

yith middle body causing trouble “when she walked ; 
was attacked with peritonitis in 1873, which caused 
gxation of the liver in the right ileo-cecal region. He 
reports 2 ona case in a washerwoman of 49, who died 

oi hemiplegia. Another woman, aged 33, shad severe 
{ympanites. Another woman, aged 44, died of 
coma of the Jaw; an autopsy was held. Another case 
yas that of a man aged 55. There was a history only 
of intermittent fever “with tympanites. He also reports 

se of a married woman aged 34. ‘There was poor 


a Cas 
digestion brought on after her sixth confinement. An- 
other case of a woman aged 21, a silk-worker, was 

caused by lifting a heavy weight. He reports the case 
of a woman aged 27, apparently followed after dancing 
until she was “exhausted five or six evenings in succes- 

Perrone** gives a case of a married woman aged 
5x, who fell downstairs. Kidney was very movable. 

H. Rosenkranz®® states a case of a married woman 
sved 48, who was seized with severe vomiting, and pain 
in the abdomen. This was followed by ascites in the 
edema of the legs. This disappeared after two months. 
Dislocated liver was found, which could be turned with- 
out trouble on its sagittal axis. 

R. Pichevin®* states a case of.a movable lobe of the 
liver and a floating kidney. 

kK. Szigethy®? gives a case of a man of 42, with dif- 
ficulty of breathing, jaundice and ascites caused by 
wandering liver. 

I. H. Parker** reports a case of a child, 10 months 
old. with a tumor, which he thought was a movable 
liver, but was pronounced sarcoma of the kidney by 

E. Maragliano™ reports the case of a woman 51 years 
old, with movable liver, evidently accompanied or 
caused by cancer. 

George Curtius*® gives a case of a married woman 
aged 41, with very movable liver, which was relieved 
by wearing a flannel bandage. 

M. Einhorn*! states the case of a carpenter aged 57, 
who had always been healthy; it came on suddenly, 
with severe chill and dizziness, accompanied by vomit- 
ing and pain. 

Gonterman* reports a case of a girl nearly a year old. 
taken with whooping cough complicated with peritoni- 
tis. She was later taken with diarrhea and meteorism 
and became greatly emaciated. After this a tumor was 
noticed. Sudden ‘death occurred, which was supposed 
to be due to twisting of the pedicle, ‘although no post- 
mortem was made. 

S. Salome-Marino** gives a case of a wandering liver 
which suddenly appeared in a girl of 5 years without 
producing severe symptoms. 

F. Binnie** reports a case of a single woman aged 
‘7, a music teacher. She had a tumor on the right 
side three years, and an attack of jaundice six months 
:an exploratory laparotomy was made. On open- 
ing the abdomen, a floating liver, rotated and freely 

hy fore 

movable. was found. On its surface were nodules like 
hepatie careinoma. 

Schtscherbakow and Rudow** give a case of a woman 
age! 35; after eleven births it occurred, apparently, by 

getting up too soon after severe confinement. She wore 
a bandage. 

(;: N. Kreider*® reports a case of a veteran of the 
War of the Rebellion; it was thought that the liver was 



loosened by lifting heavy casks. The patient declared 
that he suffered no inconvenience from the organ. 

Richelot** reports a’case of painful movable tumor 
in the right iliac fossa, which proved to be the displaced 
liver. He operated and three months later the relief 
was still complete. 

Dr. V. Poli** reports a case of movable liver in a 
woman aged 29. He operated with success. 
M. Albert Mathien*® reports a floating liver in a 

woman aged 53; he operated; the patient recovered. 

J. Buchholz®® records a case of floating liver in a 
widow aged 50; abdominal bandage was applied. with 
complete recovery. 

Dr. S. Weissenberg,®' of Jelissawetgrad, reports a 
case of hepar migrans s. mobile, as follows: F. H., 
female, aged 43; abdominal bandage gave temporary 
relief. Operation refused; patient died later. 

Prof. W. Leube,*? of Wurzburg, Germany, 
case of floating liver as follows: S. H., 
aged 17; operation; recovery. 

Dr. Benjamin Hellier, M.R.C.S.,°* reports a case of 
enlarged gall-bladder, with inguiform appendix of the: 
liver, in a married woman aged 32. Exploratory in- 
cision was made. Patient made excellent and rapid. 

Bastianelli®* operated in a case of floating liver in a 
woman aged A diagnosis of cancer and displace- 
ment of kidney had been made. Good recovery occurred. 

Lannelongue and Faguet,®* of Bordeaux, operated in 
a case of floating liver, diagnosed as tumor of the large 
intestine, with good recovery. 

Dr. J. E. Graham, 
movable liver. Case 1. 
bandage was used; 

reports a 
peasant’s son, 

London, reports three cases of 
Female, aged 62. Abdominal 
patient made rapid recovery. Case 

J. R.. aged 32; patient died from other causes ; post- 
mortem revealed floating liver. Case 3. M. T., boy, 
aged 17, with transposed and movable liver. Treatment 

was not stated.** 

Bobroff reports a movable liver in a woman aged 50 
vears; laparotomy was performed; there was marked 

Glubinsky®* reports a case of movable liver in a fe- 
male aged 38; operation, with complete recovery. 

Dr. Frederick A. Packard reports a case of floating 
liver in a male laborer aged 40. Exploratory puncture 
was made, with recovery.®” 

Pean records a case of movable liver in a female aged 
29 years ; operation, with complete recovery.*° 

Dr. Felix Franke reports two interesting cases of 
floating liver as follows: Case 1. A. Sch., woman, 
aged xe: ; operation and subsequent good recovery. Case 
2. H. W., widow. 41 years old; laparatomy, with good 

Areilza®? reports a floating liver in a male aged 

years; laparotomy, followed by recoverv. 
Delageniére®* records a case of floating liver in a 
female aged 30 years; operation and complete recov- 

ery followed. 

J. Lucas Championniére reports floatine liver in a 
female aged 35; median laparotomy and recovery.** 

R. Crawford reports a case = “anteverted, wander- 
ing liver,” in a woman aged 65; postmortem revealed 
above condition.® 

Blane reports an interesting case of movable liver in 
a woman aged 35; vertical incision was made, with per- 
fect success and rapid recovery.®° 

P. Ferrari reports a singular case of floating liver in 
a girl 24 years old; operation and recovery.* 


Dr. H. McNaughton-Jones reports a case of complete 
laparotomy in a female aged 38. There was splendid 

Dr. Aristide Muratori reports a case of movable liver, 
the result of probably carcinoma, in a male laborer aged 
61. Operation was made, with recovery.*® 

Professor Einhorn, of New York, reports five cases of 
movable liver, as follows: Case 1. Sarah D., aged 37; 
a#bdominal bandage was employed, with rapid improve- 

ment. Case 2, aged 50; abdominal bandage and rapid 
improvement. Case 3, female, aged 55, with abdominal 

bandage, improved immediately. Case 4. David L.. 
aged 41; abdominal bandage ordered, with marked im- 
provement. Case 5. A. S., 25 years; full diet and 
bandage were ordered ; marked improvement resulted. 

Einhorn reports .four other cases of movable liver, 
diagnosed incorrectly ; three were pronounced cancer of 
stomach; the fourth as appendicitis or gallstone. 
Bandage relieved all symptoms. Among five other cases, 
wrongly pronounced gallstone colic, was that of a man 
aged 60. Adjustment of bandage resulted in great 

Dr. N. O. Nisbet, of Charlotte, N. C.. reports mov- 
able liver in a woman aged 45. Abdominal bandage 
relieved all symptoms.” 

These cases enable us to see with reasonable certainty 
that the cause of a movable liver is always an injury, 
severe fall, heavy lifting, or, in a few cases, the develop- 
ment of a malignant growth in the liver. 

The symptoms of a floating liver are a distress and 
feeling of weight in the region of the liver. Often a 
good deal of tympanites and symptoms of intestinal 
indigestion. The action of the bowels seems to vary, 

‘even in the same individual; sometimes diarrhea and 
sometimes constipation is present. ‘The nervous symp- 
toms can not be all enumerated; they are as numerous 
as we get in hysteria. They are (as we find in all reflex 
nervous condition of other organs). headaches, restless- 
ness, hypochondriasis, gastric disturbances, etc. Quite 
a few of these cases cause no symptoms except the sensa- 
tion of weight, and patients were quite comfortable 
when wearing a bandage. 

Few attempts have been made so far to relieve this 
condition by operative interference. In the case of 
Dr. Binnie, a simple exploratory operation was made 
and the diagnosis cleared up. Others made exploratory 
operations, but few attempts at a radical cure. Richelot 
was the first, I think, who deliberately operated to cure. 

In cases of general enteroptosis the abdominal ban- 
dage will be valuable, as recommended by Einhorn. In 
such cases operation will be of no benefit. as we have to 
deal with a general condition of the system. My case is 
as follows: 

Mrs. R. Elkhart, Ind., a patient of Dr. Mast, aged 48, passed 

the menopause; married a second time, but never had children. 
She is a hard-working woman, weighs about 220 lbs., never has 
been seriously ill, but has had the usual symptoms of the 
menopause well marked. During the last year she has been 
troubled with pain in region of the liver extending down to 
the pelvis, a sensation of fulness and distress; sometimes she 
was obliged to keep in bed for a half day to two days; occa- 
sionally she was jaundiced for a few days. All symptoms indi- 
cated some diseased condition of the liver, but no symptoms of 
gallstones, no severe colic; simply a feeling of fulness and 
distress. "She was inclined to be constipated; her digestion 
was good, although she complained a good deal of gas. The 
nervous symptoms were also well marked, especially hypochon- 
driasis and despondency, as is often found in disturbances of 
the digestive system. 


Jour. A. \ A. 

EXAMINATION: The woman being heavy and stout, it Was 
difficult to make a positive diagnosis of abdomina| trouble 
Percussion on the right side down to the pelvis indicated 
tumor, or solid mass, the character of which could not be made 
out; it might be an enlarged liver, tumor of the kidney. an 
ovarian tumor developed in that direction, or possibly a lone 
pedicled fibroid. It might also be a malignant growth, al. 
though the general appearance of the patient would discredit 
such condition, or one of those very rare tumors, such as 4 
hydatid or a cyst of some other organ attached to the right 
side. The growth did not seem movable. I did not * 
press an opinion of its character, but suggested an exploratory 
operation. _ 

OPERATION: She was operated on April 24, 1900. An jngj 
sion made at the outer edge of the rectus two inches below the 
ribs and downwards for two and a half inches. After cuttino 
through a thick layer of fat and opening the peritoneum, the 
enlargement proved to be the liver. The right lobe was much 
enlarged and hanging down to the brim of the pelvis. It could 
be easily replaced in its normal position and then projected 
about two inches below the ribs. There were no gallstones, 
All other abdominal organs seemed normal. 

It seemed to me that the only thing to do was to fix the 
liver as near as possible in its normal place. I therefore 
scraped as thoroughly as I could the anterior side of the liver 
and the anterior wall of the peritoneum, so as to get it thor. 
oughly denuded of epithelium and to allow adhesions to take 
coronary ligament and brought it forward and stitched it to 
the upper angle of the wound. I then closed the abdomen with 
dry sterilized catgut in layers and dressed the wound as usual. 
The patient made an uninterrupted recovery. Nearly all her 
symptoms had disappeared when she left the hospital on the 
20th day. I heard of her three months later, still much im- 
proved, but occasionally troubled with gas. 

I report my case for the purpose of calling attention 
to the condition, which is certainly rare, and still, by 
being on the lookout for it, perhaps, a good many more 
cases would be found than we suspect, especially in these 
chronic abdominal troubles with no marked symptoms. 

I also report it for the purpose of calling attention to 
the fact that operative procedure will offer a radical 
method of cure. 


Ann. Univ. do Med., Milano, 1866, exeviii, 373. 
Riv. Clin. di Bologna, 1868, vii, 239-243. 
Schmidt's Jahrb., Leipz., 1869, exci, 107-114. 
Morgagni, Napoli, 1870, xii, 848. 
Memorabilien, Heilbron, 1872, xvii, 67-69. 
Arch. f. Gynaek., Berlin, 1872, iv, 145-156. 
Deutsches Arch. f. Klin. Med., Leipzig, 1874, xiv, 146-149. 
Osservatore Med., Palermo, 1874, 3 S., iv, 185-224. 
Arch. f. Gynaek., Berl., 1874-5, vii, 152-168. 
Morgagni, Napoli, 1875, xvii, 852-854. 
Arch. f. Gynaek., Berl., 1875, viii, 531-533: 
12. Gazz. Med. Ital. Lomb., Milano, 1875, 7 S., ii; 283; 242; 249. 
13. St. Petersb. Med. Wehns., 1876, i, No. 30. 
14. Riv. Clin. di Bologna, 1876, 2 S., vi, 65-68. 
15. Wien. Med. Presse, 1876, ,xvii, 10: 885; 921; 976; 1008. 
16. Etude sur le foie mobile, Paris, 1876. 7 
17. Beitraege zur Casuistik der Wanderleber, 8. Greifswald, 1877. 
18. Med. and Surg. Reporter, Phila., 1877, xxxvii, 350. 
19. St. Barth. Hos. Rep., London, 1877, xiii, 141-148. 
20. Allg. Wien. Med. Ztg.. 1877, xxii, 330. 
21. Med. Chir. Central., Wien., 1879, xiv, 554. 
22. St. Peters. Med. Wochenschr., 1879, iv, 324. 
23. Wien. Med. BI.. 1880, iii, 755: 784. 
24. Finska lak. Sallsk. Handl., Helsingfors, 1881, xxiii, 279. 
25. Deutsche Med. Ztg., Berl., 1882, iii, 247; 259. 
26. Obst. Gaz. Cincin., 1882, v, 337-343. ’ 
27. Manuale di semiotic fisca ad uso dei giovani o dei medici 
practici. 8. Napoli, 18838. pt. 1, 113. note. 
28. Wien. Med. BI., 1883, vi,.695-700. : 
29. Zur Casuistik der Wanderleber. 8. Stuttgart, 1884. 
ae An. del Cere. Med. Argentine, Buenos Ayres, 1884, vii, 151- 
31. St. Petersb. Med. Wehnschr., 1884, n. F., i, 410. 
32. Berl. Klin. Wehnschr., 1884, xxi, 372-375, with woodcuts. 
33. Studi di Clin. Med., 8, Palermo, 1885, 185-224. 
34. Morgagni, Napoli, 1886, xxviii, 585-593. 
35. Berl. Klin. Wochenschr., 1887, xxiv, 715. 
36. Progrés Méd., Paris, 1888, 2 S., vii, 253. 
37. Pest. Med.-Chir. Presse, Budapest, 1889, xxv, 1013. 
88. New York Med. Jour., 1889, xxix, 656-658. 
39. Riforma Med., Roma, 1889, v, 2; 8; 14; 20; 26; 74; 80; 
374: 380. 
40. Symptome und Aetiologie der Wanderleber in Anschluss a0 
einen solchen Fall. 8. Halle a. S., 1889 

St sh ol aah yah al 

41. Med. Monatsschr., N. Y., 1889, i, 351-353. 

I then brought the raw surfaces together, grasped the ” 

M. A. 

't, it wag 
| trouble. 
dicated a 
be made 
idney, ay 
y a long 
wth, al. 
uch as a 
the right 
not ex. 

An ing 
Clow the 
“um, the 
AS much 
It could 

fix the 
he liver 
it thor. 
to take 
ped the | 
d it to 
en with 
3 usual, 
all her 
on. the 
ich im- 

1, by 


ion to 

; 249. 




May 17, 1902. 

» Deutsche Med. Wochenschr., Leipzig, 1890, xvi, 1043. 
42, Dewi d. Cong. di Med. Int., Milano, 1891, iv, 338-341. 
43. “iernat. Jour. Surg., N. Y.,'1892, v, 332. 
45. Ibid., page 86. 
jh Med. News, Phila., 1893, Ixii, 436. 
- [Union Méd., Aug. 5, 1893-94. 
4s. Riforma Medica, vol. ix, 7., 105, 1893-94. 
Gaz. des HOpitaux, Oct. 24, 1893-94. 
“Norsk Magazine for Laegevidenskaben, vol. viii, 1893-94, p 

Pa Deutsche Med. Wochenschrift, Nov. 30, 1893-94. 
2) Miinchener Med. Wochenschrift, Jan. 23, 1894. 
2 prit. Med. Jour., May 4, 1895. 
’ 1) Policlinico, Rome, April, 1895. 
’-’ La Semaine Médicale, Aug. 7, 1895. 
-: Canadian Practitioner, 1895, vol. xx, p. 399. 
57. Wratsch, 1895, No. 46, p. 1299. 
= Voiyeny Med. Jour., Nov., 1895. 
<9. University Med. Mag., 1896-97, vol. ix, 9, 266. 
eo Congrés de Chirurgie, Paris, Oct., 1896. 
61. Centralblatt fiir Chirurgie, 1896, vol. xxiii, p. 775. 
)” Rivista di Medicina y Cirurgia Vratica, 5 Jiullet, 1896, p. 24. 
63. Archives Provinciales de Chirurgie, 1897. 
64, Gaz. des Hépitaux, April 1, 1897. 
65. Lancet, Nov. 6, 1897. 
66. La Loire Méd., Dec. 15, 1897. ; 
67. Centralblatt fiir Chirurgie, 1897, vol. xxiv, p. 1301. 
68. Med. Press and Circular, May 18, 1898. 
69. Gaz. Degli 6 Spedali e delle Cliniche, 1898, Nov. 20. 
70. Zeitschrift fiir Diatiitische und Physikalische Therapie, Leip- 
ig, 1900. . 
me The Carolina Med. Jour., Feb., 1901. 


Assistant in Otology, Harvard University ; Assistant Aural Surgeon, 
Massachusetts Charitable Eye and Ear Infirmary, etc. 


It is my purpose in presenting this paper to call to 
your attention some of the more common conditions 
which confront us when we have occasion to examine 
the ear. The two most frequent symptoms which drive 
the ordinary person to seek medical attention for this 
organ are pain and deafness, and to treat either success- 
fully we must remember that we have' to deal with symp- 
toms and not diseases. Take the pain, for instance, and 
we find that it may come from an abscess of the middle 
ear, from an ulcerated tooth, from a furuncle in the 
canal, or perhaps tonsillitis or rheumatism, or some 
other general disturbance is at the bottom of it. We 
learn to recognize that deafness, too, is but a symptom, 
and that it may come from one of many causes. 

In examining a case of earache, we thoroughly inspect 
the drum, noting in the first place the presence or 
absence of normal appearances. If we detect any con- 
gestion we at once conclude that here is sufficient cause 
for pain and proceed to treat it. In the absence of any 
inflammation, we know that it is not possible for such 
in ear to give rise to pain, and we must look elsewhere 
for the cause. The most common cause of earache, aside 
trom actual inflammation of the ear itself, is due to the 
presence of a carious tooth, and this is usually found 
to be a lower molar on the affected side. 

The presence of a furuncle is usually easily demon- 
strated, as we have a sharply localized swelling in the 
canal which is extremely sensitive to the touch, and 
which renders examination rather difficult. In the early 
stages the drum can be seen, and the fact that it is not 
inflamed aids us in the diagnosis. Very rarely the fur- 

uncle will assume such proportions as to simulate a mas- 
toil swelling, the ear standing out from the side of the 
head, and there may even be fluctuation behind the ear. 

Diagnosis in these cases is often difficult and it may take 
a day or two to clear up the question. 

Treatment should be directed toward giving the 
patient comfort. Repeated hot applications, the use of 
i ticht tampon of cotton, dipped in a 4 per cent. solu- 
tion of earbolie acid in glycerin, placed in the canal, and 

19 * Read before the Essex North District Medical Society, Jan. 1, 


in extreme cases of a long, slim flaxseed poultice, curved 
about the ear in the shape of a horseshoe, have given the 
best results in the writer’s practice. Incision should be 
resorted to only when the furuncle is pointing. Prema- 
ture opening apparently does no good, and many think 
that it favors the formation of more infected areas. The 
patient’s general health should be attended to, and tonics 
given. Above all, any scratching or fingering of the ear 
should be prohibited. 

Children are the most frequent sufferers from ear- 
ache, and perhaps the majority are subjected to all kinds 
of home treatment before the physician is called. Their 
unusual susceptibility is due to the fact that there is a 
certain amount of adenoid tissue in the naso-pharynx of 
almost every child, and in some this is abnormally devel- 
oped, with the result that the child is continually getting 
head colds. With each cold nasal respiration is more 
or less blocked, the growth swelling so as to obstruct 
the naso-pharynx, and in this way the Eustachian tube 
becomes involved. As a direct result we have one of two 
things. The child may have severe pain with develop- 
ment of an abscess, or it may become deaf from closure 
of the Eustachian tube and subsequent exudation of 
serum into the ear cavity. The first is due to invasion 
of bacteria along the inflamed membrane, the second to 
the complete occlusion of the tube. We will take up the 
discussion of the latter condition first, leaving the sup- 
purative inflammation of the middle ear for a few min- 

Acute closure of the Eustachian tube is painless, and 
usually begins with a stuffy sensation in the head, fol- 
lowed by a more or less marked deafness. In the case of 
a child this may be attributed to stupidity. Sounds 
within the head appear to be very much louder than they 
really are, and to the patient his own voice sounds as 
if he were speaking with his head in a barrel. Inspec- 
tion of the drum shows a darkened, retracted membrane, 
without any injection of the vessels. If the disease has 
progressed so far that there is already fluid within the 
ear, we may be able to make out its upper level through 
the drum. 

In slight cases where there has been no exudation, the 
natural tendency is toward spontaneous recovery with 
the passing of the cold which caused the trouble. Re- 
peated attacks, however, can not but result in organic 
changes in the ear. which later in life become apparent 
as the familiar dry catarrh of the middle ear, with very 
considerable deafness. 

In the severer forms where an exudate has formed in 
the middle ear, treatment of the nasopharynx and infla- 
tion by means of Politzer’s method will usually restore 
the hearing in a very short time. If the child is subject 
to these attacks, however, we must not look for a perma- 
nent cure until the adenoids, and particularly those 
around the Eustachian tubes, have been removed. 

This collection of fluid in the middle ear is by no 
means confined to children, and sometimes we have very 
much greater difficulty in securing absorption in adults. 
If after about ten days of careful treatment of the naso- 
pharynx, and inflations, the fluid has not disappeared, it 
may be advisable to perform paracentesis in the lower 
part of the drum, and then inflate. thus forcibly expell- 
ing the fluid. The hearing will be restored almost imme- 
diately to normal, and the incision will have healed by 
the end of twenty-four hours in the vast majority of 

Aeute suppuration of the middle ear, the cause of the 
earaches with which we are so familiar, presents an en- 
tirely different clinical aspect. The patient has almost 

Soap patie agente 




from the first a sharp pain in the ear, steadily growing 
worse. Inspection of the drum shows a congestion of the 
upper posterior part, which gradually increases until the 
whole upper part of the membrane is involved. Should 
the disease progress still further, there will appear a 
decided bulging of the upper posterior quardant, with 
marked deafness. 

In the early stages, heat applied locally is of as much 
value as any one thing. A good way of using it is to 
douche the ear every hour or two with water as hot as 
can be tolerated, using from one to two quarts of fluid 
each time, in order to get a prolonged application. In 
severe cases it is well to also employ heat in the form of 
a hot water bottle. or hot salt bag, between the douch- 
ings, Free catharsis should be attended to, and it may 
be necessary to give a little bromid, or phenacetin. In 
mild cases this treatment will cut short an otherwise 
painful illness, and the patient will escape with only a 
few hours of pain, and subsequently a feeling of fulness 
with slight deafness. In the severer forms of infection 
the inflammation goes on rapidly to pus formation, with 
the. consequent bulging of the drum of which we have 
just spoken. 

Here,;we have arrived at a stage which often puzzles 
the,general practitioner. He knows that he is justified 
in using palliative treatment to a‘certain extent, but he 
also-has in. mind a wholesome dread of possible infection 
of the mastoid, or of the meninges, even, should the 
case be neglected. ‘To allow the abscess to develop until 
it opens spontaneously is to needlessly expose the patient 
to these. dangers. The question then naturally arises, 
when--shall he perform paracentesis, and also, what risk 
is he running by so doing? 

In answer to the first I would say that whenever we 
have a bulging of the drum, with pain which is not 
easily controlled by the means we have mentioned, I 
should unhesitatingly open the membrane. In doing 
this the whole posterior half of the drum should be 
freely incised, a curved opening being preferable, as not 
so likely to close again too quickly. Regarding the dan- 
gers of this procedure, they refer mostly to the future 
hearing of the patient. Until one has had a little experi- 
ence, there is, of course, some likelihood of injuring the 
delicate mechanism of the middle ear, but hearing is of 
secondary importance as compared with bringing the 
patient safely out of the trouble. In practiced hands 
no evil result need be feared, as most of these cases 
recover their normal degree of hearing. The operation 
is an exceedingly painful one, and is best done under 
the influence of primary anesthesia. We must not expect 
the escape of a large quantity of pus immediately on 
opening the drum. There is usually a free bleeding at 
first, followed by a serous discharge for twelve or more 
hours, beforé we get pus. As has been repeatedly proven 
by cultures, the bacteria are there from the start, but 
have not sufficient opportunity to multiply. To mini- 
mize this growth of bacteria, and to prevent the access 
of others from without, it is better before doing para- 
centesis to carefully cleanse the canal with a cotton stick 
dipped in an antiseptic, and then to allow a corrosive 

sublimate solution of a strength of 1 to 5000 to remain 
in the ear for at least five minutes. The paracentesis 
needle is, of course, sterilized, and after the bleeding 
has in a measure subsided, the canal is carefully cleared 
of blood clots, and a loose wick of sterilized absorbent 
cotton inserted. Outside of this, still another piece of 
cotton is placed, for the purpose of receiving the capill- 
ary drainage of the wick. This latter piece is to be 
changed as often as it becomes soiled, the wick remaining 


Jour. A. M4 MA 


in place for twenty-four hours, when it is replaced 

ss bya 
fresh one. Wicking is kept up as long as the discho; 



is thin enough to escape through the cotton. By moan For 
of this method of treatment we materially reduce ;,fqmMmo (el 
risk of infection from without, as must inevitably of before 
sult when we syringe the ear, and: in a certain proportioy n ac 
of cases the ear will cease to discharge after one or ty, ully 

days, healing without having really suppurated. 

When an ear is really suppurating actively, however 
we have to resort to the use of the syringe 
of cleanliness. 

g Syl 
5 a | 
n th 

. . aS a Measure 
It is best used in. the form of a doy 


the heat being grateful to the patient, and tending his 
allay the inflammation. Leeches are sometimes of yalyp Me™”: © 

where the congestion is very great. They are best a. Te 

plied immediately in front of the ear. and over the me. Ieee? 2 
toid process. It is absolutely essential that the opening [ge??” 
in the drum should be maintained during the progres IY’! 
of the disease, and this sometimes requires repeated In 
openings. pblig 

It sometimes happens that the patient does not come fat! 

to us for treatment until after the most severe of tho MME?) 

inflammatory symptoms have subsided. He may com. Mmt!° 

plain simply of deafness, or of the inconvenience of hay. ge” 
ing a constant discharge from the ear. Examination after et” 
cleansing the canal of all secretion will usually show . [ge 
red and edematous drum in which we may possibly se fgg!!! 
the perforation, or the latter may be so small as to be BP" 
invisible except on performing Valsalvan inflation, ee" 
When this is done, fluid or air will come out through He" 


the drum, making the location of the hole apparent. Ii : 
we keep the canal cleared of the purulent discharge, the . 
natural tendency in acute cases is toward recovery. Ho!" 
Keeping in mind the fact that our abscess cavity is inside 
the drum, and that the perforation may be so small as 
to be invisible, we can readily see the futility of attempt- 
ing to bring about a cure by instilling the various solu- 
tions recommended for this trouble. It is probable that ¥°” 
not one particle ever enters the tympanic cavity. Of 3° 
course, this does not apply to cases with larger perfora- im 
tions, but these do not usually appear in acute cases, and 
to discuss them would be to open up a larger field than 
we have time for to-day. When the discharge is profuse te 
it is my custom to have the patient syringe the ear sev- I 
eral times daily. allow it to dry as well as possible, and my 
then blow in a small quantity of boracic acid. As the - 


discharge diminishes, it is sometimes preferable to use mM 
the so-called dry treatment, mopping out the canal with 
a cotton stick, and then using the ‘powder. We shoul 7 
keep track of the hearing during this time, for cessation wu 
of the discharge alone might mean that the drum was “ 
closing prematurely, to cause mischief later on, but a 
diminished discharge with improved hearing would indi- : 
cate recovery. 

A point of great interest to the general practitioner > 
is the recognition of the presence of infection of the mas 
toid. Many times I have had the statement made to me ? 
by physicians that they have been in practice twenti , 

years, we will say, and have never seen a case of mastoid- 
itis, and almost in the next breath ask: What are the 
symptoms ? 

Here we have the whole matter in a nutshell. It is 
not that the disease is infrequent, but because the svmp- 
toms are obscure, and in many cases to be made out onl) 
by inspection of the ear by means of the speculum and 
reflecting mirror. that it is not more often detected. Be- 
cause some years since mastoid abscesses were not com- 
monly opened until there was an exudate of pus between 
the bone and periosteum, this is the picture most often 
before the minds of many of us at the mention of the 

M. 4 

aced by 

By Means 
duce the 

tably te. 


Riis; {Wo 


Lie Wever 

nding ‘“ 

of Value 
best ap- 
the mas. 




It Come 
of the 
Vv COm- 
of hay- 
mn. after 
show q- 
bly see 
5 to be 
nt. If 
xe. the 
al] as 
e that 
, and 
* sey- 

s the 

Vay 17, 1902. 

jase. We rather expect to see a certain amount of 
jema behind the ear, and perhaps fluctuation. 

Fortunately for our patients, we are to-day enabled 
» detect the présence of extension to the mastoid long 
fore it has reached this stage. Every patient who ha~ 

n acute suppuration of the middle ear should be care- 
lly examined for evidences of mastoid involvement, 
; symptoms may appear as early as the second day. It 
; a well-known clinical fact that the absence of tem- 
nerature is no guide whatever ; during the acute process 
n the middle ear we are apt to have some elevation, but 
his may entirely subside with free discharge from the 
ar, even although the mastoid be filled with pus. 

{enderness over the mastoid antrum is apt to be a bet- 
ter guide, but it must be remembered that this is often 
ppparent only on deep pressure, and also that with some 
very thick bones we are not able to elicit tenderness. 

In the absence of these two symptoms we are 
sbliged to turn to an inspection of the condition of the 
middle ear. With an increasing collection of pus in 
‘he mastoid there will be a more pronounced bulging of 
the drum, and in many cases which give no evidence 
externally there will be almost a complete closure of 
the auditory canal from swelling of the wall nearest 
the mastoid. There is usually much pain with this con- 
dition, but in some cases, and especially with phthisical 
patients, there is none. The presence of this increased 
swelling of the drum and posterior canal wall is diag- 
nostic of mastoid trouble, however, and it should not be 
allowed to persist long without operation. 

Now as to the treatment which should be instituted 
once we have made the diagnosis. We must bear in 
mind the faet that mastoiditis is always secondary to a 
purulent inflammation of the middle ear, and use our 
vest efforts to abort this trouble. Free drainage should 
be maintained through the drum, and at the first suspi- 
cion of tenderness or other sign of mastoid involvement 
we should apply cold by means of Leiter’s coil. At this 
stage leeches to the mastoid are often of value, and the 
patient should, of course, be kept in bed. Active treat- 
ment should at the same time be continued for the sup- 
uration in the middle ear, as we have just indicated. 
lf the pain and tenderness of the mastoid persist for 
more than twenty-four hours after free paracentesis and 
the use of the cold, it would be advisable for most prac- 
titioners to consult with some one skilled in such mat- 
ters, as there is very great danger in delaying operation 
too long. No one can tell in which direction the pus will 
turn to seek relief. and practically the only notice we 
have of its penetration inwards to the lateral sinus or 
srain is a sharp chill, ushering in a condition of septi- 
emia, and then it may be too late to interfere. 

Carried out in competent hands the mastoid operation 
s devoid of danger, and in uncomplicated cases the pa- 
tients recover so rapidly that it is often advisable rather 
than submit to the tedious. processes of spontaneous re- 
covery, which may take many weeks, and which gives us 
ho assurance that the patient may not ultimately be 
obliged to submit to operation after weeks of delay. 

Prescribing by Druggists.—The Paris “Syndicat des 
Medecins” sued a pharmacist fer illegal practice of medicine 

vecallse he had made an analysis of the urine of an applicant 
‘nd then preseribed for him on the ground of what he found -in 
the urine. The court decided that pharmacists are not com- 

petent to draw conclusions from examination of the urine so as 
‘0 prescribe understandingly, and consequently condemned the 
defendant to a fine of $10 and a similar sum to be paid to the 



Professor of Obstetrics and Gynecology, Rush Medical College, the 
University of Chicago. 


In his earlier papers describing his method of exam- 
ining the female bladder, Dr. Howard Kelly recom- 
mended that the necessary elevation of the pelvis be ob- 
tained by placing pillows under the hips as the patient 
lay on a flat table in the lithotomy position. More re- 

Fig. 1.—RBoldt table representing the elevation used in examining 
the female bladder. The author's shoulder support is shown, at 
tached to the table-top. The leg-holders are also in position. 

cently he has advocated the genupectoral posture as more 

fach of these methods has certain disadvantages. 
When the first posture is adopted, the examination is 
frequently unsatisfactory. The elevation necessaril\ 
leads to a flexing of the upper part of the abdomen on 
itself. This interferes with the free descent of the in- 
testines toward the diphragm, which is necessary to the 
complete distension of the bladder with air. The hips 
can not be raised much above twelve or fourteen inches 
without discomfort to the patient if she be not anes- 
thetized, and if an anesthetic be employed, the cramping 
of the abdomen interferes with free respiration. In 
women with tense or fat abdominal walls, it is often im- 
possible to obtain distension of the bladder by this 

The genupectoral posture, while undoubtedly most 

amare 4 


favorable to bladder distension, is very unpleasant to the 
patient if she be not anesthetized, while if an anesthetic 
i used, its administration is very awkwardly carried out. 
The patient’s neck is apt to get much bent, and if she 
vomits or secretes mucus freely there is often trouble in 
managing these complications satisfactorily. Moreover, 
the position of the examiner is not apt to be at all a com- 
fortable one, especially in catheterizing the ureters. 
During the past three years the writer has employed a 
method which is free from these objections. The patient 
is placed on a Boldt operating table in the lithotomy 
position, the ankles being fastened to upright rods, the 
buttocks projecting slightly over the end of the table 
resting on a rubber pad. A steel bar with two padded 
supports is attached to the top of the table so as to sup- 
port the shoulders. After the external genitals and 
vagina are cleansed, the patient is enveloped in sterile 
sheets, the urine is withdrawn from the bladder, the 

Method of examining the female bladder on the Boldt 

Fig. 2. 
urethra is dilated to the necessary size and a speculum 
containing its obturator introduced into the urethra. 
By means of a crank the top of the table is turned on a 
transverse axis so that the lower end is elevated and 
the upper end depressed. The patient is thus made to 
rest on an inclined plane. being held by the shoulder 
supports, her trunk being flat against the table and not 
bent in any way, so that her respiration is free and the 
anesthetic easily administered. The writer usually 
raises the table-top until its lower end is twenty-three 
inches above the normal level. The obturator is then 
removed from the speculum, allowing air to enter and 
dilate the bladder. The examination of the bladder and 
ureters is then carried out, the examiner standing on a 
stool so that the eves may be well above the outer end 
of the speculum. 


‘ he is positive as to the nature of the trouble. 

Jour. A. M. 4 

This posture has all the advantages of the genu pectory 
position and none of its disadvantages. In difficult Case 
in which distension of the bladder has not been tho, 
oughly satisfactory I have not been able to vet bette 
results by trying the genupectoral position. [hj 
method is also advantageous in the cases in which exay. 
ination of the bladder or catheterization of the ureters i 
to be followed by operation. The table is merely lower 
and the procedure at once begun if the vaginal route ; 
to be chosen. q 

In the examination of the rectum also, the positigy 
is highly satisfactory, air distension being obtainej 
in the great majority of cases as soon as the anus j 
opened. ‘The various forms of rectal specula may }y 
used with great ease. I have also found it serviceabj. 
for certain obstetric maneuvers for which ‘the genupe. 
toral position has hitherto been employed. 

Professor of Medicine, University of Nebraska College of Medicine 

The combined group of symptoms which establishes tly 
diagnosis of typhoid fever are: a gradually increasing 
fever with evening exacerbation and morning remission: 
general malaise with headache; a furred tongue with 
red edges and tip; nose bleed; a relatively slow pul 
(possibly dicrotic) ; abdominal distension with tympany. 

_ gurgling and tenderness in the right iliac fossa on firm 

pressure ; a roseolar eruption confined principally to the 
abdomen and chest; enlarged spleen, and the physical 
signs of bronchial catarrh. 

Should every case of typhoid fever present the fore- 
going symptoms, the diagnosis would be simple and mis 
takes would not be common, but unfortunately this is not 
true and I believe the classical history, as portrayed in 
the books, is the exception rather than the rule. Be- 
cause of the great variability in the symptoms and the 
tardiness of the appearance of many of them, the diag- 
nosis is often not clear until the patient is far advanced 
in his illness. We have to wait a week from the con- 
mencement of the attack to demonstrate the character 
istic fever chart, seven to ten days to find the rose spots, 
usually the same time to demonstrate an enlarged spleen; 
during this period what an anxious time the attending 
physician has in satisfying the family and friends that 
he starts off with la grippe, which does not respond 
in a few days to treatment. but turns out to be a malarial 
fever which later becomes complicated by typhoid at the 
first sign of an intestinal hemorrhage or a perforation. 

Probably typhoid fever can be made to answer for 
a greater number of affections than any other disease. 
The only consolation the physician can find in his unfor- 
tunate position frequently is, that he is not the only one 
to be similarly situated; in fact, he is not even an ex- 
ception, for we have all been there and will be agait. 
The eminent men who were in attendance upon the Czar 
of Russia a year ago had him down with la grippe for 
nearly a week before typhoid fever showed up. 

In quite a number of cases, the preponderance of some 
symptom leads away from the suspicion of the disease. 
and accounts for many errors in diagnosis. I have see? 
the physical signs of bronchitis so intense in the earl! 

* Read before the. Rotna Valley Medical Society, at Avoca, [owa, 
Feb. 13, 1902. 

Too often. 


M. A. 

cult Case 
en thor. 
et better 
mn, This 
ch €Xam. 
ureters js 
y lowere 
| route jg 

anus jg 
may be 



shes the 
le with 
Vv pulse 
on firm 
’ to the 
hy sical 

e fore- 
1d mis- 
S is not 
ived in 
nd the 
> diag- 
e Com: 
's that 
| often. 

at the 


oy for 



V one 

n eX- 



e for 




May 17. 1902. 

story of a case with accompanying high fever as 
» entirely mislead; the pain in the head so great as 
» make the attending physician certain of a case of 
meningitis, and obstinate constipation with distension 
snd tenderness in the right iliac region are suggestive 
nf appendicitis ; and I have myself a number of times, 
from the rapid onset and severity of chilliness, headache, 
eneral aching, fever and cough with acute catarrh of 
he whole respiratory tract, felt certain of a diagnosis 
‘Ja grippe, only to find out later that I had guessed too 
oon. ‘There seems no similarity whatever between a 
p-called walking case of typhoid fever and a case pre- 
onting most all the characteristic symptoms in their 
reatest severity, and within these two extremes what 
can not be represented? The physician who does not 
make snap diagnoses, or, properly speaking, “guesses” ; 
who examines every case of disease carefully at each 
visit: who elicits a clear, concise history and always has 
typhoid fever in his mind when he finds a continued 
fever, will come out in the long run with fewer mistaxes 
charged against him. It is not that we are not con- 
versant With the diagnostic symptoms and signs of 
typhoid fever, but it is that we do not sufficiently apply 
that knowledge to the individual case. 

It is important that the diagnosis be made at the 
earliest possible time, and yet this is not always prac- 
ticable because of the tardiness of many prominent diag- 
nostic symptoms. Fortunately for him, the physician 
is not consulted until the patient has ailed for several 
days, and the history will be presented of a slowly-de- 
veloping affection which will be in marked contrast with 
most other acute diseases. I have come to regard a 
relatively slow pulse, which is so often present through- 
out the entire course of the disease, as strongly suggestive 
of typhoid and if it be found dicrotic in character the 
presumption will be quite strong. This is also in marked 
contrast to most diseases confounded with typhoid fever. 
The pulse in the first week rarely exceeds 90, is often 
8) or less, even in the presence of a temperature of 

103 or more. Women and children are frequent excep- . 

tions to this rule. 

An early sign almost invariably present is the diazo- 
benzol urinary reaction of Ehrlich, which is commonly 
found as early as the fourth day. A few years ago the 
writer read a paper before the Missouri Valley Medical 
Society on the “Early Diagnosis of Typhoid Fever,” in 
which his experience with this test, as applied to about 20 
cases: was narrated, and his observations since, extend- 
ing over about as many more, confirm his belief that the 
application of this test is not sufficiently frequent in 
practice, and that its value as a diagnostic sign is 
underestimated. The very fact that it may often be 

found by the fourth day, three days before the earliest: 

rose spot, or palpable spleen, adds to its importance. 
True, it is found in malaria, in measles, in the latter 
stages of tuberculosis and in smallpox; but aside from 
malaria, these affections could hardly be confounded 
with typhoid fever. There is response to the test until 
about the eighteenth day of the fever. On the occur- 
rence of a true relapse it reappears. I always keep the 
solutions on hand and have found it advantageous to 
carry them with me to suspected cases in the country. 

The test solutions are: 1. Sulphanilic acid, grains 
“0; hydrochloric acid, drams 3; distilled water, ounces 
‘:mix. 2. Sodium nitrite, grains 24; distilled water, 

ounce 1. 3, Aqua ammonia. 2 drams of No. 1, are 
mixed with 3 drops of No. 2 in a test tube; an equal 

(uant'ty of the urine added and thoroughly shaken. 


Eight drops of ammonia are then allowed to fall upon 
the foam, when a distinctly pink color of the latter 
occurs, to be followed by a bright carmine-red .zone 
underneath. If the liquid be then poured into a white 
porcelain dish it will appear as a light yellowish red. 

The Widal blood reaction is of considerable diagnostic 
importance, and when obtained in dilutions of forty or 
more, the certainty of the existence of typhoid fever in 
a suspected case may be entertained. Work along this 
line is demonstrating, however, that the reaction occurs 
in those who have previously had the disease, and this 
fact should be elicited before the deduction is made. 
It requires fresh cultures of the bacillus typhosus to 
make the test satisfactorily, and hence it is not always 
practicable to the country practitioner. 

In cases where the test is essential to clear up an 
uncertainty, a coverslip of blood or serum can be readily 
sent to the bacteriological laboratory connected with 
any of our medical colleges. The typical reaction does 
not usually occur before the sixth or seventh day; ex- 
ceptionally it is considerably later. 

The rose spots vary within wide limits as to numbers 
and location. Oftentimes they are so few as to escape 
detection unless carefully searched for. 
nostic significance is based upon their disappearance 
under pressure, to reappear so soon as the pressure is 
vithdrawn ; their non-elevation above the surface, and 
the individual spot having a life history of three days. 
They are occasionally found upon the arms and about 
the wrist. I believe from my own observation that they 
may be found in every case. Not appearing before the 
seventh day and occasionally as late as the tenth, they 
are of course not an early diagnostic sign. 

The combined symptoms which are almost invariably 
present during the first week to be relied upon for a 
presumptive diagnosis are: a daily increasing temper- 
ature with headache and malaise; moist furred tongue 
with red edges and tip; a pulse of 80 or thereabouts 
and evidences of bronchial catarrh. 
added the diazo-benzol urinary reaction on the fourth 
to the sixth day with or without the occurrence of nose 
bleed, the presumption is very strong. A _ palpable 
spleen, rose spots and the Widal reaction early in the 
second week, supplementary to the foregoing, would 
make the diagnosis absolute. 

The diseases most commonly mistaken for typhoid 
fever are: remittent malarial fever, continued fever of 
uncertain septic origin, commonly called simple febri- 
cula, acute miliary tuberculosis, la grippe, appendicitis, 
typhoid pneumonia, and septicemia. 

Remittent fever or estivo-autumnal fever is the only 
form of continued fever of malarial origin. It is rarely 
seen outside of malarial districts and in this section of 
the country is scarcely known excepting in the arena 
of a mistaken diagnosis; and yet I believe more cases of 
typhoid are treated for malarial fever than are treated 
for typhoid. This is a broad statement. but it is based 
upon observation and experience. The word malaria 
covers a multitude of sins, but it is inexcusable to carry 
it into a domain where recent knowledge and methods 
can so readily disarm. There are many points in com- 
mon between these two fevers, but there are more points 
of difference. Malaria] fever is usually ushered in by 
a distinct chill, often repeated, followed soon by hich 
fever with two daily exacerbations and remissions; ty- 
phoid by chilliness followed by gradual rise in fever 
with only one exacerbation and remission daily. The 
rapid pulse of commencing malaria is in marked con- 

Their diag-, 

If to these be. 


oni gene ge GES TR 


trast with the slow pulse of typhoid. In the former 
there is rarely nose bleed, in the latter this is quite 
frequent. There are rarely abdominal symptoms in 
malaria, and there is commonly nausea and vomiting. 
The roseola is not found in malaria. The presence of 
the Widal blood reaction would be favorable to typhoid, 
and the crescentic plasmodium in the blood demon- 
strable by the microscope would be positive of malaria. 
An intestinal hemorrhage would be presumptive of ty- 
phoid and a marked susceptibility of the fever to quinin 
would savor of malaria. Simple febricula has not the 
nose bleed, slow pulse, diazo urinary reaction, palpable 
spleen, roseola and abdominal symptoms of typhoid, 
runs a shorter course and is much more readily influ- 
enced by treatment. ; 

Acute miliary tuberculosis has not infrequently been 
confounded with typhoid fever. The onset of the for- 
mer is more rapid and pronounced, the pulse rate much 
higher, greater frequency of respiration; there is not 
apt to be nose bleed, palpable spleen, rose spots; there 
is decided tendency to fine moist rales throughout the 
chest with loose cough not common to typhoid, and 
frequently the sputum will contain abundance of tu- 
bercle bacilli. 

La grippe and typhoid fever prevail at the same sea- 
son of the year. Mild cases of the latter are not unlike 
moderately severe cases of the former which have not 
early complications. La more sudden in on- 
set, is usually consecutive to or coincident with a cold, 
has a more rapid pulse, the fever is more susceptible to 
treatment responding in two or three days where sequele 
do not supervene; the diazo-reaction is absent, and 
there are no rose spots or palpable spleen. 

Cases of prolonged appendicitis with slow onset will 
present differences only which require close investiga- 
tion. The pulse here will be higher in proportion than 
the fever, the morning and evening temperature will 
vary less; there is no nose bleed, or roseola, or enlarged 
spleen, or bronchial catarrh, or diazo-reaction. There: 
is more apt to be abdominal pains, muscular rigidity in 
right iliac region and moderate leucocytosis, which is 
much increased where pus is present. 

Walking cases of typhoid with perforation of the 
intestine, are quite suggestive of fulminating appendi- 
citis. and I have known errors of diagnosis to occur 
where, at operation, a perforated intestine and ulcerated 
Peyer’s patches demonstrated the typhoidal character 
of the case. Intestinal perforation occurs at such a 
time in typhoid fever that a careful inquiry into the 
above differences in the symptoms and signs should 
leave no room for doubt, and although operation might 
be advisable in both, it is much the more satisfactory 
that the diagnosis be made beforehand. Appendicitis 
may complicate typhoid fever and develop when the 
abdominal symptoms are most pronounced. A case of 
this kind was reported to the American Medical Asso- 
ciation at the meeting in Atlantic City by Dr. Siegfried 
Weiss of Vienna, reported in THE Journat of Nov. 
24, 1900. The case was that of a child 934 years old, 
which was supposed first to have influenza, then typhoid ; 
then on the development of signs of an inflammatory tu- 
mor in the appendical region, and leucocytosis, the for- 
mer diagnoses were thrown over and a suppurative ap- 
pendicitis accepted. Why the author discarded typhoid 
T can not understand, for the symptomatology included 
fever. bronchial catarrh, diazo-urinary reaction, en- 
larged spleen, rose spots, diarrhea and the Widal blood 
reaction with the development of the local signs of 


Jour. A. M4 

appendicitis only on the twelfth day of the illness, Wy 
it not more likely a typhoid infection with involvemey 
of the appendix? Why this complication is not more 
common puzzles us, for certainly the bacillus typhosus 
should have as ready access to the appendix as do fy, 
eign bodies, which enter from the intestine to exci 
inflammation. Perhaps it is more frequent than We 
think for, but undetected. 

Typhoid pneumonia is a misnomer, for it sugges 
the presence of a typhoid infection in a type of pnep 
monia which is so severe as to present certain symp. 
toms suggestive of the typhoid state, when in realit 
the latter does not exist. The disease starts in violent)y 
with severe chill, high fever, rapid pulse, pain in ches 
frequent breathing, to be soon followed by low delirium 
abdominal distension, involuntary evacuations, con 
and death within a week or so. The frequent abseng 
of cough and expectoration mislead. A careful exan. 
ination of the chest will detect a solidified lung, and ; 
marked leucocytosis will indicate no typhoid fever, 

Septicemia of gradual onset presents a similarity of 
symptoms which lead to error, and especially when ty. 
phoid occurs in the puerperal state. In septicemi 
there is usually discoverable some focus of infection: ; 

is attended by a higher relative pulse-rate; there is no- 

the fever chart of typhoid. Frequently sweating «. 
curs, the rose spots are absent as is also the Widal blood 

The irregularity of typhoid fever in children. I }v- 
lieve, accounts for its supposed relative infrequency at 
this period of life. In many cases the onset is mor 
abrupt; there is less apt to be complaint of general 
malaise; nose bleed is comparatively rare; nervous 
symptoms are more pronounced. The abdominal 
symptoms, when present, are similar to those of enteric 
or gastro-enteric catarrh and especially in young chil- 
dren or infants are many of the symptoms wanting. 

If the diazo-urinary test, and the Widal blood rea- 
tion and splenic enlargement and a search about the ab 
domen and chest for rose spots, were more carefully 
inquired into, in the continued fever of early life, we 
would find more typhoid. The loose movements of er- 
teric catarrh are not like those of tvphoid. They ar 
apt to be green; they contain mucus, sometimes blood 
and generally undigested food. Colicky pains fr. 
quently precede or attend the movements, all of which 
are not found in typhoid fever. 



Professor Emeritus of Principles and Practice of Surgery and Clin 
ical Surgery, Ohio Medical University ; Division Surgeon, 
U.P.R.R. Co.: Surgeon U. P. Coal Co.; 
Surgeon-General of Wyoming. 


It has been my privilege during the last twenty years 
to have met with a class of grave abdominal injuries 
which has given little or no external evidences of trat- 
matism. The patient in each instance has -given a his 
tory of a severe injury which resulted in death in from 
24 hours to 26 days after the traumatism. I wil! on) 
report three of these cases in detail, as the others wer 
practically duplicates and to make a full report woul! 
only take up valuable time without special advantage. 

The first of these cases which came to my notice 0 

* Read before the Western Surgical and Gynecological \ssocit 
tion, at Chicago, Dec. 18-19, 1901. Z 


ve I Vemeny 
not mor 
- Lyphosys 
1S do fop. 
{0 eXcit, 
than ye 

SU gest 
of pney. 
in SYmp- 
ND reality 
in chest, 
18, coma 
t absence 
ul exam. 
g, anda 
larity of 
when ty. 
ction: jt 
re 1s not- 
ting 00- 

‘al blood 

n. I be. 
lency at 
iS more 
ng chil- 

’d rear. 
the ab- 
life, we 
: of en- 
hey are 
s blood 
1s fre- 


nd Clin 

a his 
- were 

ee O- 


May 17, 1902. 

curred about fifteen years ago, in an unusually large, 
healthy man of some 36 years of age, who had charge of 
a planing mill in Crestline, Ohio. At the time the acci- 
dent occurred, he was engaged in sawing palings with a 
puzz-saw. These palings were about three feet in length, 
ome two inches wide and one inch thick. In some man- 
yer one of them caught in the buzz-saw, and was thrown 
forcibly endwise, a distance of some six feet, striking 
him very foreibly over the left hypochondriac region. 
Whilst the injury caused some pain, he continued his 
york for a short time, when he became sick and was 
taken to his home. ‘T'wo of the local physicians were 
called in to see him, and being unable to find any ex- 
ternal signs of injury, further than the mark made by 
the end of the paling, which had simply reddened the 
skin for a distance of two inches in one direction and one 
inch in the other, they were of the opinion that he was 
simply suffering from shock and that he would soon re- 
cover. On the contrary, he continued to grow worse ; 
the abdomen became tympanitic and grave symptoms 
made their appearance. . I was called in counsel, and, 
after examining the case carefully, gave it as my opin- 
ion that there was a rupture of the intestine and advised 
operation. There being no hospital at our command 
and not even trained nurses, he was operated on at his 
home with the assistance of the local physicians. On 
opening the abdominal cavity, I found the abdominal 
parietes perfectly intact. Not the slightest ecchymosis 
or the slightest tear of the muscles of the abdominal 
walls could be found. On entering the abdomen, I found 
a large tear of the ileum, located immediately under the 
point of contact made by the paling. This tear was of a 
triangular nature, and was sufficientlv large to enable 
me to pass my finger into the intestine through this open- 
ing without difficulty. The abdominal cavity was filled 
with fecal matter. Acute general peritonitis had set in, 
and although the abdominal cavity was washed out care- 
fully and the injured intestine sutured with silk, the 
patient died in three days after the operation, about six 
days after the injury. It seemed to me at the time 
remarkable that a traumatism of this character should 
produce such a grave injury of the intestine without in- 
jury to the abdominal walls, further than a little redden- 
ing of the skin. 

A few years later, I saw in counsel two cases similar 
to the one above described. One was kicked by a horse 
and the other, while running at night, ran against the 
end of a rail. In each instance there was no injury to 
the abdominal walls, but a tear of the stomach in one 
case and of the large intestine in the other, produced 
death a few hours after the accident. I regret that I 
have not all of the details of these two cases at my com- 
mand, yet at the same time they are so nearly like the 
one already described that it would add but little to our 
fund of knowledge if we were able to give the full de- 
tails of them. 

On Sept. 21, 1901, a Bohemian miner, aged 45, was 
caught by falling rock, producing a contusion of the 
back and hips, extending to both thighs, without frac- 
ture of the pelvis. He was brought immediately after 
the injury to the Wyoming General Hospital, which was 
less than two miles from where the accident occurred, 
an’ was admitted to the same as Case No. 1816. 
He suffered severely from shock, which was complicated 
by vomiting and epistaxis. but beyond this, no hemor- 
thage occurred. The ordinary line of treatment was fol- 
lowed, such as morphin and strychnin for the shock, with 
warm local applications over the contused parts. He 



never rallied from the shock and died in about 24 hours 
after the accident. A postmortem, held 12 hours after 
death, revealed two perforations of the small intestine, 
located about six inches above the ileo-cecal valve, whieh 
were followed by peritonitis, the result of infection from 
the fecal extravasation. A careful examination failed to 
find any material injury to the abdominal walls, not 
even a tear of the parietal peritoneum, and no solution 
of-continuity of any of the muscular layers of the ab- 
dominal walls. In fact, the injury had not produced 
any marked ecchymosis, and the physical signs usually 
present in severe injuries were conspicuously absent. 

A similar case to the one I have just described was ad- 
mitted to the Wyoming General Hospital, Nov. 20, 1901, 
as Case No. 1895. This man was an American, aged 
30; occupation, a driver in the Union Pacific Coal Com- 
pany mine at Spring Valley, Wyo., and was injured 
Nov. 15, 1901. While driving the cars, he was caught 

‘in some way between the “ribs” of the mine and car, 

sustaining a contusion on the left side and back, with a 
fracture of the pelvis on the left side, along the ileo- 
ischial juncture. There was no evidence of displacement 
of the fragments, but in certain positions, crepitus could 
be readily elicited. The symptoms were so negative at 
first, that the very competent assistant surgeon, Dr. 
Levers, was led to believe that the injuries were of a 
trivial character. During the first four days follow- 
ing the injury, the patient’s pulse, temperature and res- 
piration was normal. Following the administration of 
small doses of magnesium sulphate, he had thorough 
evacuation of the bowels. Notwithstanding the fracture 
of the pelvis, this man was able to be up and stood on 
his feet and walked some on the third day following the 
injury. On the morning of the fifth day. his condition 
suddenly grew worse, pulse increased to 120 and tem- 
perature decreased to 97. The abdomen became dis- 
tended, was dull on percussion over the left side and the 
patient became delirious, in which condition he reached 
the Wyoming General Hospital, on November 20, five 
days after the accident. ; 

The general appearance of this case when he reached 
the hospital was such as to impress one with the fact 
of the existence of a rupture of the intestine, with local- 
ized peritonitis, except for the fact that his bowels moved 
regularly, which could hardly be expected in case of a 
rupture, with either general or local peritonitis. His 
delirium continued for four or five days after his admis- 
sion to the hospital, when it began to subside, and his 
temperature, which had ranged from 98 to 103.5, sub- 
sided to normal, although the dulness over the left 
hypochondriac region continued. This, however. began 
to subside, until the resonance on the left side of the 
abdomen approached nearly to the normal, which led me 
to the conclusion that we had had a hematoma to contend 
with, which in my judgment was located between the 
layers of the muscles of the left side of the abdémen. 
About December 3 the patient became worse. The area: 
of dulness suddenly became much larger and very 
marked. His temperature ranged from 97 to 103.5 F., 
and an operation seemed to be imperative. I operated 
on this case on December 6, making an incision in the 
left iliac region. I dissected carefully through the differ- 
ent layers of muscles, and to my surprise, found them 
intact, and no hematoma. On passing through the last 
layer, I found a large cavity, filled with blood, broken- 
down blood clots, and serum. This cavity contained 
about a gallon of this liquid. After washing the cavity 
out thoroughly, I found that the peritoneum had been 

Pepe ee 


icrn loose from the walls of the abdomen from a point - 

midway down the pelvis to the diaphragm, and from 
the rectus muscle anteriorly to the vertebra posteriorly. 
The left kidney had been displaced and was apparently 
floating, and the entire descending colon, together with 
the balance of the abdominal viscera which should oc- 
cupy the left side, were pushed over to nearly the me- 
dian line, and were enveloped in a sack of loose peri- 
toneum. There was not the slightest evidence of peri- 
tonitis, the bowels being flat. and apparently showing 
no signs of irritation. 

There being considerable hemorrhage in the form of 
capillary oozing, I carried a second incision at right 
angles with the first, for the purpose of drainage, cutting 
through the abdominal muscles, to the outer border of 
the lumbar muscles. After thoroughly cleansing this 
cavity, I drenched the parts.with hydrogen peroxid, after 
which it was packed with a large quantity of gauze 
soaked in warm bichlorid evaporating solution. The 
patient, although weak and exhausted before the opera- 
tion, rallied from it very nicely. 

The day following the operation he seemed to be semi- 
conscious, which seemed to be the result of exhaustion, 
us there was no evidence of inflammatory trouble, and 
little or no rise of temperature. There was no effort at 
repair, and whilst the wound remained perfectly clean, 
there was a peculiar ammoniacal odor connected with 
it, although there was no evidence of escape of urine into 
ihe wound from either the kidney, ureter or bladder; 
this condition, to my mind, indicated molecular dissolu- 
tion. There was incontinence of urine, and whilst the 
patient took considerable nourishment, which apparently 
seemed to digest, yet he gradually sank and died on De- 
cember 11. just five days after the operation and twenty- 
seven days after the accident. 


We have had here a series of injuries in which there 
were grave abdominal injuries without corresponding 
external evidences of traumatism, yet the result in each 
case was fatal. In four of the cases reported, we have 
had rupture of some part of the alimentary canal, fol- 
lowed by death. What are the lessons we are to learn 
from these grave accidents? Could the lives of these 
patients have been saved through operative interference ? 

In the first case, in which the patient was struck by a 
paling. I firmly believe that if operative interference 
had been resorted to immediately after the accident, thar 
the patient would have survived the injury. In the case 
of rupture of the stomach, there was such general in- 
fection of the entire abdominal cavity, as shown by 
the postmortem, such rapid collapse, that I question 
whether it would have been possible to have saved the 
life of this patient unless the surgeon had been actually 
on the ground at the time, and made immediate opera- 
tion. It must be remembered, as in this case, that these 
accidents frequently occur miles from surgical aid, and 
by the time the surgeon reaches the patient the time for 
active interference has past. 

This applies to the third case, in which the patient 
ran violently against the end of a rail, producing rupture 
of the intestine, but as the patient was past all hope of 
recovery when seen by the writer, and no postmortem was 
permitted, it is only conjecture as to the real injury 
produced. At all events, operative interference would 
have failed in this case by the time it was possible for 
a surgeon to reach him. 

In the Bohemian miner, the question of immediate op- 
erative interference might well be considered. This man 


Jour. \. Mo 4 

was in the hospital in less than three hours from jj, 
time the accident occurred. The question o! operatip, 
intervention came up, but inasmuch as the patient poy 
rallied from shock, I do not consider it good surgery s, 
undertake an abdominal operation without any know), 
edge of where the injury might be located, with a puly. 
less patient, suffering from extreme shock, from which 
he never rallied. Had I seen the slightest sign of rally. 
ing, I would have operated on him at once. 

This, of course, brings up the mooted question of 
operating in shock, and although I have for many yeax 
advocated major amputations under shock, and_ hay 
made many such amputations under such circumstance 
where the patient has rallied after the removal of , 
mangled limb, which I doubt ever would have rallio) 
without its removal, I was skeptical in this case, Ip 
abdominal operations where there is severe shock, } 
seems to me that there is a different condition of affairs 
to contend with. and it is a question in my mind whether 
operative interference for grave abdominal injuries, wit) 
the patient suffering from the severest form of shock. js 
advisable, or would result in benefit to the patient except 
in hemorrhage. | 

The last case is a peculiar one, and brings up the 
question of operations for hematoma. 
not to operate for hematoma as long as there is reason- 
able hope that they are being absorbed. I see many acc- 
dents every year in which there are severe hematoma b- 
cated between the muscles, which are rapidly absorbed, 
and the patient gets well with little or no difficulty. O¢- 
casionally we have hematoma that do not absorb, which 
I consider proper cases for operative interference, and 
would treat such cases the same as I would a pocket of 
pus: evacuate and drain thoroughly. We admit, in these 
days of antiseptic and aseptic surgery. that incision into 
muscular tissue with evacuation of collections of blood, 
ought not to be followed by infection, but notwithstand- 
ing all the precautions the surgeon may resort to, these 
patients are liable to become infected. I seldom make 
compound of ‘simple or open of closed wounds when it 
can be avoided, and particularly so where nature is in- 
clined to take care of the extravasation by the natural 
channels of absorption. This is particularly true when 
we have different nationalities to deal with who do not 
readily understand or thoroughly comprehend the Eng- 
lish language and are liable to unintentionally disregard 
the surgeon’s instructions. 


From reading the literature of this class of cases, t0- 
gether with my own experience, I am led to the conclu- 
sion that it is the surgeon’s duty to make an exploratory 
incision in all cases where there is grave doubt as to the 
real nature of the injury, and particularly so when the 
constitutional symptoms point to a condition more ser'- 
ous than is indicated by either the subjective or o}- 
jective symptoms, provided the physical condition of the 
patient is such as to warrant an operative procedure. 

Glinical Report. 

D. GEIB, M.D.. ann J. D. JONES, M.D. 

This case, reported to the South Dakota State Medica! Sv 
ciety, June, 1900, and to the Aberdeen District Medica! So 
ciety, June, 1901, by Dr. D. Geib, was further described in 4 
communication to the Aberdeen District Medical Society. 
September, 1901, by Dr. J. D. Jones and concluded by report 

It is my custom 


of t 
by } 



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May 17, 1902. 

to time of death, January 8, 1902, with autopsy, 
Geib and J. D. Jones. 

ut, Mr, K., having enjoyed good health previous to 
\1, began at that time to be constipated and was 
three months by Dr. Nicholas Senn, then of Dodge 
County, \Visconsin, no bowel movement being secured. The 
nly result of cathartics and laxatives was severe pain. The 
* stipation continued until death. It was a common occur 
= for him to go three weeks or as many months without 
, movement of the bowels. At the age of 20 he did not have 
4 movement for three or four months at a time. He con 
auited a homeopathic physician, who prescribed for him two 
drops of croton oil, to be doubled in two hours, tripled in four 
and quadrupled in six hours. This produced no result 

of the car 
by Drs. D. 

The pal It 
the age ©! 
treated fo! 


put after a period of several weeks, his bowels moved again. 

For seven years following, his bowels were fairly regular. 
\t the age of 29 he contracted a severe cold and five months 
and three days passed without an evacuation. After a few 
months of regularity, his bowels did not move for six months 
and fourteen days. 
st. Paul, without immediate benefit, but during the next six 
vears his bowels were regular. In February, 1900, the consti- 
pation returned. The patient had no movement from June 18, 
1900, to June 21, 1901. 

During these periods of costiveness he could eat full meals 
and do a good day’s work. His respiration was always nor- 

mal; the urine was normal when he was free from pain, but 

The colon of Mr. K. 

highly colored when in pain. The evacuation of his bowels 
made him very weak and he was greatly troubled with gas so 
that he had to lie on his right side to relieve himself and was 
partially disabled for work. 

His abdomen was greatly distended so that the liver 
the stomach erowded up the diaphragm and the floating 
were visibly pushed out. There was tenderness in the 
moid flexure, but over the remainder of the abdomen he could 
bear heavy pressure. 

He was not troubled with gas when regular. The admin- 
istration of valerian, sumbul and asafetida by Dr. Geib gave 
him considerable relief. ; 

On June 19, 1901, Dr. Jones was called in with Dr. Geib to 
relieve the patient from his painful condition. The abdomen 
was greatly distended. ‘The colon, on palpation, seemed to be 
as large as a six-inch stovepipe. From the head of the sig- 
moid ilexure to the rectum, the bowel seemed to be perfectly 
straight and hard. On digital examination the rectum was 
found filled with a mass of fecal matter so hard that no im- 
pression could be made on it. The anus was dilated and the 
mass removed from the rectum with a bone curette and hot 
water. Further operation was postponed because of the pain 
suffered by the patient, and olive oil enemas were ordered. 

June 21, on further attempt to evacuate the bowels,. it was 
found that the olive oil had softened the hard mass so that 




At this time he consulted Dr. Stamm of - 


about two pounds of the feces could be removed before the pa- 
tient complained of pain; his weakened condition prevented 
further operation. The circumference of the patient at this 
time at the ensiform cartilage was 39 in., at the umbilicus, 
38.5 in., and at the crest of the ileum, 39 in. 

On arrival at the house on the morning of June the 
report was received that he had passed an ordinary pailful of 
feces since the day previous. There was much rejoicing in the 
family. The patient was very weak and sore, so no further 
operation was attempted at this time, but the olive oil enemas 
were ordered continued. 

The patient, when next seen, on June 25, was feeling com- 
fortakle; the gas had ceased to trouble him and he had passed 
about three quarts of feces that morning. His measurements 
at this date were, at the ensiform cartilage 34 in., umbilicus 
33 in., and at the crest of ileum 30 in. 

The enemas were ordered continued. Mr. K. estimated that 
he had passed about eight gallons of feces since the beginning 
of the treatment. On June 29, he was cheerful and pleased at 
his progress. The measurements at the ensiform cartilage 
were 34 in., umbilicus 30 in., crest of ileum 29 in. From that 



-date he received massage treatment given by Dr. Geib, twice 

a week for three weeks, and improved in strength so that he 
was able to ride to town and walk about. One July 8, after 
his massage, he suffered considerable pain for about three days. 

His bowels moved frequently. The contents were described 
as resembling soft soap and during this period of discomfort he 
passed a hard mass about the size of a duck’s egg, containing 


grape seeds. He had not eaten grapes since the fall before. 
After this he had little trouble and gained in strength and 

weight. The only treatment then given was massage, iron and 

The history of the case subsequent to the above report to the 
Aberdeen District Medical Society is as follows: Since the 
treatment in June, 1901, the moved regularly; 
occasionally he was obliged to take an enema, but he was well 
nourished and weighed more than he had for years. He was 
very sensitive to cold this winter, chilling on the least ex- 


On the second day before his death, which occurred Jan. 8, 
1902, he rode to town, a distance of eight miles. He retired 
at 1l p. m. apparently as well as usual, and awoke about 5 
a.m. with pain. He arose about 8 a. m., built the fires and 
did part of his morning’s work. The pain, however, became 
very intense and he went to the house and suffered more or 
less all day. There was a great desire to evacuate the bowels, 
but it was impossible. At 2 o'clock the following morning, he 
died while sitting on the stool. No medical aid was called. 

The autopsy showed the abdomen greatly distended with gas 
and fecal matter. On making an incision along the linea alba, 
the tension was sufficient to tear the flesh apart; the omentum 
was very thin and the colon was brought at once into view. 
The position of the colon was as shown in the photograph, 
save that the extra loop overlaid the normal colon. The splenic 
flexure, transverse colon and descending portion of the extra 
loop were very much thickened, containing much more muscu 
lar fiber than normal. The parts most distended were the 
splenic flexure, the transverse and the descending portion of 
the extra loop, but the whole colon was much larger than 

The most distended portion measured 1914 inches in circuin- 

ference. ‘The rectum contained a hard mass of feces shaped 
like a goose egg, measuring about 4 inches in the shoriest 
diameter and 6 in its longest. This was pressed tightly 

against the sphincter and acted as a valve. The remaining 
portion of the colon contained soft feces; the total contents 
were an ordinary bucke‘ful. The stomach and small intestines 
were empty. The diaphragm was crowded up to the level of 
the fourth rib on the right side; the heart and lungs were 
both displaced. 

Iodoform Odor.—Oil of turpentine is suggested for the re- 
moval of the odor of iodoform. It is.claimed that it at once 
removes the objectionable smell from the hands or implements. 
—Med. Fortnightly. 



61 Market Street : : 

Cable Address: 

‘“* Medic, Chicago”’ 

Subscription price: Five dollars per annum in advance 

SATURDAY, MAY 17, 1902. 



During recent vears glycerinated vaccine lymph has 
come into general use and the results obtained with it 
have been so favorable that the older method has been al- 
most entirely discarded. Some doubt has recently beén 
thrown on the relative value and advantages of dried 
and glycerinated lymph, and it is well to bear certain 
It has 
been shown that the vaccine material as it comes from 
the animal, be it pulp or exuding serum, is practically 

facts in mind in arriving at any conclusions. 

never free from bacteria. These bacteria are often non- 
pathogenic, but in some instances infectious organisms 
are present, especially pyogenic bacteria. If the ivmph 
is stored in a moist condition without the addition of 
preservatives, the bacteria originally present rapidly 
multiply to an enormous extent and destroy the virus. 
If the lymph is dried upon ivory points in the usual 
manner, it does not part with all its moisture at once, 
and it is not unlikely that the bacteria in the lymph may 
multiply for a time. The numerous bacteriologic exam- 
inations of ivory points would seem to indicate that 
such is the case, as the points when they reach the mar- 
ket usually contain a very large number of bacteria. 
Rosenau’ found an average of 4807 bacteria per point 
upon 41 dry points examined. Copeman, in 1891, de- 
vised the method of mixing the pulp or serum with pure, 
He found that if this were done the 
bacteria in the lymph gradually died, while the vaccinal 

sterile glycerin. 

organisms survived for a considerable length of time. 
The observations have been subsequently verified by 
numerous observers so that there is no doubt of their 
accuracy. The time required for glycerinated virus 
to become sterile is from two to four weeks and if the 
initial number of bacteria in the lymph is very large it 
may require a longer time or perhaps it may never occur. 
Rosenau examined 51 tubes and capsules of glycerinated 
virus. purchased in the open market, and found an 
average of 2865 bacteria per vaccine. It is hardly neces- 
sary to say that such a number of bacteria should not be 
present. Rosenau believes the impurities found in gly- 
cerinated lymph upon the market are largely due to 
over-confidence in the germicidal value of glycerin, oper- 
ators becoming careless of contamination and trusting to 
the glycerin to purify their product. He also thinks 
that some of the glycerinated virus on the market is 

“oreen,” not having been kept a sufficient length of 

1. American Medicine, April 19, 1902, p. 637. 


Jour. A. M4 

From his studies Rosenay cq, 
cludes that we ought not to discredit glycerinated yin, 
the superiority of which he considers demonstrated, be 
he condemns the practice of manufacturers who place 
an unripe product on the market. The general Opinic 
of persons competent to judge is that 

lymph is superior to the dried form. 

In an editorial in the New York Medical Journa| 
Sept. 21, 1901, thoroughly desiccated lymph is high} 
advocated. The writer refers to some observations mai 
by the late J. H. Kidder, who subjected ordinary driej 
vaccine slips to several days’ additional desiccation }y 
exposure in hermetically sealed receptacles to the pres. 
ence of strong sulphuric acid or anhydrous calciny 
chlorid. Such slips were then sealed in a piece of rubber 
tubing and kept at 98 degrees for a month, when they 
were as potent as fresh lymph. Slips prepared in this 
way were sent as far as Japan and upon their retum 
In discussing the papers upon 
vaccination read before the New York Academy of Mei- 
icine (New York Medical Record, March 8. 1902), Dr 
Frank P. Foster stated that such desiccated lymph would 
keep for 7 or 8 months. It is very desirable that further 

time before it is sold. 


gly cerinated 

were found unimpaired. 

‘observations be made with thoroughly desiccated lymph 

and that the fate of the bacteria contained in such lymph 
be determined. This method is similar to that devised 
bv Reissner and formerly much employed with good 
results. The lymph was dried over sulphuric acid and 
reduced to a powder. The desiccation effectually pre- 
vented the growth of bacteria. 

In view of the results of Rosenau’s examinations, it 
is apparent that some measures are required to protect 
the public from improperly prepared vaccine virus. The 
lvmph or pulp, before glycerin is added to it, should be 
so collected and protected from contamination that it 
will contain a minimal number of bacteria.- After be- 
ing mixed with glycerin it should not be placed on the 
market until bacteriologic examination has shown it to be 
Health authorities, either local or, better, gov- 
ernmental, should inspect the institutions which produce 
vaccine virus, and samples of their product should be 
frequently tested as to their bacterial content. When 
manufacturer’s virus is found contaminated beyond what 


is unavoidable, either because of improper preparation 
or from being sold too soon after collection. the facts 
should be announced publicly. Matters which are of 
such vital importance to the health of the people are 
not subjects to be treated carelessly nor only from thi 
viewpoint of commercialism. 


Do medical schools at present supply, as well, at least, 
as they might supply, that psychophysical equipment, 
fitness of brain and hand, to women practitioners which 
they require to prepare them for their professional 
lives ? 

Without going far into the psychophysical nature of 
women as such. it will perhaps be generally granted 


Nau cv le 
ted Virus 
‘ated, but 
"ho Dlace 


/urnal of 
is highly 
Ms made 
TV dried 
ation by 
he pres- 
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ven they 
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of Med. 
2). Dr 
h would 
| lymph 
1 Lymph 
h good 
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ly pre- 

ions, it 
s. The 
ud be 
that it 
ter be- 
on the 
it to be 
r, goy- 
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re of 

Vay 7 1902. 

at women are, on the average, more emotional, more 
ormally unreasoning, more unmechanical, physically 
jaker, yet stronger in svmpathy, than are men. 
jould not these basal characteristics have far 
pore vonsieration in fitting women to practice medi- 

ine than they now have? One of the strongest trends 

yf modern pedagogy is towards the adaptation of study 
» the student. Boys and girls and men and women 

» the most successful schools no longer are treated as 
yutomata to be mechanically crammed with routine facts 
»nd systems of knowledge,-but they receive the considera- 
ion really due to individuals, each of whom is unique. 
How much greater is the rational demand that the needs 
if a sex be met! 

On the basis of the above-noted secondary sexual char- 
cteristies, it seems obvious that womanly women are ill 
hdapted to be, for example, surgeons. Some things more 
than knowledge, experience, and a delicate touch are 
Jemanded of a surgeon. and some of these things 
womanly women, as compared with men, seem to lack. 
Minor surgery and ‘minor gynecology are much more 
within the feminine sphere. Could not the average 
course for women medical students, with much benefit, 
both theoretical and practical, be better adapted in this 
respect ? 

Obstetrics one thinks of next, and here one wonders al- 
most that the preference of women for male accouchers 
is so strong, a wonder that is lessened only at the thought 

hat women consider in this perhaps the stronger judg- 
went of men and certainly their better advantages in 
most medical centers for obtaining obstetric experience. 
Provided always that she be ready to call upon her pro- 
fessional brother promptly in those ever rarer cases when 
asurgical operation is required, obstetrics is the woman 
medical practitioner’s best future field. Should not the 
medical school give her additional facilities in this direc- 
tion to the exclusion, if need be, of something less well 
adapted to her needs ? 

As general practitioners women seem as_ well-fitted 
waturally as men, although perhaps lacking, relatively 
wain. in that good and quick judgment which many 
‘case and erisis requires. Given that confidence which 
future adapted medical education for the sex will inspire 
aid a woman will be as welcome at a complex critical 
case as a man would be. 

As children’s physicians women should be the supe- 
riors of men, for they surely have an instinctive under- 
standing of child-nature which many men sorely lack. 
Here again the medical curriculum can be adapted to this 
portion of-its patrons, and can thus make women excei, 
‘0 the good of the public and to the schools’ additional 
success : 

In the specialties of the ear, eye and throat women 
shoul be the equals of men naturally. But one looks 
in vain for the eminent female eye or ear surgeon. 
Women naturally have the delicacy of touch which should 

wake them, with adequate training, the equals of their 



professional brothers, provided they had the other neces- 
sary qualifications. Psychology, we know. proves that 
women’s discriminative power and accuracy of move- 
ment are somewhat inferior to those of men. Perhaps 
this demonstrated fact explains all these doubts concern- 
ing feminine surgery of every sort. 

These are but prominent examples of the directions in 
which the medical education of women mav be called, 
from this point of view, defective or at least improvable, 
to-day. Whether in schools solely for women or in co- 
educational colleges, women are at present being taught 
practical branches of medicine to which they are ill- 
adapted, and that at the expense of time and energies 
which might, if better emploved, be made to make 
women more useful both to themselves and to humanity. 

However, the whole question of woman’s place in 
medicine hinges on the fact that when a critical case 
demands independent action and fearless judgment, 
man’s success depends on his wrile courage. which the 
normal woman has not nor is expected: to have. 

Localization of the intellectual functions in a definite 
part of the brain is a conception which though not en- 

‘tirely originated by Gall, the physiologist. was at least 

popularized and made definite through his writings. 
Previously, the seat of the mind or soul had been often 

placed in the heart. diaphragm or pineal gland. The 
general rejection of phrenology carried with it 

most of the belief in definite localization of the mental 
rier in thinking it “absurd to speak of a special seat of 

Modern psychologists generally follow Fer- 

intellect or intelligence in the brain,” and Munk who 
asserted that “intelligence has its seat everywhere in the 
cerebrum and nowhere in particular.” Interest in the 
question has declined, especially since researches by phy- 
siologists have accomplished little except to throw them 
into dispute on the subject. Wundt, perhaps the fore- 
most of physiologic psychologists, acknowledges,’ how- 
ever, the suggestiveness of certain anatomic findings and 
pathologic sequences in the cortical areas of the frontal 
lobe, but thinks localization of the intellectual activities 
in that region needs better backing through more direct 
evidences and through the clearing up of certain con- 
tradictory findings in cases of injury and disease. 
Fulfilling Wundt’s requirements by proofs which 
pathology more adequately than physiology can present, 
Phelps, who has had a large experience with brain in- 
iuries, recently publishes* his discovery that the center 
for control of the mental faculties is in the left pre- 
frontal lobe. Bearing directly or indirectly on this 
question Phelps has observed 800 cases of intracranial 
traumatism, of which more than 300 were either sub- 
jected to operation or postmortem inspection. Of these, 
48 were lesions in the frontal lobes verified by necropsy. 

1. Outlines of Psychology, p. 206. 
2. Amer. Jour. of Medical Sciences, April, May, 1902. 


For his study Phelps has also collected 51 other cases 
of injury to the left frontal lobe where report of intel- 
lectual condition has been given, besides including the 
facts in hundreds of other cases which have indirect re- 
From this mass of data Phelps 
draws the following conclusions : 

1. The more absolutely the lesion is limited to the left pre- 
frontal lobe, the more positive and distinctive are the symp- 
toms of mental default. 2. The integrity of the mental facul- 
ties remains unimpaired in right frontal lesion, though it in- 
volves the destruction of the entire lobe or even extends to the 
entire hemisphere. 3. The exceptional instances in which 
seemingly opposite conditions exist are always reconcilable, on 
more careful examination, with the assertion of an exclusive 
control of the mental faculties residing in the prefrontal region 
of the left side. 

lation to the problem. 

Cases may possibly arise, although Phelps has seen 
none, which can not be explained except by taking into 
account the fact that the right side of the brain, as in 
the well-known occasional existence on the right side of 
the speech center in leftthanded people, may take up the 
function of the opposite side. , 

The tracing of any direct relationship between mind 
and body is a subject of large human interest. The 
work of Phelps is a splendid contribution to our knowl- 
edge, and outside of its medical value which is, of course, 
comparatively limited, marks an important step for the 
progress of physiology and psychology. It must be at 
once acknowledged, however, that the facts give no 
clue to the nature of mental processes. There is not the 
slightest bridging of the chasm between neural activity 
and mental states. There is still no answer to the ques- 
tion of where thinking is done, since there is no evi- 
dence whether this left prefrontal lobe is the center 
for direct control of mental phenomena, for mental co- 
ordination, or for mental inhibition. The point is one of 
brain topography rather than of pure psychology, and to 
quote Phelps, “if the same nature and degree of proof 
which is deemed sufficient for the localization of -other 

- cerebral functions may be accepted in the case of the 

mental faculties, their center of control has been estab- 


The physician probably meets with no more unex- 
pected surprises in ordinary practice than those which 
come from the renewal of his prescriptions. Some com- 
bination of drugs that he meant should meet a temporary 
indication and against whose prolonged use—if such 
a possibility had occurred to him—he would himself have 
been the first to protest, he finds at times has been used 
for long periods, perhaps even months. Fortunately, 
‘the human system, as a rule, soon accommodates itself 
to most ordinary drugs and accomplishes its work in 
spite of the disturbing element. 

Occasionally a prescribed remedy becomes a sort of 
fetish with the patient, who is sure that he, or more 
eften she, would not be well without it. Perhaps too. 
friends are persuaded to use the remedy for indications 


Jour. \. A 

uiterly foreign to the conditions for which 1 
prescriber wrote. 

If the renewal of prescriptions were always as harp 
less in its effects as we have thus suggested, it mio}; 


seem idle to protest against it, but it is needless to ¢y 
that there are many prescriptions that may do yy¢h 
harm if their use is prolonged. Pills containing tities 
of silver, for instance, may be indicated for the relief « 
They have be na ‘Te 
vorite remedy of many of the older practitioners apj 
their use is not infrequent at the present moment. Thijs 
is just the sort of prescription that a patient may haye 
renewed almost ad infinitum, for, after the severer symp- 
toms of dyspepsia disappear, there will nearly always 
remain sufficient real or imaginary gastric disturbance t 
require remedial treatment—at least in the patients 
mind. Besides, there is an ineradicable tendency jy 
non-medical people to believe that what has done them 
good once will surely do good again, and the thought js 
sure to be entertained that a remedy which benefits may 
also act as a prophylactic. Several cases of argyria from 
the prolonged use of silver nitrate in no larger dose thay 
one-fourth grain t.i.d.. have been reported. 

long-standing gastric distress. 

Arsenic }s 
another remedy whose cumulative effects may in sus. 
ceptible individuals make themselves manifest after pro- 
longed use of even small doses. The temptation to have 
prescriptions containing the drug renewed indefinite) 
comes very easily because arsenic has to be used for long 
periods to produce the desired effect. 

If the personal inconvenience, or sometimes even seri 
ous disturbance, of the original patient were the only 
thing to be considered in this question of the renewal 
of prescriptions without a physician’s advice, the stat 
of affairs could not be nearly so bad as it actually is 
Practically every one, not a physician, feels justified 
in recommending remedies to friends who seem to them 
to be suffering from an ailment like their own. Diag- 
nosis is the most difficult thing in modern medicine, 
but for the lay mind there is no hesitation in deciding 
the character and significance of a friend’s symptoms. 
A physician’s reputation may suffer from diagnostic mis 
takes on the part of over-enthusiastic patients who 10- 
sist on persuading acquaintances that the prescription 
that has helped them will surely relieve that friends 
symptoms also. Some years ago a correspondent of the 
London Lancet called attention to an abuse of privileg' 
in this matter that had proved actually detrimental t 
his own reputation. A patient suffering from .speciii 
sore throat with hoarseness as a prominent syiptol 
was treated successfully by the usual specific remedies. 

A friend suffering from tuberculous laryngitis )ecame 
persuaded that the same remedies might be usefu’ !n 5! 
case and took them for several weeks to the seriou~ (et! 

ment, as might be expected, of his general health and. 0! 
course. without any relief of his throat symptoi:. 4 

third person, suffering from recurrent tonsillitis 
a chronic inflammatory condition, also took the 1 

lL SUS- 

IV is. 


tions they would not approve. 
the printed injunction not to refill will not effectually 

human nature to be thus easily gotten rid of. 
will help in the education of the public as to the dan- 
gers that exist in the practice and will act in most cases 
as an effectual deterrent at least of the frequent and 
prolonged repetition of a remedy without further con- 

‘urther resolved to publish similar notices 


May 17, 1902. 

for some time, naturally without any effect except an 
unwarrauted prejudice against the doctor whose remedy 
help him. Such an annoying state of affairs 

did not 
may also develop when an anemic natient, by taking 
yon, is relieved of painful arthritic conditions due to 

jpwered nutrition of the joint structures and persuades 
, individual suffering from subacute 
matism, or an occupation neurosis, to try the same—but 
) this case contra-indicated—remedy. 


nlethoric rheu- 

The existence of an abuse in this matter of prescrip- 
rion renewal is well recognized. Many physicians have 
‘heir preseription blanks printed with the express pro- 
hibition of renewal. This seems an eminently advisable 

ecaution. under the circumstances, and, as far as pos- 
ile, physicians should insist on the observance of the 

junction. It is not often that prescriptions may be re- 
nae without some change in their contents if he 
highest good of the patient is to be consulted. While 
the physician seems to be consulting his own interest 
hy forbidding renewal and thus requiring further calls 
from the patient he is really assuring the best interests 
of the patient and of the community at large. 
entirely too much assumption of medical 
non-medical people. The practical expression of this 
takes the form of lending or passing on prescriptions. 
Physicians must at least secure themselves as far as 

There is 
sapience by 

possible against abuse of their prescriptions under condi- 
The mere insertion of 

revent the present abuse which is too deeply rooted in 
But it 

‘tation of the physician. 


It has repeatedly been remarked in THE JOURNAL 
iat the study of medicine is overdone, especially in this 
ountry. There come to our desk frequent reminders 

foreign medical literature that we do not suffer alone, 

and that we have occasion also to feel for others’ woes. 
A late item in the Allgemeine Medicinische Central- 

eitung is to the point; the local medical association 
Aerztekammer) of Austrian Silesia has published a 
rning to prospective medical students against enter- 
ng upon their studies. It was specially resolved that a 
‘ular should be sent to the heads of the Silesian gym- 

nasia calling attention to an already published appeal of 

Vienna Students’ Association in which the unfavor- 
outlook for the medical profession was shown. It was 
in the pol- 
‘ica, journals and to seek for codperation of other med- 
odies for the same general end. It evidently takes 

“ss to Induce action over there than in this country for 
where they have one physician we have many. 
wer, they are not there multiplying medical colleges 



therwise working to cut their own throats finan- 



cially by increasing their competitors in an already over- 
crowded profession. This is the case here; with a nec- 
essary reservation, that it is the few who profit by ex- 
ploiting the mass of the profession. 


The Department of Agriculture has just issued a neat 
pamphlet entitled “Market Milk; a Plan for Its Improve. 
ment” by Raymond A. Pearson, assistant chief of the 
Dairy Division of the Department. 
in a prefatory statement, viz.. to answer questions as to 
the means of improving the milk supply of committees 
by showing the ideal conditions or rather those that ean 
be prac’ ‘cally realized wherever it is seriously attempted. 
It does more than this, however, it lays down a plan of 
organization of local commissions mainly or entirely of 
physicians who are to educate the dairy men and the 
public as to the requirements of the ideal or model dairy 
product and to endorse the milk supply from such as 
furnish it under the proper conditions. The work of the 
loca! medical societies in New York and Philadelphia 
is noticed and the forms used by the Philadelphia Pe- 
diatric Society and the circular sent out by the New 
York County Medical Society are given in an appendix. 
While the methods proposed would require a revolution 
in the milk trade, they will ultimately have to be followed 
and the general circulation of this pamphlet will prepare 
the way not only by instructing the dairy men but by 
educating the public. There has probable been no more 
important minor publication issued by the Department 
than this one, and it is to be hoped that we shall before 
long see widespread results. 

Its object is given 


Studies with the various serums and anti-serums have 
led to the demonstration that milk, human and other- 
wise, generally contains fibrin ferment. This fact is 
readily demonstrated by adding a drop or so of milk to 
hydrocele fluid, which contains fibrinogen but no fibrin 
ferment, and coagulation results. We owe this observa- 
tion to Moro and Hamburger’: and Bernheim-Kauer.? 
Hydrocele fluid may lose the property of coagulating 
after st: inding for some days and after heating for thirty 
minutes to 55-56 C. The ferments in various milks do 
not react alike to heating, that in cow’s milk not being 
affected by so low temperatures as the ferment in 
woman’s milk. Bernheim-Kauer sought to obtain an 
antibody for the fibrin ferment in human milk by re- 
peated injections of rabbits with milk. and with success. 
3y suitable experiments with this anti-serum he shows 
that the ferment in cow’s milk is not identic with that 
in human milk because the anti-coagulative action of the 
serum of rabbits injected with human milk is limited 
to human milk and does not affect to similar degree the 
ferment in cow’s milk. He finds, further, that normal 
serum contains anti-coagulative substances in small 
quantities. To what extent if any the anti-coagulating 
substances normally present in the blood prevent clot- 
ting during life is as yet wholly conjectural. 
vations referred to are 

i Wien. Kl. 
2. Centralbl. 


The obser- 
interesting as far as they go. 

1902, p. 121. 

1962, xxx, 

f. Bakt., 


No doubt further experiments will give us additional 
information concerning the origin and nature of this 
interesting ferment in milk. 


Several observers have found in the sputum from cases 
with pulmonary lesions, bacilli which are acid-proof 
and which closely resemble the tubercle bacillus on 
superficial examination. A. P. Ohlmacher’ has re- 
ported finding an acid-resisting bacillus, which was at 
first mistaken for .the tubercle bacillus, in the sputum 
from a case exhibiting certain clinical evidences of 
phthisis. He is of the opinion that the organism was 
identical with those described by Fraenkel, Pappenheim 
and Rabinowitsch in association with pulmonary gan- 
grene. lLichtenstein* has also recently presented before 
the Berlin Society of Internal Medicine, a case in the 
sputum of which acid-proof bacilli were found. They 
were first mistaken for tubercle bacilli. The patient had 
had hemoptysis. Herr* has shown that acid-proof bacilli 
are widely distributed, not only upon grass and in cows’ 
dung, but also in the dust from hay and in the soil of 
fields. In ‘view of the fact that these acid-preof bacilli 

are so common in the external world, it would not be- 

surprising if they should sometimes gain entrance to 
sputum or even be inhaled. That they may sometimes 
find favorable conditions for multiplication in the ex- 
udate in diseased Jungs, in bronchial secretions, and 
in sputum is not unlikely. Some of these bacilli stain 
exactly like the tubercle bacillus, and to mistake them for 
the latter is excusable. In examining sputum for tu- 
bercle bacilli these facts are to be remembered, and thus 
something more complicated is introduced into what has 
usually been considered one of the most simple and 
accurate means of diagnosis. 


In a leading article of a Canadian contemporary* on 
“The Canadian Summer” by one Ezra H. Stafford, 
M.D., we find the following remarkable statements ad- 
duced as evidence of the evil climate of the United 
States : 

In the cities of the plains the temperature in July rises for 
many days in succession to 105 and over. During a summer’s 
residence in Nebraska I painfully remember this period of pro- 
tracted heat, which was so great that the brick-paved streets 
exploded with loud detonations, casting the bricks in all direc- 
tions. There was no breeze, and fortunately, for any move- 
ment of the air only served to put in motion the suffocating 
alkaline dust that whitened on the banks of Salt Creek or was 
strewn in hot powder on the shores of Salt Lake. . . . 
In the large cities I have found the conditions quite as dis- 
tressing. New Orleans is more endurable during the summer 
than Chicago, and San Francisco is more pleasant than either; 
but in Boston the humidity of the air renders the heat almost 
insupportable; while the contiguous resorts on the coast confer 
in the long run no more permanent ease than does the moment- 
ary application of cold to a fresh burn. In New York the heat 
seems to bring with it an even greater depth of despair. This 
is partially due to the fact that, in the matter of space, this 
city is architecturally constructed upon the frugal plan of a 
chiffoniere. It is nothing more or less than a huge piece of 
furniture in brick and iron; and serves to indicate the mon- 

. Trans. of the Chicago Pathological Society, Dec. 9, 1901, 33. 
Deut. Med. Woch., Vereins-Beilage, March 13, 1902, 88. 

. Zeitschr. f. Hygiene u. Infektionskrankh., xxxviii, Heft 1. 

. The Canadian Journal of Medicine and Surgery, May. 



Jour. A. M, 4 

strous lengths to which the obsession of American Uti litarianign 
can go. Baltimore and Washington [ also found undesirable 
and here malarial poison is added to the heat. : 
July the Washington shopkeepers, to attract trade, fry eggs by 
breaking the shell and allowing the contents to fall upon the 
heated asphalt of Pennsylvania Avenue.” 

This is not offered as a joke, but seriously, as evidence 
of the conditions existing in the United States, and jy 
published in a medical journal, presumably for the edi. 
cation rather than the amusement of its readers. |} 
the climate of Canada needs the support of such state. 
ments to demonstrate its comparative excellence, it js 
worse than it ought to be. In fact, they give it, to ue 
a common expression, a black eye. The most serious 
consideration, however, is where do the author and the 
editor that publish such Munchausenisms as facts ey. 
pect to go. 


That reddish discoloration of the urine is due to hem. 
oglobin can be determined by spectroscopic examination 
and, if it be a result of hemorrhage, red blood-corpuscles 
will be discoverable microscopically. Hemoglobinuria 
is currently attributed to toxic influences of varied kird, 
but the exact mechanism of its production is not known. 
Hematuria may be secondary to a large number of cor- 
ditions, some obvious, others obscure, and occasionally i 
may occur in the absence of any appreciable lesion. An 
unusual cause for such hemorrhage is described by F. 
Suter’ under the caption of “Unilateral Hematuria du 
to Telangiectasis of the Pelvis of the Kidney.” He re- 
ports the case of a woman, 32 years old, with hereditary 
predisposition to tuberculosis, whose urine, passed with- 
out difficulty, had been turbid and more or less bloody 
for a year and a half. No attention was given to this 
abnormality until the genera! health began to fail and 
the patient became pale and tired readily. On examina- 
tion tenderness was discovered in the situation of the left 
kidney, without increased resistance or tumefaction. 
The urine contained blood, squamous epithelial cells and 
isolated leukocytes, but no renal elements and no tubercle 
bacilli. Cystoscopic examination showed the bladder to 
be normal, but the vesical orifice of the left ureter was 
small and through it bloody urine entered. Tumor or 
tuberculosis of the left kidney was suspected and lumbar 
nephrectomy was successfully performed. The removel 
organ was found entirely normal, but in the pelvis an? 
the adjacent ureter a condition of disseminated miliary 
telangiectasis was found. The condition appears to be 
a rare one—at least not many cases have been reporte( 
and it is not generally referred to in the text-books. [. 
Hurry Fenwick? relates that he has repeatedly observel 
painless unilateral hematuria in young persons without 
the discovery, on nephrotomy and digital exploration 0! 
the pelvis of the kidney, of a cause for the hemorrhage 
He reports two cases in which, when the ‘pelvis of the 
kidney was opened and examination made with a cyst0- 
scope, a condition of telangiectasis of a papilla was 
found. Removal of the affected tissue was followed by 
cessation of the hematuria. 

1. Centralblatt fiir die Krankheiten der Harn- und Sexual-0r 
gane, Rd. xiii, H. 1, p. 26. 
2. British Medical Journal, Feb. 5, 1900. 



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May 17, 1902. 

Medical News. 


The gold medal offered by the State Medical Society of 
\rkansas to the graduate of the State University passing the 
host examination in all branches was awarded to Dr. M. D. Me 
(lain; Drs. J. A. Bogart and K, Kreugar received honorable 

Personal.—Dr. George W. Hayman, Little Rock, has been 
appointed one of the colored commissioners of the World’s Fair 
at St. Louis————Dr. David A, A. Sims, Greenwood, has moved 
to Bonanza. ——Dr. W. W. Jackson has been elected president 
of the Jonesboro Board of Health. 

Commencement.—The twenty-third annual commencement 
exercises of the Medical Department of the State University 
were held at Little: Rock, April 8 The annual address was 

delivered by Rev, Perey J. Robottom; the degrees were con- . 

ferred on a Class of 11 by the governor of the state, and the 
farewell of the faculty was pronounced by Dr. Edwin Bentley. 

Again in the Hands of the Law.—Dr. Morris Hale, Hot 
Springs, Was convicted, on April 16, of sending obscene and 
objectionable matter regarding the Alma (Mich.) Sanatorium, 
of which he was once superintendent, through the United States 
mails, and was sentenced to fifteen months’ imprisonment at 
hard labor in the state penitentiary at Atlanta, Ga. This is 
his second offense. 


Proposed New Laws.—tThe bills proposed by the Medical 
Association of Georgia for passage at the next session of the 
legislature, provide that no prescription shall be refilled, and 
that patent medicines must have all of the constituent elements, 
and respective proportion of each element, distinctly set forth 
on the iabel. 

Personal.—Dr. W. A. Brewster has resigned as superinten- 
dent of the City Hospital, Augusta, and will locate in Valdosta, 
June 1. Dr. Frank E, Williams, ‘Tipton, has entered on his 
duties as interne at Lamar Hospital, Augusta. Dr. M. W. 
Hollinshead, has decided to locate in Newman.——Dr. W. Hal 
Moncrief, Atlanta, has passed his examination for the medical 
department of the Army.——Dr. Benjamin W, Bizzell, Atlanta, 
has been commissioned captain and surgeon of the Fifth In- 
fantry, G, S. T., viee Dr. Edward C. Davis, Atlanta, resigned, 
and Dr. Bernard Wolff, Atlanta, assistant surgeon of the same 
command, vice Dr. J. Dawkins, Cromer, Atlanta, resigned.—— 
Dr. Jaines W, Eberhardt, Hartwell, has moved to Gilmer, Texas. 


Grand Army Mortality.—The report of the medical direc- 
tor of the Illinois department, G. A. R., shows that the deaths 
during 1901 in that department numbered 683, a mortality rate 
for the year of 3 per cent. 

Insane Hospital Maintenance.—The cost of maintaining 
the Bartonville insane hospital is higher with one exception 
than that of any other state institution of its character. The 
average cost of keeping each inmate during the first quarter 
Was $61.74. The best record during the quarter was made at 
the Jacksonville hospital, where the average per capita cost 
Was $31.13. The high per capita cost at Peoria is said to be 
incidental to the opening of the institution. 

Personal.—Dr, John W. Parmely, Anna, has returned to his 

lormer home at Goleonda.—-——Dr, Joseph Perkins, Rardin, has 
moved to Fair Grange.——Dr. Samuel Glasford, Pekin, has 
located in St. Louis———Dr. R, W. Markley, Blackstone, is 
about to move to Elgin.——Dr. Charles R. Bird, Toledo, has 
located in Indianapolis.———Dr. James 8S. Collins, Carlinville, 
sailed for Europe on the “Pretoria,” April 29.——Dr. Emmet 
nos, late chief of staff of the Illinois Eastern Hospital for the 
lusine, Kankakee, has located in Herscher.———Dr, Benjamin 
(, Pinkerton has returned from an eight-months’ stay in Syria 
and Keypt, and will practice in Springfield ——Dr. Charles H. 
Walters, Springfield, has moved to Taos, N. M., where he will 
have charge of the Franklin Placer.—--Dr. Isaac B. Ennis, 
Gilman, has located in Rock Island. 


Personal.——-Dr, J. M. Mitchell has located in Pontiae,—-— 
Dr. Dwight C. Oreutt sailed for England, May 3.——Dr. Martin 
Strand has moved to Chicago Heights——-Dr. Charles E. 
Parker has opened an office in Sterling——Dr. Edwin A. 

Weimar has returned to Pekin to locate-——Dr. D, A. K. Steele 



and wife have returned from a three-months’ trip to Egypt and 

Chicago Surgeon Wounded.—Major Ralph 8S. Porter, 
U. S. V., who was seriously wounded in the battle of Bayan, 
Mindanao, entered the volunteer service as first lieutenant and 
surgeon of the Second Illinois Infantry in 1898. He afterwards 
was appointed first lieutenant and assistant surgeon of the 
Thirty-first U. S. Volunteer Infantry, and later rose to his 
present rank. 

Successor to Dr. Fenger.— Dr. Arthur Dean Bevan has been 
appointed professor of surgery in Rush Medical College to fill 
the position made vacant by the death of Dr. Fenger. Dr. 
Bevan graduated at Rush in 1883. He was an officer in the 
U. S, Marine-Hospital Service from 1883 to 1888, professor of 
anatomy at Rush from 1888 to 1900, and professor of surgical 
anatomy and associate professor of surgery from 1900 to 1902. 

Cook County Interneships.—For the examination for in- 
ternes at Cook County Hospital, held May 1, 13 candidates 
appeared from the University of Iliinois; 30 from the Univer- 
sity of Chicago, and 16 from Northwestern University Medical’ 
School. Of these 16 received appointments—8 from North- 
western, 4 from Rush and 4 from Illinois. The highest mark. 
made by a successful candidate was 421.6; the lowest, 366.2. 
Northwestern men won the highest three marks. 

The Week’s Mortality.—lor the week ended May 10, the 
recorded deaths are 549, 45 more than for the preceding week 
and 78 more than for the corresponding week of 1901. Within 
the past fortnight there has been a marked change in the type 
of all the contagious diseases. Scarlet fever, diphtheria, whoop- 
ing cough and measles are much milder than a year ago; so 
much so that measles, which is epidemic throughout all sections, 
caused only one death last week, whooping vough but three, 
diphtheria five and scarlet fever nine or ten less than the week 

Disinfection.—Through the increase of the force of disin- 
fectors three weeks ago every call for disinfection had been com- 
plied with at the close of the week—the first time in many 
tinonths. This, together with the efforts of the Memorial Inst- 
tute for Infectious Diseases in making increased provision for 
scarlet-fever cases, gives promise that the spread of the con- 
tagious diseases may soon be materially checked. Milder 
weather, by favoring ventilation and sunning of interiors, will 
also do much toward putting an end to their almost unpre- 
cedented prevalence. Advantage should be taken of every 
sunny day, not only in household, where there has, been cop 
tagious illness, but by every housekeeper. 


Iola Hospital Open.-—The physicians in charge of the Iola 
Hospital announce that the institution is now ready to receive 
patients. ‘ 

Does Good by Stealth.—A member of the faculty of Kansas 
Medical College, Topeka, who does not disclose his identity, has. 
furnished the money to put up a $10,000 addition to the cal- 

Personal.—Dr. George Howard Hoxie has opened an office 
in Lawrence.——Dr. Samuel W. Williston, Lawrence, has been 
appointed correspondent for the London Geographical Society. 
-——Dr. Barnard D. Eastman, Topeka, has been elected per- 
manent superintendent of Christ Hospital———Dr. W. Mell- 
wain, Wabaunsee, has located at Lone Wolf, Okla. 

No Chinese Provision in Law.—‘Dr.” Ah Sam of Leaven 
worth and “Dr.” Andrew Wu, of Topeka, Chinese doctors, have 
appealed to the board and to the governor not to molest them. 
Chinese practice medicine differently from Americans, and the 
legislature has made no Chinese provision in its law. The 
board is said to have taken the matter under advisement. 

He Wants a Diploma.—A mandamus suit was filed in the 
Supreme Court, May 7, against the Kansas Medical College by 
J. P. Shelton, a student, asking the court to compel the college 
to issue him a diploma and give the degree of M.D. Shelton 
alleges that he had an understanding with the college whereby 
he should attend for a three months’ term and receive a 
diploma. He says he has done this and has passed a satis- 
factory examination in all branches in the college, but is refused 
the diploma. 

The Law Upheld.—<As the Supreme Court has upheld the 
constitutionality of the medical registration law passed by the 
last legislature, the State Board of Medical Registration an! 
Examination has instructed the secretary to commence prose- 
cutions against all physicians practieing in the state who have 


failed or refused to take out a license to practice. This action 
by the board will effect from 75 to 80 physicians in the state. 
The law says: 

Any person who shall practice medicine or osteopathy in the 
state of Kansas without having received ang had recorded a certifi- 
cate under the provisions of this act shall be deemed guilty of mis- 
demeanor and upon conviction thereof shall pay a fine of not less 
than $50 nor more than $200 for each offense, and in no case 
wherein this act shall have been violated shall any person so vio- 
lating receive compensation for services rendered. It is the duty 
of the secretary of the State Board of Medical Registration and 
Examination to see that this act is enforced. 

Eye and Ear Hospital.—The annual meeting of the Eye, 
Ear, Nose and Throat Hospital, New Orleans, was_ held, 
April 16. During the vear 5098 patients were treated, 1149 

of whom came from outside parishes. The officers were re- 

Cisterns to be Screened.—At a recent meeting of the Or- 
leans Parish Medical Society resolutions were adopted en- 
dorsing the ordinance now pending before the City Council and 
providing for the screening of all cisterns in order to prevent 
the breeding of mosquitoes therein. — 

Alumni Meet.—The annual session of the Alumni Associa- 
tion of the Charity Hespital of Louisiana was held April 29 and 
30. Dr. Lucien F, Salomon lectured before the Association on 
“The Rational Treatment of Typhoid Fever,” and on the follow- 
ing day Dr. Frederick W. Parham spceke on “The Present 
Status of the Reentgen Rays as a Therepeutic Measure.” The 
annual banquet was given at Lamothes, April 30, after the 
business session. 

Tulane Commencement.—The commencement exercises of 
the medical department of Tulane University, New Orleans, 
were held April 30. The annuat address was delivered by 
Robert B. Fulton, LL.D., chancellor of the University of Mis- 
sissippi. President E. A. Alderiman of the University conferred 
dlegrees on a class of fifty. ‘The small number of graduates is 
said to be due to the fact that this is the transition peried 
from the three-vear-course regime to that of the four-year 


Medical Society Banquet.—The fifth annual banquet of the 
Baltimore County Medical Association was held at the Overland 
Hunt Club, Towson, May 14. 

Personal.—Dr. Charles F. Davidsen, Easton, has been re- 
elected a member of the State Examining Board.——Dr,. T. 
Ross Payne has been appointed secretary of the Sanitary Board 
of Baltimore County. The sanitary physicians met for organ- 
ization, May 14. 

Annapolis Emergency Hosp'tal.—A meeting of physicians 
was held, April 30, at the. building recently purchased to be 
used as the Emergency Hospital of Annapolis. Drs. Frank R. 
Smith, Thomas S. Cullen and Joseph C. Bloodgood were elected 
members of the consulting staff, and the physicians of An- 
napolis named as the attending staff. 


At the Johns Hopkins Historical Club, May 12, Dr. Ber- 
nard Sachs ef New York read a paper on “Hindoo Medicine.” 
and Dr. William Osler, exhibited a collection of Jenner’s orig- 
inal publications, which had been bequeathed to him by the late 
Dr. Hunter MeGuire, of Richmond, Va. 

To Complete Endowment.-—A committee of 70 citizens has 
been entrusted with the duty of raising the remainder of the 
endowment required by the Johns Hopkins University ; $800,000 
are in hand, and it is hoped to complete the million by com- 
mencement day, June 10. A system of municipal scholarships 
is proposed and meets with the approval of the mayor. 

The Maryland Medical College commencement was held 
May 13, Capt. Richmond Pearson Hobson, U. 8S. N., being the 
orator. The introductory address was made by Dr. Bernard 
P. Muse, the degrees conferred by Dr. John B. Schwatka, and 
the prizes awarded by Dr. J. Charles Linthicum. There were 39 
graduates. E, F, Peters took the first prize, J. M. Graham 
second, and J. H. Cahoon third. 

Health Wardens Must Marry.—The Minneapolis Tribune 
announces that the health commissioner of Baltimore, who has 
a staff of twenty-four health wardens, has issued the fiat that 
the doctors in his employ must marry. His reason is that the 
department demands the service of steady men, and that a man 
is not apt to settle down to the serious business of life until 
he has a wife to take care of. 


- general hospitals, are given special instruction in the caye 

Jour. A V4 

Personal.—Drs, Edward C. Moriarity and Charl». 7. Blake 

have been appointed resident physicians at the Baltimore 
University Hospital———Dr. Frank O. Miller, a recen; graduate 

of the University of Maryland, has been appointed a resident 
physician of the insane department of Bayview Asylum —_ 
W. C. Gewin was appointed resident physician at the Franklin 
Square Hospital, with F, E. Smith, associate. 

The Baltimore Eye, Ear and Throat Charity Hospita) ». 
ports for the past year 5055 patients applying for tre 
3162 white and 1873 colored. 
over last year. The cases were divided as follows: Eye de 
ment, 3175; ear, 913; throat, 937. The dispensary visi, 
numbered 17,745, about 60 per day. The indoor department 
has been reorganized, and there is now a corps of trained n 
who are always on duty. 

Orgies 3 atment, 
This is an increase of § per cent 



Nurses are obtained from one of { 


This jg 

eye, ear and throat cases, and on the expiration of four mont! 
service, if satisfactory, they receive a certificate. 
effected at but slight additional cost. 

Awarded the Boylston Prize.—Dr. Robert Lee Randolph, 
associate professor of ophthalmology and otology in the Johns 
Hopkins Medical School, has been awarded the Boylston prize 
by Harvard University for his essay entitled “The Rdle of the 
Toxins in Inflammations of the Eye.” The contribution is ey 
perimental in character, and the author has been at work on 
it for the past two years in the pathologic laboratory of the 
University. Among other things the work shows that not only 
do the bacteria themselves produce inflammation when brought 
in contact with the eve, but that their toxins can produce it 
also. Many bacteria, however, have not the power to produc 
these soluble toxins. Dr. Randolph shows that our ideas on 
this subject need revision, and that many bacteria probably 
produce inflammation through the agency of properties which 
previous tests have failed to discover. It is also shown that 
many of the most serious external inflammations of the eye 
are caused not only by the presence of bacteria between the lids 
and eyeball, but that the harmful effects of these bacteria are 
rendered more certain if the individual should rub the eye when 
the infectious material flies into it. The rubbing removes the 
epithelial covering of the eyeball, and thus an entrance is made 
through which the bacteria, which are always present, can enter 
the tissues. For instance, when certain organisms suspended 
in sterile water are droppéd continuously upon the normal eye 
of a rabbit, even for a considerable time, no inflammation re- 
sults, but let a slight wound or abrasion of the eyeball be made 
and inflammation always follows. The practical bearing of 
this discovery is obvious. Eyes into which infectious or irri 
tating substances have entered, should never be rubbed, al 
though the inclination to do this is usually very strong. The 
soyiston prize rarely finds its way out of New England. Dr 
Randolph was awarded the Alvarenga prize by the University 
of Pennsylvania in 1900 for an experimental work on the crys- 
talline lens. He was one of those who received the honorary 
degree of M.A: at the recent jubilee of the Johns Hopkins 


Jewish Hospital Opened.—The new Jewish Hospital! at 
Kansas City was formally opened May 4. 

Dr. Dickerson’s Will.—-The will of the late Dr. D’Estaing 
Dickerson of Kansas City proyides for a bequest to Albany 
Medical College, but leaves the bulk of the estate, which is 
valued at from $700,000 to $1,000,000, to his widow, who is 
appointed executrix without bond. } 

More Honors for Dr. Gregory.—At the commencement ¢x 
ercises of the medical department of Washington University, 
St. Louis, May 8, the faculty of the institution presented Dr. 
Elisha H. Gregory with a portrait of himself and a loving “up, 
the presentation being made by Dr. Norman B. Carson. 

Marion-Sims-Beaumont Graduation.—The graduating ex 
ercises of this medical college were held in St. Louis, May ! 
Degrees were conferred on a class of 91 by Dr. Young H. bond, 
president of the college; Hon. George Tansey delivered the 
address and Dr. William G. Moore presented class honors. 


Hospital Dedicated.—St. John’s Hospital, Helena, was vetll: 
cated with appropriate ceremonies by Bishop Brondel, Apri! |. 
Buys Sanatorium.—Dr, James F, Blair, Butte, has pur 

chased the Foster Sanatorium at Butte for $25,000 and will 
take possession about May 25, 


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¢ Timber.—-A fire, on April 20, in the office of Dr. 
\foore, Big Timber, destroyed papers and instru- 
| at several hundred dollars. 

The “Spotted Fever” Epidemic.—The epidemic of cerebro- 
a] meningitis in Bitter Root Valley has caused 8 deaths 
puring the last week and the state health officials are reported 
_ peng seriously alarmed over the condition. A conference 
as held at Hamilton, May 1, between Dr. William P. Mills, 
finvula ; (ommissioner J. A. Ferguson of the State Bureau 
; Agriculture, and the officials and physicians of Ravelli 
atv. relative to the adoption of measures to suppress the 

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Gift to Hospital.—The children and grandchildren of the 
Mate Edward Joslin of Keene have presented $12,000 to the 
yliott City Hospital for the construction of a nurses’ building, 
a je known as the Edward Joslin Home for Nurses. 

Imprisonment for “Greek Doctor.”—A. G. Zervondacki, in- 
jicted for practicing medicine without a license in Summer- 
worth, has been tried at Dover, found guilty and sentenced to be 
imprisoned for three months and to pay the costs of prosecu- 

School of Instruction for Health Officers.—Under the 
auspices of the State Board of Health and the New Hampshire 
\sociation of Boards of Health a sanitary conference and 
~hool of instruetion for health officers was held at the State 


House, Concord, April 29 and 30 and May 1. 

Sanatorium for Tuberculosis.—The New Hampshire Sur- 
vical Club, at its semi-annual meeting in Manchester, March 26, 
adopted the following resolutions: 

Wuereas, The experience of the past years in the treatment of 
pulmonary tuberculosis at special institutions known as sanatoria, 
has resulted in the cure or the arrest of a very large majority of 
the cases received, and, 

Wuerras, Means should be provided whereby persons financially 
unable may receive the benefits of such treatment, therefore, be it 

Resolved, That the New Hampshire Surgical Club recommends to 
the Legislature of 1903 a candid consideration of this subject, with 
the view to the establishment of a state sanatorium for the treat- 
ment of consumption. 


Bequest to Nyack Hospital.—By the will of the late Dr. 
Charles H, Masten, of Nyack, about $20,000 is bequeathed to 
the Nyack Hospital. 

Albany Hospital Internes.-—As the result of a competitive 
examination, held May 2, Drs. Willis G. Merriman, Jr., John 
Gutmann, Jr., and M, Joseph Mandelbaum have received ap- 
ointments as internes at the Albany Hospital. 

Hospital Must Pay Duty.—The United States general ap- 
praisers have handed down a decision which holds that the 
Albany Hospital must pay duty amounting to $110 on the 
sirgical instruments imported for use in the hospital by Dr. 
Macdonald in August, 1901. 

Albany Medical College held its seventy-first annual com- 
mencement, May 6. Andrew Van Vranken Raymond, chan- 
cellor of Union University, conferred degrees on a class of 26. 
Dr. Samuel B. Ward announced the awards of prizes and ap- 
potments, and Hon. Nathan L, Miller, Comptroller of the 
State, delivered the annual address. 

New Yerk City. 

Addition to Long Island College Hospital.—Henry W. 
Maxwell has purchased for the Long Island College Hospital 
property adjoining the hospital on which a dormitory, costing 
60,000, will be built for the use of the nurses of the hospital. 

Water Ambulance Launched.-—An electric launch specially 
constructed for the St. John’s Guild floating hospitals for use 
between the floating hospitals and the Seaside Hospital at New 
Dorp, S. L., was launched, May 2. The launch has been built 
io the order of Mr. Isaac N, Seligman, who presented it to St. 
J Guild. 

Hospital’s Change of Name.—The name of the Colored 
Home and Hospital has been changed to the “sincoln Home and 
Hospital.” It has been designated as an ambutance station 
by the city authorities. The ambulance service will be amply 
provided for in the emergency ward. White and colored people 
lave always been treated alike in the hospital. 

Avoidance of Extra-Medical Publicity.—Drs. William 5S. 
Gottheil and Milton W. Franklin desire us to publish a dis- 
claimer of their responsibility for a postal card sent to the 
medical profession by an electrical firm and an article in a New 
York daily regarding the transmission of light through the 

ohn s 


human body, in which their names were mentioned without 
their consent. 

Land for Columbia.—-A number of the friends of Columbia 
University, who are desirous that the university shall acquire 
the two blocks of land south of One Hundred and Sixteenth 
street, Manhattan, known as the “South Field,’ have made a 
formal offer to the New York Hospital to purchase the property 
for $1,900,000, with the intention of giving the university an 
option to buy it at cost. 

Appointments to Honorary Offices.—Commissioner Lederle 
of the Board of Health has given out the tollowing appoint- 
ments to honorary oilices: Daniel Draper, Ph.D., consulting 
meteorologist; Dr. George Henry Fox, dermatologist; Steven- 
son Towle, sanitary engineer; Dr. Clarence C. Rice, laryngolo- 
gist; Dr, Arthur B. Deuel, attending otologist, and Dr. George 
IF, Shrady, consulting surgeon. 


Personal.—George W. Crile, Cleveland, read a paper before 
the surgical section of the Buffalo Academy of Medicine on 
Experimental Study of Surgical Shock.” Drs. Harry Rooth 
and Marshall Clinton were elected president and secretary re 
spectively of the surgical section of the Buffalo Academy of 
Medicine.——-Drs. A. W. Hengerer, L. Page and Charles Den- 
man have been appointed resident physicians to the German 


Sanatorium Sold.—Maysville Sanatorium has been sold to 
Drs. Charles D. Mills, Maysville, and Robert S. Carroll, Cal- 
vert, Texas. 

Hospital Appropriations._-lhe Senate has appropriated 
$35,000 for a new college at the Cleveland State Hospital and 
$50,000 for a similar purpose to the State Institution for 

A Cleveland Philanthropist, Mr. J. H. Wade, has given 
$100,000 to the Cleveland Fresh Air Camp, $100,000 to Lake 
side Hospital, and $50,000 to the Cleveland Day Nursery and 
Kindergarten Association. 

Verdict Against Doctors Set Aside.—Judge Williams has 
set aside the verdict for $1000 for malpractice recently obtained 

by Mrs. Beebe Guthrell against Drs. Will J. Means and J. Will 
cheur Barnes, Columbus, and has granted the defendants a new 

trial. He took the ground that the verdict was not supported 
by the weight of the testimony. 

Banquet to Dr. Weber.—.A reception and banquet was given 
to Dr. Gustav C. E. Weber of Cleveland, under the auspices of 
the Cleveland Medical Library Association, May 8. Dr. Harris 
G. Sherman was toastmaster. While the banquet was in pro 
gress Dr, Weber was stricken with apoplexy. He has now re 
gained conscicusness and there are hopes of his recovery. 

Personal.—Dr. Harry H. Drysdale, assistant physician, Mas 
sillon State Hospital, has resigned to accept the position of 
physician-in-charge of the sanatorium at Lodi.——Dr. Eugene 
G. Carpenter has been reappointed superintendent of the Colum 
bus State Hospital——Dr. Charles W. Newton, Toledo, has 
been appointed Workhouse physician———Dr. Sterling B. Tay- 
lor, Columbus, has been appointed medical examiner for the 
civil service commission, vice Dr, Harry M. Taylor, resigned. 

The New Health Code.— Under the provisions of the new 
code recently enacted, boards of health are composed of five 
instead of six members, and the mayor is not a member of the 
board. ‘Three members constitute a quorum. ‘The present 
members of the board serve out the terms for which they were 
appointed. In hamlets and villages of less than 2000 inhab- 
itants the council may appoint a health officer in lieu of a board 
of health, but such appointee must be approved by the State 
Board of Health. If any city, village, hamlet or township fails 
or refuses to establish a board of health or appoint a health 
officer, then the State Board cf Health may appoint a health 
oflicer for such city, village, hamlet or township, and fix his 
salary and term of office. The salary of such health officer, and 
the expenses created by him in the discharge of his duties, be- 
come a charge against said city, village, hamlet or township. 
Entirely new provisions are made for the prevention of con 
tagious and infectious diseases. The duration of quarantine in 
smallpox, diphtheria and membranous croup and scarlet fever 
is fixed. It is left optional with boards of health to quaran- 
tine measles, chicken-pox or whooping cough. The Board of 

Health is required to disinfect any house or room in which a 
person has been ill with any of certain named contagious dis- 
eases; and it is a misdemeanor to rent any such house or room 


until disinfection has been carried out. Disinfection 
be done at public expense, and boards of health are author- 
ized to purchase disinfecting apparatus and supplies. 


Faculty Changes.—Additions have been made to the faculty 
of the Miami Medical College as follows: Dr. William E, Lewis, 
professor of anatomy; Dr. William H. Wenning, professor of 
clinical gynecology; Dr. John M. Withrow, professor of clin- 
ical gynecology; Dr. George A. Fackler, professor of clinical 
medicine, and Dr. Mark A Brown, professor of hygiene. 

Improvement of Cincinnati Hospital.—The authority to 
issue bonds to the extent of $500,000 for the improvement of 
the Cincinnati Hospital having passed both houses of the legis- 
jature, Drs. Holmes and Isham and Mayor Fleischmann of the 
hospital board have been appointed a committee to devise plans 
of procedure tor spending the money. Hon. Prescott Smith was 
appointed a committee of one to test the constitutionality of the 
act under which the allowance was granted, so that there may 
be nothing in the future to retard the progress of the new build- 
ing contemplated. 

The commencement exercises of the Medical College of 
Ohio were held May 6. The valedictory was delivered by Dr. 
Benjamin K. Rachford. A class of forty-two received their 
degrees from President Ayers of the University; Dr. Phineas 
S. Conner delivered the faculty address, and Dr. James G. 
Hyndman announced the awards of prizes——On May 1, the 
Miami Medical College graduated a class of thirty-three, the 
largest for several years. The vaiedictory was delivered by 
Dr. Charles F. Goss, who made a strong plea for the endow- 
ment of medicai colleges. 

Dr. George Gottstein, first assistant to Professor von 
Mikulicz, University of Breslau, Germany, was recently a 

visitor at medical schools and hospitals of the city. 

Library Report.—The librarian of the College of Physicians 
reports, for the month of April, 227 volumes, 491 pamphlets, 
and 2708 journals received. The donors numbered 60. 

Appointments in Jefferson.—Dr, Max H. Bechroch has 
been appointed demonstrator of nervous diseases; Dr. Alfred 
Gordon, instructor in nervous disease, and Dr. William C. 
Pickett, instructor in insanity. 

The Nathan Lewis Hatfield Prize for Original Re- 
search in Medicine.—Flor the best essay in competition for 
this prize, the College of Physicians announces, through its 
committee, that $500 will be awarded. The subject specified is: 
“The Relation Between Chronic Suppurative and 
Forms of Anemia.” Essays must be submitted on or before 
March 1, 1903. The treatment of the subject must include 
original observations or researches or original deductions. The 
competition is open to members of the medical profession and 
men of science of the United States. Particulars may be ob- 
tained from J. C. Wilson, M.D., chairman, College of Physicians, 
219 South Thirteenth Street, Philadelphia. 


Health of the Troops in the Philippines.—The latest re- 
port received, May 2, 1902, at the office of the Surgeon-General 
of the Army, is that dated March 15, 1902, from Lieut.-Colonel 
Charles Heizmann, chief surgeon of the Division of the Philip- 
pines. The strength of the command during the month ended 
on the latter date was 35,814 men, with a percentage of sick 
to the command present of 6.45. This rate is practically the 
same as that for the month immediately preceding and is re- 
garded as satisfactory. Of the total sick present 20.99 per 
cent. were affected with venereal diseases; 10.12 with dysen- 
tery; 6.44 with diarrhea and the same percentage with ma- 
larial fever. Injuries constituted 10.12 per cent. of the 
total. From a careless examination of this record, venereal 
diseases are liable to be regarded as extremely prevalent, as 
they constituted 20.99 per cent. of the cases under treatment, 
but it must be remembered that the total of the eases consti- 
tuted only 6.45 per cent. of the command, so that the venereal 
cases in the command formed only 20.99 per cent. of 6.45 per 
cent., or 13.5 cases of venereal disease in every 1000 men pres- 
ent. The chief surgeon remarks that while it is believed ¢hat 
the semi-monthly examinations of enlisted nen wi!l] ho'd this 
class of diseases at a moderate figure, there is now little con- 
trol of prostitution in most of the provinces, and that a slight 
increase may be looked for from month to month. 



is to 

JOuR. M. A 

‘ The number of deaths in the division decreased from 5, 
43, dysentery being responsible for 11 and variola {oy - 
the fatal cases. ' 

Bubonic plague had not attacked the command durine th 
month and had been discovered in but two: civilians. both a 
tives, in the San Nicholas District of Manila. The boarq Y 
health is continuing its active measures for the SUppressig 
of the disease. It is believed in Hong Kong that there wif 
be little plague this year, either there or in Manila, and a 
the experience of that board with the disease extends as be 
back as 1894, its opinion is of value. An active epidemic 9 
cholera was in progress at Canton, with rumored ¢age< . 
Hong Kong at the time the chief surgeon wrote. The wl 
merce with the latter port makes this a matter of importane 
although the efticient work which the Marine-Hospita] Servigs 
is doing in guarding the Philippines from epidemic diseass 
renders the introduction of cholera improbable. The possibility 
must be recognized in the cases of stowaways and of thow 
smuggled into the minor ports. Cholera appeared twice jy 
the Philippines in epidemic form, both times in the °70s, kj). 
ing in the more severe visitation over 30,000 people. 


J Jelaware: On account of the prevalence of smallpox at the 
Delaware State Hospital, Farnhurst, the trustees held thejy 
regular meeting at the Wilmington Club May 2. The small. 
pox situation was discussed, and it was stated there had beep 
twenty-one cases and three deaths had been the result sing 
the outbreak. The patients have now been removed to the 
Emergency Hospital, and it has been fenced in to prevent 
the escape of insane patients. 

Illinois: At Monmouth, neighbors of a man affected with 
smallpox burned the house in which he was quarantined, the 
patient and his wife escaping with difficulty. Fifty Chicago 
& Northwestern track layers are quarantined in boarding car 
at Elva. A bad case of smallpox has developed among them. 
The school children at Montrose wit lose a month of 
schooling on account of smallpox. It is reported that 25 
known cases of smallpox exist in Staunton, Macoupin County. 
Smallpox in Chieago has changed from the mild type to 
a much more severe form, as noted in the Bulletin of April 
19, and the first deaths from the disease since January 3 o- 
curred during the week. This disease, however, is of minor im- 
portance in Chicago, as it is in any well-vaccinated community. 
.Of the total 169 cases discovered and treated since the first 
of the year not a single one had ever been properly vaccinated 
and the great majority of the victims come from the lowest 

Indiana: The Vanderburg county council, at ‘a special meet 
ing Thursday. made an appropriation of $4000 for smallpox in 
the county. This makes a total of $14,500 appropriated this 
year for smallpox purposes. In all, there have been 268 cases 
of smallpox in the county this year. There are now eighteen 
cases in the pest-house. Mrs. Joshua Collins, Southport. 
is dead from smallpox and seven other members of the family 
are suffering from the same disease. She belonged to a sect 
known as the “Church of God,” which claims there is no war 
rant in the Bible for vaccination. Secretary Hurty, of the 
State Board of Health, who returned May 2 from Shelburn and 
Hymera, says there are more than a hundred cases of smallpox 
there. Health officers, he declares, are badly handicapped in 
tighting the disease by lack of funds. At. the Indiana Re 
formatory, Jeffersonville, fifteen cases were reported and the 
remaining twelve have broken out so far this month. Vaecina- 
tion was not as thorough as it should have been, on account 
of the contractors demurring against all of their men being 
idle at the same time. Fontanet has 7 new cases of small: 
“pox. Dr. James N. McCoy, of Vincennes, was arrested May 
8 on the charge of breaking the quarantine law by taking three 
negroes afflicted with smallpox to the polls at the recent elec: 
tion. He pleaded not guilty and was placed under a $100 
bond to appear for trial in the Knox Circuit Court, May 25. 

Kansas: Smallpox has broken out in the State Industrial 
School for Boys, Topeka. Eight cases have appeared already. 
Seven of them are boys who are inmates of the school amd the 
eighth is an emplove. A lav report in the Kansas N‘at 
Journal of May 8 alleges that Garden City is full of sma!!pox. 
Out of the possible 1500 inhabitants of that town 20!) are 
either convalescing or breaking out with what the physicians 
advertise as “Cuban itch,” which is really smallpox. They 
have it in a mild way, and the health authorities cheerfully 
overlook it. 

Maryland: Five new cases of smallpox were reporte in 
Baltimore during the week ended May 10. - A white man. aged 
6», was sent to quarantine May 9 with smallpox. ‘nis case 

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originated in the city and excites fear that the disease is 
ining ground. Three colored men who had been confined 
in the observation house of the health department developed 
symptoms of smallpox May 5 and were removed to quarantine. 
‘ney contracted the disease at Sparrow's Point, a water suburb 
of Baltimore, where cases of the disease have recently occurred. 
The Commissioner of Health has permitted a limited num- 
yer of students, under careful regulations, to see the cases of 
gnallpox at the quarantine hospital. Sections of two classes 
have enjoyed this privilege, one under Dr. C. Hampson Jones, 
Assistant Health Commissioner, the other under Dr. John S. 
Fulton, Secretary of the State Board of Health. ; 
Michigan: There were 5 deaths from smallpox during April 
in the following localities: Benton Township, Cheboygan 
County, Belding City, Ionia County, Fairplain Township, Mont- 
calm County, Croton Township, Newaygo County and Buena 
Vista Township, Saginaw County. Smallpox was reported 
present at 110 places, May 1. 

Minnesota: Six cases of smallpox have appeared in one fam- 

ily in Minneapolis. Dr. H. M. Bracken, secretary of the 
State Board of Health, and the surgeons of the railways run- 
ning out of Minneapolis and St. Paul, held a conference May 2 
to devise means by which the spread of smallpox among the 
trainmen might be restricted. The concensus of opinion as to 
the best method of regulating the matter seemed to favor com- 
yulsory vaccination of all employes. The smallpox report 
jor the week ending April 28 showed 263 new cases in the 
state, distributed among 40 counties and 70 localities. The 
previous week’s report gave 140 New cases in 54 localities and 
35 counties. Todd County takes the lead, with 42 new cases, 
31 in Staples Village, and 11 in Gordon Township. Hennepin 
County reports 38, 16 in Crystal Lake Township and 10 in 
Minneapolis; Seott County 22, 18 in New Market Township; 
St. Louis County 16, 12 in Duluth; Blue Earth County 14, 11 
in Mankato; Otter Tail County 12, and Meeker County 10. 
Ramsey County has six new cases, all in St. Paul. No deaths 
are reported. 

Nebraska: During the week ended May 10, 17 new cases of 
smallpox were discovered in Lincoln. 

New York: The death from smallpox of an attendant em- 
ployed in Long Island State Hospital, King’s Park, as well 
as the development of another case, making the fourth, 
has resulted in a general quarantine of the entire institution. 
——A Buffalo priest who had been asked to minister to a dying 
sma!]pox patient, and who thus exposed himself, has contracted 
the disease and was sent to the quarantine hospital. 

Ohio: Smallpox is reported as follows: Point Pleasant, 18 
or 20 cases; Cleveland, 13 cases; North Baltimore, 7 cases. 

Pennsylvania: Assistant Medical Inspector Alexander C. 
Butcher, Philadelphia, had his attention called late yesterday 
afternoon to two suspicious cases of illness in Hutton street. 
He visited the premises and found that the patients were suffer- 
ing from smallpox. The authorities had the patients removed 
at once to the Municipal Hospital and quarantined the entire 
block. A corps of physicians was then sent to vaccinate the 
inmates of all the houses. 

South Carolina: In the report of the health officer of Charles- 
ton for 1901 the outbreak of smallpox receives special atten- 
tion. Before March 6, 1901, there had been but one case in 
the city (imported in 1900) in several years. After March 6, 
when the disease again appeared, there were 54 cases—9 white 
and 45 colored—all traceable to sources outside the city. The 
disease was for the most part of a mild type, and no death 
occurred. Active methods, by quarantine, vaccination. eté.. 
were employed to prevent its extension and it was speedily 
suppressed. In “no instance did it spread,” even to occupants 
in other rooms in the house where it appeared. The work of 
vaccination, it is noted, “was most thoroughly and efficiently 
done.” At least 30,000 persons. or more than half the popula- 
tion of the city, were vaccinated in a few weeks. 

South Dakota: Crazed by whisky, three patients in the 
county pest-house at Deadwood ended a night of riot May 2 by 
setting fire to the building and destroying it, after they had 
overturned beds and destroyed the furniture. The other pa- 
tients. many of whom were in the worst stages of smallpox, 
narrowly eseaped death, being rescued with difficulty. A tem- 
porary shelter was found for them after they had spent near!y 
all the night on the hillside. 

lennessee: Obion is still suffering from smallpox. There 
are twenty or thirty cases there. There have been two deaths 
‘rom the disease, and three of the victims are not expected 
to recover. The disease has been more virulent there than 
‘nywhere in that section of country. 

Utah: At the close of last week there was one case of small- 
Pox in the detention hospital at Salt Lake City. 

Four new 



cases developed during the week and none having been dis- 
charged, left 5 cases at the close of this report. 

Canada: In addition to two cases of smallpox in Nelson, 
British Columbia, a case is reported from Kitchener on the 
Crow’s Nest and a suspected case from Slocan City, which came 
down from the Enterprise mine. At Slocan City twenty-five 
people are quarantined, but no case has developed. A man 
who escaped from quarantine at Nelson was captured at Ymir. 


No Compulsory Vaccination for Montreal.—The Montreal 
City Council voted down the by-laws, making vaccination com- 
pulsory, by a very large majority. This vote has been regis- 
tered in face of the fact that the Provincial legislature had 
passed an enactment giving the Quebee Board of Health power 
to order the City Council of Montreal to pass an act making 
vaccination compulsory. Although the great value of vaccina 
tion has been strikingly proven by recent events in Montreal 
the council thus puts itself on record. In the recent outbreak 
of smallpox in that city, out of 361 patients, only three bore 
good vaccination marks; 322 of the 361 had never been vac 
cinated at all. The outbreak of the disease has cost the city 
thousands upen thousands of dollars, and all because people 
would not be vaccinated. Over three hundred municipalities 
of the Province of Quebec have already passed this compulsory 
vaccination by-law. The metropolitan city of the Dominion 
has rejected it. 

The Golden Jubilee of Thre2 Montreal Physicians.—The 
medical profession of Montreal tendered a banquet, April 30, to 
three of the most distinguished medical men in that city, viz.: 
Dr. J. P. Rottot, dean of the Laval Medical Faculty; Dr. D. C. 
MacCallum, emeritus professor in the medical faculty of Me 
Gill; Sir William Hingston, professor vf Clinical Surgery at 
Laval, and one of the founders of the medical faculty of 
Bishop’s. Dr, F, W. Campbell, dean of the faculty of medicine 
at Bishop’s, occupied the chair. The occasion was the fiftieth 
anniversary of the entering of each of these into the ranks of 
the profession of medicine. Dr. Rottot was admitted a gradu- 
ate of the old Montreal College of Medicine in 1847, which 
afterward became the Victoria, and now is the medical faculty 
of Laval. Dr. MacCallum graduated at McGill in 1850, and 
subsequently held the chair of obstetrics in that institution for 
many years. Sir William Hingston graduated in 1851 from 
McGill. He has been mayer of Montreal, and is now a senator. 

Canada To Have a Dominion Medical Council.—Dr. Rod 
dick’s Bill for a Dominion Medical Council has passed its third 
reading in the House of Commons, having been opposed by only 
sixteen members, all of whom are from Quebee constituencies. 
Dr. Roddick had the following amendment added to the bill: 
“No province shall be represented upon the council either by 
appointed or elected members unti! the legislature of the 
province has enacted in effect that registration by the counci! 
shall be accepted as equivalent to registration for the like 
purpose under the laws of the province, provided that when all 
the provinces of the Dominion shall have legislated in effect as 
aforesaid, it shall be Lawful to appoint and elect in the manner 
aforesaid members of the council representing the provinces 
which have so legislated, universities and incorporated schools 
aforesaid, situated within such provinces, and such members 
shall subject to the provisions of this act, constitute the 
council.” Both Sir Wilfred Laurier, the leader of the govern 
ment, and the Hon. R. L. Borden, the leader of the opposition, 
supported the measure. 


A new Chinese hospital is being built at Canton, China, 
by the French. Ground was given and the Chinese contribute: 

Kyoto Asylum Burns.—The Funaokayama Lunatic Asylum 
at Kyoto, Japan, burned April 19, and 18 of the 39 inmates 

Foreign Medical Students in France.—The number ot 
foreign medical students in France has constantly decreased 
since more stringent regulations were introduced about 1895. 
There are now 764, while in 1894 there were 1054. Russia and 
the southern countries of Europe afford the largest contingent. 
Turkey, Roumania, Greece and Bulgaria. There are 6 students 
inscribed from the United States; 16 from South America; 1] 
from the Antilles, and 8 from Central America, with 3 from 
Mexico. The total number of French medical scholars is 7118. 
or 7882 in all, of whom oniy 54.8 per cent. are inscribed at 

Transvaal Medical Practice.—-A proclamation, noted in the 
Consular Reports, provides that licenses must be obtained by 


persons (not already duly admitted to practice) as physicians, 
surgeons, dentists, chemists or druggists. The license is to 
be obtained from the secretary of the Transvaal administration, 
and before obtaining it a diploma or certificate entitling the 
holder to practice in the country where it was granted must be 
submitted. The license will not be granted unless it is shown 
that in the country which conferred the. diploma, British sub- 
jects legally qualified to practice medicine in Great Britain are 
afforded privileges equivalent to those granted by license under 
this proclamation. 

French Medical Congress.—The Sixth French Congress of 
Internal Medicine met at Toulouse in April with Lemoine of 
Lille in the chair. Three notable addresses on “Hepatic In- 
sufficiency” opened the proceedings. In the first Charrin de- 
scribed the results of his personal researches which have dem- 

onstrated among other facts the constant existence of degen- - 

eration of the liver in the fetuses of women diseased during 
their pregnancy. In one case there was actual cirrhosis of the 
liver in a prematurely born infant who only lived one or two 
days and no germs could be detected in the liver. He thinks 
that the insufficiency of the liver noted in eclampsia is merely 
an exaggeration of the processes which occur physiologically 
during pregnancy. Ducamp proclaimed that intermittence in 
the elimination of methylene blue is the most reliable and con- 
stant sign of hepatic insufficiency. He added that insuffic- 
iency of the kidneys may abolish all the signs of insufficiency of 
the liver. Hepatic organotherapy will be found useful in the 
form of hepatic insufficiency characterized by continuous glyco- 
suria, exaggerated after meals, associated with hypoazoturia, 
urobilinuria and indicanuria and occasionally with gingivitis, 
impotence, neuralgia, cutaneous lesions or a cataract. Ver 
EKecke described the therapeutic indications which can be de- 
duced from study of the effects of experimental ablation of the 
liver. The other addresses were on “Convulsions in Children” 
and *“Anti-Waste Medicines” (Médicaments d’Epargne). The 
Semaine Médicale of April 2 to 16 contains the full text of most 
of the numerous and valuable communications, including those 
on “Treatment of Parasyphilitic Affections,”’ “Dysenteric Endo- 
carditis,” “Diagnosis of Abdominal Aortitis,’ “Fixation Ab- 
seesses,” “Diagnosis of Variety,of Aneurysm of the Aorta from 
the Aortic Pulse,” ete. 

German Medical Congress.—Naunyn presided over the 
Twentieth Congress of Internal Medicine, which met at Wies- 
baden, April 15 to 18. Ewald and Fleiner delivered addresses 
on the “Diagnosis and Treatment of Gastric Ulcer” and Bie of 
Copenhagen on “Phototherapy.” The latter denied that the 
isolated chemical rays are more powerful than the undecom 
posed white light; in fact, the reverse is true. The benefit 
derived from red light in smallpox is due to the exclusion of 
the injurious chemical rays, and it should be so perfect that a 
photographic place exposed in the room does not become altered. 
He stated that Finsen’s Institute has treated 640 cases of lupus 
and permanently cured 456. About 15 per cent. of all cases 
have proved rebellious, but even the most malignant cases were 
not excluded from the treatment. The curative results in 
eczema and other cutaneous affections have been very satisfac 
‘tory, but not so brilliant as in lupus. The chief interest cen- 
tered in Von Leyden’s address on the “Parasitism of Cancer” 
on the eve of his birthday. He stated that only the per- 
manent irritation of a living body can explain the constant 
growth and proliferation of the cells in cancer. It does not 
devour the cells, but stimulates them to proliferation like the 
similar excrescences on plants, especially “cabbage hernia.” 
The clinical picture of carcinoma has many points in common 
with an infectious disease. He knows of a case in which a 
young physician drank by mistake the juice squeezed out of a 
carcinoma, and died two years later from carcinoma of the 
stomach. Naunyn also reported the case of a physician who 
exhibited evidences of carcinoma of the stomach three months 
after he had inadvertently drunk the fluid which had been 
siphoned out of the stomach of a cancer patient. Von Leyden 
has lately succeeded in finding sporulation-forms of the endo- 
cellular bodies—Zelleinschliisse’—which he accepts as_ the 
parasitic agent of carcinoma. He has also reproduced on other 
dogs carcinoma and even metastases after inoculation from a 
carcinoma of the penis on a dog. No experiments have yet been 
successful in which cancer was transmitted from one species to 
another, and even contagion of one person from another—al- 
though probable—has not yet been proved. The congress will 
convene next year at Leipsic. 

The International Conference of the Medical Press.— 
France sent the most numerous contingent to this conference, 
which was held at Monaco, April 9, with 27 delegates in at- 


‘from Hungary, Sweden, South America, Canada, and 

Jour. A. \. A 

tendance, all men of note and influence. The Briti 
Journal, the Lancet and the Clinical Journal were t} English 
journals represented. Germany sent the editors of the thre 
great weeklies, Austria one, Belgium three, Spain two ang 
Italy three, including the editor of the Riforma Mcilica, thy 
only medical daily in the world. The duly approved lelegates 


the three 
from the United States were unable to be present, jut their 

absence was excused. Russia refused to take part -in the cop. 
ference. The first article voted was that the association sha}j 
be composed of journals inscribed by their title and representa; 
by a member of the staff. and secondly, of journalists accepted 
by the National Press Association. In countries with no py. 
tional organization the editors or secretaries of journals yjjj 
be accepted as members if approved by the central committe 
of the International Association. Each journal may be repre 
sented at each general assembly by three representatives, }y 
has only one vote. Each representative must agree to auecept 
the regulations in respect to property in medical literature 
The resolutions on this subject prepared by the committee (Spe 
THE JOURNAL, page 1017), were adopted with the addition tha: 
illustrations can be freely reproduced by other journals oy 
condition that the original source be cited. The question oj 
exchanges between medical journals was the subject of much 
discussion, and the following proposition was finally vote: 
“Acceptance of exchange between members of the Association 
of the periodicals of which they are the directors or editors-in 
chief. ‘he exchange is based on the differential price of th 
subscription and postage, and with the reserve that the pro 
prietor of the journal also accepts. If the request for exchange 
proceeds from a journal whose subscription price is highe 
than that of the one addressed, the latter has the option of 
declining.” It was decided to publish an international bul 
letin; to provide international identification cards for members 
of the Association traveling in other countries, and to establish 
a code of telegraphic abbreviations and other measures to de 
crease the expense of communication between the medical press 
Some of the delegates wished to abolish exchange altogether, but 
Laborde succeeded in maintaining it as a fundamental obliga 
tion and courtesy between members united and “solidarized” }y 
the projected association. Detailed reports of the proceeding: 
are being published in the Gazette -Med. de Paris, whose edito 
is the general secretary of the International Committee of () 

The Smallpox Epidemic. 

There are 1515 cases of smallpox in the metropolitan hos 
pitals, against 1522, 1437 and 1431 in the 3 preceding weeks; 
367 new cases were admitted during the week, against 37), 
274 and 328 in the 3 preceding weeks. During the first quar- 
ter of the present year there were 734 fatal cases of smallpox 
in London, against 35 and 193 in the 2 preceding quarters. 
The deaths from smallpox last week were 42, against 54, 73 and 
42 in the preceding 3 weeks. 

The Public Health. 

The weekly returns of the Registrar-General for London ani 
75 other great towns of England and Wales correspond to al 
annual rate of 17 per 1000 of their aggregate population; i 
the preceding 3 weeks the rates were 17.6, 17.4 and 18.3. U! 
55 fatal cases of smallpox, 42 belonged to London. ‘The annuai 
death rate of London was 17.4, against 17.6 17.3 and 18.1 10 
the preceding 3 weeks. 

Vexatious Actions Against Physicians: The Case of 
Dr. Law. 

Recently in Tue JourNAL the preposterous action of a nurse 
against Dr. Law for damages in consequence of becoming ad 
dicted to morphia, which he prescribed for her, was described. 
Of course, the action failed, but as usual in such cases, becaus 
of the poverty of the plaintiff, costs can not be recovered trol! 
her. Thus Dr. Law will have to defray very heavy expenses. 
The hardship is all the greater as his attendance—as Is Us| 
in the case of nurses—was gratuitous. However, the profes 
sion will show their practical sympathy. A meeting i- t) " 
held and many eminent physicians have promised their st): 

Conspicuous Delay of Growth and Development. 

At the Clinical Society Mr. Hastings Gilford showed a re 
markable case of arrest of development of a kind which }\:s no! 
hitherto been systematically described, though some doven 0! 
more cases have been recorded by French and German writers. 
The patient was a man aged 28, of a healthy family. \t ” 
he was 1.078 meters in height (3 feet 6 inches) and ha: since 



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the hand showed that ossification was no further advanced 
than in a child of 10, and the dentition also corresponded to 
that age. Lhe contour of the body and the appearance of the 
head and face were childish. The sexual organs were the 
most backward in development: the testes had not descended 
and the external genitals were infantile. The intelligence was 
ood but the behavior and conversation were more like that of 
4 child than an adult. The thyroid gland could be felt. The 
sm was apparently not due to any known cause of that 
Achondroplasia, rickets and microcephaly could be 

condit ion. 

The Plague in Egypt. 

For the week ending April 13 there were 23 cases of plague 
in Egypt and 13 deaths, for the week ending April 20, 31 cases 
and 1) deaths. In the latter week 2 cases occurred at Alexan- 
dria. which has been free from the disease since February 17. 
Inthe Mauritius there were no cases for the week ending 
April 24. 

Medicine and Egyptian Progress. 

The annual report of Lord Cromer shows very gratifying 
progress of Egypt under British rule. The foundations of 
well-being and the material prosperity of a civilized community 
have been laid. From the medical standpoint progress is well 
marked. Well-equipped and well-managed hospitals are pro- 
vided for the sick. The lunatic is no longer treated as a wild 
beast. The number of admissions to hospital continues to 
increase: 23,447 in-patients were treated in 1901, against 22,- 
572 in 1900. Independently of plague, 3622 cases of infectious 
disease and 682 deaths were notified, against 4144 cases and 
1027 deaths in 1900. Sinallpox accounted for 1883 cases and 
99) deaths. Cairo was comparatively free from the disease 
during the year, only 20 cases and 4 deaths occurring, against 
172 cases and 41 deaths in 1900. This immunity was, no 
doubt, due to very thorough vaccination. The benefit of vac- 
cination is illustrated by the epidemic in Port Said. The popu- 
lation consists of 35,000 natives and 12,500 Europeans. In 190] 
smallpox broke out and there were 174 cases, 56 deaths. Of 
these, 129 eases and 38 deaths occurred in the Europeans, 45 
cases and 18 deaths in the natives. This enormous dispropor- 
tion was, no doubt, due to lack of vaccination among the 
Europeans, among whom, unlike the natives, enforcement of 
vaccination is not possible. Smallpox, which was formerly 
very prevalent in the province of Assouan, has been almost 
entirely stamped out by vaccination. In Cairo 357 cases of 
diphtheria oceurred in 1901, against 210 in 1900. The diffi- 
culty of checking this disease arises from the fact that many 
cases are not brought under the notice of the sanitary author- 
ities until after death. In all infected houses prophylactic 
injections of antitoxin are given to the surviving children when 
the parents accept it; in such houses second cases have never 
ocurred. During the year 227 cemeteries were condemned 
id other sites were selected in lieu of them. The work of 
improving the sanitary condition of the mosques continues. 
There is a great difficulty of good water supply. The one 
the Nile—has from time immemorial been used as a 
main sewer. Arrangements have been made to supply several 
more provincial towns with good water. Borings have been 
successfully made and steps taken to prevent contamination. 
\t Alexandria new filter beds are being constructed. In Cairo 
asystem of surface drainage for the removal of storm water 
has been completed. 


Plague in India. 

The latest returns show that the disease is spreading. There 
were 26,108 deaths in the week ending March 22, against 

25,655 in the preceding one. The Punjab shows the chief in- 
16.829 deaths. In Bombay City the mortality con- 
tinues to inerease—1902 deaths were registered for the week 
ending April 2, of which 999 were due to plague. 


Plague and Rats on Ships. 

An outbreak of plague which has occurred in Western Aus- 
tralia is important because it shows in a striking manner how 
e disease is spread by rats on ships. The S. S. Antillean 
i troop-ship of 3686 tons, left Capetown on Feb. 1, 1901, and 
entered Sydney harbor on March 2, having no cargo but shingle 
ballast. The health officer of the port was informed that all 
hands were well except a sailor who was thought to be suffer- 
ing from pleurisy. It was known that plague had occurred 
it Capetown subsequently to the departure of the Antillean 
‘Xamination showed that he had plague. He was therefore re- 
moved to the hospital, where he died on March 3, and the ves- 
el was sent to the maritime quarantine station; inoculation 



—" illimeters. His height and proportions resembled — 
- of a boy between the ages of 6 or 7. A radiogram of 


was offered to all hands, but onty 10 accepted. On March 12, 
a man who was a storekeeper on board, fell ill with plague. 
Two rats were found dead on the vessel on March 4—teeming 
with plague bacilli. The captain said that there were not 
many rats on board, but on February 22—the day of the de- 
parture of the vessel from Albany, Western Australia, where 
it had been for 24 hours—-15 careasses were discovered. At 
Albany the vessel anchored in the stream and received coal 
from a lighter which came alongside. Plague broke out im- 
mediately afterwards in Western Australia, but not in Albany ; 
most of the cases occurred in Perth, 245 miles from Albany, but 
connected with it by rail. At Sydney the Antillean was fumi- 
gated 4 times with sulphur, more than three-quarters of a ton 
being burnt. The storerooms, having probably been the resort 
of rats, were twice sprayed with corrosive sublimate  so- 
lution (1 in 500) by means of Geueste-Hirscher sprays, and 
were separately fumigated. After repeated searches only 83 
dead rats were found. In reporting on this case Dr. Y. Ashbur- 
ton Thompson, President of the New South Wales Board of 
Health, points out that plague communicated to 100 rats which 
infested a vessel continued among them for 29 days and yet 
at the end of the term it killed only a minority. Hence, a 
voyage within the limits common with steamships at the pres- 
ent day does not prevent infection of clean ports. Another 
fact of even greater practical importance is that a ship may 
be infected at a port under no suspicion of plague at the time. 
Generally communication of such a ship with clean port would 
be unrestricted and it appears that the epidemic at Sydney in 
1900 originated in this way. 
Legacies and Medical Men in France. 

There is a law in France that medical men ean not receive 
any legacy from a patient whom they have treated during his 
last illness, and this law has been the cause of some complaint 
on the part cf physicians. A member of the French parliament, 
Dr. Delarne, has advocated a change in this law, and_ his 
proposition has been sent before the committee of judicial 
reform belonging to the Chamber of Deputies. The corporation 
of physicians in France is well represented in the parliament, 
since it seems that there are about 50 doctors for 493 members 
of that body, and this new law will certainly find some zealous 

Statistics of a French Sanatorium. 

Dr, Sabourin, a well-known French physician, has recently 
published in the Presse Medicale the result of the treatment of 
consumption in the French sanatorium of Durtol. Out of a 

.total of 250 cases, Dr. Sabourin has analyzed the number of 

patients cured. By this is meant that for three months there 
have been neither expectoration nor cough, that the patient 
looks well, and shows no reaction after exercise or any other 
causes which produce a change in a tuberculous patient. On 
their arrival at the sanatorium examination showed that, out 
of the total of 250 cases 100 had lesions which prevented all 
chance of a cure. Out of the 150 that were not too far gone 
92 were discharged cured, which makes a percentage of 60 per 
cent. Of the 100 who were incurable 2 did ultimately recover. 
Out of the 94 cured 10 have since had a relapse. There were, 
therefore, 84 patients who recovered out of a grand total of 250, 
which makes a percentage of 34 per cent. The 4 patients 
were affected in the following manner: Fourteen had lesions 
of the first degree, 56 of the second, and 24 of the third degree. 

The Fight Against Alcoholism. 

The French Antialeoholic League has just distinguished itself 
by an act of courage, which is certainly to be admired in this 
epoch of trusts, combinations, and general exploiting of the 
public. This league has instituted legal proceedings against 
one of the most important manufacturers of absinthe, on ac- 
count of the following advertisement, which has been appearing 
in several newspapers: “As oxygen has a special renovating and 
exhilarating power, Cusenier’s oxygenated absinthe, green or 
white, is recommended rightly by doctors and sought after by 
amateurs.” The medical profession was brought into cause, 
and such is the reason for this action. Cusenier is the great 
absinthe king in France, and it will be interesting to note the 
result against one of the evils of the age in France, the selling 
of poison to the population. 

Calob’s Treatment of Pott’s Disease. 

The treatment of Pott’s disease by the straightening of the 
vertebral column, was advocated a few years ago by Dr. Calob of 
Berck-sur-Mer. ‘This treatment was not, however, accepted by 
the majority of surgeons, who considered it a most dangerous 
operation. A recent thesis by Dr. Rogovy calls one’s attention to 


the perils one encounters in carrying out this technic. According 
to the author the only safe form of treatment is to place the 
child as early as possible in a well-made plaster apparatus. 

A New Treatment of Whooping Cough. 

A French physician, Dr. de Lamalleree, has been using in the 
treatment of whooping cough the inhalation of formic acid 
vapors. All that is required is to burn a pastille of formol 
on an alcohol lamp every hour. In one to three days the 
vomiting stops, as well as the fits of coughing. The latter are 
reduced to two or three in the twenty-four hours. Out of 22 
cases Dr. de Lamalleree has had two failures, four tardy results, 
and 18 complete cures in eight days, the convalescence being 
included in this period. The treatment should, however, be 
applied in the first eight days, and the patient should be kept 
in the same room during the whole treatment. . 

Action for Malpractice Non-Suited. 

A well-known surgeon of Amiens has just been prosecuted 
for malpractice by the parents of a young woman on whom he 
operated two years ago, The parents accused the doctor of 
having left a compress in the abdomen after having performed 
laparotomy and pretended that the death of the patient, which 
took place eleven months afterward, was due to this error in 
the treatment. No clear proof of this could be furnished by 
the parents of the young woman, and they were condemned to 
_pay 1000 frances damages. 


Voluntary National Examining Board. 
WHEELERSBURG, Ou10, May 12, 1902. 

To the Editor:—The proposed organization of a national 
medical examining board as outlined by Tnt JouRNAL, January 
11, page 108, and advocated in the iast number by Dr. W. L. 
Rodman, Philadelphia, is a move in the right direction, and to 
my mind offers the best practical pian yet suggested for over 
coming the abuses which the best elements of the profession 
would giadly see abolished. 

With regard to the compensation of the proposed board, 
I wish to in- 
quire why it might not be feasible to obtain recognition from 
the trustees of the great Carnegie Institution whose objects, in 
addition to the promotion of research, are declared to be “to 
encourage the application of knowledge to the improvement 
of mankind; to conduct, endow and assist investigation in any 
department of scientific literature or art, and to this end to 
co-operate with governments, universities, colleges, technical 

about which there seem to be divergent views, 

schools, learned societies and individuals.” 

Is not the avowed scope of this institution as here set forth 
by the trustees, as well as in the proclamation of its distin- 
guished founder, sufliciently broad to admit of entering into 
legitimate relations in harmony with its declared purposes, 
with such a board as it is now in contemplation to create? Is 
which the 
institution could be applied that would so stimulate the ad- 

there any other use to immense resources of the 
vancement of practical science, and indirectly promote orig 
inal research, as an affiliation and co-operation with a board 
designed to uplift the qualifications of the most 

Would not the board itself derive 

learned of the professions ‘ 
additional consideration and authority by reason of its con 

nection with this unique institution—-thus insuring perman- 
ency, independent action and universal recognition, commen- 
surate with its own high character and its distinguished asso 
elation % : 

In this event would the board need to limit its action to the 
bestowal of diplomas of one grade only? 
just as the licensing board in England issues the diploma of 
M.R.C.S. and also the higher diploma of F.R.C.S.? In this 
way the advantages of a national certificate could be secured by 
a much larger number of physicians, and need not be confined 
to the young men of the future who, as Dr. Rodman says, are 
fresh from the colleges and ambitious. Would not the hope of 
winning the highest distinctions in the power of the board to 
confer stimulate numbers to engage in the original research 
who otherwise would have small incentives to lead them on? 

James L. TAYLOR. 

Might it not issue 

certificates of grades—according to qualifications 


Jour. A. M. 4 

Derroir, Micn., May |2, | 99 

To the Editor:—I again endorse the idea of a voluntay 
national examining board. ‘The establishment of sich a board 
and the movement: toward interstate reciprocity can go yoy 
well in hand, and will probably do so for.some time io come 

It is to be hoped that all those who will participate in tj, 
meeting of the American Medical Association at Saratoga— 
especially those who will attend in an official capacity—wiy 
study the subjects and become familiar with the various sides of 
the questions. 

Some information may be furnished by the confederation of 
members of Reciprocating State Medical Examining and Licey 

sing Boards, a meeting of which, as 1 understand, will tae 
Very truly yours, 


place in Chicago, May 20. 

Chloroform and Gaslight Again. 
Cuicago, April 30, 1902, 

To the Editor:-—A few days ago a druggist handed me q 
bottle marked “Squibb’s Chloroform” and said that it had 
been returned to him by a physician, with the statement that 
it contained so much chlorin that it could not be used for 
anesthetic purposes. The druggist made inquiry and found 
that: it had been used at night in the presence of an open 
gaslight. The druggist wished to know whether it contained 
chlorin or any other injurious impurity. On making the 
appropriate tests it was found to conform to the pharmacopeial 
requirements, containing no free chlorin, no acid or other. 
impurity. I then used some of it to anesthetize a patient fo 
an operation lasting 40 minutes and its effects were all that 
could be desired of chloroform. 

This is written to call attention again to the irritating gas 
which is formed when the vapor of chloroform comes in con: 
tact with a light or a fire. Chloroform is not readily combust 
ikle, yet it will burn when the conditions are favorable. The 
products of this combustion are free chlorin and some ver 
irritating compounds of chlorin, and deaths have been caused 
by inhaling the mixture so produced at operations where chio 
roform has been used too freely and without any precautions. 
All discomfort and danger may be avoided by hanging a towel 
below the gaslight and keeping the towel moistened with am 
monia water throughout the operation. There is no occasion 
to fill the room with the fumes of ammonia, the amount neces 
sary is small and it is seldom that the operator or his assist 
ants detect its presence. There is little occasion to question 
the purity of the chloroform and ether at present in the ma 
ket, and the frequent complaints about impurities in the anes 
thetics is usually due to ignorance of some such facts as s¢t 
forth in this communication. Yours truly, 

D. H. GALLowAas 

State Boards of Registration. 

In Texas, next week, the State Board of Medical Exaimineis 
expect to be very busy, as 100 candidates are expected. 

The New Jersey Board of Medical Examiners has ex! 
ined 87 applicants for medical licenses in the past year; ¢! 
these, 63 obtained licenses and 24 were refused. 

The California Board has had a Chinese doctor arrested { 
practicing without a license. He has done a large business 
among both his own countrymen and white persons. 

More Study in Illinois medical schools is proposed by ‘!\ 
hoard in. this state. At the session April 29, in Chicagt, 
a committee proposed the extension of the time required 1! 
medical study to eight months in each of four years. - 

The Pennsylvania Medical Examining Board met 11) Har 
risburg April I. In organizing, Dr. Henry Beates, Jr.. Phi’ 
delphia, was made president. and Dr. H. 8. MeConne!', Nev 
Brighton, secretary. The next examination will be he! June 
25-28, simultaneously in Pittsburg, at the Centra! High 
School, and in Philadelphia, in Industrial Hall. 

The Tennessee Medical Examiners held simultaneous 
aminations at Nashville, Memphis and Knoxville, Apri! | #m! 

2. The number of questions was 64, on 8 subjects, 60 per «em 


17 fo 
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May 17, 1902. 

being required for temporary license and 75 per cent. for per- 
manent. Of 49 candidates, 38 passed and 11 failed. Of 34 
non-graduates, 8 successfully applied for temporary license and 
17 for permanent; 6 desired permanent license, but were only 
able to attain a grade entitling them to temporary license; 3 
“np pejected absolutely. Of the 15 graduates, one from the 
“College of Eclectic Medicine and Surgery was granted 
temporary license, not being able to pass 75 per cent., and one 
was rejected absolutely. The remainder, numbering 13, were 
permanent license and are enumerated as follows: 



(andi- Sch. of Year Per- 
date. Pract College. Grad. cent. 
-o4 = OR University of Georgia............... 1901 84 
49 (CURR Medico-Chir. College, Philadelphia.... 1901 97 
co; OR University of Louisville............. 1901 87 
“1 6 Richmond Medical College........... 1900 82 
8] R University of Maryland........... »» 1901 81 
92 iN Ecl. Med. Inst. of Cincinnati......... 1901 86 
84 R University of Virginia.............+- 1896 95 
Sh t. Missouri Medical College............ 1899 96 
86 t University of Maryland......... ‘ 1899 87 
a0 t. TUIRMO OMI VORGILY 0.0 sc op eciseresees 1900 92 
9? R Coll. of Phys. and Surg., N. Y........ 1900 87 
93 t New York Polyclinic................ 1899 92 
98 t Kentucky School of Medicine......... 1898 86 

The Oregon Board of Medical Examiners held its regular 
gmi-annual examination January 7 and 8. The number of 
subjects was 9, questions 90. The percentage required for 
passing was 75. There were 17 applicants, all of whom passed. 
Their percentages are withheld by the board. 

Sch. of Year 
Pract. Name, Residence and College. yrad. 
R R. C. Cross, Carlton, Ore., Harvard Med. Coll........ 1891 
R W. ©. Spencer, Huntington, Ore., Cooper Med. Coll.... 1897 
R R. H. Jenkins, Fossil, Ore., Med. Coll. of Tennessee... 1900 
4 D. P. Love, Riddell, Ore., Medical Coll. of Tennessee... 1890 
" H. I. Keeney, Portland, Ore., Jefferson Med. Coll...... 1901 
R k. F. Lehman, Portland, Ore., Jefferson Med. Coll..... 1884 
R F. M. Day, Eugene City, Ore., Med. Dept. U. of Minn.. 1901 
H A. Carey, St. Johns, Ore., Cleveland Hom. Med. Coll.. 1898 
R W. T. Rowley, Corvalis, Ore., University of Michigan. 1901 
4 J. W. Luskey, Portland, Ore., Starling Med. Coll., Ohio 1881 
R J. H. Thompson, Ogden, Utah, Western Pa. Med. Coll. 1896 
R G. G. Baar, Portland, Ore., Vienna Univ., Austria..... 1897 
g F. J. Gober, Trask, Ore., Rush Med. Coll............. 1885 
t M. C. Findley, Grant’s Pass, Ore., U. M. Coll., K. C... 1896 
R W. W. Kimmell, Lebanon, Ore., Ohio Med. Coll....... 1881 
t T. A. Long, The Dells, Ore., Amer. M. Coll., St. Louis. 18838 
R R. Goucher, Mulino, Ore., Amer. Med. Coll, St. Louis.. 1854 

Utah Examination.-—The Board of Examiners of Utah, at 
Salt Lake City on April 7, examined 10 candidates for li- 

ense and found 7 able to answer 75 per cent. of the 70 


‘andi- Sch. of Year Per- 

date. Pract. College. Grad. cent. 

1 R. U. of Georgetown, Washington, D. C. 1893 80 1-7 

2 rR. Coll. of Phys. and Surg., Chicago.. 1902 92 5-7 

& Tniversitv Medical. Kansas........ 1897 77 2-7 

! t. Coll. of M. and S., U. of Minneapolis. 1901 87 1-7 

4 R. Rellevue Hospital Med. Coll., N. Y.. 1881 82 5-7 

6 R. Northwestern UJ. Med. Sch., Chicago. 1901 83 6-7 

7 R. Berlin University, Germany......... 1899 83 3-7 

8 H. Hahneman, Kansas City, Mo....... 1901 701-7 

9 R. Western Reserve, Cleveland, Ohio... 1898 nO 2-7 

10 R. St. Louis College of Phys. and Surg. 1891 60 1-7 

Kansas Board Will Examine.—Commencing April 21, all 
andidates for license to practice medicine and surgery in 
Kansas will be required to pass a satisfactory examination. 
No registration will. be made on diplomas or on certificates 
from other state boards. Candidates will not be required to 
present their diplomas when applying for examination, but 
‘they will be required to prove that they have devoted not less 
than four periods of six months each to medical study, no 
two of these periods being in the same twelve months. The 
law requires that osteopaths be registered and licensed to 
practice osteopathy on presentation of diplomas from ac- 
credited schools of osteopathy which have required study for 
not less than four terms of five months each. The board also 
provides for granting a temporary license to any student who 
las completed two or more full courses and who presents a 
petition from a majority of the practitioners in the county 
in Which he intends to practice, petitioning the board to grant 
such temporary license. The next examination will be held 
in Topeka, June 10 and 11. The last examination was held 
April 17 and 2 out of 10 apvlicants were able to answer 70 
per cent. of the questions. There were 8 subjects for oste- 
opaths and 9 for others. 

‘Candi. Sch. of Year Per- 
date. Pract. College. Grad. cent. 
l 0. National School of Osteopathy....... 1900 78 
2 = NOC. @ MRRGURUO. icc cece ce ce cates i 80 



3 (?) American Health College............ 1895 54 
4 “? POE Oi MEMONON Aa. os ch cc cv eke as ath 60 
5 ia Cee VOI eS. 5 oo. os vc Soc Beg 32 
6 - Pee  OOUON os ky cs c's cca Wacoees ae 65 
7 i oe get Be. Re a ee ee eer 11 
8 era Pee Ee eee 45 
9 . ROTO PRED 6. ous vk ee ee ede we bea 50 
10 “ ROE MERI. wis bao ccard thee o0< nia 39 

Montana Examination.—The examiners in Montana, on 
April 1 to 3, at Helena, met 20 applicants, of whom 13 passed 
and 7: failed. There were 70 written questions on 14 subjects, 
and 75 per cent. was required in order to pass. 


Candi- Sch. of Year Per 
date. Pract. College. Grad. cent. 
1 R. MECC DRIVOVOIEG 350s 5k kde wee ews 1897 83 
3 R. University of Minnesota............. 1897 82 
4 R. Univereity Of DEICHIOGR. «6 uc cccu neces 1900 80 
6 R. Marion Sims-Beaumont College of Med- 
a re arr 1901 75 
7 t. Durham University, England......... 1895 80 
8 R. URIVGrsity Of "KOPOMEO. £050.05 nc sccces 1892 82 
9 R. University of Strassburg, Germany.... 1888 81 
10 R. Western University, London, Ont..... 1900 88 
18 R Dalhousie University, Halifax, N. S.. 1900 86 
15 t Feueh Medical Coleme. nc. cccccecccce 1901 83 
16 g Coli. of Phys. and Surg., Kansas City. 1902 77 
ay R Hosp. Coll. of Med., Louisville........ 1897 83 
18 t Med. Coll. of South Carolina......... 1888 75 
2 t. Med. Dept., Univ. of New York....... 1884 51 
5 a Marion Sims Coll. of Med... St. Louis... 1896 - 67 
1 ? he Hahnemann Med. Coll., Chieago...... 1900 70 
12 t Ohio Med. Univ., Columbus.......... 1901 57 
14 a Coll. of Phys. and Surg., Keokuk..... 1891 68 
19 3 Univ... of Dueblin, Tv@leNd.:< ..0.<.< 665005. 1881 26 
20 H. Homeopathic Med. Coll., St. Louis.... 1898 54 

In Idaho, April 1, at Boise, 16 applicants were asked 115 
questions on 12 subjects in a written examination and 10 
passed, while 6 were unable to reach a grade of 75 per cent. 


Candi- Sch. of Year Per- 

date. Pract. College. Grad. cent 
2 R. University of Kansas City.......... 1899 87 
5 R. Rush Medical College..............- 1901 91.7 
8 R. Rush Medical College..... hana & aaa 1899 85 
9 R. Rush Medical College.............. 1901 87.7 
I R. Ruen Medical Colleme...... ccc 1900 84.7 
12 R. Coll. of P. and &., Chicag@o......... 1900 85.5 
13 R. Coll. of P. and &.. Chicég@o........ . 1900 81.6 
14 R. Coll. of P. and G.,. CHICAGO... \ 6.6 1901 79.7 
6 R. Pt. weene, Com. OF BIOs occ cscnwe 1881 77 
10 R. University of Pennsylvania......... 1900 87 


1 R. Coll. of P. and S., St. Joseph, Mo... 1882 37.7 
3 R. Unit. -Of NAARVIM, TORR vv. 6i0cicw cc 1901 72 
4 a Con. of Fr. and. G., Bt. Loeie........ 1893 62 
< R. University of California. ........06s. 1888 67 
15 R. University of Michigan............ 1892 66.5 
16 R. University of Chattanooga.......... 1901 68.5 

District of Columbia Examination.—The Board of Medical 
Supervisors examined 11 candidates for license to practice 
medicine at Washington, D. C., April 10, and found 8 able to 
attain a grade of 75 per cent., 2 failed and 1 withdrew. The 

. examination was partly written and partly oral, the former part 

consisting of 80 questions, and covered 17 subjects. 

Candi- Sch. of Year Per- 
date. Pract. College. Gred. cent 
303 ; faltimore Medical College....... 1897 88.37 
304 R. Columbian Univeraity ... 600s cesses 1901 82.31 
298 8. Jefferson Medical College........... 1900 84.94 
305 R. Jefferson Medical College........... 1901 91.12 
302 R. Johns Hopkins University......... -. 1901 87.25 
295 R. DOALIOUEL TIUAVOSUIEY ook can ces cmsies 1899 87.84 
*300 R. INDCIOMIEY EUMEVOIWICY seicicsce bes cccce 1900 75.84 
294 R. University of Georgetown.......... 1901 92.84 


7299 R. National University ............... 1901 69.03 
1297 R. Wm VGWOIty OC, BOWt ac cc ois ciscceves 1901 70.00 

*301 R. National UMivertiey 6.0 cdc veedswes 1900 shies 
Notrre.—*Second examination; *third examination; tfourth exam 


California Examiners, at San Francisco, August and 
December, 1901, and April, 1902, found 14 out of 22 applicants 
able to answer correctly 75 per cent. of the 27 written questions 
on 9 subjects. Below is the list. 


Candi- Sch. of Year Per- 
date. Pract. College. Grad. cent. 
ad R. Qe ae ae er ree 1875 83 
R. Umiveraity Of DEICI@GR... 6.6 ice ciete 1890 81 

R. Univereity of MicBigam... ... 2. .s0ccecs 1893 80 

R. University of Vienna, Austria........ 1893 82 

R: Medical School of Maine............. 1899 “79 

R. Columbia University, N. ¥........... 1894 83 

R. CoU.'GF F. Gd G., CHICAES... «ce ccsce 1897 83 


Candi- Sch. of : Year Per- 
date. Pract. College. Grad. cent. 
54 B University of Michigan.............. 1899 79 
56 Ss University of London, England. . .1892-1894 87 
a5 R. Northwestern University, Chicago.... 1894 77 
61 t. Harvard University, Massachusetts... 1898 7 
59 2 Northwestern Medical School, Chicago. 1901 85 
58 3 Columbia University. New York...... 1895 92 
58 a Cooper Medica] College, California.... 1899 79 


R. Kansas City Medica] College, Mo..... 1894 51 
a Univ. and Bellevue Hosp. M. Coll., N. Y. 1900 64 
t. Kentucky School of Medicine......... 1889 ° 62 
& Ceeete OF OWA. 6645.05 6 6 bcs we 1874 65 
R. Rush Medical: College............... 1895 70 
cf Cpicaee tom: Met: Coll... ..ccccce ss 1888 70 
t. Columbus Medical College. Ohio...... 1882 67 
t. Coll. of Phys. and Surg., Keokuk, Iowa 1869 25 

Isaac F. Crospy, M.D., Stuart, Iowa, to Miss Marie Bartley 
of Atlantic, Iowa, May 1. : 

W. G. Marcuan, M.D., to Miss Edna Boucher, both of Bis- 
marck, N. Dak., April 30. 

Grorce E. Jackson, M.D., to Mrs. Josephine FE, Reid, both of 
Chatfield, Minn., April 24. 

Epwarp Darrow, M.D., West Superior, Wis., to Miss Daisy 
Larkin, of Bay City, Mich., April 30. 

James G. Bearrir, M.D., Preston, Ill., to Miss Lillie Hogue, 
of Nashville, Ill., at St. Louis, May 1, 

Rozert J. Conway, M.D., of Hornellsville, N. Y., to Miss 
Francis Harriet White, at Buffalo, April 28. 

Tuomas H. Srreet, M.D., Alexander City, Ala., to 
Minnie Lancaster, of Wetumpka, Ala., April 30. 

JEFFERSON D. Kiser, M.D., Lexington, Ky., to Miss Jennie 
Butterfield, of Ironton, Ohio, at Covington, Ky., May 2. 

Artuur A. Smart, M.D., Toronto, Ont., to Mrs. David L. 
Barnes, Chicago, daughter of Col. B. J. D. Irwin, U. S. Army, 
retired, May 12. 


Deaths and Obituaries. 

Zabdiel B. Adams, M.D. Harvard University Medical 
School, Boston, 1853, medical examiner for the Eighth Middle- 
sex District, and the oldest practitioner in Framingham, Mass., 
aged 80, met sudden death, May 1, by a fall over the face of 
the dam at Southboro. Dr, Adams commenced practice in Rox- 
bury. At the outbreak of the Civil war he volunteered, and 
was made assistant surgeon of the Seventh Massachusetts, and 
later was promoted to be surgeon of the Thirty-second Massa- 
chusetts Volunteers. He was taken prisoner in 1864, and was 
confined in Litchburg and in Libby Prison. Soon after his dis- 
charge he returned to Boston, but soon moved to Framingham. 
‘He was a member of the Framingham and Middlesex County 
medical societies, and had been medical examiner of the district 
for twelve years. 

John S. Miller, M.D. Jefferson Medical College, Philadel- 
phia, 1882, formerly assistant demonstrator of anatomy at 
Jefferson Medical. College, but who was obliged to go to 
Colorado in 1900 for his health, died in Denver, Colo., April 29, 
aged 46. Dr. Miller was appointed resident physician at the 
German Hospital, and subsequently surgeon to St. Joseph’s 
Hospital. He was one of the physicians who went to the relief 
of Plymouth, Pa., in the typhoid epidemic and to Johnstown 
during the flood. While in Denver he was demonstrator at 
Gross University. He was a member of the Philadelphia 
County Medical Society, the State Medical Society, and Ameri- 
can Medical Association. 

Lyman Beecher Todd, M.D. Jefferson Medical College, 
Philadelphia, 1854, the oldest and most prominent physician 
of Lexington, Ky., died, May 13, aged 70. After Dr. Todd’s 
graduation he began practice in Lexington, and three years 
later was elected city physician. From 1861 to 1870 he was 
postmaster at Lexington, and in 1874 was appointed surgeon 

to the detachment of United States troops stationed in that — 

city. He was a member of the Lexington and Fayette County 
medical societies; was treasurer of the Kentucky State Medical 
Society from 1869 to 1875 and also served a term as presi- 
dent of the society. 

James Francis Finney, M.D. Tulane University, New 
Orleans, 1871, prominent as a physician and clubman, ex- 


Jour. A. M. A 

coroner of New Orleans, and quarantine physician under ty, 

governors, died at the Hotel Dieu, New Orleans, May 9. fron 
pneumonia, after a short illness, aged 53. During the yeljo, 

fever epidemic in 1873 he was one of the corps of physicians 
who volunteered their services and worked heroical|y to 
the lives of their fellow citizens. 

Thomas Dudley Isom, M.D. Jefferson Medica! (o}Jeg, 
Philadelphia, 1839, and a resident of Oxford, Miss.. sinco Me 
graduation, died at his home, May 4, from heart failure. after 
a very short illness, aged 86. He was a delegate to the sero, 
sional convention in 1860, and served as a surgeon throughoy 
the Civil war. He was first president of the Confederate hog 
pital, Richmond, and afterward was president of the hospit 
at Columbus. 

Cyrus D. Hottenstein, M.D. Jefferson Medica! Colley. 
Philadelphia, 1848, for more than twenty years physician tp 
the Working Home for the Blind, West Philadelphia, surgeon 
and chief surgeon of the Third Division, First Army Corps, 
throughout the Civil war, and thereafter a practitioner o 
West Philadelphia, and surgeon to the Pennsylvania Railroad, 
died at his home, May 1. 

William S. Loomis, M.D. University of Michigan, Any 
Arbor, 1895, died at Manila, April 30, from intermittent fever. 
after a short illness, aged 33. Dr. Loomis formerly practiced in 
Ann Arbor, Mich., but went to the Philippine Islands in Decem 
ber, 1900, and was in charge of a large hospital there. Tropical 
heat and overwork are said to be responsible for his fatal 

Charles W. Marvin, M.D. Wesiern Reserve University, 
Cleveland, Ohio, 1851, the pioneer medical man of Ithaca, Mich, 
where he located in 1860; assistant surgeon of the Twenty 
sixth Michigan Volunteer Infantry, and later a trustee ard 
director of the school board, died at his home in Newark, Mich. 
April 27, after a long illness, aged 78. 

D’Estaing Dickerson, M.D. Albany (N. Y.) Medical (o- 
lege, 1857, the wealthiest physician of Kansas City, Mo.; a 
veteran of the Civil war, through which he served, being dis 
charged as chief surgeon of the Sixth Army Corps, died from 
pneumonia, at his home in Kansas City, May 3, after a short 
illness, aged 67. 

Joseph A. Tarkington, M.D. University of Georgetown, 
Washington, D. C., 1870, who practiced for thirty years in 
Washington, D. C., and was then obliged to retire on account 
of ill-health to the family homestead near Greensburg, Ind. 
died there May 1, aged 64. 

Maximilian A. Cachot, M.D. Cooper Medical College, San 
Francisco, 1864, a native of France, but a resident of San Fran 
cisco for nearly forty years, died at his office in that city from 
apoplexy, after a few hours’ illness, April 29, aged 68. 

Edward Lawrence Feehan, M.D. Washington University, 
St. Louis, 1861, brother of Archbishop Feehan of Chicago, and 
for forty years a practitioner of St. Louis, died at his home in 
that city, May 8, from Bright’s disease, aged 67. 

Harvey W. Curtiss, M.D. Western Reserve University, 
Cleveland, 1852, a practitioner of Chagrin Falls, Ohio, for fifty 
years, a state senator, and once acting lieutenant-governor ot 
the state. died at his home, April 30, aged 78. 

John Homans, II, M.D. Harvard University Medical 
School, Boston, 1882, a member of the Papyrus Club and of the 
State Medical Society, died at his home ia Boston, after a 
brief illness, May 4, aged 45. 

Charles McDonough, M.D. Pennsylvania Medical College, 
Philadelphia, 1848, who ‘had practiced in Reading for fifty-five 
years, and was a veteran of the Civil war, died recently at his 
home in Reading, aged 75, 

John T. Shutt, M.D. College of Physicians and Surgeons, 
Baltimore, 1880, a charter member of the Mercer County ( Pa.) 
Medical Society, died suddenly from neuralgia of the heart, 
May 4, aged 50. 

William D. Karns, M.D. College of Physicians and Sur 
geons, Keokuk, Iowa, 1878, a practitioner of Dahlgren, !!!., for 
nearly twenty-five years, died at his home in that place, Apr! 
26, aged 58. 

Charles H. Masten, M.D. Bellevue Hospital Medica! Col 
lege, New York, 1867, died at his home in Nyack, N. Y., May], 
from pneumonia, after an illness of ten days, aged 62. 

F. Antes Canfield, M.D. Rush Medical College, Chicago, 
1872, the pioneer physician of Juneau County, Wis., died at his 
home in Necedah, April 22, aged 71. 



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May 1902. 

Henry D. Green, M.D. Medical College of the State of 
South ( a) olina, Charleston, 1850, died after a prolonged illness 
at Donalds, S. C., April 29. 

Ulric D. Stone, M.D. Umaha (Neb.) Medical College, 1892, 
died at his home in Steinauer, Neb., April 18, from neuralgia 
of the heart, aged 38. 

William E. Byrd, M.D., died from pneumonia, after a short 

ines, at his home in Montrose, W. Va., April 30, aged 64. 

John M. Bye, M.D. University of Michigan, Ann Arbor, 
died recently at his home in Canton, Ohio. 


Association News. 

Railroad Rates for Saratoga Meeting. 

The Committee on Transportation reports that a rate of one 
and one-third on the certificate plan will now apply throughout 
the entire United States, all the passenger associations having 
acreed to the same. This rate has been extended to include the 
meeting of the American Academy of Medicine, which meets 
at Saratoga, June 7. The return limit is June 17 without extra 
fee and July 2 on payment of fifty cents. All going tickets 
must be accompanied by a certificate and, in order to receive 
reduction returning, certificates must be signed by Dr. William 
&, Swan, Saratoga, between June 11 and 13. In order to secure 
the privilege of time extension between June 16 and July 2, all 
certificates must be signed as above and deposited with the 
local ticket agent not later than June 17. ‘Failure to com- 
ply with any of these requirements will result in forfeit ot 
time extension limit and reduced rate returning. In order to 
avoid delay and extra cost of baggage transfer across New York 
City, delegates and members from the southeastern territory, 
and that of the trunk line south of New York City will find 
it convenient to purchase tickets direct over the Pennsylvania 

f lines or other roads connecting with the West Shore Railroad 

at Jersey City going direct through to Albany or Saratoga. 
For those in the central and extreme western and southwest 
ern territories, the most direct and continuous routes will be. 
via the Chicago, Milwaukee & St. Paul and Big Four connec- 
tions by way of the Lake Shore & Michigan Southern Railway, 
all of which run direct to Saratoga via Buffalo and Albany over 
the New York Central and Delaware & Hudson Road. Any 
of the passenger and ticket agents of the roads herein enumer-. 
ated will furnish special information to delegates in the matter 
of time, trains, and return certificates. 
H. L. E. Jonnson, M.D., Chairman, 
Committee on Transportation. 

Special Report of the Committee on National Legislation. 

The Committee on National Legislation reports that the bill 
proposed by them to promote and honor the ex-president of the 
American Medical Association, Surgeon-General George M. 
Sternberg, was introduced in the Senate by Senator Gallinger 
April 12. The Bill is known as Senate 5213 and reads: “A 
Bill providing for the selection and retirement of medical offi- 
cers in the Army. Be it enacted by the Senate and House of 
Representatives of the United States of America in Congress 
assembled, That the President of the United States is hereby 
authorized to select one from such medical officers of the Army 
as have served forty-one years or more, nine years of which 
shall have been as Surgeon-General, and by and with the ad- 
vice and consent of the Senate, appoint him a major-general of 
the United States Army, for the purpose of placing him on the 
retired list.” 

On May 7 Senator Joseph R. Hawley, Chairman of the Sen- 
ate Committee on Military Affairs, reported the bill favorably 
and recommended its passage. His report includes letters from 
the Seeretary of War addressed to the House of Representa- 
tives. from the Adjutant-General, from the Surgeon-General, 
and others. The report also gives many details in regard to 
Surgeon-General Sternberg, showing what he has accomplished, 
the honors that have been conferred on him, together with a 
list of his contributions to medical literature previous to 1893. 
The report is very flattering to General Sternberg. 



The Fee-Splitters.—The abominable practice of fee-splitting 
must come to anend. The fellow who auctioneers his patients 
off to the surgeon and specialist—to the highest bidder—has 
had his day, and will as surely receive his just deserts as time 
lasts. At the next meeting of the American Medical Associa- 
tion there can be no doubt but what that great body will take 
such action as will force every one of the fee-splitters to aban- 
don the abominable practice or be expelled from any medical 
society that they may then belong to, and will bar them from 
entering any medical societies in the future. There can be no 
way of evading the punishment that is in sight for them; it 
is inevitable-—Amer. Practitioner and News. 

Hospital Statistics.—American Medicine makes some inter- 
esting observations on the figures published by the State Board 
of Charities bearing on the number of in-patients at a par- 
ticular institution therein referred to. It is stated that dur- 
ing the year 1900 this hospital admitted no less than 9308 new 
patients. Now, the total bed accommodation for patients 
in that institution happens to be 292, and the average number 
of beds occupied during the year was 194. Taking the average 
stay in hospital of each patient to be eighteen days, an estimate 
which some pains have been taken to verify, the figures seem to 
show that at least 5656 persons must have slept two in a bed; 
indeed, if instead of the total bed capacity, we take the average 
of bed days, as reported, it will be seen that a large number 
of patients must have slept three in a bed! Our contemporary 
naturally asks how this can have come to pass and suggests 
the following alternative explanations—either the average stay 
in hospital must have been less than eighteen days, although 
in other hospitals the average varied from twelve to twenty- 
one days, or the figures must have been falsified in order to in- 
fluence the allocation of State funds. As the latter hypothesis 
is, of course, inadmissible we are thrown back upon the sup- 
position that several persons must have slept in a bed. If so 
it may be remarked that disease, like poverty, makes strange 
bedfellows.—Med. Press. 

The Proposed Uniform Organization of State Medical 
Associations.—A committee appointed for the purpose by the 
president of the American Medical Association, consisting ot 
Dr. J. N. McCormack, of Bowling Green, Ky., Dr. P. Maxwell 
Foshay, vf Cleveland, and Dr. George H. Simmons, of Chicago, 
has devised a form of constitution and by-laws intended to 
serve as the substance of the constitution and by-laws of each 
State organization affiliated or to be affiliated with the national 
association, and the’ plan is set forth in a report published in 
the association’s JOURNAL for May 3d. The gentlemen of the 
committee do not profess that their device is perfect or that in 
all its details it will be found available to advantage in every 
State; indeed, they intimate that much of the wording of those 
portions that in all probability will prove acceptable in all 
the States need not be formally enacted, inasmuch as it is 
elucidative rather than declaratory. It is desirable to have the 
constitution and by-laws of any society as brief and condensed 
as may be consistent with clearness, but in this instance we 
think the entire report of the committee should be preserved 
in the.archives of every State society that adopts its funda- 
mentals, for it will furnish the readiest means of expounding 
the enactments. 

Recognizing the diversity of conditions in the various parts 
of such an enormous country as this, the committee has wisely 
aimed at flexibility in all but essentials, and has sought to 
provide the greatest facility for conciliation and compromise 
in regard to disagreements and friction of all sorts and for the 
utmost liberality in rating individual physicians as to their 
eligibility to membership in the component county societies, 
which membership carries with it the right of representation 
in the State organization and in the American Medical Associa- 
tion. There is, indeed, so far as we can see, no reason why, 
under such a general scheme as the committee has devised, 
there should not shortly be achieved a close approach to such 
an ideal unification of the medical profession as was lately 
forecast by Dr. Charles A. L. Reed, of Cincinnati, in his re- 
marks before a Dayton society, published in our issue for 


April 19, for no reputable legally qualified practitioner would 
be kept out of a county society or debarred from acting as its 
representative in the State and national organizations, no 
matter what his therapeutical theories or practice might be— 
provided only he renounced sectarianism, which would not at 
all mean that he should give up his belief or cease to practice 
in accordance with it, but only that he should no longer 
exploit it with the laity. Only as a united profession can we 
readily influence legislation in the interest of the public health 
and for the advancement of medical science, and we believe that 
the great body of physicians throughout the Union will concur 
in the liberality shown by the committee, and feel thankful 
to the gentlemen composing that body for the assiduity and 
broad-mindedness which they have brought to the devising of 
their scheme.—N. Y. Med. Jour. 

A Training School for Nurses in Turkey.—The great 
scarcity of nurses in Turkey has led to a proposal, made by 
the authorities of the American College for Girls in Con- 
stantinople to its trustees in Boston, that in connection with 
the academic course a medical department in the form of a 
hospital and training school for nurses should be established. 
It is urged that there is a splendid opening for nurses in tak- 
ing charge of the native women, who lead idle, aimless lives, 
and take very little air or exercise, and who consequently de- 
velop many real or imaginary diseases. These women greatly 
need someone to instruct them in the simple laws of hygiene 
and the care of the body, and nurses would be heartily welcomed 
by them. The Turkish: hospitals import their nurses from 
Germany.—Brit. Med. Jour. 



American Medical Association, Saratoga §prings, N. Y., 
June 10 to 13. 

Illinois State Medical Soclety, Quincy, May 20-22, 1902. 
Medical Association of the State of Missouri, St. Joseph, May 
20-22, 1902. 
Arizona Medical Association, Tucson, May 21-22, 1902. 
Medical Association of Montana, Anaconda, May 21-22, 1902. 
Medical Society of West Virginia, Parkersburg, May 21-23, 1902. 
Iowa State Medical Society, Des Moines, May 21-23, 1902. 
‘Indiana State Medical Society, Evansville, May 22-23, 1902. 
American Pediatric Society, Boston, May 26-28, 1902. 
American Laryngological Association, Boston, Mass., May 26-28, 
American Gynecological Society, Atlantic City, May 27. 1902. 
Connecticut Medical Society, New Haven, May 28-29. 1902. 
Ohio State Medical Society, Toledo, May 28-30, 1902. 
American Laryngological, .Rhinological and Otological 
Washington, D. C., June 2-4, 1902. 
American Surgical Association, Albany, N. Y., June 3-5, 
Louisiana State Medical Society. Shreveport, June 3-5, 
Maine Medical Association, Portland, June 4-6, 1902. 
South Dakota State Medical Society. Scotland. June 4-5. 1902. 
Wisconsin State Medical Society. Milwaukee, June 4-6, 1902. 
Rhode Island Medical Society, Providence. June 5, 1902 
Association of Military Surgeons of the United States. Washing- 
ton, D. C.. June 5-7, 1902. 
American Orthopedic Association, Philadelphia, Pa., June 5:7, 



American Academy of Medicine, Saratoga Springs, N. Y., June 7, 

American Association of Wife 
Saratoga Springs. June 9, 1902. 

National Confederation State Medical Examining and Licensing 
Boards. Saratoga Springs. N. Y., June 9, 1902 

Association of American Medical Colleges, Saratoga Springs, N. 
Y., June 9, 1902. 

American Climatologicat 
9-11, 1902. 

Americen Proctological 
June 10, 1902. 

Medical Society of Delaware. Newark, June 10, 1902. 

Massachusetts Medical Society, Boston, Mass., June 10-11. 1902. 

Medical Society of the State of North Carolina, Wilmington, 
June 10-14, 1902. 

Colorado State Medical Society, Pueblo, June 17. 1902. 

American Medico-Psychological Association, Montreal, 
20, 1902. 

Minnesota State Medical Society, Minneapolis, June 18, 1902. 

Medical Society of New Jersey, Atiantic City. June 24-26 19902. 

Washington State Medical Society, Tacoma, June 24-26, T902. 

Michigan State Medical Society, Port Huron. June 26-27, 1902. 

Insurance Examining Surgeons, 

Association, Los Angeles, Cal., June 

Association, Saratoga Springs, N. Y.. 

June 17- 

Detroit Physicians’ Association.——At the annual meeting 
of this Association, April 28, Dr. Daniel Kerr was elected 
president and Dr. Walter J. Cree, secretary. The Association 
now numbers nearly 300. ; 

Austin (Texas) Academy of Medicine.—At a recent meet- 
ing of the Academy, Dr. Matthew M. Smith was elected presi- 


‘ship of eight. 

Jour. A. M, 4 

dent; Dr. Joseph S. Wooten, vice-president; and Dr. \y, Allen 
Harper, secretary and treasurer. 

Pike County (Ill.) Medical Society.—At the annual moo. 
ing of this Society, held in Pittsfield, April 24, Dr. Henry 7 
Duffield, Pittsfield, was elected president; Dr. Francis M. Cyan. 
Pittsfield, vice-president, and Dr. Rufus H. Main, Barry, ga 
retary. ; 

American Orthopedic Association.—This Association yjj 
meet at Hotel Walton, Philadelphia, June 5, 6 and 7. A featyy 
of the meeting will be an evening with the plaste: of-paris 
bandage in the amphitheater of Jefferson Medical College Hog. 
pital, June 6. 

Barry and Eaton (Mich.) Medical Association. —,t ;), 
annual meeting of this Society, held in Nashville, April 24, p; 
Aleck F. Hutchinson, Nashville, was elected president; 
Arthur E. West, Eaton Rapids, vice-president, and Dr. Ff. » 
Shilling, Nashville, secretary and. treasurer. 

Lewis and Clark County (Mont.) Medical Society.—\ 
number of physicians of Helena met, April 30, and reorganized 
this Society, which disbanded in 1894, with an initial member 
Dr. George W. King was elected president; ); 
Benjamin C. Brooke, secretary, and Dr. Rudolph Horsky, treas 

Charity Hospital (New Orleans) Alumni.—The internes 
and ex-internes of Charity Hospital met and banqueted, April 
30. Dr. E. Denegre Martin, New Orleans, was elected presi: 
dent; Dr, John J. Laurans, New Orleans, vice-president; Dr 
§. M. D. Clark, New Orleans, secretary, and Dr. Jules Lazard, 
New Orleans, treasurer, 

Linn County (Mo.) Medical Society.—At the annual meet 
ing of this Society, held in Laclede, April 29, the following 
officers were elected: Dr. F. W. Burke, Laclede, president; Drs 
Emanuel 8. Wenger, Brookfield, and Urbane C. Dryden, Shafter, 
vice-presidents; Dr. Edmond D. Standly, Linneus, secretary, 
and Dr, John L. Burke, Laclede, treasurer. 

Central Medical College (St. Joseph, Mo.) Alumni Asso 
ciation.—-On April 28 this Association elected the following 
officers: Dr. Louis J. Dandurant, St. Joseph, president; Drs 
H. A. Green and F, Austin Patterson, St. Joseph, vice-presi 
dents; Dr. Herbert Lee, secretary; Dr. Grace M. Bliss, corr 
sponding secretary, and Dr. A. D. Pope, treasurer. 

Central Illinois Medical Association.—The twenty-eighth 
annual meeting of this body was held at Pana, April 29. Th 
following officers were elected: Dr. Everett J. Brown, Decatur, 
president; Drs. John H. Miller and George W. Fringer, Pana, 
vice-presidents; Dr. John N. Nelms, Taylorville, treasurer, ani 
Dr, Frederick J. Eberspacher, Pana, secretary. 

North East Missouri Medical Association.—This Society 
held a session in Memphis, April 8 and 9. The following officers 
were elected: President, Dr. Robert B. Turner, Canton; vice 
president, Dr. Frank B. Hiller, Kahoka; secretary, Dr. FE. F 
Parrish, Memphis, and treasurer, Dr. James B. Bridges, Down 
ing. The next meeting to be held at Kahoka, October 14. 

Berkshire District (Mass.) Medical Society.—At the au 
nual meeting, held in Pittsfield, April 24, this Society elected 
Dr, Stephen C. Burton, Pittsfield, president; Dr. Lucius T 
Ingham, West Stockbridge, vice-president; Dr. Lawrence ( 
Swift, Pittsfield, secretary; Dr. William Le R. Paddock, Pitts 
field, treasurer, and Dr, William W. feavitt, Pittsfield, 


State Association of Colored Physicians of Florida. —!h« 
colored practitioners of Florida met at Fernandina, April 24, 
and organized this Association, with Dr. Perey N. Richardson, 
Fernandina, president; Dr. A. L. Pierce, Orlando, vice-presi 
dent; Dr. W. C. Smalls, Jacksonville, secretary, and Dr. A. S 
Jerry, Tallahassee, treasurer. The next meeting will be held in 
St. Augustine in May, 1903. 

Ohio Valley Medical Association.—T'he seventh sem! 
annual meeting of this Association was held in Owensboro, Ky. 
May 1 and 2. The following officers were elected: Dr. 1. 
Atchison Frazer, Marion, Ky., president; Drs. A. M. Hayden, 
Evansville, Ind., and- Daniel M. Griffith, Owensboro, Ky., and 
Campbell H. Johnson, Henderson, Ky., vice presidents, and Dr 
Dudley S. Reynolds, Louisville, librarian. 

Addison County (Vt.) Medical Society.—This Society, 
which was organized in 1813, but which had not held a meeting 
for 22 years, is to be reorganized. In response to a eal! of Dr. 
James M. Hamilton, Rutland, nine physicians met at Middle 
bury, April 29. Dr. Edward P. Russell, Middlebury, was made 


M. A. 
W. Alley 

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Henry 7 
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nd Dr. Merritt H. Eddy, Middlebury, secretary. A 
n reorganization, constitution and by-laws was 
) report in June. 

appointed ti 
College of Physicians and Surgeons, Baltimore, Alumni 
Associatic n.—This Association held its annual business meet- 
ing and banquet, April 28. The following officers were elected: 
Dr. Samuel H. Allen, Provo City, Utah, president ; Drs. Charles 
Raltimore, and Thomas A. Councell, Easton, Md., vice- 

F Blake, : : c 

presidents ; Dr. Hubert C. Knapp, Baltimore, secretary; Dr. 
; \v. G. Rohrer, Baltimore, assistant secretary, and Dr. 
charles E. Brack, Jr., Baltimore, treasurer. 

University of Buffalo Medical Department Alumni 
Association. —At the annual meeting of the alumni of this 
nstitution, held at Buffalo, May 2, the following officers were 
elected: Dr. Alfred W. Bayliss, Buffalo, president; Drs. Alfred 
i. Henckell, Rochester; Fridolin Thoma, Buffalo; Henry S. 
Benham, Honeoye Falls; Jane W. Carroll, Buffalo, and George 
4. Himmelsbach, Buffalo, vice-presidents; Dr. Thomas H. Me- 
Kee, Buffalo, secretary, and Dr, Herman K. De Groat, Buffalo, 

Clark County (Ohio) Medical Society.—The first meeting 
of the newly-consolidated Clark County Medical Society and 
Springticld Academy of Medicine was held at Springfield, May 
5. The following officers were chosen for the new society: 
Dr, Read L. Bell, president; Drs. John P. Dugan, and Noah 
Myers, vice-presidents; Dr. J. C. Easton, secretary, and Dr. D. 
\\alter Spence, treasurer, all of Springfield. Drs, Isaac Kay, 
John H. Rodgers and Henry H. Seys, Springfield, each of whom 
jad practiced medicine for more than fifty years, were made 
emeritus members. 

International Association of Railway Surgeons.—The 
fifteenth annual meeting of this Association was held in St. 
Louis, Mo., April 80, May 1 and 2, under the presidency of Dr. 
Rhett Goode, Mobile, Ala. The following oificers were elected 
for the ensuing year: President, Dr. William A. McCandless, 
St, Louis; vice-presidents, Drs. Arthur L. Wright, Carroll, 
lowa; John B. Rule, St. Louis; John C. Wysor, Norfolk, Va.; 
gE. E. Kitchener, Canada; William G. Jameson, Palestine, 
Texas; Reyes M. Ortego, City of Mexico, and Philander Daugh 
ety, Junction City, Kansas. Drs. David 8S. Fairchild, Clinton, 
lowa; A. 1. Bouffleur, Chicago, and Joseph R. Hollowbush, 
Rock Island, Ill, were elected members of the executive board. 
Drs. Louis J. Mitchell, Chicago, and James A. Duncan, Toledo, 
Ohio, were re-elected secretary and treasurer, respectively. In 
dianapolis, Ind., was selected as the place for holding the next 
imnual meeting. 

Regular Meeting, held April 21, 1902. 
The President, Dr. Moreau R. Brown, in the Chair. 
Congenital Heart Disease. 

Dr. Joun Epwin Ruopes reported a case of probable con 
genital heart disease in a girl of 11. Her mother and father 
we living. They have had 8 other children; all are living and 
vell, except one who died of hip disease from an injury. She 
veighs 60 pounds; is well nourished, lips red, skin of a healthy 
tormal cobor and temperature normal. She had rétheln when 

‘was 3 years of age, followed by double pneumonia and she 
as had several attacks of’pneumonia since. She has never had 
theumatism. Her mother says that she was never as strong as 
ler other children, but she gives no history of cyanosis at birth 
or subsequently, although she says that her color was not as 
good as that of the other children. The child says that as long 
as she can remember she has been somewhat short of breath on 
‘Xertion, as in walking fast or going upstairs, but it seems to be 
io Worse now'than it has been for some years past. There is 
io pain or tenderness over the chest. She often has palpitation 
when tired or excited, the heart’s action then being much ac- 
velerated. I found her pulse 104, rather weak,‘ but regular, 
fesplrations 22; temperature is usually normal. Her blood 
“ount shows 5,300,000 red corpuscles, white 17,000. The tongue 
's cleon; the appetite and digestion good, and the bowels 

lhere is no eyanosis, except a slight duskiness of the finger 


nails, and no clubbing of the fingers. The impulse of the heart's 
apex is in the fifth intercostal space, half inch outside of the 
mamnillary line, and is about 1 inch in diameter. An impulse 
is also seen at the base of-the left border of the sternum in the 
No thrill is felt over the apex. Over 
the upper portion of the precordia as far out, on the left side, 
as the anterior axillary line in the second and third intercostal 
spaces and with diminishing foree as high as the clavicle, a 
thrill is felt. Its maximum intensity is in the second inter- 
costal space two inches from the median line. The thrill is 
There is no bulg- 
Dulness on the left side begins at the 
Dulness to the 

inches in the 

third intercostal space. 

not perceptible to the right of the sternum. 
ing of the precordia. 
first rib and extends downward to the sixth. 
right extends 1% inches from midsternal line in 
fourth interspaces. Dulness to the left 

from midsternum in first 
sternai line in second and third interspaces, 3 
fourth interspace, and 34% in the fifth. On auscultation at the 
apex there is no distinct murmur but a slight systolic reugh- 

extends 1% 

interspace, 24% inches 

ness which is not transmitted. Over the base of the heart a 

loud diastolic and a systolic murmur are heard distinctly in 

A case of probable congenital heart disease. 

the pulmonary area and very distinctly at the left border of 
and third 
systolic murmur being more distinct in the second intercostal 
space about 2 in. to left of sternum. These murmurs are not 
apparently transmitted to the arteries of the neck nor are they 
heard behind. 

the sternum in the second intercostal spaces, the 

The second pulmonic sound is very markedly 
There is ne accentuation of the second sound in 
the aortic area nor are there murmurs in this area.’ No venous 
hum is heard at the base of the neck. 
of tumor in the pulmonary area. 

There are no evidences 

In this case we probably have an obstruction and insufficiency 
at the pulmonary orifice with hypertrophy and dilatation of the 
right ventricle. , Tiere is probably also a hypertrophy of the 
left ventricle and dilatation hypertrophy of the left 
auricle with intra-pulmonary obstruction te account for the 
accentuation in the second pulinonic sound, 

A Case of Aneurysm of the Aorta of About Forty Years’ 

Dr. Ruopes also presented this case: Mrs. W 



. H. S., aged 50, 
Her maternal grandfather had rheumatism; some 

second cousins of the mother died of phthisis. She had scarlet 


fever and measies in childhood. She never had rheumatism or 
other illness of importance. She is of medium height, weighing 
148 pounds; five years ago her weight was 185. She has never 
had children or miscarriages. Her pulse is 86; that at the 
left wrist being somewhat stronger than that at the right. 
Her strength at the present time is not very good. She has 
frequent headaches and an occasional slight edema of the ankle. 
She has dyspnea on slight exertion and is occasionally conscious 
of shortness of breath when quiet. She has been able for years, 
however, to go about her ordinary duties without much diffi- 
culty; of late, she has suffered somewhat more than usual from 
dyspnea on exertion, as in putting coal in the furnace. The 
respirations are not much accelerated; appetite is good, diges- 
tion not good; the bowels are regular. She complains of oc- 
casional very marked throbbing of the arteries all over the body. 
She is complaining of numbness lately in the back part of the 
throat and tongue and occasionally suffers from palpitation 
after eating. She states that when she was a child she was in 
the habit of jumping a rope to great excess and to this over- 
exertion she attributes her trouble. She knows that she has had 
this affection of her chest for 40 years. Over 21 years ago 
she was seen by Dr. Austin Flint, Sr., Dr. Janeway and others 
in New York and a diagnosis was made of aneurysm of the 
aorta and she was shown to the students in classes at Bellevue 
and elsewhere. 

On examination of the chest, we find on the first interspace 
on the right no dulness. On the left side there is normal 
resonance and no bulging. There is slight bulging over 
the sternum at the second rib more marked to the right than 
to the left. At the second rib there is dulness one inch to the 
right of the sternum, third rib 2 inches, fourth rib 1 inch, at 
which latter point there is some tenderness. A thrill is felt in 
the second interspace on the right over which area pulsation is 
felt and seen. The thrill is felt 2 inches to the right of the 
sternum and about 14 inch farther to the right than the area 
of actual dulness. The apex is in its normal position. On 
auscultation a loud systolic murmur is heard all over the left 
side of the chest, increasing in intensity into the aortic area. 
In the aortic area, systolic and diastolic murmurs are heard 
and a systolic shock is present. The systolic murmur is loud 
over the upper part of the chest, but more marked in the 
second and third intercostal spaces of the right side. This 
murmur is also heard over the carotid and behind at the right 
side of the spine from the apex ‘to the fourth dorsal vertebra. 
An interesting feature of this case is that the patient has been 
able to pursue her usua] avocations for about 40 years and 
there jiias evidently been very little increase, if any, in the size 
of the aneurysm, and she has suffered very little from such 
symptoms as one with such a lesion might ordinarily be ex- 
pected to have. 

Dr. WitLiAM E. CasseLBerry—lI am a little surprised, if it 
be an obstructive lesion of the pulmonary orifice, that there 
should not be disclosed more hypertrophy of the right ventricle. 

Dr. E. FLETCHER INGALS—In the case of the little girl there 
is no way of telling the exact condition which causes the signs. 
The history and the systolic murmur at the base of the heart is 
indicative of a communication between the auricles or ventri- 
cles; yet the character of the murmur and the sudden sharp 
closure of the pulmonary valves would indicate that the sound 
is produced at the pulmonary orifice. 

Dr. A. M. Conwin—tThe case of the little girl is one of those 
interesting instances of heart lesion, the signs of which are 
seemingly at variance with the rules in our text-books and 
about which it is unsafe to dogmatize. The absence of aortic 
regurgitation, and of all the classical signs and symptoms of 
that affection, would rule out aortic leakage as a cause of this 
diastolic murmur. The murmur is more of the type of that 
produced by mitral obstruction in some respects, but unlike 
the obstructive murmur in that it lasts seemingly 
throughout diastole. The supposition of mitral obstruction is 
strengthened by the accentuated pulmonic sound and the clear 
and loud mitral first sound, and also by the entarged left auricle. 
The signs of tricuspid obstruction, which is a rare affection, are 
absent in this patient. 



Jour. A. ¥. A. 

Dr. Ruopes (closing the discussion) —Iin making diagnosis 

of pulmonary obstruction and regurgitation, I have done 
largely by exclusion. If we had a diastolie murnur at the 

mitral valves, it would be apt to be a presystolic :,urmyy at 
the latter part of the diastole and be heard distinctly in ,, 
mitral area. The thrill of mitral stenosis is presystolic, , 
tricuspid diastolic murmur would have the same time and 
rhythm as the mitral and it would be apt to be a presysty 
murmur. We would have epigastric pulsation. 
no such evidence here. The right side of the heart is enlargg 
but not markedly so. It is an anomalous condition, and wwe can 
not say that the only lesion is located at the pulmonary valye 
In the determination of the question as to whether the lesions 
were congenital or acquired, | have arrived at the decision oj 
congenital disease from the fact that congenital lesions at this 
valve are not uncommon, and the right side of the heart is th: 
ene usually involved. Pulmonary obstruction is usually “i 
companied by incompetency in congenital disease. It would 
be a most unusual occurrence to have these valves selected fo: 
involvement in an acquired endocarditis. It is quite possible 
| suppose, that the attack of German measles may have cause 
further disease in an already crippled heart and the conditioy 
of the left auricle and ventricle may have dated from that tine. 

But there js 

(To be continued.) 


Seventeenth Annual Meeting, held in Washington, D. (. 
April 29 and 30, 1902. 

President, Dr. J. C. Wilson, Philadelphia, in the Chair. 
Presidential Address. 

Dz. WILson referred to the early history of medical organ 
ization in this country, the beginning being far back. Two 
organizations, one in Boston and one in New York, both short. 
lived, preceded the oldest existing medical society in this cow: 
try, the Litchfield County Medical Society of Connecticut. 
which was founded in 1765 and is still flourishing. After this, 
societies were formed in New Jersey, Massachusetts, Philadel. 
phia and finally in 1847 the American Medical Association came 
into being. 

He stated that the services rendered to the profession, an| 
through the profession to the people, by this great Association, 
with its constituent state and county societies, could not be 
overestimated. “It has brought the profession together and 
given it solidity. It has not only encouraged the formation 
and growth of local societies, but has proved a constant stim 
ulus to activity on their part. It has, by means of its section 
work and excellent journal, set a high standard of professional 
attainments and fostered among phyvicians a deep sense of 
responsibility and a lofty conception of the duties and privi- 
leges of their calling.” 

The address closed with tributes of respect to the members 
who have died during the past year, including Drs. John T. 
Metcalf, who was chosen an honorary member when the societ} 
was first organized; Meredith Clymer anc William Waring 
Johnston, an original member of the association, for man} 
years its treasurer and at the time of his death a member 
of the council. ; 

An amendment to the Constitution providing for the increase 
of the possible membership to a hundred and fifty was intro 
duced, and, under the rules, laid over for a year. 

Comparative Toxicity of Ammonium Compounds—A 
Study in Auto-Intoxication. 

The scientific programme was then taken up and the first 
paper presented by Dr. B. K. Rachford on the above subject. 
He had studied the comparative toxicity in mice of such salts 
as may be formed by the union of ammonium, potassium 
sodium, calcium and magnesium with such acid ions a* ma} 
be present in the body in health and disease. From these ex 
periments he drew the same conclusions as those which lhe ex 
pressed before this society three years ago, that the xanthin 
bodies were the important toxic principles, but that their tox 
icity was increased by small quantities of ammonia i» com 
bination with them. The ammonium compounds of the x nthin 


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“May 1902. 

hodies are toxke agents in producing migraine and other lith. 
emic disorders which he described in his previous papers as 
being due to xanthin bodies alone. This point seems plausible 
when one remembers that the functionally incompetent liver, 
ghich is cn important etiologic factor in all these conditions, 
may by the fall of its urea-forming function throw into the 
eeneral -irculation sufficient ammonia and uric acid leucomains 
a combine and in this way diminish the excretion of urea and 
increase thie excretion of ammonia and xanthin bodies. 

An Estimate of the Amount of Toxin in the Blood of a 
Horse Infected with Tetanus. 

Dr. B. MEADE Botton referred to the outbreak of tetanus in 
<. Louis last year which was shown to be due to.the use of 
diphth ria antitoxin which contained tetanus toxin. The anti- 
toxin used in those cases was obtained from a horse that ex- 
hibited symptoms of tetanus two days after the blood was 
jrawn and he was able to demonstrate the presence of a con- 
siderable amount of toxin in this serum. There is no evi- 
dence in literature of such a finding having been made previ- 
ously under similar circumstances. All the known facts before 
have seemed to show that the toxin in some cases, whether 
it was injected into the blood or developed in the tissues from 
infection, disappeared from the blood, while in other cases 
even though a minute quantity had been used it could be 
found in the blood. In experimental work it was found that 
the toxin remains circulating in the blood in guinea-pigs, 
while in rabbits it disappears from the blood and combines with 
the tissues. Dr. Bolton’s work consisted in inoculating horses 
with garden earth known to contain the tetanus organism by 
the result of tests upon small animals and also by inoculating 
one horse with a culture that produced tetanus in smaller 
animals. The blood from all the horses was drawn at inter- 
vals of twenty-four hours after inoculation and the amount 
of toxin in the serum determined by the injection of guinea- 
pigs and other small animals. It was shown that the toxin 
makes its appearance in the blood of the horse several days 
before any symptoms of tetanus are to be observed and that 
it gradually increases until about two days before the symp 
toms become noticeable, after which it rather suddenly dim- 
inishes and even disappears in some cases. The amount of 

toxin varies considerable in different cases. 

Pseudo-Tubercle Bacilli. 

Dr. A. C. ABnoTr read a paper on “The Etiologic Significance 
of the Acid-Resisting Group of Bacteria and the Evidence of 
Their Mechanical Relationship to the Bacillus of Tuberculosis.” 
He remarked that it was somewhat disturbing to learn that 
there exists a group of bacteria that resembles the tubercle 
bacilli in staining qualities and in appearance. Dr. Abbott 
and his assistants have conducted an investigation of these 
organisms, the expenses of which have been borne by the Rocke- 
feller Institute. He gave an account of the methods of inves- 
tigation and the points of resemblance. He thought that these 
organisms might be dismissed from consideration in so far as 
anv danger of their causing trouble by infection from milk 
and butter is concerned. More work has yet to be done to 
show how closely they are related to the tubercle bacillus. It 
isshown that they grow as actinomyces and the work of others 
has shown that the bacillus tuberculosis under particular 
methods of inoculation may likewise develop as actinomyces. 
These last experiments were confirmed by Dr. Abbott with the 
tubercle bacillus, an organism being secured that strongly re 
smbles this acid-resisting group. : 

In diseussion, Dr. Flexner said that he had had the privilege 
i examining Dr. Abbott’s specimens and felt that there could 
no doubt that the lesions produced by this group of organ- 
isms were not true tubercles. The whole lesion studied to. 
gether reminded one of granulation tissue with a large number 
of giant cells. He thought the lesions were very similar tu 
those produced by the blastomycetes. 

Dr Meltzer referred to the ¢ase of a man who had for many 
years been considered to be tuberculous, but whose sputum 
°n careful examination showed these peculiar organisms. 

The Histologic Alterations of Cytotoxinic Intoxication. 

Dk. SIMON FLEXNER said the studies of Bordet, Ehrlich, 
Metchnikoff and others have proven that many kinds of body 


cells, when injected into alien animals, give rise to the pro- 
duction of cytotoxins agreeing in many physiologic properties 
with bacterial and other toxins. He worked particularly with 
the cytotoxins of the lymphatic organs and found that the 
lesions produced in the glands are general throughout the 
body just as they would be after bacterial toxins. The work 
has some bearing upon the question of terminal infections and 
shows that in the majority of cases of sueh infections there 
is a great reduction of the complement of the circulating blood, 
if not an entire absence of it. 

A Study of Bacterial Cells. 

Dr. V. C. VAUGHAN read this paper and referred to the ap 
paratus by which he was able to raise various micro-organisms 
by the acre and thus secure a sufficient quantity to study chem- 
ically their constituents, particularly their pigments. The 
bacillus prodigiosus has a pigment which is soluble in water 
and can be used as a stain for cotton, wool or silk goods. 
Two coloring matters are obtained from this pigment, one 
yellow and the other beautiful pink, and Dr. Vaughan exhib- 
ited some silk handkerchiefs colored therewith. 

Subjecting masses of the germs to alcohol he extracted their 
toxins and evaporating the alcohol obtained a dried powder. 
Some of these toxins were capable of being split up into two 
or more forms, for instance, the diphtheria organism produces 
a soluble toxin against which antitoxin protects, but anothe 
toxin is left after the first washing which may or may not be 
protected against by the antitoxin, and a third toxin is still 
obtainable from the residue against which antitoxin offers no 
protection. In all the work of splitting these toxins it was 
evident that the residues were always less toxic than the whole 
original substance and if heated further it rapidly lost its 

On Some Effects of Tobacco on the Tissues of Rabbits 

Dr. I. 
rabbits confined within proper limits and fed exclusively on cab- 
bage mixed with an infusion of tobacco. An animal killed 
after two and a half months shows an enlarged liver, pale 
and granular, the liver lobulation being very pronounced. The 
proliferation of fibrous tissue follows the tract of the portal 
vessels and bile ducts. The liver cells are absolutely normal 
and the process is restricted entirely to the interstitial tissue. 
Dr. Adler would not at present attempt to draw an analogy 
between his findings and a cirrhosis of tl e liver. 

Cases of hematoporphyrinuria after use of sulphonal were 
reported by Dr. James Tyson and after trional by Drs. Eith 
ington and Starr. 

ADLER gave a preliminary report on experiments on 

Pneumococcic Arthritis. 

Dr. JAMES B. HERRICK stated that this affection was a rare 
one appearing oftenest during or shortly after croupous pneu- 
monia and most frequently in men. He gave the symptoms and 
diagnosis. The mortality is 65 per cent. The treatment is 
immediate incision and drainage. 

Drs. OSLER AND Musser discussed the subject. In discus- 
sion Dr. Osler remarked that one of his assistants had re- 
cently worked up this subject carefully and had divided the 
ases into three groups, one with local symptoms mainly, the 
second group that follows or is associated with pneumonia and 
a third group in which the arthritis is associated with a general 
pneumococcie septicemia. He related the history of one case 
of the latter kind in which it was difficult to say where the 
primary lesion was. Blood cultures showed numerous pneu- 
mococci as did also aspiration of the joint, and autopsy showed 
an extensive pneumococcic meningitis, arthritis and general 
infection of the blood. 

Dr. Musser reported a somewhat similar case with involve- 
ment of the joints, beginning with the sterno-clavicular, but the 
patient finally recovered. : 

Dr. W. T. Howarp, JR., read a paper on “The Pathology of 
Herpes Labialis and of Herpes Zoster occurring in an Acute 
Croupous Pneumonia.” 

Dr. H. F. Vickery opened the afternoon session by the narra- 
tion of “A Case of Hodgkin’s Disease with Recurrent Fever.”’ 
Drs. Starr, Kinnicutt and Musser took part in the discussion 

(To be 

continued. } 



[It is the aim of this department to aid the general practi- 
tioner by giving practical prescriptions and, in brief, methods 
of treatment for the diseases seen especially in every-day prac- 
tice. Proper inquiries concerning general formulae and out- 
lines of treatment are answered in these columns without 
allusion to inquirer. ] 

Glutol in Preventing Pitting of Smallpox. 

John Moir, in an extract occurring in London Lancet, states 
that glutol is a whitish powder, prepared by exposing sheets of 
gelatin to the vapor of formalin. The solvent action of 
glutol is facilitated by the addition of lard and by application 
the gelatin is dissolved and formalin liberated. He recommends 
it in suppurative conditions of the mouth, gums and tongue; 
carcinoma; tuberculosis; severe burns and chronic ulcers. But 
he especially recommends it mixed as follows as a preventive of 
severe pitting and deep scars from smallpox: 

Eis! ROEM CS Sy ee as Sues 6k 6h hale As SRS 5ss-3i 15-30] 

Paraffin (soft) ..5iv 120} 

M. Sig.: To be applied locally. 

The same proportion has been employed in carcinomatous and 

epitheliomatous cases as well as in severe burns. It is entirely 
harmless as an application in diseases of the mouth, even when 
swallowed in considerable quantities. 1t has been employed by 
others with marked success in the treatment of warts, chan- 
croid growths and in sycosis vulgaris, although it took more 
time than most remedies; but it was easily handled, did not 
cause pain and left no scar. 

Removal of Dandruff. 

The following outline of treatment is recommended by Med. 
World to be employed in removing dandruff: 

R. Thymol oi |06 
Olei lavendule iv |30 
Petrolati ii 60} 

M. Sig.: Rub a small amount in the palm of the hand and 
apply to the scalp, first washing the head thoroughly with 
medicated soap. This should be done once or twice a week, 
followed by a wash containing resorcin and salicylic acid. 

Hyde recommends the following as a lotion: 

R. Hydrarg. bichloridi rr. ii 15 
Ol. amygdalx dule. ii 8 
Tinet. cantharidis ii 8 
EMER ONL. 1s) 5c sya 3 oh. wes. svelae 3ii_~=—s-« 60 
Aq. destil. q. s. ad ri 180 
Sig.: To be rubbed into the scalp; or: 

Resorcin 15 
Alcoholis ii 60 
Aq. rosx ri 180 

M. Sig.: Apply locally to the scalp with friction. 

As an ointment the following containing sulphur is recom- 
mended in treatment of all disorders of the sebaceous glands: 

Rs: MAP RRIUENEID Siche, om 2'5 0 el visio x is he 4 gr.xvtolx 1-4 
Ung. aque rose i 30} 

M. Ft. unguentum. Sig.: Apply locally. 

The following is recommended by Veiel as quoted by Hyde: 

Se MR ONL on Sis kas ee yo ba be aed gr. Xx 1/30 
ee Ligh iy Ee ER ee eT gtts. xv 1| 
Tinct. cantharidis gtts. xxiv-3ss 1.5-2| 
Suce. citri m. Xv 1| 
A NEN 5 be xa oes sak on csyposwene Jiss 45} 

M. Sig.: To be rubbed into the scalp once or twice daily. 

Exophthalmic Goiter. 

S. Tschirjeff of Kieff attributes this disease to the accumu- 
lation of waste products of albumin owing to the insufficiency 
of the thyroid gland. These waste products affect the cells of 
the medulla, especially those which regulate the action of the 
heart. He has succeeded in curing all recent cases and per- 
manently benefiting the old-established ones by treatment de- 
signed to restore the thyroid gland to normal and regulate 
the heart’s action. He paints the goiter with iodin every 
evening or every second evening. Then he applies a cold water 
bandage during the night and Faradizes the gland every second 
day. He also administers internally gr. iv to gr. viii (25 eg. 

Jour. A. M.A 

to 50 cg.) a day of a mixture of potassium iodid o 
sodium iodid three parts. The tachycardia is coibateq by 
convallaria. The patient is also instructed to take a warm 
bath every evening or every second evening. These baths. he 
states, prove very useful in scothing the patients and regulating 
the heart’s action. All stimulants and violent exertion are 
forbidden. Two to seven drops of Fowler’s solution are Ordered 
if indicated. The improvement in six weeks of this 
is very remarkable: 

© pe Art and 

t Treatment 
Pregnancy is no contra-indication, 

Normal Salt Solution. 

Himmelsbach, in NV. W. Lancet, recommends, as a matter of 
great importance, relatively small and repeated injections ¢ 
the normal salt solution subcutaneously. The quantities {oy. 
merly given in this manner, from one to three pints, are ep. 
tirely unnecessary, and according to his statement an equally 
specific effect can be produced upon the renal organs when the 
solution is given in smaller amounts, as shown by the elimina. 
tion which is many times greater than the quantity injected, 
This has the advantage in that the time taken to do the opera. 
tion is curtailed, which is of great importance in childrey, 
Lenhartz advocates injections subcutaneously of two to six 
ounces every three or four hours, and states that they have a 
better diuretic effect and cause less strain on the kidneys than 
a pint given several times a day. 

Incontinence of Urine. 

The following has been recommended in treatment of incoy. 
tinence of urine occurring in children: 
R. Antipyrini 
M. Sig.: One teaspoonful at bedtime in a small amount of 

For the Relief of Flatulency. 

R. Creosoti 
Bismuthi subcarb. 
Glycerini | 
Aq. menth. pip i 30} 
M. Sig.: One teaspoonful every three or four hours; or: 
R. Saccharin 
Pulv. carbo, ligni 
Bismuthi subnit. 
M. Ft. chartule No, xii. Sig.: 
half hour before each meal. 

Folliculitis Barbae (Barber’s Itch). 

The following is recommended by Merck’s Archives in tii 
treatment of barber’s itch: 
R. Acidi tannici 
ROMMEADIIRERRS SIT OORD, © oon 0:5 eos vb. o vole WA "Biss 
Zinci oxidi 
M. Sig.: To be used morning and night. 
Van Harlingen advised for acute cases a wash composed 
R. Zinci carb. (precip.) 
Zinci oxidi, aa 
Liq. plumbi subacet., Aa 
Aque ros 
M. Sig.: Use as a wash morning and night. 

One powder to be taken one 

Follicular Conjunctivitis. 

J. W. Bullard, as noted in Pediatrics, states that mild casts 
may be cured by rubbing the everted lids with copper sulphat? 
or alum and washing the excess off with sterile water. This 
may be done two or three times a week, and in the interval the 
following may be instilled three times a day: 

se eee ee gr. i-ii 06-12 

| ea ra eee meee Bec Zi 330 

M. Sig.: Instill into the eye three times a day. 

He states, however, that operative procedure is more rapid 
and very effective. With the usual aseptic precautions, and 
having applied cocain, pass one blade of Knapp’s roller forceps 

or Gifford’s forceps, well back into the conjunctival cu!-de-s 


and th 
sure Pp 
the f 

cid 5 

with a 

to pre 
tity of 
Of the 

in ad 

The 8 
‘The 1: 
of wis 
so im 
the ed 
a lim! 
Was nl 
the a 
of act 
him | 

i sta 
is a 
not 1 
are | 

it and 
ted by 

ths, he 
on are 

tter of 
Ons of 
es for. 
re en- 
en the 
to six 
have a 
S than 


int of 


n one 

| the 

\AY ve 1902. 
| the other over the everted conjunctiva, and with firm pres- 
a pull from the eye. This breaks down and squeezes out 
the follicles. After this procedure mep the lids with a 
yioplorid solution (1-500), washing off the excess with a boric 
vid solution or sterile water. Repeat every one or two days, 
»sing the zine sulphate solution from one to three times a day. 
Corrosive Sublimate in Pertussis. 

(. Calabro, according to the Med. News, treated 56 cases by 

winting \ne throat with the following solution: 

R. Hydrarg. chloridi corros. .......... gr. ili 20 
Sod si eeeen Rete eee se ates arate gr. 1 |06 
Be eae Tees 5a 8 a Oi 500) 

Aque destil. 

M. Sig.: Paint well over the pharynx, epiglottis and tonsils 
vith a soft long-handled brush three times a day. 

The author advises that the patient be fed before painting 
to prevent irritation of the empty stomach by the small quan- 
tity of the solution which is swallowed during its application. 
Of the 56 cases he states that 39 were cured with one daily 
application and 17 of the cases received three treatments daily 
in addition to other remedies commonly used in pertussis. 


Authorized Means to Prevent Spread of Diphtheria.— 
The Supreme Court of Arizona says, in the case of Haupt vs. 
Maricopa County, that, in addition to the enforcement of 
suitable police and sanitary regulations, the boards of super: 
visors are empowered “to adopt such provisions for the preser- 
vation of the health of their respective counties as they may 
jem necessary. and to provide for the expenses thereof.” 
lhe language used in the statute indicates a broad grant of 
power, and that it was intended to intrust to the board a 
large discretion concerning the means to be employed tor the 
preservation of the public health. It would not be the part 
of wisdom to unduly hamper with restrictions the exercise of 
s) important a function. The prevalence of contagion may 
require the adoption of different measures, according to the 
peculiar exigencies of the situation which is presented, and 
the court goes on to say it does not feel justified in prescribing 
a limitation which might, in effect, tie the hands of the board 
when the urgency was the greatest. The question in this case 
was not whether liability for certain property destroyed under 
the advice of a physician to prevent the spread of diphtheria 
could have been avoided by the adoption of a different course 
of action, but, rather, one as to whether, unger the law and the 
procedure taken, an obligation had been created against the 
county. The property destroyed consisted of the house occu- 
pied by the sick family, admittedly a “small affair,” and its 
contents of furniture, household effects, stores, and personality. 
Considering the circumstances, the court is of the opinion 
that the board of supervisors possessed the requisite power, 
under the foregoing grant, to contract with the owner to pay 
him for the taking and destruction of his property, as the 
most efficient means for the eradication of the disease with 
which it was infected. The question of the sufficiency of the 
evidence to establish. such contract was one which should have 
been left to the jury. 

Constitutionality of Medical Practice Act.—The Supreme 
Court of Kansas holds, in the case of State vs. Wilcox, that 
hapter 254 of the Laws of Kansas of 1901, “An act to create 
i state board of medical registration and examination and to 
regulate the practice of medicine, surgery and osteopathy in 
the state of Kansas, prescribing penalties for the violation 
thereof, and repealing chapter 68 of the Session Laws of 1870,” 
constitutional enactment. It says that if the title had 
been “An act to regulate the practice of medicine and sur- 
gery,” instead of the more elaborate one used, it would have 
every provision of the siatute, and under numerous 
decisions would have been considered as a single subject, and 
not void because of its generality. The provisions fixing the 
standard and testing the qualifications of medical practitioners 
are not prohibitive in their nature. It is not an arbitrary 
discrimination, nor an invalid deprivation of right, to provide 





that only those possessing a knowledge of the human system, 
of its ailments and diseases, and who possess the skill to apply 
remedies and practice the art of healing, shall be allowed to 
practice. If such regulations and conditions are adopted in 
good faith, and operate equally upon all who may desire to 
practice, and who possess the required qualifications, the fact 
that the tests and conditions imposed by the legislature may 
be rigorous will not invalidate the legislation. It is to be pre. 
sumed that the board of examination and registration, like all 
other tribunals vested with such powers, will act with judg 

‘ ment and conscience, and will deal justly with all applicants 

for license. It is vested with discretion to determine the 
standing of medical schools from which the diploma comes, and 
also whether a physician who submits to an examination 
possesses the requisite character, learning and skill; but it is 
not an arbitrary, capricious and unrestrained discretion. The 
law requires that the board shall exercise an honest and im- 
partial judgment and discretion in accordance with just rules, 
and if the board should depart from this course, and should 
act arbitrarily and unjustly towards applicants for license, 
the courts are open to them, and will award them relief and 
protection. The act is not invalid because it provides that 
“nothing in this act shall be construed as interfering with any 
reiigious beliefs in the treatment of diseases, providing that 
quarantine regulations relating to contagious diseases are not 
infringed upon.” The express exclusion of the element of 
religious belief in the application of the law was hardly neces- 
sary. Religious freedom is guaranteed by the constitution, 
and without mention in the statute would have been implied. 
And the court can see nothing in this provision which makes 
an illegal discrimination against or in favor of any class of 
physicians. Neither, it says, is there any force in the objection 
to the provision making the statute inapplicable to the admin- 
istration of domestic medicines, or to gratuitous services which 
one friend or neighbor may render to another. It is the prac- 
tice of medicine and surgery for compensation that is sought 
to be regulated and controlled, and not the use of home reme 
dies, nor the neighborly offices which one may kindly and gratu- 
itously perform for another. 

Anticipating Injury from Malpractice—Curettement— 
Experimenting.—The Supreme Court of Wisconsin says, in 
the malpractice case of Allen vs. Voje, that the rule is without 
exception that liability in damages for acts or conduct lacking 
in ordinary care can not arise unless the act be such that an 
ordinarily careful person would anticipate that some injury 
to another might probably result therefrom. Indeed, that cir 
cumstance is an essential element of actionable negligence. 
With mere carelessness the law has no concern, unless it be 
such that some injury may be reasonably anticipated. But 
it is not essential to the existence of actionable negligence, o1 
of liability therefor, that a reasonably prudent person would 
have foreseen the exact injury which did result. It suffices 
that some injury might reasonably have been foreseen to occur. 
And the court says that it is convinced that there is no room 
for difference of opinion as to whether, from the lack of skill, 
care, and precautions ordinarily exercised by physicians in 
treating or operating upon the highly sensitive portions of the 
feminine anatomy involved in the treatment in this case, where 
a curettement was performed, an injury must be anticipated 
as .likely to oecur. To hold otherwise would involve a con- 
tradiction in ideas. It is the very peril of physical injury 
which necessitates a code of precautions in diagnosis and treat- 
ment by physicians and surgeons. They serve no other pur 
pose. Taking for illustration the precautions to render an 
operation aseptic, it is apparent that they are adopted for no 
other reason than that every physician anticipates injury te 
the patient as probable in their absence. It is unreasonable 
to say that a physician may improperly and negligently ex 
coriate the lining of a delicate internal organ, and escape 
liability by doubt as to whether he, in the exercise of reason- 
able care, should have anticipated injury to the patient 
thereby. The relationship between such an act of the physician 
and the physical condition of the patient is so intimate that 
he must necessarily anticipate some physical effect as the 
result of such operation, and, of course, that such effect wil] 


le bad if his act be improper or improperly done. The view Medical News (N. Y.), May 3.. 
above expressed, the court says, is confirmed by the fact that 30 *Another Chapter on Phthisiophobia, and Resolutio: s Adopteg 
in no decided case cited by counsel or found by the court, nor ; by the New York Academy of Medicine. 8S. A. Knopf 
. ‘ : se 3 : ¥ whee 31 *Intravenous Infusion of Saline Solution. George (Cyi\e 
in any text-book, is declared the necessity of any finding of 32 *The Right and Wrong Us» of Digitalis Based on (Carjj,. 
this element of anticipation of injury from professional neg- al Pathology. William H. Porter. ; 
iinet ih ee ae fe 1 ti . De 33 *Operative Treatment in Certain Suppurative Conditivns of th 
igence in medical treatment or surgical operations. nl- Kidneys. Alexander B. Johnson. the 
formly, liability is made to depend on whether injury in fact 34 "are * raced of Cystoscopy in the Female. — Pyeqsyj. 
resulted from departure from recognized methods or omission - a a ee ani 
of usual precautions. In line with this, the court says that + Le, ene Ravtew, Agen. 26. 
it has little doubt that, if the first case of vaccination had Smallpox: A Consideration of the Present Mild Type iy ij 
4 oe ee k $e Mississippi Valley. Alembert W. Brayton. 
proved disastrous and injured the patient, the physician should May 3 
have been held liable. It does not believe that a physician of a ae or eee ; 1 
: . 3 . ¥ : ‘ 36 *Some Remarks on the Difficulties of Diagnosis in Sinaljyo, 
standing and loyalty to his patients will subject them to mere _W. A. Hardaway. I 
experiment, the safety or virtue of which has not been estab- 3 The Diagnosis of Smallpox. William T. Corlett. 
lished by experience of the profession, save possibly when the Cincinnati Lancet-Clinic, May 3. 
patient is in extremis, and fatal results substantially certain 38 The Borderland of Insanity. A. N. Ellis. 
unless the experiment may succeed. It also suggests that it When | Studied Medicine. (Continued.) George J. Monro 
is not impossible that cases of malpractice might be presented The Medical Age (Detroit, Mich.), April 25. 
wherein the proximate causation of injury should be passed Interesting Features in Locomotor Ataxia. A. C. Griggs 

3 +: a - ¥ aii aa t et rae Some Experiences with the Salts of Gold. John E. Sylveste; 
on by the jury, although it does not consider that it was neces Retained Placenta: Tubal Abortion (Ectopic Pregnann, 
sary here. A. M. Cartledge. 

Virginia Medical Semi-Monthly (Richmond), April 11. 

3 Sympathetic Insanity in Twin Sisters. Geo. S. Walker. 
Gurrent Medical Literature. Relapse in Typhoid Fever. Clifton Mayfield. 
*Gonorrheal Rheumatism. J. Douglas Westervelt. 
Four Cases of Mastoiditis. John Dunn. 
Rectal Feeding. D. Perey Hickling. 
AMERICAN. $ «6Burns, Scalds and Their Treatment. O. Henley Snider. 
5 a eA . , ' pe 9 Acute Pyelo-nephritis. J. Randolph. 
Titles marked with an asterisk (*) are abstracted below. Progress Made in Surgery About the Region of the Appendix, 
ican Medicin Phil Iphia May 3. Joseph Price. 
America edicine (Ph ataty )s y ‘ i A Suggestion in the Treatment of Fracture of the Femur 
*Dietetic Aphorisms for Infant Life. J, P. Crozer Griffith. J. W. Henson. 
2 *On the Effect of the Digestion of Gelatin on Its Styptic Prop- 52 Medical Inspection of School Children. M. D. Hoge, Jr 
erties. Horatio C. Wood, Jr. ; f April 25 
*A Simple Method for Determining Percentages of Milk in pri . 
Home Modification. Rowland G. Freeman. 538 The Importance of Early Diagnosis and the Treatment o 
Cysts of the Ureter. Henry Harris. ; Pott's Disease. A. R. Shands. 
*Indications for the Mastoid Operation. Lee W. Dean. : Remarks on Influenza. Presley C. Hunt. 
A Leiomycma of the Skin Arising from the Erector Muscle of 55 *History of the Medical Society of Tennessee. Deering J 
the Hair-Bulbs. Ernest B. Hoag. : ” Roberts. 
Report of a Case Belonging to the Erythema Group of He- 56 *Appendicitis from the Standpoint of a General Practitione 
noch’s Purpura, with Chronic Parenchymatous Nephritis— R. L. Hillsman. 
Autopsy. Edward J. Wynkoop. __ : yA : 57 Drainage After Abdominal Section. L. E. Burch. 
Brief Statement of the Principles Underlying the Physician's *The Applications of Some of the Secretions of the Liver to 
Obligation to Secrecy. William C. Woodward. the Treatment of Diseases of That Organ. E. L. Whitney 

New York Medical Journal, May 3 Benzoate of Guaiacol. Mark W. Peyser. 
, ; 
*The Mechanical ahd Operative Treatment of Tuberculous and American Practitioner and News (Louisville, Ky.), April 15. 

Other Affections of the Joints. A. M. Phelps. 60 Diphtheria. M. K. Allen. 
*A New Treatment for Deafness from Chronic Catarrh of the 61 The Gall-Bladder. J. Lively Johnson. 
Middle Ear: A Preliminary Report. W. H. Bates. 62 Gastric Lavage. H. H. Roberts. 
Deformities Due to Muscular Paralysis: Method of Produc- ; ; ’ " 
tion; Vossibilities in Tendon Transplantation; Combina- Pediatrics (N. Y.), April 15. 
yg: Baer ae Been Made to Correct Deformity. Wisner 62 *The Etiology of Hodgkin's Disease. John M. Dodson 
R. Townsend. . , ’ S i7ISCaSC. M. son. 
—r ; ; iti ; x 64 The Advent of Self-Consciousness and Its Relation to the 
Operations for the Relief of Paralytic Deformities, with Spe- Bas! : 
cial Reference to Tendon Transplantation: Introduction, Crime of Abortion. J. Allen Gilbert. 
History, Indications for Operation. Royal Whitman. MedicaleFortnightl St. Louis), April 25. 
Suture of a Perforating Wound of the Sclerotic. Carl Koller. he g y ( ), Ap 
*Heredity. David W. Reid. 

Philadelphia Medical Journal, May 8. 6 The Death-Rate of the Rich and the Poor. Wm. Wormley 
*The Surgery of the Heart, with Presentation of a Cas. ‘H Relations ote Treatment of Suppuration of the Middle Fa! 
N i : 7 in ; A. E. Prince. 

L. Nietert. ae a> : ; * a 
*The Relation of Urie Acid and Xanthin Bases to Gout and may isms of the Lungs and Pleura. (Continued.) Alber 

the So-called Uric acid Diathesis. David L. Edsall. Abrams. . 
a Electricity in the Treatment of Insanity. Robert H. Pennsylvania Medical Journal (Pittsburg), April. 

Chase. : ae 
*An Investigation of Solanum Carolinense, with Reference to *Address in Obstetrics, Medical Society of the State of Penn- 

Its Special Value in the Treatment of Epilepsy. M. Clayton sylvania. David S. Funk. 7 3 ae 

Thrush. Report of a Case of Double Extra-uterine Pregnancy 4 

A Cas® of Foreign Body in the Lung—Diagnosis Confirmed by Ball. : : 
Radioscopy. Francis Huber. *The Doctor’s Fee—Is It Fixed and Definitve? Louis J 
Traumatic Meningitis with Effusion—Cerebral Convulsions a _tenbach. i 
Double Trephining—Recovery. Thomas W. Jackson. *Etiology of Acute Dysentery. Simon Flexner. a 
. . *A Remarkable Case of Infantile Typhoid of Fetal Origin, 
Boston Medical and Surgical Journal, May 1. with Recovery. H. C. Westervelt. 
: harerary » 8 ac "li Tinea Versicolor. John V. Shoemaker. salt 
—— Relating to Surgery of the Stomach. William J. 5 Value and Importance of Teaching the Fundamental! Princ: 
r\ yo. = ici ir Practical 
*Thrombosis of the Cavernous Sinus; with Report of Four ude Gee th ee of Their Pract 
Cases. Including One Cranial Operation. Edwin W. Dwight. - ‘ ae pee ns f ¢ ee Lee ee - M. 
22 *The City Consumptive Hospitals and the Duty of the Munici- wo ey Tubal Gestation and the Physician. John 3 
j a © » > ardi ‘ j J ray . . . 5 
ig and People Regarding Consumption. Edward 0. 77 Some Surprises Met in the Practice of Obstetrics. R 
‘nae Ini . Progressive Fact Atr , . Ewing. = 
A P os -< a ere Saari, aaegey. s. 8 Report of a Case of Fracture of the Neck of the [emur 
ourtney. Charles E. Thompson. 

i N. Y.), May 3. , j ; 
ppc npnggnti ) . “a : Chicago Medical Recorder, April 15. 

Inoperable Round-Celled Sarcoma of the Upper Jaw. with : J 
Metastases Successfully Treated with the Mixed Toxins of *Report of Cases Treated with Roentgen Rays. Wm. Alled 
Erysipelas and Bacillus Prodigiosus. ©. K. Winberg. Pusey. mca 

*The Indications for the Surgical Treatment of Cholelithiasis. 8 at ye to the Surgery and Pathology of Gastric Ulcer. 
A. A. Berg. Emil Ries. 

26 *Functional “a Peralytic Strabismus. TD. BR. St. John Roosa. ‘ *A Study of. Goiter, with Special Reference to the Goiter of 

*Hydrophobia and the Pasteur Method—A Rejoinder. Charles Puberty and Pregnancy and Its Treatment. William 
W Dulles. Cuthbertson. mae’ 

Cancer of the Prostate, Complicated by General Fibroid 2 *The Accidents of Anesthesia, Their Prevention and Treat 
Change of the Urethra—Urethrotomy—Prostatotomy, by ment. Daniel N. Eisendrath. 
the Bottini Method—Subsequent Partial Enucleation. Gran- 83 An Analysis of 328 Operations upon the Gall-Bladder § 
ville MacGowan. Rile Passages, with Observations upon the Same. William 

*Gonorrheal Rheumatism. J. Douglas Westervelt. J. Mayo. 


of the 

' the 






rer to 






\ len 

4 of 



Mastoid Operation for Chronic Suppurative Otitis 
William L. Ballenger. 

Buffalo Medical Journal, May. 

S4 Mev 

- ~The liagnosis and Surgical Treatment of Nephrolithiasis 

from the Viewpoint of the General Practitioner. Ramon 
yuiteras. : 

ge ule is in Relation to Structural Changes. I. Park Lewis. 

<- [Indian Medicine. Nelson W. Wilson. Ss : 

ce Removal of Ovarian Cyst, Hematoma and Fibroid. L. G. 

Albany Medical Annals, May. 

« #The Bearing of Oral Pathology on General Medicine. M. L. 
‘ Rhein. _ 
on itame Needed Amendments to the Code Regarding the Waiver 
‘ of Vhysicians’ Privilege. John D. Peltz. , 
91 *The Value of an Occasional Convulsion in Certain Cases. 
William P. Spratling. 

Journal of Medicine and Science (Portland, Me.), April. 

y? The Conduct of Normal Labor. Wellington Johnson. 
3 Ectopic Pregnaney. Herbert F, Twitchell. ; 
iy What Shall We Do with Heredity? J. G. Gehring. 
o, Tetanus Appearing in the Course of Vaccination. E. D. 
‘ O'Neill. 
St. Paul Medical Journal, May. 

aj *Some Unusual Drug Effects upon the Nervous System. Ar- 
thur W. Dunning. . 
y7 *Stricture of the Rectum in Women Due to Inflammatory 
Processes in the Pelvis. J. L. Rothrock. 
Sympathetic Ophthalmia. J. H. James. 
9 Cretinism. W. D. Kelly. 

Washington Medical Annals, March. 

100 A New Factor in the Etiology and Treatment of Intermittent 

j Fever; Destruction of the Parasite by Ultra-Violet Rays of 

Fluorescent Light. A. F. A. King. 

‘ase of Choledochotomy. I. 8S. Stone. 

‘ase of Exfoliative Dermatitis Due to Quinin. E. W. Reis- 


‘ase of Fatai Ilemorrhage from Stomach Due to Cancerous 

Uleer. T. C. Smith. 

104 Case of Cancer of Lungs, Spleen and Ribs. C. W. Franzoni. 

5 Case of Removal of Portions of Ovary. J. W. Bovee. 

106 The Causation of Disease. George M. Kober. 

107 Case of Pneumonia, with Right Side Endocarditis. D. S. 


108 First American Case of Infection with Lamblia Duodenalis. - 

Cc. W. Stiles. : 
109 Case of General Tuberculosis with Cerebellar Tumor. G. N. 

110 The “Buchhold’’ Anatomic and Pathologic Specimens. D. 8. 

111 Case of Tubo-ovarian Cyst. J. W. Bovee. 
The Laryngoscope (St. Louis), March. 

112 *Tinnitus Aurium; Some Remarks on Its Cause and Treat- 
ment. Thomas J. Harris. 
113 *Ear Complications and Sequele of Influenza. M. A. Goldstein. 
114 *Deviation of the Nasal Septum; Why Do Our Corrective 
Operations Often Fail? Chevalier Jackson. 
5 Operation for the Removal of Septal Spurs. Melville Black. 
) Vapor Massage—Its Origin and Uses. Geo. T. Hawley. 
7 The Nose and Throat in the History of Medicine. (Contin- 
ued.) Jonathan Wright. 
118 *A New Phase of Serum Therapy; A New Serum for Use in 
Mixed Infections. E. von Quast. 
Southern Practitioner (Nashville, Tenn.), May. 
11) Address, Tennessee State Medical Society. Deering J. Roberts. 
Canadian Practitioner and Review (Toronto), April. 
120 Smallpox and Vaccination. John Caven. 
121. Vaginal Section—Exploratory and Operative. T. Shaw Web- 
122. Two Cases of Contracted Pelvis. K. C. Mellwraith. 
Clinical Review (Chicago), May. 
125 *Tuberculosis. Victor C. Vaughan. 
14 Some Internal Injuries to the Knee-Joint. M. L. Harris. 
-) Non-Descent of the Cecum; An Unusual Malposition. H. A 
26 Clinical Lectures upon the Etiology, Pathology, Diagnosis and 
Treatment of Tumors. A. H. Levings. 
Woman’s Medical Journal (Toledo, Ohio), March. 

‘i Gastroptosis. Emily A. Hill. 
iS The History of Medical Education of Women in Russia. Z. 

Medical Examiner and Practitioner (N. Y.), April. 

0 Arterioselerosis. E. Moritz. 

Some Practical Suggestions on the Physical, Chemical and 
Microscopic Examination of Urine for Life Insurance. W. 

a I. Fitch. 

sl Aids in Life Insurance Examination. Abbot S. Payn. 

‘« The Therapeutic Value of Pheno-Bromate. Robert A. Gunn. 
Colorado Medical Journal, March. 

A Sketch of the Workers in Physiology in Colorado. C. B. 
Van Zandt. 

134 *Some Pathologie Conditions to Which the Miner Is Peculiarly . 

S Liable. J. W. Coleman. 
‘0 Puerperal Sepsis. J. A. Dunwoody. 
Journal of Eye, Ear and Throat Diseases (Baltimore), 

’ Normal Nose and Its Functions. FE. L. Mather. 

136 T) 
I Report of a Cese of Auricular Perichondritis. W. K. Rogers. 


Southern California Practitioner (Los Angeles), April. 

138 Marriage, Heredity and Divorce. H. Bert Ellis. 

139 Chloro-Anemia. E. E. Major. 

140 When Is Surgical Interference Indicated in Tuberculosis. 
Rose T. Bullard. 

141 Medical and Surgical] Progress. B. F. Church. 

142 Lecture on Prostatic Hypertrophy. Granville MacGowan. 

143 A Case of Carcinoma of the Breast Treated by X-Radiance. 
Albert Soiland. 

144 Formaldehyd and Disinfection. B. M. Davis. 

145 The Obstetrician as a Preventive Gynecologist. John C. King. 

Therapeutic Gazette (Detroit, Mich.), April 15. 

146 *Amebic Dysentery. William Osler. 

147 *Bacillary Dysentery. Simon Flexner. 

148 Tropical Dysentery with Abscess of Liver; Rupture into 
Right Lung; Ameba Coli in the Sputum—Exhibition of 
Case. L. Napoleon Boston. 

149 *The Value of Ipecac in Dysentery. Alfred A. Woodhull. 

150 Tropical Dysentery. T. S. Dabney. 

151 Dysentery in New Orleans; Its Treatment. E. M. Dupaquier. 

152 *The Treatment of Dysentery. H. A. Hare. 

Chicago Clinic, April. 

153 Report of a Case of Leucoplakia Buccalis, with Remarks on 
Its Histopathology. John M. Beffel. 

154 The Teaching and Influence of Samuel Hahnemann. William 
E. Quine. 

Vermont Medical Monthly (Burlington), April 25. 

155 *Prostatic Hypertrophy and Its Relation to Hemorrhoidal 
Operations. W. W. Townsend. 

156 What Is the True Value of Alcohol? Geo. W. Sargent. 

157 Paretic Dementia. J. M. Clarke. 

158 Case of Tubal Pregnancy—Operation—Recovery. A. Lap- 

: thorn Smith. 

159 Smallpox with Some Remarks on Cases in Mendon, Mass. 
J. M. French. 

160 Smallpox, with Report of Cases in Franklin, Mass. Chas. B. 


Charlotte Medical Journal, April. 

161 Surgery of the Biliary Passages. John B. Deaver. 

162 Lobar Pneumonia with Report of a Case. L. B. Cook. 

168 Treatment of Gonorrhea. G. A. Davis. 

164 Case of Dystocsia. Jno. Randolph. 

165 When Should We Use Forceps in Labor Cases? L. G. Frazier. 

Medical Times and Register (Philadelphia), April. 
166 *The Modern Pharmacology of Calcium Sulphide. John Aulde. 
167 Gonorrheal Rheumatism. J. Douglas Westervelt. 
Occidental Medical Times (San Francisco), April. 

168 President’s Address, San Joaquin Valley Medical Society. 
Henry Hildreth. 

169 Some Obstetric Criticisms. T. M. Hayden. 

170 Picric Acid. Louis Maddock. - : 

17 Railway Spine. A. J. Pedlar. 

172 Calomel, Its Uses and Abuses. C. W. Kellogg. 

173 The Preferable Operation for the Radical Cure of Inguinal 
Hernia. A. W. Morton. 

174 Some Clinical Aspects of Osteosarcoma. Thomas W. Hunt- 


175 Report on a Case of Probable Erythema Exudativum Multi- 
forme Bullosum, with Rheumatism and Endocarditis. Ray 
L. Wilbur. 

176 Mentholization of the Air-Passages in Ether Anesthesia. W. 
A. Briggs. 

177 Fibroma of Mesentery. Louis A. Kengla. 

Nashville Journal of Medicine and Surgery, April. 

178 *Address of President, Tennessee State Medical Society. Deer- 
ing J. Roberts. 

1. Dietetic Aphorisms for Infant Life.—The following are 
the aphorisms offered: 1. Nature’s way and Nature’s food are 
the best. The possibility of improvement of the quality or 
quantity of mother’s milk should always be considered before 
putting the child on artificial feeding. 2. We should do the 
best we can with what we have. Here Griffith protests against 
the adoption of any one fixed formula for infant feeding. The 
mixture must be made to meet the special requirements of the 
child. 3. Keep up with the times. What is unscientific will 
not pass muster. He gives formulas and equations of infant 
food, giving the most recent and from experience the most suit- 
able. 4. Know what you want. We should know why we give 
this or that mixture to certain children and shoulld not be lazy 
or too adherent to old ways. 6. Go slow and do not increasé 
the strength of the milk too rapidly or introduce too much 
starchy food. The age of the child should not be the guide, but 
its general condition, especially its weight, should be. 7. 
Lastly, he mentions the starvation treatment, meaning by this 
the judicious temporary reduction in the amount and strength 
of the food given, to meet the necessities of the case. 

2. Gelatin.—The following are the conclusions of Wood’s 
paper: “1. Pepsin digestion of gelatin does not destroy its coag- 
ulating effect on the blood. 2. The resulting product is dialyz- 
able, and therefore capable of absorption. 3. The administra- 


tion of gelatin by the mouth in the treatment of hemorrhage is, 
therefore, a rational procedure. 4. Gelatose seems to antag- 
onize, if given in suflicient quantity, the anticoagulating action 
of peptone.” 

Milk Percentage.—-The method here given by Freeman is 
summarized as follows: “This method of obtaining percentages 
in modifying milk is simple and is applied as follows: 1. After 
having decided on the number of feedings for the 24 hours, the 
amount to be given at each feeding, and the formula of the 
food required, first determine the desired relation between the 

amount of fats and proteids, and obtain a cream or milk in 

which these constituents exist in that proportion. 2. Dilute 
this cream or milk with the required amount of water. 3. 
Determine the percentage of sugar required for 24 hours’ feed- 

ing and order the same in packages containing the required 
amount. ‘If lime water is added, the amount so added must 

he deducted from the amount of water used.” 

Mastoid Operation.—Dean insists on the greater danger 
of non-operative over operative treatment, and points out the 
symptoms to which attention should be given, namely, exam- 
ination of the fundus to see if there is a choked disc, the result 
of an increased intracranial pressure. 2. Examination of the 
tympanic membrane for perforation and discharge, which is 
the most frequent cause of mastoidiiis. Partial or com- 
plete obstruction of the drum with pus in the middle ear. 4. 
Necrosis in the attic or posterior wall of the middle ear. 5. 
Cholesteatomatous masses in the middle ear. 6. Sudden eleva- 
tion of temperature to 103 to 105. No one of these symptoms 
will make certain the diagnosis but will suggest it. 
of neglect. 

He insists 
on the danger 

Joint Tuberculosis.— Phelps describes orthopedic ap- 
paratus, with illustrations for tuberculous joint disease and 
reiterates his former expressed opinion of the need of early 
operation in any joint trouble associated with abscess. He is 
convinced that a single rheumatic joint never occurs. If rheu- 
matism exists, more than one joint is affected; any single joint 
disease is either purulent, tuberculous, gonorrheal, or is due to 
If one joint be- 
evidence of 

pneumococcus or some central nerve lesion. 
aifected after 


comes another it is presumptive 

10. Deafness.—Bates describes operation which he has 
employed in cases of chronic catarrhal 
where there was overgrowth of the connective 
the fibrous growth continuing on the mem- 

middle-ear deatness 
tissue in the 
form of adhesions, 
brane and the functional defect due generally to this connective 
tissue growth. All the patients improved by this treatment 
had symptoms of an obstruction to the sound-conducting part 
of the ear. All heard the Hartmann tuning forks better by 
bone conduction than by air. Tinnitus was not always present. 
The treatment only employed after other well-known 
methods had failed. “The object of the operation was to obtain 
room for treating the region of the oval window, and not to 
improve the immediately. patient, received no 
special preparation. The hair in the neighborhood of the ear 
was not cut or the parts treated with antiseptics, as is the 
practice of many operators previous to a mastoid operation. 
An incision was made through the skin over the mastoid, 
to the insertion of the auricle and the bone, beginning above 
close to the hair and ending below at the tip of the mastoid. 
rapidly dissected from the bone with blunt 
canal in its cartilaginous 
chisel the 


hearing ine 


The auricle was 
scissors until the external auditory 
With a 
A bent probe was inserted in 

was cut through. superior and 
posterior walls of the external 
until the antrum was reached. 
the aditus ad antrum and was found a useful guide in prevent- 
ing injury to the facial nerve in the further steps of the opera 
tion. The outer wall of the attic, 
and overhanging bone were removed, converting the tympanum, 
canal, and the 
During the operation the hemorrhage 
either by pressure with moist 
the use ef artery forceps. 


canal were removed 

the membrana and ossicles, 

the external auditory mastoid antrum into one 
cavity with smooth walls. 
was controlled in the usual way, 
pads of cotton, by hot water, or by t 
After the completion of the operation, the cavity was dusted 


Jour. A. \ A 
lightly with iodoform powder. 
sutures (silk No. 000) and covered with a collodion, jg 
and cotton dressing. A small pledget of cotton was placed j 
the orifice of the external auditory canal, the ear covered = 
a large wad of cotton, and a bandage applied: The day after 
the operation the bandage was removed and was not Used 
again. Secondary hemorrhage occurred, but was not oe 
The sutures were removed with the collodion dressing usual} 
in five days. Primary union of the skin wound was the rule 
with healing of the parts without deformity. The patients 
were confined to bed until recovery from the anesthetic. The 
ear did not in any of my cases produce uncomfortable symp. 
toms. Most of the patients were able to go outdoors the day 
after the operation. To prevent infection of the middle ear, 
the patient instilled twice daily in the external auditory canal 
a solution of bichlorid of mercury, 1 to 3000.” This was COL: 
tinued during the after-treatment, which was for the ’ removal 
and prevention of recurrence of connective tissue from the inne 
wall of the tympanum and was not altogether easy. He foun 
the cutting operation better than caustics for this PUrpose, 
using local anesthesia. The reaction from the use of the knife 
caused a temporary loss of hearing which later returned, [hp 
removal of the connective tissue is soon replaced by soft mate. 
rial which becomes hard and fibrous. He thinks it best tp 
remove this as rapidly as it forms, therefore he removes small 
portions at frequent intervals. The patient can continue the 
treatment at home by instillation of peroxid of hydrogen, 
bichlorid of mercury, or other antiseptic solution followed }y 
Some antiseptic solution was found necessary to by 
used daily to prevent infection. When the cases are cured tle 
inner wall of the tympanum is lined with a thin, light-colored, 
smooth, dry membrane. Most of the cases were also benefited 
by treatment prescribed by the family physician and in some 
cases treatment of the nasopharynx is also of value. The ave 
age time to restore hearing for ordinary conversation at ten feet 
was about six months. A number of cases are reported. He 
says: “The treatment was found beneficial in a class of cases 
which were not benefited by treatment of the nasopharynx or 
Eustachian tube or by operative measures in the middle ear. 
Perhaps the only objection to this new method is the necessary 
time required in order to obtain good hearing. Yet | believe 
this objection can be overcome after further experience has per: 
fected the technic of removing the excess of connective tissue 
wall of the tympanum.” 

The skin wound was closed with 

lof lor 

olive oil. 

from the inner 

14. Surgery of the Heart.—Nietert draws the followin 
conclusions from his observations and studies on the suturing 
of heart wounds: “1. Gentle manipulation may be applied with 
out producing shock. The introduction of the suture pr 
duces but a slight irregularity in the heart’s action. 3. Heart 
wounds heal rapidly. 4. Intrapericardial pressure is increased 
even if hemorrhage occurs during diastole alone. 5. Al] heart 
wounds, in which there is danger of fatal hemorrhage, shoul 
be sutured. 6. If the wound does not involve the pleura. the 
extrapleural route should be employed, as described above. 
If the pleura has been injured, the intrapleural method soul! 
always be employed, and the flap devised by Rotter is the best 
8. Although it is advisable for the surgeon to familiarize hin 
self with the methods of operation and the flaps devised by tl 
different operators, a thorough knowledge of the anatom) of 
the region is most essential and each operator should modi!) 
the flaps as best suits his case. 

Uric Acid Diathesis.—FEdsall criticises the theories ©! 
acid and its connection with gout, maintaining that 
though those who have been recent!) 

methods have been false, 
stating that uric acid is absolutely nontoxic have not suilicie 
ground for their assertions and are opposed to convineiny tes! 
mony. He is inclined to believe that urie acid does not car’ 
any notable evidence of intoxication and does not produce 

general symptoms of gout, though it may produce much of ! 

difficulty at the time of the attack as well as in tie 
There is little ground for the belief that it has * 
He suggests that it is possible that 

purely mechanical action. 

the urie acid in gout is different from the uric acid i! 

sre d 
» th 

the s 
vet tle 
In ca 
In ca 
is deg 
be de 
jas b 
Is gre 
of th 
s pu 
to Wa 


Sed with 
laced in 
red with 
AY after 
lot used 
the rule 
ic. The 
© symp. 
the day 
idle ear, 
ry canal 
Vas Cop. 
he inner 
le found 
he knife 
d. The 
ft mate. 
best. to 
*S small 
nue the 
wed by 
‘vy to be 
ired te 
in some 
he aves 
ten feet 
ed. He 
of cases 
ryNX oF 
lle ear, 
las per: 

» tissue 

d with 
re pre 
| heart 
ra. the 
ve. 7 
ie best 
e him 
by the 
my of 


in the 

has a 
e that 


May 1%. 1902. 

The relation between uric acid and the so-called 

jiathesis is a complex condition and he says a large 
ders have been called by one name, which, so far 
is not actually deserved by many of them. We do 

ihe true cause. He also considers the theory of the 

bases In excess being the cause of gouty manifesta- 
so the result of faulty methods of study. 

yri¢ acid 
class of ¢ 
qs we kno 
not know 
tions, as 
\j, Static Electricity in the Insane.—Chase finds that the 
yeurasthenic forms of mental ailment, such as melancholia, 
cidedly benefited by the static breeze and spark directed 
1 the spine or to various parts of the viscera. He reports 
cases W hich seem to have been benefited in this way. The 
y not only does good by its direct effects, but also through 

are de 


17, Solanum Carolinense.—This plant, which belongs to 
the Sulanace family and is known under the names of horse- 
nettle, bull-nettle, ete., has been used for a number of years by 
yevroes in the South in the treatment of epilepsy with excellent 
sults. Thrush has investigated the substance and tried it in 

four Philadelphia hospitals in 25 cases of epilepsy with encour- . 

wing results. He offers the following conclusions, which he 
thinks are warranted: “1. It is of great value (probably better 
than any one known remedy) in grand mal of idiopathic type 
without hereditary taint and where the disease has begun be- 
yond the age of childhood. 2. It is perhaps next of greatest 
value in’ hystero-epilepsy with marked convulsive seizures. 
In cases of petit mal the drug does not seem to do the great 
wod that we have noted in the major type of the disease. 3. 
In cases of well advanced epilepsy of any type in which there 
is degeneration of the cerebral neuron, the drug will act specific- 
ally for a time even better than the bromids, but it will finally 
ie determined that the bromid salts will ultimately control the 
attacks better in these cases. 4. The foregoing clinical study 
jas brought out sufficient clinical evidence to warrant the state- 
ment that the inherent advantage of vegetable depressomotors 
is great as compared with any mineral salt given with the same 
intent, since destruction of the blood corpuscles by the latter 
isa most detrimental feature towards lessening the resistance 
of the individual in a disease, where, above all, the constitu- 
tional tonicity should be favored as ideal treatment. 5. A 
thorough impregnation of the nerve cells can alone be had and 
therefore cure hoped for in epilepsy in proportion as solanum 
s pushed to the fullest physiologic dosage and maintained 
through periods of months, a year not being too short a time 
to Warrant its discontinuance. 6. The fluid extract of the drug 
nade freshly is the ideal. form of pharmaceutic preparation 
given in ascending doses commencing with one tluid drachm and 
increasing to the full constitutional effect. 7. 1t is to be de- 
videdly preferred to the bromids in those cases in which it can 
te used advantageously, because no toxic symptoms follow its 
lee administration and the mental faculties are not impaired 
ly its use.” 

20. Surgery of the Stomach.—The first problem of gastric 
‘gery noticed by Mayo is the difficulty of making a diagnosis, 
“very operation being to a certain extent exploratory in its 
wipiency. The only cases of cancer of the stomach which he 
las been able to diagnose sufficiently early to extirpate are 
those where obstruction and dilatation were present. There is a 
urge group of chronic dilatations where there is no apparent 
wlequate cause, and he queries the assumption of pyloric spasm. 
ln very few cases did he find a definite thickening in the pyloric 
ting; in these there was very little dilatation. In a number of 
ives angulation was present, that is, a high-lying pylorus 
wmeWhat firmly fixed with a sharp bend of the stomach down- 
He has seen a number 

id and immediately proximal to it. 
such and these may be due to adhesions resulting from peri- 
“istrilis or gastric ulcer of cholecystitis. The most perplexing 
ases, however, are those of neurotic origin, in which he places 
‘he Various grades of gastroptosis. In the purely neurotic 
‘ariety, the symptoms of ulcer may be so perfectly simulated 
‘to lead to an exploration which proves negative. The 
tomacl may contract until it is no larger than the colon, and 
tle pylorus dilate so as to admit two or more fingers. The 
when dilatation with retardation of the passage of 




food out of the stomach demands operation, largely, he says, 
depends on the experience of the surgeon and the disability of 
the patient. He describes the methods of making gastric drain- 
age, the value of which is apparent and needs no argument. 
Various operations on the stomach are mentioned and he finds 
gastro-enterostomy the most satisfactory one. He has _per- 
formed it 80 times with 8 deaths, and details his analysis of the 
cases and gives the methods. It affords drainage, which is one 
of the essential conditions and prevents stagnation and vomit- 
ing of food and relieves the patient. He uses the Murphy but- 
ton in the operation and says that the main thing is that the 
operation should be low down, near the greater curvature in 
either operation, either posterior or anterior; it is bad practice, 
he thinks, to make it about half way between the lesser and 
vreater curvatures because there are but few blood vessels in 
the locality. It leaves a pouch into which the bile and pan- 
creatic secretions can easily enter, and it encourages “vicious 

21. Thrombosis of the Cavernous Sinus.—NSeveral 
are reported by Dwight and Germain, who discuss the condition 

und the possible effects of operation. In one case with caver- 
nous thrombosis, operation was followed by apparent relief 
of symptoms, but the patient soon died. An incision into the 
one sinus instantly and completely relieved the interference 
with circulation in both. So far as they know, the operation 
has been done but Hartley and Knapp; the 
patient in this case survived for a considerable period and, 
think, however, that the two operations performed show that 

once before, by 
finally succumbed from the original disease, sarcoma. 

thrombosis of the cavernous sinus is distinctly an operable con- 
dition, and there is some hope for the decreasing of the mor- 
tality by active interference. 

22. Tuberculosis.—Otis’ article sums up his arguments in 
the following: ‘1. Consumption is one of the most prevalent 
diseases, especially among the poor. 2. It attacks its victims 
at the most useful period of their lives. 3. It is contagious or 
and hence avoidable. 4. It is curable, 
especially so when taken at its inception. 5. It is most preva- 

communicable very 
lent in crowded portions of a city and in tenement-house exist- 
ence. 6. The contagion is restricted, as with other contagious 
source of contagion. 

7.The dried sputum is the principal - 
8. Sanatorium treatment, especially for 

diseases, by 

the poor, gives the best results with favorable cases. 9. Sana- 
toria and consumptives’ hospitals afford the best means of isola- 
tion. 10. By means of such institutions, we steadily and surely 
reduce the existing number of cases. 11. Every means which 
increases the resisting power of the individual decreases his 
chances of contracting the disease. 12. This resisting power 
is established and maintained by favorable environment, as to 
abode, place of labor, rest, food, ete. 13. Economically, it is 
probably less expensive to care for the poor consumptive in 
a sanatorium or consumptives’ hospital than in any other way. 
14. Morally, we owe the destitute consumptive in our midst a 
reasonable opportunity for recovery or a decent place to die 


in. Sanatoria and consumptives’ hospitals are in the air. 
people are awakening to their importance.”  Sanatoria 
consumptives’ hospitals are, he says, the order of the day, and 
the movement will go on until every city has made provision 
for the poor consumptive. 

25. Cholelithiasis.—Berg states his conclusions as follows: 
“a. Indications for medical treatment: Choleeystitie pain or 
attacks of biliary colic, in either case unattended with fever. 
b. Indications for Surgical Treatment: 1. Operations of choice’ 

—undertaken in the quiescent period, with the object of avoid- 
ing serious complications, a simple procedure, and followed by 
‘ 3 per cent. mortality. (a) Severe cholecystitiec pain, or 
oft-repeated uncomplicated attacks of biliary colic, persisting 
in spite of medical treatment. In virtue of which symptoms 
the patient becomes invalided, and incapacitated for work. 
(b) After the first attack of acute cholecystitis, associated with 
fever. 2. Compulsory operations—undertaken at any time of 
the day or night; often amidst unfavorable surroundings, and 
in, patients who are septic, emaciated, and of low vitality. 
Difficult and laborious procedures, and attended with high 


mortality—450 to 75 per cent. (a) Foudroyant and intensely 
acute attacks of cholecystitis. (This may be the first indica- 
tion of calculous disease, but usually follows previous milder 
attacks.) (b) Hydrops, empyema, gangrene, or perforation of 
the gall-bladder, cholemia, abscess of the liver, and diffuse peri- 

26. Strabismus.—-Roosa insists on the non-existence of mono- 
lateral strabismus, except in cases of paralysis. All strabismus 
with the exception of paralytic squint is necessarily con- 
comitant and he would adopt the names suggested by Panas 
of “functional” and “paralytic” strabismus to describe the two 
varieties. He now invariably, for non-paralytic or functional 
strabismus, divides both the interni in convergent strabismus, 
and both externi in divergent strabismus, having stretched 
them according to the rules laid down by Panas. 

27. Hydrophobia.—Dulles replies to criticisms, saying that 
he has not denied that rabies is a specific disease or that the 
muzzling of dogs is not a preventive of hydrophobia, but still 
claims that the muzzling laws in England have been inefficient, 
and that he has not misrepresented Pasteur. His idea that 
hydrophobia can be conveyed by the bite of a non-rabid dog is 
still maintained. The article is decidedly controversial in 

29.—See title 45, below. 

30. Phthisiophobia.—Knopf’s article gives a history of the . 

recent action of the New York Academy of Medicine protesting 
against the decision of excluding well-to-do consumptive immi- 
grants by the Treasury Department. He points out that the 
effect of such teaching has been to create hardship te innocent 
sufferers, even those who are not infected with the tubercle 
germs. He also points out that the order of the Treasury 
Department was countermanded by President Roosevelt when 
the facts were laid before him. 

31. Saline Solution in Shock.—The cases of shock that are 
not benefited by injection of saline solution have been studied 
experimentally by Crile, who gives the details of his researches. 
He finds that there is a well-marked and characteristic group 
in which saline solution is of but temporary aid and does, not 
alter the general condition. Vasomotor breakdown is an im- 
pairment which can‘not be relieved by this means any more 
than by drugs. The benefits from saline solution in shock are 
in cases of hemorrhage alone or hemorrhage with shock, and 
result from restoring the fluid to a normal volume and adding 
force 10 the venous stream, but when the vasomotor mechanism 
has become exhausted it can not respond. 

32. Digitalis.—The motif of Porter’s article is to show that 
the prolonged use of digitalis acts damagingly on the heart 

muscle, both by its action as a muscle poison and by its inter-’ 

ference with eardiac nutrition through the circulation. 
Divitalis. he thinks, is of service temporarily in certain cases by 
improving the mechanical action of the heart, as in mitral 
in-ufiiciency and stenosis, but in aortic lesions there seems to be 
no good reason for using it in any stage. It is contra-indicated 
in fatty degeneration or in enfecbled condition of the heart 
muscle. In hypertrophy of the heart it might 
useful in cutting down the nutritive supply, but is too dan- 
gerous for such service, and, as a rule, is of service for only a 
few days at a time at the longest. It should only be given to 
influence the heart and circulation wien the arteries are very 
much relaxed, and pulmonary and systemic veins are overfilled 
with blood. In such cases it will tighten up the vessels and by 
augmenting the power of the systole will force a large volume 
of blood into the arterial system. This accomplished, it should 
at once be stopped and reliable remedies used. The use of 
nitroglycerin only partially relieves the damaging effects of 
digitalis and does not antidote this toxic action. 

33. Kidney Suppuration.—Johnson discusses the conditions 
in pyelonephritis and pyonephrosis, solitary or local abscesses 
and cases of suppuration occurring as a secondary condition in 
hydronephrosis. Cases where tuberculosis or renal caleulus is 
strictly the cause of the disease he does not consider. He finds 
in regard to pyelonephritis that in many cases it is limited to 
one kidney and early operation often leads to brilliant results. 


Jour. A. M4 Vas 

In pyonephrosis the operation of simple nephrotomy leavegimm val 
much to be desired, and, although in unfavorable « nditions jg 
may be all we desire to perform, this is not usually the cg 
All the openings and passages containing pus must je opened 
up; this involves traumatism nearly equal to that in Nephirees 

| un 
5S L 

tomy. The kidney must also be pulled down and forward jg ‘ on 
inspection and the disturbance of its vessels impairs the nuty; oe 
tion of the organic kidney substance. He therefore rath ge 
favors primary nephrectomy in such cases and thinks th at 
nephrotomy can hardly be regarded as the operation of choig iim — 
nor even secondary, though nephrectomy is not always pra 
ticable. It should be remembered that septic nephritis of eo, fim’ ih 
siderable severity in one kidney is not always a contra-indig{ilm . 

tion to the removal of its fellow, as is shown by the case y oe 
Israel, and also by another to which he here refers. EXxcisiog - 

of the diseased portion in local abscess is brilliantly success. (3. H 
ful in some cases. In case of infected hydronephrosis tine *!W 
conservative operation is often effectual. The patient can jdqmpe °! 
relieved of septic irritation by incision and drainage and, \ggeety ‘ 
the kidney is still capable of functional activity, recovery ma is pt 

65. F 


take place. A much larger portion of these cases are cured } 
conservative operation than in pyonephrosis, and nephrotony 
is the operation of choice. When nephrectomy is required, thd 
kidney has long ceased to functionate. ld by 
its @ 
prge ¢! 

bss tot 

34. Cystoscopy in the Female.—Bierhoff describes in detaj 
the technic of cystoscopy in the female and calls attention t 
the difficulties of satisfactory bladder examination in spite ; 
the fact that the introduction of the cystoscope is easy. He 
insists on thorough exploration of the cavity of the bladde 
previous to cystoscopy, using the unlighted cystoscope as : 
sound and calls particular attention to the danger of inte 
tion if cauterization occurs with the cystoscope. In case it has 
occurred it is advisable to wash out the bladder thoroughly an 
inject about 50 c.c. of a one-eighth per cent. solution of nitrat 
of silver, which should be allowed to remain until next 


, 911. 
81. C 


36. Smallpox.—Certain diffiqilties in the diagnosis of 
smallpox are noticed by Hardaway, including the differentiatioufi™, ),.., 
from some systemic disorders like cerebrospinal meningitis, thls... 
nervous form of influenza, which may resemble the prodromal 
stage, certain cases of menstrual eruptions, erythema, etc 
The erythematous initial rashes of smallpox have nothing 
characteristic about them. The petechial or hemorrhagi 
rash of the cruro-abdominal triangle, sometimes seen extending 
to the side of the body, is very rare, but always means small! 
pox. In the papular stage it is sometimes possible to confusé 
smallpox with measles, but the differences in the character of 
the fever and catarrhal symptoms usually clear up the cas 
In the rare papular or button-like measles there maybe trouble. 
An examination of the mouth and pharynx will be of value here 
because in cases of smallpox the lesions will have vesiculate’ 
while yet papular on the skin. The history may give troul! 
Hardaway has seen several casts 

he ian) 

ure by 
82. J 
he phy 
ions a 

ver a 

t shor 
f blo 


in some cases of varicella. 
the past winter of what may be called erythema papulatum. [ 
one patient in particular there was fever, pain in the lesy 
headache, gastric disturbances and various discrete eruptions 
of hard, small, red papules of the face, arms and legs. In al 
other case there was some eruption of the papules which 

the second day showed slight vesiculation and, if oue was 
intimately acquainted with smallpox lesions and the manifo 
peculiarities of cutaneous diseases in general, mistakes in ti 
He mentions here also a certain t 

diagnosis might occur. vpe 
of pustular syphilid and iodic papules which, may closely sim! 

an the 

late the papules of simallpon. 

45.—See title 29, above. 

55.—See tit'e 178, below. 

56. Appendicitis.—Hillsman discusses the medical vil > 
vical treatment of appendicitis and concludes that it 1+ bette! 

to operate prematurely than to delay too long and that we eur 
not anticipate the severer forms and have no method of tel! 
the catarrhal cases from the gangrenous ones, hence the safet! 
of the general rule of operation. Acknowledging the recovelt 
of 40 to 60 per cent. under medical treatment alone, this is 0 



OY leayey 
ditions it 
the Case! 
pe Opened 
| Nephree. 
Ward for 
the nutri 
re rather 
nks tha 
Of choi 
AVS prac. 
is of cop. 
€ Case g 
is timely 
it can be 
e and, if 
very ma 
cured b 
lired, the 

in detai 
ntion ti 
spite 0 
asy. Hi 
ype as 
Of intee 
se it hag 
zhly an 
f nitrat 
til next 

1OSIS off 
‘itis, the 
na, ety 
s small 
acter off 
he case, 
ue here, 
al casey 
um. Ii 
he legs 
In al 
hich om 

nd. sure 
ye cal 

is nd 

Vay |i 1902. 
yivalent toa mortality of less than 1 per cent. from early 
j jimely operation and does not affect the rule. 

33. Liver Secretions in Therapeutics.—Whitney suggests 
e possible use of the bile salts as a solvent for biliary calculi 
j for stimulation of the biliary secretion, also apparently 
jmulating the glyeogenie function of the liver. He has seen 
es of diabetes and ordinary glycosuria much benefited and 
jew cleared up entirely by this treatment. The question of 
be use of some of the other ferments of the liver is one that 
»s never been clinically worked up, but the possibilities of the 
» of the oxidizing ferment isolated by Jacobi are obvious and 
ye of the reasons why experiments along this line have not 
ron done is, perhaps, the difficulty in our determining definite- 
the lesion of the liver. e 

(3. Hodgkin’s Disease.—The case reported by Dodson failed 
p show any tubercular infection either by microscopic examina- 
on of the gland or the tuberculin test. He doubts the pro- 
riety of attributing all cases of this condition to tuberculosis. 
js probably of infectious origin, but the infection is not yet 
mown. ‘ 
(). Heredity.—Reid’s article is largely an exposition of the 
feissmann theory. He appears to believe that this theory is 
ld by all the most advanced authorities and is revolutionary 
its effects on our ideas. He does not seem to be aware of the 
pve class of Neo-Lamarchian biologists who reject it more or 
bss totally. 
69.—See abstract in Tue JOURNAL, xxxvii, p. 1057. 
71.—Ibid., p. 997. 

72.—lbid., p. 1058. 


79.—This article has appeared in Tue Journa of April 12, 
911. j 

81. Goiter.—Cuthbertson reviews the whole subject and calls 
ttention to the value of hydrastis as a special treatment in 
he goiter of puberty and pregnancy. He has administered it 
mn doses of one-half a grain of the dry extract three times daily 
iter eating, and in twenty-five unselected cases he effected a 
ure by this method. 

‘2. Anesthesia.—Eisendrath gives a comparative table of 
he physiologie action of ether and chloroform and their indica- 
ions and contra-indications in practice. Ether should not be 
iven When there is an increased arterial tension, as in athero- 
patous conditions, nor when great tympanites or other con- 
fitions exist which will interfere with the action of the dia- 
Nephritis is also a contra-indication. Chloroform 
hould never be given when it is necessary to administer it for 
ber an hour, on account of its poisonous action on the heart. 
t should not be given in decreased arterial tension and blood 
lessure, as, for instance, when there has beén a dangerous loss 
t blood, and in other cachectic or anemic conditions. The 
vcalled thymie state is seen from recent researches to be 
tuother contra-indication. The danger point is much less evi- 
eit in chloroform, and, therefore, constant watching of the 
ulse and respiration is required. Lowering of the head is 
seful to prevent a tendency to syncope. Another point is to 
iiminister chloroform drop by drop, never giving large quan- 
ities at a time, and with a free dilution of air. The patient 
hould be kept on his side as much as possible during the ad- 
limstration of the chloroform and the anesthetizer instructed 
Mm the best method of pulling the jaw forward. Ether causes 
Mirreased seeretion of the mouth and inspiration of this secre- 
on has sometimes caused pneumonia, but keeping the head 
“pendent, lowering the trunk and turning the head to one side 

‘help to prevent the mischief. There is little danger in 
ther, other than from bronchial irritation, if these sug- 
estions followed. The idea that acute pulmonary com- 
Pications are more frequent after ether seems to be incorrect. 
le sums up as follows: “1. Limit as much as possible the ad- 
Ministration of a general anesthetic, using the method of 
Shleich as much as possible. 2. Chloroform should not be 
given in myocarditis. In other cardiae conditions it is not as 
angerous as was formerly thought. 3. Ether should not be 





given when there is any hyperemia or stenosis of the respira- 
tory tract. 4. Chloroform should not be given in the status 
thymicus. 5. Ether is in general contra-indicated in diseases 
of the kidney. 6. Chloroform causes fatty degeneration of the 
heart muscle, liver and kidney, in prolonged administration. 
7. In chloroform the anesthetizer should watch the pupils, pulse 
and respiration constantly. 8. We can avoid chloroform syn- 
cope by keeping the head low and turned on one side, and 
avoid the pulmonary complications of both ether and chloroform 
by keeping the head below the level of the body to allow the 
mouth secretions to run out, by preventing the chilling of the 
patient and avoiding conditions which favor hypostasis. and 
interfere with action of diaphragm. 9. The order of procedure 
in case of syncope should be understood by all who are responsi- 
ble for patient, viz., raise foot of table, artificial respiration, 
massage of heart, rhythmic tractions of tongue and intravenous 
transfusion. If these are of no avail, use the method of Prus, 
exposing heart and making direct mechanical stimulation, or 
intratracheal insuftlations. Hypodermics are of little avail 
until the heart beats.” ' 

89. Oral Pathology.— Rhein calls attention to the import- 
ance of paying attention to the condition of the mouth as 
affecting the general conditions of the body, especially as an 
etiologic factor in auto-intoxication. 

90. Waiver of Privilege.—-Peltz, who is a lawyer, thinks 
that the amendments to the New York law prohibiting the 
waiver of privilege on the part of the patient, except when done 
in open court, should be immediately rescinded and that the 
waiver should be made at any time and at any place. The 
effects of the amendments are to nullify the waiver given in 
life insurance contracts, and while it is right for companies to 
issue incontestable policies it is not right for the law to compel 
both parties to make their contracts incontestable, which is 
the result produced by the amendments. 

91. Utility of Convulsions; Their Occasional Value.— 
Spratling calls attention to the importance of occasional 
epileptic fits as a danger signal in certain cases. It may be 
sufficient warning to put the patient on his guard and prevent 
nis becoming a confirmed epileptic. Another way that an oc- 
sasional fit may be of benefit is in giving vent to the nervous 
strain and apparently neutralizing or destroying the autotoxic 
poisoning which causes,it. He refers to cases illustrating both 
these facts. 

96. Some Unusual Drug Effects.—Dunning remarks upon 
the occasional bad effects of iodid of potassium in increasing 
the neurotic conditions of lead poisoning and reports a case 
which was lost, he thinks, in this way. He also reports a 
case of mental disturbance preduced by digitalis, which was 
relieved when the drug was discontinued. Arsenic he 
mentions as producing motor symptoms prior to the sensory, 


and he reports a case which was significant from the absence 
of the usual toxie effects, thus accounting for the too prolonged 
use of it in this instance. 

97. Rectal Stricture in Women.—Rothrock reports three 
cases of rectal stricture in females due to inflammatory condi 
tions in the pelvis, in one so serious as to require colotomy for 
its relief and in the others giving rise to serious inconvenience. 
He thinks the reason why stricture does not more frequently 
occur is that pressure alone from the size of the tumor seldom 
causes obstruction and there must be considerable peri-rectal 
infiltration before the mischief can be produced. It is not at 
all uncommon in local inflammatory conditions in the abdomen 
io see the intestines firmly adherent in a mass of exudate and 
vet have the bowels move naturally, 

112. Tinnitus Aurium.—lTJarris reviews the 
treatment, ete., of tinnitus aurium and finds it a very common 


and annoying symptom in ear disease of not always very well 
understood origin, but due in many cases to the interference 
with the sound waves. It does not always mean deafness, and 
much can be done for it if the exact 
Drugs are disappointing; strychnin seems to be the best of 
them when local treatment has failed. A careful study and 
recording of cases is necessary for their proper management. 

cause can be discovered. 


113. Influenzal Otitis.—ioldstein finds that: “1. Epidemic 
or endemic influenza is the etiologic factor in this affection. 2. 
A careful differentiation should be made between simple otitis 
media and influenzal otitis. 3. Free incision of the drum 
membrane at the earliest indication of effusion into the tym- 
panic cavity should be made. This free drainage should con- 
stitute the most important principle in the treatment of this 
affection. 4. A guarded prognosis should be given, especially 
as concerns the complete restoration of hearing. 5. Conserv- 
atisin is urged concerning operative interference when mastoid 
symptoms appear, as many of these symptoms are accompani- 
ments of influenza and should be regarded as neuralgias rather 
than evidences of suppuration.” 

114. Septal Deviations.— From his observations, Jackson 
sums up as follows: The turbinated bodies in health and dis- 
ease swell at night during sleep, the swelling being greatest in 
the inferior cne and on the side next to the pii'tow. This 
periodic swelling, aided by the irritation of acute coryza and 
acute and chronic rhinitis, is often a primary and secondary 
factor in the production of septal deviation, both’ before and 
after operation, the deviation being usually of the cartilaginous 
septum, but often of the anterior bony portion as well. This 
etiologic factor is usually overlooked because it occurs in the 
night, disappearing prior to oflice examination. When the 
patient sleeps habitually one one side the turbinal pressure is 
always in one direction. In other cases one turbinal being 
larger and more expansible than its fellow, the septum is 
pushed by it into the position of deflection which in time be- 
comes permanent, while the larger turbinal becomes larger, 
which change is pathologic. The idea that it is a physiologic 
compensation and should not be touched, is the foundation of 
failure of attempts at correction of septal deviation. Almost 
every case of deviatien demanding operation requires resection 
of the inferior turbinals on the concave side for two purposes: 
immediate and permanent correction of the septal 
and to secure adequate nasal respiration during 
is an error to base the estimation of the adequacy of 
the nasal respiratory canal on either the patient’s statement 
or the size on inspection of the canal, whether the parts be 
not. If the imprint of the inferior turbinal is 
seen on the septum, it is a certain indication for a radical 
resection of the inferior turbinated body, including a fringe of 
the bone on the concave side. Soft hypertrophies will expand 
at night and exert pressure and yet shrink so small. as-to leave 
a free and open channel during the day. These often do more 
harm than the hard hypertrophies and if left untouched or 
merely cauterized with a galvano-cautery the cases might as 
well be left If the resection of the turbinal be. suffi- 
ciently radical there will be no need of a Mayer, Asch, or Kyle 
iube, nor of packing to hold the septum in its position. He 
asks the skeptic not to act on theory, but to go home and take 
the case that failed of cure, cut out the inferior turbinal on the 
concave side, and after this is healed do his septum operation 

to secure 
sleep. It 

cocainized or 


over again and note the result. 

118. Serum Therapy.—The complications of diphtheria with 
streptococcus infection led von Quast to try to obtain a serum 
which would be effective against both types. Correspondence 
with Parke, Davis & Co. induced them to prepare for him a 
serum from a horse first immunized against tetanus, then strep- 
tococeus and then diphtheria infection. He has employed it on 
8 cases, 3 of which were virulent and malignant types of scar- 
latina, with the best results and also reports a case of diph- 
theria with mixed infection, in which it was employed with 
favorable outcome. He hopes that further clinical trial of this 
serum will be made. 

123. Tuberculosis.—Vaughan notices certain cases of tuber- 
culosis and calls attention to the communicability of the dis- 
case and the importance of good feeding im the cure of incipient 
cases. He says he regards rest, proper feeding and the use of 
such tonics as strychnin the best and practically the only 
things needed in the early stages of pulmonary tuberculosis. 
He also uses nucleinie acid in the early stages, though there 
is nothing specific in its action and it is simply a tonic for the 

phagocytes of the body. There are some cases that are pos- 


_grains is not a maximum dose for an adult, but in the « 

Jour. A. M4 

sibly aided in this way. It may, however, do harm advanced 

isly. He 

of hemop. 

cases. He has used it hypodermically and intrave: 
also remarks that in every case of loss of weight 0: 
tysis that symptoms should not be considered due ti 
else until one can be sure that it is not due to tuber 

99 cases out of 100, hemoptysis means pulmonary tu! 

losis, In 

134. Miners’ Diseases.—Coleman finds certain pathologie 
conditions frequent among miners. Powder-smok: headache 
from the use of giant powder is the most frequent acute trouble, 
causing serious congestive symptoms, headache, muscle titel 
Ing, nausea, vomiting, ete. 

Handling giant powder wil] | 
cause headache and may give rise to severe conjunctivitis 

This is best relieved by a combination of acetanilid 
citrated caffein, seda bromid and gelsemium. 
other acute trouble which 

Sudamiina is ap. 
The chronic troubles 
Chronic laryngitis is the most frequent, ¢ 
largely to a peculiar manner of expelling air from the lung 
practiced by miners; as nearly all miners are mouth breathers, 
the cold and dust-laden air thus increases the trouble. 

he has seen. 

are more serious. le 

bronchitis tends to produce miners’ consumption, which is only 
a step along the same line. Coleman also notices miners 
nystagmus, though he does not call it by that name, probably 
not being familiar with the accounts of the condition given 
elsewhere. The constancy of the work, Sundays and _ week. 
days, also tends to wear the miner out. For some time Cole. 
man has been making urinary tests for mineral poisoning and 
has undoubted evidence of general systemic poisoning by anti- 
mony, arsenic, copper and lead. 

146. Amebic Dysentery.—-Osler has had a number of cases 
of this form of dysentery in the Johns Hopkins Hospital, some- 
times three, four or five from the same locality, mostly males 
and tew colored. It is a disease of the adult. More than 5 
per cent. of the cases were in the third and fourth decade of 
life. The tendency is to become chronic. Very few cases die 
of dysentery itself, but it drags on for months or years with 
alternating periods of constipation and diarrhea. 
important and serious sequel is liver abscess. It is quite dis 
tinct from the bacillary form, less epidemic, rarely as acute, 
more chronie and liable to recurrence, the ameba are present in 
the stools, and lastly, and this is a very important point, it 
lacks the reaction of the Shiga bacillus. 

The most 

147. Bacillary Dysentery.—-The conclusions which Flexner 
deduces from the data available are: “1. The acute dysentery 
of Japan, Philippine and West Indian Islands, of Germany, and 
the United States is due to bacilli indistinguishable from each 
other. 2. Certain cases of chronic dysentery owe their begin- 
ning to the same organism. 3. The sporadic and inst itutional 
outbreaks of acute dysentery are caused by bacillus dysenterie, 
and this organism is identical with that causing epidemic acute 
dysentery. 4. The acute bacillary dysenteries are attemled by 
diphtheritis and ulceration of the intestine. 5. When dip) 
theritis complicates amebic dysentery a mixed or terminal in 
fection with the bacillus of dysentery is to be suspected.” 

149. Ipecac in Dysentery.—W oodhul! holds that ipevac is 
as specific in dysentery as quinin is in malaria, but it must be 
given in the proper way. The patient must be recumbent, the 
stomach empty, and about twenty minutes before giving the 
ipecac it would be well to paint the epigastrium with tincture 

‘of iodin or apply a mild sinapism sufficiently to induce gentle 

counter-irritation. Ten or fifteen minims of laudanum may be 
given, followed in ten or twelve minutes by 15 to 30 or more 
grains of ipecac in pill form or as a paste with ver) little 
No tiuids should be taken for at least four hours and 
The opium may 

dose ol 

the recumbent position strictly maintained. 
be given with the ipecaec in pill form. The size of the 
ipecac should be in proportion to the gravity of the case. SIM) 
acute tropical dysentery 15 to 20 grains will suffice. 

152. Treatment of Dysentery.—Hare reviews the (i llerent 
treatments, first, the ipecaec method, which is proven be of 
value by observers in the tropics. So far as we know, the 
effect seems to be largely by the production of a more profuse 

After the vomiting from the large dos small 

flow of bile. 


a pro! 
fav ra 
also Te 
on the 

given | 
or con 
the 1p 

beng | 
ing to) 


in the 
used 1 
but by 


In col 
the ki 
of con 
lto 4d 
wo be 

be mi 
the di 
ally i 

The | 


MAL May 17, 1902. 

uly anced 

sly, J 

ve grains are given every hour and continued until 
lack, tarry stool is passed, which is considered a 
favorable “Sign, the vomiting being controlled by opium. It 
yes tenesmus and pain. While stimulants may be re- 
is advisable not to use alcohol because of its action 
Another plan is the purgative, which has been 
prought forward from experience in the Philippines and in 
South Africa. The bowels are first thoroughly moved with 
Epsom 01 Rochelle salts, and then aromatic sulphuric acid is 
given freely, SO that it will exercise its well-known astringent 
or constipating influence. This is a more rational plan than 
the ipecac treatment, as it is well known that the micro- 
oyanisms in the intestines in dysentery are destroyed or ren- 
dered inert by an acid medium. The third plan of treatment 
mentioned consists in the use of intestinal antiseptics, bismuth 
glicvlate, benzonaphthol, satel, calomel, ete. An antiseptic 
influence of the mercurial, however, is probably unduly ac- 
wedited with the effect. produced, the real value of calomel 
ing that it increases the activity of the liver, both in destroy- 
ing toxic material and in secreting bile. 
muth or salol as intestinal antiseptics to the exclusion of the 
sulines or ipeeae. Local treatment is often necessary. Clysters 
which will reach far up into the descending and transverse 
colon are necessary. Hare has found.sulphocarbolate of zine 
in the proportion of 20 gr, to the pint very satisfactory if 
ued in this way. The method of making the injection is 
important. It should not be by means of a pumping syringe, 
but by a fountain syringe or surgical irritator and the pressure 

Jose of U! 

p profus 

I hemop. 

met hing 
‘OSIs, In 

als reli 

quired, 1 
on the liv 

it hologie 

| trouble, 
' twitch. 
Vill also 
‘itis and 

la Is an- 

ent, due 
he lungs 

He does not use bis- 

| is only 

1 Obably 

nN Liven 
1 week. 
ne Cole. 
ing and 
XV anti- 

ot cases fm never be over two or three feét, the injection being gently given, 
I, some. fag prolonged for ten, fifteen or twenty minutes. Where there is 

> males fg great bowel irritability it is well to use two catheters so as to 
than jag iaciitate the return flow and prevent bowel distension. Hy- 

cade of gg genic and dietetic methods have their place in the treatment. 

In conclusion, he mentions the need of active measures to aid 

ses die 

swith gg tle kidneys in elimination and the employment of antibacillary 
e most geeum in the treatment of dysentery in Japan. This is not an 
ite dis gg antitoxic serum but an antibacterial one. Still another form 
acute, Mao! combating dysentery is by injecting quinin in the strength of 
sent in gg) to. 5000 high in the rectum to destroy the ameba. This seems 
int, it te be as rational as the use of quinin in malaria, and it is 

hoped that a similar agency will be found to destroy the Shiga 
‘ bacillus as quinin does the ameba. 

|). Prostatic Hypertrophy and Hemorrhoids.—Three 


and gg cases ave reported by Townsend, who thinks there was a con- 
1 each A wection between aggravation of prostatic inflammation and en- 
bevin Q augement and the operation for hemorrhoids. He says he may 
tional ag OC Mistaken, but he thinks the subject is one of suflicient im- 
tery, Rg RoTtance to receive attention. Obliteration of the circulation, 
acute lg Oe disturbance and further congestion of the already chronic- 
led by illy inflamed area are likely to produce, he thinks, acute pros- 
diph tatitis where the chronic congestive condition already exists. 
al in 166. Calcium Sulphid.—This substance is found of value in 
various skin diseases with glandular activity and suppurative 
ee conditions, especially in combination with nuclein. In dis- 
at ta orders of the mucous membrane, especially uterine catarrh, it is 
t. the Well to combine with alkaline-saline medication, for its general 
« the a lene effect, together with strychnin arsenite to restore the 
cial muscle tonus. The physiologic properties are summed up as 
mee Ymphatic glandular stimulant, anti-suppurative and resolvent. 
as the conditions to which it is therapeutically applicable are 
nore a UPPUrative conditions, boils, abscesses, carbuncles, smallpox, 
little ‘atarrhal affections, bronchitis, cystitis, laryngitis and skin 
— fruptions arising from suboxidation. Aulde gives a long list of 
ae remedies that are valuable in collateral and alternate treat- 

oe ment, such as aconitin in neuralgia, anemonin in uterine ca- 
tarrh, arsenic, arsenic bromid, ete. 


nary l7S.—See title 55, above. 

erent FOREIGN. 

be ol Titles marked with an asterisk (*) are abstracted below. 
_ the 

British Medical Journal (London), April 26. 

1 *Vaccination and Common Sense. 'T. D. Acland. 
cntract Medical Attendance upon Sick Clubs. H. 


mall Langley 




ce | 





pk fk 







44 *Ueber ein 


*Fast spezifische 


*Observations on ‘Caisson Disease” and Its Prevention. A. H. 
Muir MacMorran. 

*Cocain Intoxication 
Chunder Bose. 

A Note on the Application of Litholapaxy or Lithotrity to 
Stone in the Bladder in the Canine Species. Reginald 

Two Cases of Acute Intestinal Obstruction Successfully Treat- 
ed with Quicksilver. McKean Harrison. 

A Note on Infantile Mortality from Tuberculous Meningitis 
and Tabes Mesenterica. Hubert Armstrong. ° 

The Lancet (London), April 26. 

*The Etiology of Typhoid Fever and Its Prevention. W. H. 

Some Abnormal Physical Conditions in Children. 

*On Some Points in 
G. Ernest Herman. 

*Smallpox Hospitals and the Spread of 

A Case of Subcutaneous Myiasis. Edward B. Hector. 

The Spontaneous Cure of Senile Cataract. Sydney Stephen- 

A Case of Placenta Previa. 

and Its Demoralizing Effects. Kailas 

George F. 

the Treatment of Puerperal Eclampsia. 

Infection. John C. 

A. W. Lemarchand. 

Journal of Tropical Medicine (London), March 15. 

Duration of the Latency of Malaria After Primary Infection 
as Proved by Tertian or Quartan Periodicity or Demonstra- 
tion of the Parasite in the Blood. John T. Moore. 

Principles Determining the Geographical Distribution of Dis- 
ease. (To be continued.) Louis W. Sambon. 

Annales de Derm. et de Syph. (Paris), March. 
*Alopecia Areata of Dental La 
pelade d'origine dentaire. 

Lichen plan palmaire et plantaire. 

Un cas de paronyxis tuberculeux d'inoculation. 

*Considérations sur la médication cacodylique. 

Contagion of Venereal Disease. Audry.—Ou 
maladies vénériennes * 

(Case Reports.) Néoplasie ulcéreuse de la 
Besnier.._Lupus érythémateux anormal. Hallopeau.—Mal- 
adie de Darier. Ibid.—Malformation cranienne. Ibid. 
Chéloides spontanés multiples. Gaucher.—-Lupus érythé- 
mateux de la face et angiodermite tuberculeux des mains. 
Leredde.—Gnuérison de tabes par les injections de calomel. 
Ibid.—-Syphilis ignorée. Fournier.—-Arthropathies au cours 
dune syphilis secondaire. Ibid.—Eruption bromo-iodique. 
talzer.—Eruption polymorphe bulleuse  iodique. Ibid. 
Sur une corne de la paupiére d'un enfant. Audry.—Hyper- 
kératose circonscrite des doigts chez un syringomyélique. 

Bulletin de l’Acad. de Med. (Paris), April 15. 


Origin. L. Jacquet (Paris). 
(Concluded from No. 2.) 
W. Dubreuilh et E. Le 
se prennent les 

région inguinale. 

Vision of Radium by the Javal.—Vision du radium 
par les aveugles. 

*Les dangers de l’antisepsie 
phoide. <A Robin. 

De la gastro-entérostomie par le procédé en Y. 
Journal de Med. de Paris, March 23 and Apri! 13. 

*Etiologie et traitement du tabes. Antonelli. 
Opothérapie rénale. L. Archambault. 

Revue Hebd. de Laryngologie (Bordeaux), April 19. 


interne. Mercure et fiévre ty- 

L. G. Richelot. 

*Angine séche et Brightisme. Joal 

Berliner Klin. Wochenschrift, April 7. 

Unity of Pathogenic Streptococci. A. Marmorek (Paris). 
Die Art-Einheit der fiir den Menschen path. Streptokokken. 

Ueber die Meniére’sche Krankheit, ankniipfend an einen ge- 
heilten Fall. J. Gescheit. 

*Ueber die Frage der mechanischen Disposition zur Tuberku- 
lose nebst Schlussfolgerungen fiir Nasenplastik nach Lupus. 
ki. Hollaender (Berlin). 

*Die syphilitische Diinndarmstenose. T°. Rosenfeld (Berlin). 

Casts in Urine in Artificially Induced Stagnation of Bile. P. 
Wallerstein (Moscow).——Ueber reine Cylindrurie bei kiinst 
lich erzeugter Gallenstauung. 

Ein Beitrag zur Behandlung der chronischen Gonorrhoe.  E. 

April 14. 

Multiplicity of Complements in Serum. FP. Ehrlich and H. 
Sachs.—-Vielheit der Complemente des Serums. (Concluded 
from preceding number. ) 

*Der Verdiinnungsversuch im Dienste der functionellen Nieren 
diagnostik. G. von Illyes and G. Kovesi. 
*Die Behandlung schwiichlicher Kinder. J. 

Ist die Gonorrhoe der Lrostituirten heilbar? T 

Ein Fall von Temperaturkrisen bei 

Ritter (Berlin). 
v. Marschalko 

Tabes dorsalis. B. Oppler 

Med. Wochenschrift, April 15. 
*Beitraege zur Kenntniss der Cholelithiasis. J. Boas (Berlin). 
Kleine Reitraege zur Tuberkulose-Frage. A. Heller (Kiel). 
Throat Reflexes in Hysteria. H. Stursberg (Bonn).—Ueber 
das Verhalten des Rachenreflexes bei Hysterischen. 
*Ueber refraktometrische Blutuntersuchungen. A. 
verbessertes Verfahren 
(Ofen-Pest ). 



der Perkussion. J. Plesch 

Wirkung des Antipyrins auf 



ische Zustiinde. 


dem Befund 

46 (Case Reports.) Ueber 
eines Typhusahnlichen Bakteriums im Blute 
Brion.—Pyopneumothorax acutissimus bei 
Zwerchfellishernie. T. Struppler. 

eine Erkrankung mit 

Therapeutische Monatshefte (Berlin), April. 

47 Ueber die Behandlung der Veit. 
48 Infant Feeding. I. v. Krage der 
49 Zur Kpidemiologie der Diphtherie. A. 
50 Cacodylic Medication. I’. Mendel (Issen).—Ueber die therap. 
Verwundung des kakodylsauren Natrons und die intra- 
vendse. Arsenbehandlung. . 
51 *Ueber Verhiitung und innere Behandlung des steinbildenden 
Katarrhs im Besonderen sowie zu Gallenstauung fiihrender 
Erkrankungen des Gallensystems im Allgemeinen. N. 
Clemm. : 
Der therap. 
*Zur Therapie des Croup. L. Bayer 
*Ueber pract. Erfahrungen mit der 
unter besonderer Beriicksichtigung des 
weisses der Quecksilberausscheidungen. O. 
cluded from No. 2.) 
Recovery from Lightning Stroke. H. Cramer (Wittenberg).— 
Fall von Blitzschlag mit giinstigem Ausgange. 

Wiener Klin. Wochenschrift, March 27 to April 17. 

*400 Blasensteinoperationen. A. v. Frisch. 

Subphrenic Abscesses Containing Bile. K. Weiler (Vienna). 
—Zur Casuistik gallehaltiger subphrenischer Abscesse. 
Entziindung in cavernésen Tumoren, vendsen Angiomen und 
Venengeflechten gefolgt von Vergriésserung der alten Angio- 
men und Bildung neuer Venenektasien. O. Chiari (Vienna). 
Der gegenwiirtige Stand der Lehre von der Entstehung und 
der Verhiitung der Tuberkulose. A. Weichselbaum. 
Ueber Bacteriohiimolysine und Antihiimolysine.  R. 
and S. Ludwig (Vienna). (Third Communication.) 

Ueber die Wirkung bactericider Immunsera. M. Gruber. 

seitraege zur Kenntniss der Agglutination rother Blutkérper- 
chen. A. Klein (Vienna). 

Deaf Mutes in Early Childhood. A. 

Eclampsie. J. 
Mering.— Zur Siiuglingser- 

Gottstein (Berlin). 

Werth des ‘“‘Mangan-Eisen-Pepton Gude.” J. W. 
(Hatzfeld, Hungary). 

chemischen Nach- 
Werler. © (Con- 


Kreid! and G. Alexander. 

—Entwurf zu einer Statistik der k6rperlichen und geistigen, 

Entwicklung Taubstummer wihrend der ersten Lebens- 

Zeitschrift f. Heilkunde (Vienna), xxiii, 3. 
*Die stumpfe Verletzungen von Strumen. J. Hertle 
Ueber die primiire Resection bei gangriinésen 
Hernien. Zahradnicky (Deutschbrod). 
Tumors of Hyoid Region. G. W. Maly (Prague).—dZur 
tologie der Tumoren in der Zungenbeingegend. 
*Ein Beitrag zur Lehre vom Chloroformikterus. L. 
Axial Torsion of Small Intestine. Ibid 
von Achsendrehung des Diinndarmes. 
Modification of Intestinal Wall After Incarceration. M. Jeru- 
salem (Vienna).—Casuistischer Beitrag zur Kenntniss der 
Darmwandverinderungen nach Brucheinklemmung. 

*Ueber traumatische Lipaemie. KE. Fuchsig (Vienna). 

Ueber Cystenbildung am Ureter und in seiner Umgebung. C. 
Sinnreich (Vienna). 

Ein Fall von Diploesarkom und ein Fall von Osteochondrom 
traum. Ursprunges. H. Reimann (Vienna). 

er f. Orthopaedische Chirurgie (Stuttgart), x, 

Die Endresultate der unblutigen Kehandlung der 
Hiiftluxation. FP. Redard. 

Zur heilgymnastischen Behandlung der 
delapparate. W. Becker (Bremen). 
wer Relations of Femur. CC. Ghillini and SS. 
(Bologna).—Ueber die statische Verhiltnisse des 


Congenital Seoliosis. F. 
angeborener Skoliose. 

*Ueber Stiitzapparate bei 

Scheerenférmige Redressionsapparate mit 
C. Hiibscher (Basle). 

Combination of High Scapula and Wryneck. B. Lamm (Ber- 
lin).—Ueber die Combination von angeb. Hochstand des 
Schulterblatts mit musculirem Schiefhals. 

Untersuchungen ueber Elasticitatsverhiiltnisse in den mensch- 
lichen Riickenwirbeln mit Bemerkungen ueber die Patho- 
genese der Deformititen. C. Lange (Copenhagen). - 

Vorliufige Mittheilungen ueber meine Versuche zur Lésung 
der Frage eines portativen Detorsions- und Redressionscor- 
sets fiir Skoliosen aller Arten. A. Roth (Budapest). 

Ueber Hallus varus. G. Teichmann (Breslau). 

Ueber die Aetiologie der statischen Belastungsdeformititen. 
A. Schanz (Dresden). 



einen Fall 

Skoliose: 2 neue Pen- 

Pend] (Wiirzburg).—Ein Fall von 

Riickgratsverkriimmung. A. B. 

elastischem Zug. 

iv, 6 to 9. 
Triantaphyllides (Batoum).— 

Grece Medicale (Syra, Greece), 
*Malarial Vertigo. T. 
tiges paludéens.”’ 

Rivista di Pat. Nerv. e Ment. (Florence), March. 

*Sulla patologia delle cellule die gangli sensitivi. E. 

Contributo allo studio del morbo -di 
and P. Pini. 

Vratchebnaya Gazeta (St. Petersburg), ix, 9 to 13. 

*Palpation of Stomach. V. VP. Obraztzoff.—Oshtchupivanie 
zheludka. : 

Asepsis and Antisepsis. M. 
tiki i antiseptiki. 

*The Miser in “Dead Souls” as a Study of Senile Dementia. 
V. F. Tchizh.—Plushkin, kak tip startcheskova slaboumiya. 

Kumyss and Its Hyg.-Diet. Value. D. L. Gabriloviteh.— - 
Kumyss i yevo znatchenie v hyg.-diet. rezhim. 

“Des ver- 


Parkinson. P. Gonzales 

A. Zausailoff.—K voprosam asep- 



Caffein in Connection with Other Heart Remedies Y 

Bandaline.—Koffein i yevo klin. primyenenic 
drugimi serdetchnymi sredstvami. 

Therapeutic Value of Vaccinium Vitis Idaea. A 
Materially k voprosu o chem. sostavye i 

Gruppa Pemphigus. P. V. Nikolsky. 

Influence on Nurslings of Alcohol Taken in Breast Mi), 
V. Sajine.—Vliyanie na grudnykh dyetei alco! : 
mova v organizm kormyashtchei. 

A Galactomanometer. O. A. Litinski. 

Rapid Method to Determine Carbon the Air. y p 
Kashkadomoff.—Bystryi sposob opredyeleniya uglekisloty ¢ 
vozdukhye. 4 

*Chloroform Water in Treatment of Typhoid and Othe Gas 
tro-intestinal Affections. S. I. Dibailoff. 4 

Welander’s Method of Treating Syphilis. I. I. 

S SVyazj , 



Hospitalstidende (Copenhagen), xlv, 13 to 16 

Our Hospitals. G. Hallager.—Om vore Sindssygeanstalte 

Experimental Research with Tuberculous Exudates. J. § 
enberg.—Nogle Dyreforsog med _ tuberkulése,  seriige 
sudater i smaa Maengder. 

Substitution af Testes med Vaselin. H. Trautner 

Curve of Weight of Child Who Weighed Less Than 28 Qype 
at Birth. P. Heiberg.—Vaegtxurven for et Barn der yoy 
Fodselen vejede 1 Pund og 95 Kvint. 

Den akut hemorrhagiske Pancreatitis. L. 

Hygiea (Stockholm), April. 


Large Myoma. F. 
oma uteri. 

Simple Method of Substituting tne Bone in Partial Resectigg 
of Lower Jaw. Ibid.—En enkel metod att ersiitta beng 
vid partiella underkiikresektioner. 

Om ptosis och ptosis-operationer. G. 

Macadamized Streets from a 

Kaijser. stort my 


Sanitary Point of View. |, 

i. Vaccination.—Acland’s address made before an assen/ 
blage of hospital patrons and subscribers is adapted to the 
laity rather than the physician. Some of his points, however 
are worthy of note. He gives elaborate tabulated statements 
showing the advantages of vaccination and that the decrease iq 
the death rate of children has been mainly 
practice of vaccination was adopted, the decrease in other dis 
eases to which infants are liable being slight or nil, often in 
creasing in some respects, as in summer diarrhea. He 

since the general 

the different objections to vaccination and refutes them, and 
points out that all the accidents in several million vaccinations 
would not equal the difference it has made in the deaths f 
smallpox in one year. He also points out that the vaccinated 
and revaccinated employes of smallpox hospitals are almos 
absolutely exempt from the disorder. His tabulations and illus 
trations are absolutely in behalf of vaccination, 
They all show the same thing in different ways: 1. That the 
vaccinated are less liable to attack after exposure to smallpox 
They are less liable to suffer severely and to die from thé 
attack.. 3. Where ages are specified they show that the max 
imum protection among the vaccinated is found in the earl 
life, and that the maximum incidence of smalipog 
among the unvaccinated is in childhood, and the maximum pre 
tection by vaccination is in the early years of life; 
importance of early vaccination in infaney, He remarks tha 
it is strange that a state which is so strict about its health 
that it must label oleomargarin, etc., should be so neglectful i 
some respects as regards this much more important matter. 


years of 

hence thé 

Caisson Disease.—The experience of the Greenwich {ov 
way tunnel with reviewed by Mac Mortal 
Selection of the men was carefully made and the total pe 
centage of rejections, both primary and secondary, was 18.3 je 
cent. The exemption from serious caisson disease was consi 
ered to be due to the ample supply of fresh air. It was fous! 
that a large percentage of those who had previously work 
under similar conditions had a much lower pulse rate than th 
newer men and did not perspire nearly so freely while at wotk 
They also showed a deviation from the normal in heart souni 
usually in the pulmonary area, but: often in the aortic, but! 
several of these the heart sounds became absolutely norm 
after they had worked in compressed air for a few days. Til 
he thinks bears out the fact that the best and most, satisfactol 
remedy for a person suffering from 
him back into compressed air, and shows also the 
of the medical lock. He has never before heard 
such an abnormal condition of the heart being thus got rid of 
and he thinks that men who have previously worked unée 

“aisson disease is 


-aisson disease is to pul 


by a 

SIC hh 
yt hie 






on t 
Ms 1 
Ot t 





M.A May 
ies. yg con ns should be more carefully examined than others. 
: SVYaai he pathology of the condition is rather obscure. We know, 

at the presence of carbonic acid gas in undue pro 

Kanger_ however, 


dystyj cmpressed air causes increase in the caisson disease. 

portion I! 

believes that men whose eliminatory. functions are 

: Ait L jmpaire sluggish are more or less liable, hence the rejection 

10lV¥a yo » ? z 5 
: il, of a certain proportion who have showed signs of alcoholism 
»J obesity. For the same reason, attention to the condition 

' the liver, kidney and stomach, as shown by the pulse and 
tongue, is of as great or greater importance than attention to 
conditions. The increase of CO. must. act more seri- 
ously on some men than on others, He believes also in the path- 
jogic ellect of the hyperemia of the deeper tissues due to extra 
pressure, especially on the function of the vasomotor and sym- 

Air V Pp 
slekisloty y 

Other Gag. 

tlie heart 


J. Sch 

pathetic symptoms, though. this idea is not generally accepted 
hy authorities. As regards treatment, he finds nerve sedatives, 
buch as bromid, especially ammonium bromid, are better than 
-asesof pain cannabis indica gave great 
yelict. Potassium nitrate, potassium acetate, and ammonium 
wetate are good in the convalescent stage, or when the pain 
diminishes, but may be given from the first with good results. 
fut by far the best treatment is the medical lock, into which, 
however, the purified air should be pumped until the pain goes, 
and then the pressure very gradually reduced. To effect this 
tliere should be attached to the medical lock an apparatus con 
iaining caustic soda in screens over which the 
vould give up most of its CO,,. 

28 Ouneggl 

rn der yojfmmopium and in some severe 

stort mr. 

| Resectiog 
iitta benet 

View. |, soe te , 
alr in passing 

Most forms of caisson disease 

an assenamme!” be prevented by getting rid of the CO, where it collects 
asseny ad ’ 

ed to thammpnost. that is, at the shield in front where the men are working. 

\ll new men should be examined after work each day for a 

' however 
week, and those who are indisposed kept above ground until 

tatements ; 
F well. 


1. The Cocain Habit.—Bose gives an interesting account of 
the cocain habit He finds its exhil- 
rating effect very temporary and quickly followed by depres 
The habit is quickly acquired and very difficult to 
abandon. He thinks the depression of spirits is more imag- 
real, as he has not noticed any fall of temperature 
or slowing of pulse, but the respiration becomes slightly hur- 

e general 
other dis as observed in Caleutta. 
often inf 
le reviews sion. 
hem, and 
aths from 

nary than 

accinateime cl. The teeth and tongue of confirmed cocain eaters become 
ve almost black, probably due to the chemical change produced 
and ila by the action of lime and saliva on the drug. The habit 
ccinationamncteases on one very rapidly. It was noticed in one 
That the’ that the dose was raised from 1 to 12 gr. in a 

nonth. Unlike opium, it produces insomnia ‘and anorexia, 

smallpox : : ‘ . » 
iy soon followed by dyspepsia and diarrhea. The dyspepsia of a 

the mun inebriate is very obstinate and prolonged use of the drug 
the erties on The quantity of urine is diminished, 

‘BR clusions and hallucinations often occur and sometimes acute 
nana Which is not amenable to treatment. He reports a num 
ber of cases and from analysis finds that the action of cocain 
on the nerve centers is slightly stimulative, but this is very 
temporary, followed by a feeling of depression, which gradually 
passes into complete lethargic inertia. 

from the 
mum pro 

hence thé 
arks tha 

's heal 

The power of control 
The virile power is lost, with depression 
the heart and vascular symptoms. The cardiac action is 
regular and the ecireulation becomes languid. The 
ippetite and the failure of the digestive power is marked and 
emaciation follows. The 
‘imination is impaired, depressing the function of the brain 
nd causing insomnia and loss of memory. 
‘oms are not observed as long as moderate doses are used, but 
le person soon becomes a useless member of society and life 
comes a burden to him. The only remedy is to lock him up 
and forcibly withdraw the drug. 

is gradually lessened. 

vich foot 
¢ Morrat 

otal per 

loss of 

The craving for the drug increases. 
; 13.8 pe 
is consid 
as fount 
y worke 
than thé 
at work 

The toxic symp- 

t sounds 4 oe ; 
‘. Typhoid Fever.—This third lecture by Corfield goes over 

c, but im, sie ie scale : 

ia the evidence of the infection of typhoid fever by foods, espe- 
vs. Thi “ally shellfish, and its distribution through sewage. 
isfactor \). Puerperal Eclampsia.—-Herman discusses the state- 
s to pug@ents made in certain text-books that the proper treatment for 

Puerperal eclampsia is emptying the uterus. He gives statistics 
Which he tabulates from various authorities, showing many 
“ses with eclampsia after artificial delivery. If artificial 
telivery was satisfactory the treatment by Cesarean section 

heard 0 
yt rid of 
ad unde 



would be especially so. It is the quickest. possible method, but 
the facts are that the fits are liable to continue after it and 
the evidences of the good effects of delivery are far from de- 
cisive. He lays-stress on the importance. of the rise of tem- 
perature and the quick pulse as unfavorable prognostic signs. 
He believes in the good effect of abstraction of heat by baths 
and the promotion of diaphoresis. He reports.a;e¢ase in which 
the tepid bath seemed to be very effective. 

11. Smallpox.—The dangers from smallpox hospitals to the 
vicinity and the air-borne\conduetion are discussed by Thresh, 
who finds from the results of his investigation of certain local 
epidemics attributed to the Purfleet hospital ships: ‘“l.'That 
among the cases which occurred in Purfleet, both in the present 
and preceding epidemic, there was a large proportion which 
could not be traced to pre-existing cases. 2. That all the 
usual factors tending to produce epidemic prevalence of small- 
pox were present in the Orsett Union, with the addition (save 
in the case of Purfleet) of an unusually large proportion of un- 
vaccinated children under ten years of age. 3. That none of 
these usual factors are capable of explaining the peculiar dis- 
tribution of the disease during the epidemics investigated. 4. 
That all the results point to some central continuous focus of 
infection corresponding exactly in position with the smallpox 
ships. 5. That most careful inquiry fails to show any means 
whereby this continuous flow of infection can occur except on 
the hypothesis that it is air-borne. The extent of the 
around a smallpox hospital which may be affected directly and 
indirectly by the hospital is apparently much larger than has 
In the case of the ships lying off 


hitherto been supposed. 
Purfleet the influence is probably being felt at a distance of 
fully three miles, and the’presence of a belt of water half a 
mile in width is powerless to arrest the contagion. There can 
be no doubt that the danger increases with the increase of the 
number of acute cases in the hospital (the infectivity not being 
marked until a certain degree of concentration is reached) and 
with the proximity to the hospital. With a small hospital, say 
one constructed for from 10 to 30 cases, my impression is that 
there is but little danger of the disease being spread therefrom, 
providing the site is such as corresponds to the requirements of 
the local government board; but the danger can not be said to 
be non-existent. With hospitals having 100 or more beds, the 
danger is naturally much greater and, when we come to hos- 
pitals of the size of those required to cope with an epidemic in 
a large city, the peril may be great indeed.” He thinks the 
ageregation of a large number of smallpox patients is a serious 
danger to the neighboring community. His idea of isolation is 
scattering the patients over large areas in properly constructed 
and equipped tents, with a central permanent administrative 

17. Dental Origin of Alopecia Areata.—In Jacquet’s 273 
cases of alopecia areata, which he traces to some lesion in the 
jaws or teeth, 37 of the subjects were between 3 and 7; 79 be- 
tween 7 and 14; 22 between 14 and 19, and 68 between 19 and 
dentition. He is convinced that some excitation of the buccal 
terminals of the fifth nerve induces the alopecia at certain 
The region of the back of the neck, mastoid 

The largest numbers correspond to the various phases of 

connected points. 
and lower jaw forms the special irritable zone. His cuts show 
the routes traveled by the excitation to induce the correspond- 
ing patch of alopecia. These patches are not located over the 
nerves but in the parts where the innervation is comparatively 
The morbid stimulus is reflected to the point of 
innervation. The alopecia vanishes with 
The local neurotrophic cause 
requires a predisposition or follow. 
Jacquet is so thoroughly convinced of the neurotrophic, non- 
parasitic nature of alopecia areata that he offers to allow him- 
self to be jnoculated in the scalp or beard from the most 
virulent case that Sabouraud and Hallopeau can produce. 

the healing of the dental lesion. 
the alopecia does not 


20. Study of Cacodylic Medication._Burlureaux has been 
making a careful study of cacodylic medication during the last 
year or so and proclaims that’ it can not be compared with 

arsenic in this combination has 




nothing in common with the arsenic of arsenical compounds, 
neither from the chemical, the toxicologic nor the therapeutic 
point of view. He never encountered any evidences of an 
idiosyncrasy to the cacodylates, and they all seem to have ap- 
proximately the same therapeutic effects. He prophesies a 
brilliant future for the therapeutic application of quinin caco- 
dylate in intramuscular injections. 

24. Dangers of Internal Antisepsis.—Robin reports two 
cases which conclusively establish that saturation of the or- 
ganism with mercurial compounds does not prevent contagion 
from the typhoid bacillus and pneumococecus and does not at- 
tenuate their virulence. It even seemed to be responsible for 
the extreme severity of the infection in both cases. The patients 
were healthy young women with recent syphilis. One took .75 
gm. of mercury in fifteen days, including .04 of the benzoate in 
subcutaneous injections, .41 gm. of the bichlorid in pills and 
the balance in metallic mercury, also in pills. There were 
three cases of typhoid fever in the same ward, and this intense 
mercurial treatment did not prevent infection. It assumed a 
grave form from the first, and gangrenous phlyctene and 
phlegmatia alba dolens developed the nineteenth day, with 
death two days later. 

26. Gold in the Treatment of Tabes.—Antonelli affirms 
that specific treatment has little chance of favorably influencing 
the of tabes and ataxia exvept in recent 
syphilitic infection. He believes that far better results can be 
obtained from tonic and “disintoxicating” medication and re- 

The other case was a similarly virulent 

course cases of 

ports ten cases of old, inveterate tabes, rebellious to mercurial 
or iodid treatment, which were cured by a course of the tonic 
which he recommends. His formula is said to have been first 
used by the famous Cagliostro and has been handed down in 
certain families as a magic stimulant. Discarding the super- 
fluous ingredients, he found that the active substances were 
phosphorie acid and gold. He combines these in his formula, 
using phosphovinie acid and gold oxid in the form of gold 
phosphovinate. The gold in this combination is antiseptic and 
antitoxic, fully equal to iodin in this respect and surpassing it 
in its tonic properties, which are especially concentrated on 
the nerve cells. He alternates or combines it with progressive 
doses of metallic iodin. In one case described at length, the 
ataxia had lasted for eight years, and the patient had been 
under Charcot’s care for three. Mercurial and bromid treat- 
ment proved completely ineifectual. ‘The patient could not 
walk without crutches and could neither eat nor dress alone. 
At the end of two years of regular treatment with the gold 
and iodin the crutches were discarded and he now walks nearly 
In another 
case, eight months of regular treatment were followed by a com- 
plete cure. 

four miles a day, plays the violin and carves wood.’ 

Antonelli recommends this simple stimulating and 
treatment for all 
gravated by ordinary treatment. 

cases of tabes rebellious to or ag- 

28. Relations Between Dry Angina and Kidney Disease. 
—As early as twenty years ago Joal called attention to the 
value of sore throat of the dry type as an early sign of kidney 
disease. Experience has confirmed the importance of this sign 
‘even before the appearance of albuminuria or other symptoms 
of the kidney trouble. 
has no distinctive characteristics which differentiate it 

The chronic pharyngitis in these cases 
other affections of the throat occurring in the course of nutri- 
tional disorders or in the aged, but the dryness and absence of 
any inflammation of the nasopharynx or nasal fosse should 
always suggest the possibility of insidious Bright’s disease 
Usually the patient has long been troubled with 

ordinary pharyngitis becomes gradually transformed under the 

in such cases. 
his throat and has been treated for cough, hoarseness, ete. 

influence of the kidney disease into the dry type with slow 
hypertrophy of the pharyngeal later to 
The mucosa becomes gradually greyish and dry at 

mucosa yielding 
certain points in marked contrast to the congestion of the 
velum and anterior pillars. There is no pain, but the sensation 
of dryness in the throat impels to frequent drinking. The 
subjects are those predisposed to Bright's disease, but especially 



of the kidneys to increase the osmotic tension of the urine 

Jour. A. M. 4 

31. Mechanical Predisposition to Tuberculosis. —}{o}j,,,, 
der’s experience has demonstrated that any lesion obstructing 
the free passage of air through the nose induces a pre li spositiog 
to tuberculosis on the part of thé upper air passiges, p, 
bacilli invariably locate in the recesses where the current of 
air is least felt. The lack of ample facilities for breathing in 
case of lupus of the nose explains the frequent descending tug. 
culosis of the upper air passages in such cases. 

He has wit. 
nessed the recurrence of a healed lupus of the nose when thp 
breathing was obstructed from defective rhinoplasty. He hy 
been very in averting recurrence since he }y 
abandoned the attempt to provide a septum in restoring th 
nose after lupus. He now restores the nose with a single 
opening and finds that the results are most excellent froy 
every point of view, cosmetic, functional and in the preventiog 
of recurrence of the tubercular affections of the upper air pas 
The latter heal when respiration is unobstructed api 
normal respiration restored. ‘The photographs of his patients 
confirm his statements. 


39 VES 

32. Syphilitic Stenosis of Small Intestine.-—Rosenfeld ey 
phasizes that when symptoms of stenosis of the small intestine 
are observed, syphilitic antecedents should be carefully sought, 
especially when tuberculosis can be excluded. 
ment must be energetic and prolonged. 

Specific treat 

He reports one case of 

an architect of 28 who recovered by this means. In another 
case a man of 46 recovered spontaneously, but with strictures 

requiring resection of 10 em. of the gut. 

36. The ‘Dilution Test” for Functional Diagnosis of the 
Kidneys.—illyes remarks that correct appreciation of le 
functional capacity of a single kidney is only possible when the 

ureter catheter is left in place a long time. He recommends a 
new means of testing the kidney which may effectively supple 
ment other measures and afford information unattainable by 
any other means. It is the determination of the behavior oj 
the kidney after ingestion of Jarge amounts of fluid, that is, a 
test of its water-secreting function. In health, the osmotic 
pressure of the urine, in comparison with the freezing-point, 
is considerably higher than that of the blood. 

This capacity 

depends upon its water-absorbing capacity. If the parenchyma 
becomes inflamed, the secreting level is depressed and constant, 
that is, the normal independence between the elimination of 
solid molecules and the water diuresis is restricted 
narrow interstitial inflammation, on the 
hand, the diluting capacity of the kidney may be more or les: 
normal. Research on ten patients after they had _ ingested 
near'y two quarts of water (Salvator), confirmed the signil 
The urine was drawn 
This prolonged use of the 
catheter does no harm, he is convinced. The first irritation 
The secreting faculty of the kidney may 
The points in diag 


limits In other 

cauce of these facts in clinical diagnosis. 

from each ureter every half hour. 

from it soon subsides. 

be entirely suspended or only diminished. 
nosis are the delay in the appearance of the increased secretion 
of urine, the difference in the amount secreted by each kidne) 
and the relative proportion of molecular concentration in each 
the freezing-point. In one typical 
case the left kidney did not respond to the excessive amount 0! 
fluid ingested, but the right kidney seemed to be functionally 
sound. The “dilution secretion” made its appearance in les 
than an hour; it lasted two and one-half hours; the freezing 
point was 1.75 and the phloridzin test was also positive. The 
freezing-point of the blood was 0.61, which indicated renal 1 
sufticiency, and traces of pus were found in the urine, cons 
quently the removal of the pathologic kidney was not advised 

37. Treatment of Weakly Children.—Ritter believes th! 
any Jack in the salts in the body entails a corresponding |oss ¢! 
energy, especially in children whose supply of lymph is mu‘ 

urine, as determined by 

larger in proportion than in adults. He deseribes his mesures 

of general hygiene to increase the resistance of weakly chi idren: 

arms, legs and feet bure and linen garment for the summer, 0! 
The diet includes 
lipanin and malt extract, with 2 per cent. lime and 5 per cell 

iron. He found that the vitality of dogs. became de} vessed 

a dust-free lawn, with sand baths, ete. 


t the 


f tho: 
pe la 


a ( » 
M. A. May 17, 1902. 
-Hollaep. deprl of salts and that they recovered their vigor 
ostructing on the 0 i} amounts were supplied. He thinks that malt 
SPOsition is chief value to the salts it contains. 

ract O% - 
40, Contribution to Our Knowledge of Cholelithiasis.— 
that atypical cases of gallstone colic or cholecys 

Res. The 
Urrent of ; 
‘athing jp As Asse! 
ing tuber. 
has Wit. 

rarely correctly diagnosed, and that few attempt 
jjferentiate between cholelithiasis and cholecystitis or 
olangitis the results of secondary adhesions. In 1894 he 

in his manual that the area of tenderness in chole- 
was in the region of the twelfth thoracic vertebra, two 
ree finver breadths to the right of the spine. It frequently 
fonds further to the right, sometimes to the posterior axil- 

js are Vi 

When the 
He hag 
he has 

Oring the 

Q& sinole : ; e , - 
ingle line. On the left side there is little if any tenderness. 

ent Trom 

ies this local sensitive area, the region over the entire 

ricr surface of the liver may be sensitive. This diffuse 
mierness may persist for weeks and months after the attack. 
i; statements did not attract general attention at the time, 

air pas. 
ted and 


their correctness has been more and more confirmed by his 

her extensive experience. He now distinguishes three 
nfeld em- MMs. the margin of the liver and the region of the gall- 
Intestin MMM. (ler, the subeostal portion of the liver, and its posterior 

Y sought, MB face, The area of tenderness in the back is liable to occur 
He treat. ving an acute attack and persist long after it has subsided. 
vy exist in the latent stage of cholelithiasis as a sign of 

e Case of 

another Backs passed through, possibly years before. The sensitive- 

trictures MMM. in the back does not necessarily parallel the sensitiveness 
the margin and gall-bladder area. but may persist long after 
Ss of thefmme Jatter has vanished. His experience has also shown that 
of he 

vhen the ther in the acute or in the -latent 

iain cases are unaccompanied by any tenderness in the back 

stage. These local mani- 

mends a fggpstations are possibly due to a diffuse perihepatitis proceeding 

"supple ona choleeystitis er pericholecystitis. He finds that the 
rable by + reliable method of testing the sensitiveness is by Faradiza- 
avior of on, applving the electrodes to corresponding portions of both 
rat is, a Mmpdes of the back, commencing with a very weak current, and in- 
osmotic JMpeasing to a maximum of 4 to 6 milliamperes. A tingling on 

\g- point, e liver side is frequently felt before any sensation is experi- 

rapacity gjpuced On the other side, and it increases to severe pain, while 
w Jett side is on'y slightly if at all painful. The Galvanic 
vient answers the same purpose, applying the anode on the 
the cathode on the left This test is by no 

of the absence or presence of chole- 

e urine 
onstant, ieht and side, 
ition of eis an absolute sign 

within ptiasis, but it points with certainty to the liver as the origin 
e other ft the trouble, and even this is a great gain in diagnosing. 
or less he complete absence of tenderness in some cases and its in- 

‘sity in others may prove important means of differentiating 
f those who have opportunity for such observation will make a 


; drawn Mggpecial study of the conditions noted in operating on such cases. 

of the Pos thinks that patients with a tendency to cholelithiasis 
ritation MMeCUId be kept permanently under observation and impending 
ey may ttacks warded off. He considers 200 to 300 gm. of Carlsbad 
in diag aters taken daily for six months, an excellent means of keep- 

eretion Mae it in the latent stage. The diet should avoid articles tend- 

kidney MP to induce constipation or obesity. He advises loosening 
in each I removing the corset after meals—its complete banishment it 
typical § hopeless to expect for the present, he observes. He also 
sunt of hlorses Mébius’ recommendation of ten minutes devoted to 
ionaliy ep breathing three times a day with the chest and abdomen 
in les Mae’: Hle warns against massage, as he has witnessed numer- 
eezing Me’ Cases in which the cholelithiasis was aroused by it from the 
The tlent stage. He therefore never orders massage of the abdomen 
nal in ‘Ya Woman without enquiring in regard to preceding chole- 
conse Eeiasis and ascertaining if there is any sensitive liver area. 
dyisel. Me! (Xamining the three areas mentioned above he has found it 
5 that “sible to follow the gradual extinction of the tendency, and 
wee ‘until the last trace of tenderness has vanished does he con- 
much der his patients cured. He has also found it possible to watch 
al er his patients by repeated examination of these areas and 
iden: Helect un impending attack by increased tenderness long before 
poe: ‘is heralded by any other symptoms. 
Judes ‘3. Refractometric Examination of the Blood.—The 

"CRNAL has previously mentioned Strubell’s method of investi- 
‘ung the composition of the bleod by its refracting power. A 
gle drop will suffice and the results have proved so constant 

r cent. 



and significant in his three vears’ of testing the method that 
he now recommends it as a simple, practical and valuable 
ineans of determining the composition of the blood. 
Pulfrich’s refractometer which he described in his previous 
treh. F. Klin. Med., \xix. The 
refracting ‘power of the blood does not convey the same in 
formation as the determination of the freezing-peint, but it 
indicates unerringly the proportion of albumin in the blood. 
graduated scale and the salts in the blood an additional 8 

He uses 

communication in the Deutsche 

The water has a refracting value of about 15 marks on 

marks. 18 marks on this account, the remaining 
marks on the scale are divided by 4.2, which is the refracting 
value of 1 per cent, of albumin, and the quotient is the exact 
the The 
varying proportion of salts renders this abbreviated test im 

amount of albumin contained in serum examined. 

practicable for the urine, but it can be applied to capillary 
amounts, although there is a possibility of error in this case. 
He proclaims that this determination of the refraction exponent 
is destined to prove a valuable acquisition to our means of 
clinical diagnosis of the blood. 

.44. Improved Method of Percussion.—Instead of using the 
hand or several fingers, Plesch uses a single finger for pereus 
bent exclusively in the first 

rest of tne hand horizontal and parallel to the surface to be 

sion, interphalangeal joint, the 

examined. fe taps with the middle finger of the other hand 
on the distal epiphysis of the bent finger. ‘The vibrations in 
duced in this way cause the percussion sounds to be peculiarly 
distinct and allow the delimination of organs with a hitherto 
unattainable precision. 

45. Antipyrin in Puerperal Fever.—Curschmann reports 
that antipyrin seems to have an especially favorable, almost 
specific action on septicopyemic conditions, especially the puer 
peral. He gives it in .56 gm. doses, to a daily total of 2 to 4 
gm., and finds that a drug exanthem does not contra-indicate its 
further use. Half of his 78 cured cases during the last ten 
vears were treated with antipyrin in this way, out of a total 
experience of 174 cases. 

51. Prevention and Internal Treatment of Biliary Lithi- 
asis, Etc.—-Clemm cites various writers to the effect that fats 
stimulate the production of bile, the albuminoids nearly as 
much, while the carbohydrates have only a slight influence in 
this respect. The effect of the fats is felt for three to six hours. 
The fondness of women for carbohydrates suggests an explana- 
tion for the greater prevalence of biliary lithiasis among them. 
Prevention and treatment The 
best means of administering fat is in the form of sodium oleate, 

should be aleng these lines. 
better known as eunatrol. It requires no further saponification 
in the intestines, and is readily taken in the form of an emul 
sion of 10 gm, eunatrol and 5 of tincture of valerian in 150 of 
peppermint water with 20 drops of essence of pineapple. Tests 
in vitro demonstrated that eunatrol has a remarkable 
dissolving power, besides the cholagogue property to which it 
Clemm asserts that this treatment will cure all 


owes its fame. 
cases of pure cholelithiasis, 
as preventive measures a glass of milk with a slice of bread and 
butter at bedtime, albuminoids with the breakfast, exercises 
in deep breathing, and in case of an established lithiasis a 
tablespoonful of eunatrol at lunch and bedtime. 
This is kept up for four to six weeks after the severer symptoms 
have subsided, omitting the midday dose and continuing the 

even ones. He orders 


bedtime dose for three months. 

53. Treatment of Croup.-—Laver has treated twenty cases 
of croup without a mishap since he instituted treatment with 
calomel and apomorphin. He gives 2 cg. of calomel every two 
hours, alternating it with a teaspoonful of a mixture of apomor- 
phin, 1 cg. in 100 gm. water, with two drops of dilute hydro- 
chlorie acid and 10 gm. of simple syrup. After the first severe 
symptoms have subsided he suspends the calomel for a few hours 
during the day, but keeps it up at night. Even as late as the 
second or third day or a little later, the chances are still favor- 
able. Improvement is marked in twelve hours. In three to 

five days the threatening symptoms subside. measures 

ean be omitted. 


54. Colloid or Soluble Mercury.—Werler lauds colloid | 64. Injury of Goiter from Contusion.—Hertl. pefp 
mercury as the most effectual and convenient method of anti- cases of sudden’ hemorrhage in the goiter in young pers pemia 
syphilitic treatment by the general practitioner. A 10 percent. without appreciable cause. Withdrawal of the blood py Dig the 
salve of this soluble mercury is absorbed through the skin far ture cured the patient and averted suffocation. 1), Maschiy pount 
more rapidly and thoroughly than any other preparation of case the hemorrhage in the goiter proved fatal in a fey nie 
mercury in vogue. It is mild, non-irritating and non-toxic. He utes. In a case of contusion personally observed a womay rated 
prefers it even for internal administration. The mercury in 955 who had long had a goiter on the left side was thrown jylme7. T 
this form is eliminated very slowly, regularly and gradually. a carriage. The goiter swelled and there was mucli diticyiilmmsuds 
in breathing and swallowing. The neck was much Cnlargeifmmebrua 
the rear wall of the pharynx bulging. Puncture of the left aid ot | 
of the neck allowed the escape of a pint of dark hemorrhagiimmms4. J 
fluid. The swelling and difficulty in breathing and swalloyiy Hes tl 

. serib 
TS ty cr 

56. Four Hundred Operations for Urinary Calculi.— 
Frisch observes that he can not imagine any case of lithiasis 
vesica in which the high operation would not perfectly answer 
the purpose. It never fails even in the severest and most com- : 
plicated cases, but on account of its dangers, it should not be isappeared at once. Four days later the cyst was extirpat Htigo 
used indiscriminately. The old mortality of 30 to 40 per cent. It was as large as the head of a child and the walls were hari may 
has dropped to 13 and 20 per cent., but Guyon reports a mor- 4 hole with ragged edges was found in the rear wall, and qyines 
tality of 28 per cent. during the last ten years. In Frisch’s luid escaping from the cyst at the time of the traumatism jfifrious 
cases the mortality was 12.7, while that of lithotripsy was only burrowed a passage behind the esophagus into the lowes medigilMates, 
2.6 per cent. Contra-indications for the latter are an un- tinum, This passage was drained with long strips of gayfilhere v 
usually large stone, preventing the free movement of the in- brought out through the wound. The patient has been in jyinifes 
strument, or unusual hardness or firm impaction, an unbreak- health during the seven years since. Pantlen has reported tee by 
able foreign body and cases of cystitis complicated by a renal ase of a woman of 72 with an old, moderate goitre. — It was hii tive 
affection, rebellious to preliminary treatment. Perineal in- »y the elbow of another person, and she died immediatejiixus 
cision is much less dangerous than the high operation, but even About a pint and a half of hemorrhagic fluid was found in tig Trot 
its advocates report the disadvantages of long protracted heal- right pleural cavity. An old work mentions the cure oj gjline. 
ing and the liability to a persisting fistula. Frisch performed goiter which was pierced. by a spear during the siege of Vicnii@her n 
84 high operations under chloroform and 10 under cocain an-  Billroth has reported a case in which the goiter perforated in@ining. 
the pharynx with pyemia and death. All the ruptures oceuy it mi 
in the rear wall. In a second case observed by the writer {imse, 5) 
patient with a medium struma fell down stairs. The peice of 
swelled with symptoms of impending suffocation. A tear 4 mid the 
long was found in the inferior thyroid artery: The arteridile vert 

were ligated and the goiter drained. The patient died the rey ptos! 

esthesia, preceded half an hour before the operation by an anti- 
pyrin rectal injection. This combination proved very efficient 
—the patients experienced scarcely any pain. In 4 cases he 
was compelled to establish a fistula on account of retention 
from hypertrophy of the prostate, and 2 have been permanently 
eured of the tendency to bladder lithiasis. In 2 others the ‘ a ; raed 
formation of phosphate calculi continued, but they were readily 4@y of heart failure, although no signs had indicated the igj™Mich 4 
extracted without narcosis by merely enlarging the fistula. In Yolvement of the vagi. The symptoms had been the same as iis5, F 
4 patients with complete retention he removed the middle lobe ree tas rupture of & cystic goiter. Etienne has described ogres 
of the prostate with the thermocautery aiter extraeting the similar case in which death followed a slap on the goiter. TiByctra 
ealeuli. Two were cured, but the intervention had no effect on yepome indicated CET ceon of trachea and paralysis @ 4, 6. 
the others. In 2 instances stones developed with a ligature V#SUS: The sapsule was found lacerated with hemorrhage in ects | 
thread for the nucleus a year after the extirpation of a papil- the mediastinum and cellular tissue of neck. The experiengiey 
loma of the bladder. In 2 patients the stones developed around ‘elated indicate that the severest consequences may follo 
a cast-off piece of the scab from a Bottini incision of the pros- slight contusion of a goiter or may even occur spontaneousi 
tate. In two cases in which aspirating drainage had been In the operations it was noticed that the inferior thyroid arte 
established a hernia developed at the point of the high opera- always showed signs of arteriosclerosis even when the superi 
tion. The 12 fatal cases in the 94 treated by the high opera- #8 Still intact. * BB er t 
tion included 6 out of the 12 in whicn the bladder had been left 67. Chloroform Icterus.—W echsberg tested the urine in lOMjs pe 
open, 4 out of the 38 treated by aspirating drainage, and 2 out | chloroform anesthesias and obtained a positive reaction {@Methe: 
of the 44 in which the bladder had been completely sutured. biliary pigments in 16. The bilirubinuria appeared in 6 tuld | 
These groups correspond to the severest, the moderately severe _ first day, in 8 the second and in 2 the third day. It lasted twiind 
and the lightest. Death was due to pneumonia in 2 instances,to days in 7, three days in 4, one day in 3, four days in | ue to 
pyelonephritis in 5 and to embolism of the lungs in 1; 2 other five days in another. AJl exhibited subicterus, but none wey ja 
patients succumbed to their extreme exhaustion; 1 to the febrile cases. In a few the bilirubinuria was not accompanei@linde 
chloroform and 1 to the sudden emptying of the bladder in a _ by any icteric symptoms. He believes that the disposition (ijyey | 
case of chronic incomplete retention. The latter patient was  icterus can be traced fo some abnormal condition of the livee tra 
a man of 63 who refused interventicn for more than a year 
after symptoms of calculi had developed. The bladder reached 
to the umbilicus. The slightest mevement caused intense pains 
in the bladder region, and the urine trickled night and day. 
The prostate was in the third stage of enlargement. The pa- 
tient was anemic, emaciated, tongue dry and thirst excessive. 
Intervention seemed dangerous, but delay was out of the ques- 
tion and the high operation was performed under cocain and 
the bladder drained and tamponed. The urine was bloody that 
evening and the next day. Only 400 ¢.c. of dark red urine 
was evacuated the second day and the patient died with symp- 
toms indicating that not only the hemorrhage but the sudden 
disturbance in the renal function by the changes in the com- 
pression were responsible for the fatal termination. The shape he cerebral circulation. The multiplicity of the symptoms! 
of the stone explained the pains experienced, as it was covered lipemia is probably due to the diretitation of the droplets 
with sharp projecting points. In another case the stone was ; iepving 

i i he fund ith 1 hol fat in the blood and their arrest and accumulation at certa 
nearly round and fitted into the fundus with two deep holes points where the current is sluggish. Every fracture of a bom pal] 

is followed by more or less lipemia. The larger proportil 
operated on twice; 6, three times; 3, four times, and 3, five passes through the lungs into the general circulation. I _ 
times. Recurrence was noted after the high operation in 22.3 persistence of an open foramen ovale favors lipemia of tie bra 
per cent. and after lithotripsy in 9.8 per cent. in particular, and this had been noted in the personal 

ses 11 
bot. Ul 
y hor 


70. Traumatic Lipemia.—Fuchsig describes the case ot uld b 
girl of 17 who jumped from a third-story window shattering 
number of bones. At first the symptoms were not serious, bi th 
after a few hours convulsions and high temperature develope th i 

with death in seventy-two hours. Droplets of fat were foumgpelto 


in the vessels of all the organs examined. He produced som 
what similar conditions in animals by injecting fluid fat inj **' 
the carotid. He found that about .5 ¢.c. passed directly inj ' 
the vessels of the brain without entering other capillary # e du 
tems. After an hour of quiet the animals were seized wig \s 
fatal convulsions. The capillaries in the lungs were also gorgt 
with the droplets without causing symptoms. The death wij!) 
evidently due to paralysis of the vital centers from the ta! 

opposite the orifices of the ureters. Nineteen patients were 

M. A 

May 17, 1902. 

refers ty 

Ng pers 
dl by DU 
u few mi 

LrOWn fry 
h difficy, 
1 enlargg 
he left al 

ext inpat 
were har 
I], and th 
latism ha 
es medi 

3 Of gay 

een in fig 
ported th 
It was hi 
und in th 
cure of 
of Vien 
rated in 
S Occur 
> Writer 
The neg 
ear 4 mg 
e arterig 
1 the ne 
ed the Hi 
aINe as | 
iter. Th 
ralysis ¢ 
‘hage in 
K perienca 
Ay folloy 
pid arte 
3 supen 

ine in 10 
ction f 
in 6 tl 
asted tw 
in | am 
lone We 
the live 
case of 
‘ious, bl 
re foul 
red som 
fat int 
etly int 
zed Wi 
sO gorge 
eath wi 
he fat! 
ptoms i 
t certal 
of a bor 
“( portit 
on. T 
‘he bral 
nal ca 

etween the extremes of physiologic and traumatic 
pmia, is that induced by subcutaneous injections of oil 
therapeutic purposes. No injury results from them as the 
nount of fat—even 200 gm.—is too small. It is taken up 
,dually into the circulation and part is eliminated or incor- 
rated with the tissues. 

-- The Question of Spinal Braces in Laterai Curvature. 
Judson’s article was published originally in THe JouRNAL, 
pruary 22, 1902, p. 508, which fact the translator evidently 
got to mention. 

94. Malarial Vertigo.—Triantaphyllides maintains that be- 
Hes the symptomatic vertigo of malaria there is a paludal 
4igo which is in itself a morbid entity, a paludal neurosis. 
may be intermittent or permanent or merely a condition of 
biness, OY it may be associated with other neuroses, or the 
rious forms may alternate. In a number of cases which he 
lates, the vertigo could be attributed only to the malaria. 
here Was no anemia, neurasthenia or dyspepsia nor any other 
ynifestation of malaria, and the vertigo could be cured at 
ce by hypodermic injection of largé doses of quinin for four 
five days. It is probably due to alteration of the solar 
xus by the malaria, similar to the gastric vertigo described 
Trousseau. The vertigo usually ceases when the patients 
jine. In one of his patients compression of the sciatie and 
her nerve trunks induced the vertigo even when he was re- 
ning. The differentiation of malarial vertigo is important, 
it might easily be confounded with the vertigo in heart dis- 
xe, syphilis and arteriosclerosis. The pallor, the reappear- 
ce of the vertigo on vigorous compression of the solar plexus, 
d the various solar paresthesias which precede or accompany 
pvertigo, all aid in the diagnosis. Patients with a tendency 
ptosis of the viscera are relieved by an abdominal support, 
ich also aids in the mitigation of the vertigo. 

85. Pathology of the Cells of the Sensory Ganglia.—This 
ogress report of Lugaro’s experimental researeh is profusely 
ustrated. His previous communications were in the Rivista, 
4,6, and 9, and vi, 10. This part deals mostly with the 
ects of resection of the vagus and cervical plexus in rabbits. 
§i. Palpation of the Pylorus.—Obrastzotl describes nine 
ses in which the pylorus could be palpated as a cylinder or a 
bot, usually in the region of the right rectus. The cylinder 
‘horizontal or slanting, about the size of the forefinger or 
Both the cylinder and the knot would become soft 
ier the fingers, subside and vanish in a few seconds, resuming 
is peristaltic play again in a few minutes, independent of 
ether the stomach was full or empty. A slight rumbling 
ld be elicited sometimes by palpation, accompanied by a 
ind resembling the squeaking of a mouse. It was probably 
eto the return of gases or droplets of chyme forcing their 
by back into the resonant cavity of the stomach.: As the 
lnder or knot could be palpated from 4 to 8 cm. above the 
ver limits of the stomach, the idea that it might have been 
‘transverse colon can be discarded. A dull tympanitie sound 
uid be elicited on percussion of the liver in the region of the 
usverse colon with absolute flatness to the right on a line 
th the tumor. This tended to show that no gases passed 
t the chyme from the stomach into the duodenum. This 
antom tumor at the pylorus is merely an exaggeration of the 
yslologie peristalsis. 



The pylorus contracts more vigorously 
sastroptosis and in case of excessive acidity, on account of 
f resistance to the propulsion of the stomach contents into 
p> duodenum,’ On the other hand, in another patient the 
nitaltic involved the whole The case was 
‘nguished by complete paralysis of the secretory function 
respect to ferments and hydrochloric acid, with eructations 

ses belonging to the diamin group and a tumor in the 
lorus and adjacent part of the stomach. During the per- 
altic yave the outline of the greater curvature could be seen 
ving trom one interspace to the other. Crepitation was felt 
palpation and a friction sound could be heard. This might 

wave stomach. 

ve been due to corrugation of the surface of the gastric 
osa and the presence of a relatively large amount of serous 
i, Disappearance of this phenomenon with that of the 
mor excluded the assumption of partial peritonitis in the 



form of a perigastritis. The spasmodic contraction in the 
pyloric end of the stomach was evidently a motor neurosis ac- 
companying the grave disturbances in the secreting function of 
the stomach in a neurasthenic patient. 

89. The Miser in the Great Russian Novel, “Dead Souls,” 
as a Study of Senile Dementia.—Tchizh reviews Gogol’s 
classic portrayal of “Plushkin, the miser,” and contends that 
he is not the normal type of a miser but a pathologie type of 
senile dementia. His avarice is not a psychologic but a 
pathologic phenomenon, accompanied by his loss of moral sense, 
indifference to his children, grandchildren and social opinion, 
his uncleanliness, fear and distrust of every one, loss of the 
sense of taste and incapacity of experiencing either lasting joy 
or sorrow. He was in a state of constant apathy, with the ex- 
ception of the sense of ownership of property. His mental 
faculties were so weak, especially his memory for recent events, 
that he was incapable of managing his affairs properly. He 
was unable to concentrate his attention, or distinguish between 
profit and loss, or appreciate the relative value of things. He 
lived wholly in the present; the future and outside interests 
did not exist for him. The sight of money and the remem- 
brance of his bosom friend were the only things that could 
bring expression to his face. There was no purpose in his life. 
it was founded on his old habit of hoarding money, which he 
neither enjoyed himself nor allowed his children to enjoy. 
Habit accounts for entire behavior. Gogol pictures the 
harm caused by such a man to society, to his family and to 
himself, and Tchizh urges a more rational attitude, based on 
the principles of psychiatry, toward this class of unfortunates 
to avoid the harm and suffering which they entail. If Gogol 
had written nothing else, he adds, this masterly representation 
be suflicient to make his name im- 


of senile dementia would 


97. Chloroform Water in Treatment of Typhoid Fever 
and Other Gastro-Intestinal Affections.—Dibailoff reports 
as the results of extensive tests and experience, that chloro- 
form water assuages thirst, soothes pain in the stomach and 
relieves nausea and vomiting. It is valuable, therefore, as a 
symptomatic remedy, but it is useless in chronic gastro-intes- 
tinal catarrh, and has no specific influence in typhoid fever, as 

some have asserted. 

New Patents. 

22 and 29: 

Patents of interest to physicians, ete., April 

698,264. Hernial truss. George W. Derr, Philadelphia. 
697,994. Making thymol. Maurice Dinesman, Paris, Prance. 
698,399. Making magnesium peroxid compound. Franz Fubhr- 

mann, Berlin, Germany. 
698,270. Hernial truss. 
698,022. Electric massage machine. 

Wm. H. Garson, Philadelphia. 
Edward B. Jacobson, Bos- 

698,335. Coin-freed gymnastic apparatus. Karl Strauss, Wies- 
baden, Germany. 

698,079. Salicylate of salicyl quinin, ete. Heinrich Thron, 
Frankfort-on-the-Main, Germany. 

698,426. Abdominal bandage. Everett L. Abbott, New York 

698,786. Sanitary spittoon. Napoleon J. Beaudin and N. R. 
Thibert, Worcester, Mass. 

698,898. Nebulizer. Wm. and J. Boekel, Philadelphia. 

698,447. Syringe. Corydon I. Bush, Kansas City. 

698,833. Optometer. Francis A. Hardy, Evanston, Ill. 

Making hydrochloric acid. Edward Hart, Easton, Pa. 
Syringe. Frederick H. Jones, Wakefield, Mass. 
Sterilizing apparatus. George W. Kellogg, Hartford, 


698,713. Appliance fer assisting the hearing. Pauline A. Klaws, 
Melbourne, Victoria, Australia. 
699,095. Hernial truss. Julius C. Le Hardy, Savannah, Ga. 
698,861. Combined cushion, water bag and fountain syringe. 

John P. Schan, Brooklyn. 

The Public Service. 

Aimy Changes. 
Medical Officers under orders from the 
Washington, D. C., April 24 to 30, 1902, 

Movements of Army 
Adjutant-Generai’s Ollice, 
inclusive : 

Aristides Agramonte, 
three months granted. 

William B. Banister, major and surgeon, U. S. A., member of an 
Army retiring board at Washington, D. C.,; vice Major Edward C. 
Carter, surgeon, U. S. A., relieved. 

Walter Cox, lieutenant and asst.-surgeon, U. S. 

contract surgeon, leave of absence for 

A., to duty with 



troops from the Department of California to the Department of 
Texas and eyenteer to report to the Surgeon- General of the Army 
at Washington, D. for instructions. 

Carl R. made Ay “captain and asst.-surgeon, U. 8S. A., on his 
arrival in San Francisco, Cal., will proceed to Plattsburg Barracks, 
N. Y., for assignment to duty at that post. 

Charles L. Heizmann, lieut.-col. and deputy surgeon-general, on 
his arrival at San Francisco, Cal., will proceed to Chicago, Ill., for 
duty as chief surgeon. Department of the Lakes, relieving Lieut.- 
Col. Timothy E. Wilcox, deputy surgeon-general. 

Merritte W. Ireland, captain and asst.-surgeon, U. 8. A., 
absence for fourteen days granted. 

Richard W. Johnson, major and surgeon, U. 8S. A., now on leave 
of absence at San Francisco, Cal., is relieved from further duty at 
Fort Douglas, Utah, and will report to the commanding general, 
Department of California, for assignment. 

George IB. Jones, contract surgeon, now at Angel Island, Cal., 
will proceed to Rushville, Ind., for annulment of contract. 

Charles IF. Kieffer, captain and asst.-surgeon, U..S. A., to report 
for duty with troops from the Department of California to the 
Department of Texas, and on the completion of this duty to report 
for assignment at Fort Screven, Ga. 

Ilenry S. Kiersted, lieutenant and asst.-surgeon, U. S. A., 
of absence granted for two months, on account of sickness, 
permission to apply for an extension of one month. 

George -A. McHenry. captain and asst.-surgeon, Vols., leave of 
absence for two months granted, to take effect on his arrival in 
the United States. 

Edward L. Munson, 

leave of 


captain and asst.-surgeon, U. S. A., to pro- 
ceed to Millville, N. J., on business pertaining to the Medical De- 
partment of the Army, and on the completion of this duty to re- 
turn to his station in Washington, D. C. 

James k. Shellenberger, contract surgeon, 
Fla., to duty at Fort Ringgold, Texas. 

Allen M. Smith, captain and asst.-surgeon, U. S. A., 
sence for fifteen days granted. 

lienry ID. Snyder, captain and asst.-surgeon, 
an examining board at Governor's Island, N. Y., 
ary absence of Major William H. Corbusier, surgeon, U. S. A. 

Louis A. Thompson, contract surgeon, now at Dayton, Ohio, is 
relieved from further duty in the Division of the Philippines and 
assigned to duty at Columbus Barracks, Ohio. 

Victor kk. Watkins, contract surgeon, from Fort Williams, Me., to 
duty at Whipple Barracks, Ariz. 

Timothy E. Wilcox, lieut.-col. and deputy surgeon-general, from 
duty as chief surgeon, Department of the Lakes, to Vancouver 
Barracks, Wash., as chief surgeon, Department of the Columbia, 
relieving Major Rudolph G. Ebert, surgeon, U. S. A. 

Llewellyn FP. Williamson, lieutenant and asst.-surgeon, U. S. A., 
former orders directing him to report for duty at Columbus Bar 
racks, Ohio, amended so as to assign him to duty at Jefferson Bar- 
racks, Mo. 

from St. Petersburg, 

eave of ab- 

U. S. A., member of 
during the tempor- 

Navy Changes. 

Changes in the Medical Corps of the Navy 

Asst.-Surgeon R. M. Young, detached from the Cavite 
Station and ordered to duty at Guam, L. 

Surgeon W. R. DuBose, detached from the Wisconsin and ordered 
to the Solace. 

Surgeon ©. IF. Stokes, detached from the Solace and ordered to 
the Wisconsin, and on arrival of that vessel at Puget Sound, or- 
dered to the Oregon. 

week ending May 38, 


Marine-Hospital Changes. 

Official list of the changes of station and duties of commissioned 
and non-commissioned officers of the U. S. Marine-Hospital Service 
for the seven days ended May 1, 1902: 

Surgeon Preston H. Bailhache, detailed to represent the service 
at American Congress of Tuberculosis at New York, N. Y., May 14, 
15 and 16. 

Surgeon Hl. W. Austin, seven days’ leave of absence from April 
23, 1902, under paragraph 179 of the regulations. 

Surgeon I’. M. Carrington, detailed to represent the service at 
American Congress of Tuberculosis at New York City, May 14, 15 
and 16, reporting at Washington, D. C., en route to New York, 
and on return to Fort Stanton. 

P. A. Surgeon H. D. Geddings, detailed as supervisor of repairs 
and alterations of the steamer Neptune, at Baltimore, Md. 

P. A. Surgeon J. C. Perry, relieved from duty as chief quaran- 
tine officer of the Thilippine Islands, and directed to proceed to 
San Francisco, and await orders. 

P. A. Surgeon A. R. Thomas, relieved from duty in office of U. S. 
Consul-General, at London, England, and directed to proceed to 
Manila and assume the duties of chief quarantine officer of the 
— Islands, relieving P. A. Surgeon J. C. Perry. 

A. Surgeon H. 8S. Cumming, detailed as inspector of unservice- 
able property at office of plague commission at San Francisco. 

Asst.-Surgeon John MeMullen, relieved from duty at Baltimore, 
and directed to proceed to Boston and report to medical’ officer in 
command for duty and assignment to quarters, relieving Asst.- 
Surgeon M. W. Glover. 

Asst.-Surgeon S. B. Grubbs, Bureau letter of April 18, directing 
him to assume command of the Gulf Quarantine Station, amended 
so that he shall visit New Orleans, La., Pascagoula, Miss., and 
Mobile, Ala., en route. f 

Asst.-Surgeon H. B. Parker relieved from duty in the Hygienic 
Laboratory, and appointed chairman of Board of Medical Officers 
for the investigation of yellow fever, malarial fevers and dengue, 
at Vera Cruz, Mexico. 

Asst.-Surgeon J. F. 
special temporary duty. 

Asst.-Surgeon V. G. Heiser, 
duty in the office of the U. 

Asst.-Surgeon W. C. 
months from May 1. 

Asst.-Surgeon J. Goldberger, to report at Washington, D. C., for 
special temporary duty. Bureau letter of April 18, directing him 
to proceed to Tampico, Mexico, amended so that he shall visit 

Anderson, to proceed to Norfolk, Va., for 
to proceed to Quebec, Canada, for 
S. Commissioner of Immigration. 

Billings, granted leave of absence for two 


SERVICE. Jour. A. \f. 4 

Norfolk, Va., New York City, 
ico, en route. 

Asst.-Surgeon A. J. McLaughlin, 
at the Immigration Depot by 
ceed to Washington, D. C., 
gienic Laboratory for duty. 

Asst.-Surgeon M. W. Glover, upon being relieved f: 
Boston. by Asst.-Surgeon John McMullen, to proceed ty \oy York 
City, and report to Surgeon G. W. Stoner, Immigration pot. for 
duty, relieving Asst.-Surgeon A. J. MeLaughlin. is 

Asst.-Surgeon J. T. Burkhalter, to proceed to Sera: 1, Miss 
for special temporary duty. , 

A. A. Surgeon R. F. L. 
thirty days from May 15. 

A. A. Surgeon B. Kinsell, 
days from May 12. 

A. A. Surgeon W. ©. Wetmore, granted leave of absence 
seven days from April 19, under paragraph 201 of the i 


Junior Hospital Steward EF. L. Gibson, promoted to the grade oF 

senior hospital steward from June 11, 1 

Board convened at Washington, D. C., 
physical examination of 
assistant-engineer, R.C.S 

Havana, Cuba, and Ver; 1%, Mex 

upon being relieved from dyty 
Asst.-Surgeon M. W. Gio to pro 
and report to the directo: the Hy. 

duty at 

Burford, granted leave of absences 4 

granted leave of absence {0 seven 


April 28, 1902, fi 
candidates for the position of second 
Detail for the Board: Surgeon k. y 
chairman: Asst.-Surgeon B. S. Warren, recorder 

Heaith Reports. 

The following cases of smallpox, yellow fever, 
have been reported to the Surgeon-General, U. 
Service, during the week ended May 38, 1902: 


California: Los Angeles, April 12-19, 3 cases; San Francisco, 
April 13-20, 3 cases. 

Colorado: Denver, April 12-19, 7 cases. 

Illinois: Belleville, April 19-26, 2 cases; Chicago, Apri] 19-26 
13 cases; Freeport, April 19-26, 1 case; Galesburg, April 19-26, 

Indiana: Evansville, April 
19-26, 16 cases: Terre Haute, 

Kansas: Wichita, Apri] 19-26. 5 cases. 

Kentucky : Covington, April 20-27, 16 cases; 
19-26, 2 cases. 

Louisiana: New Orleans, April 19-26, 1 case. 

Maryland: Baltimore, April 19-26, 1 case, 2 deaths. 

Massachusetts: April 19-26, Boston, 51 cases, 3 deaths; 
ton, 1 case; Prookline. 2 cases; Cambridge, 2 cases: 
eases; Fall River, 2 «¢ s: Fitchburg, 1 case: 
Medford, 1 c2se; New Bedford, 8 cases; 
ville, 5 cases 

Michigan : 
S cases. 

Missouri: St. 

cholera and plague 
S. Marine Hospital 

19-26, 4 cases; Indianapolis, Apri! 
April 19-26, 4 cases. 

Lexington, April 

Everett, 3 
Malden, 1 case; 
Newton, 4 cass; Somer- 

Detroit, Apri] 19-26, 5 cases: Ludington, April 19-26, 

Louis April 13-27, 83 cases, 2 deaths. 

Montans Putte, April 20-27. 5 cases. 
Nebraska: Omaha, Apri] 19-26, 45 cases. 

New Jersey : Camden, 
cluding Jersey City, 
April 19-26. 1 case. 

New York: Buffalo, March 27-April 30, 21 case 
April 19-26, 56 cases, 13 deaths; Yonkers, 

Ohio: Circinrati. April 18-25, 12 cases: 
2 cases, 1 death: Dayton, April 19-26, 2 ane. 

Pennsy]vania: Columbia, April 21-28, 4 cases: Erie, 
2 cases: Vhiladelphia, April 19-26, 31 
April 19-26. 6 cas*s. 

Rhode Island: Providence, April 19-26, 2 cases. 

Tennessee: Memphis, April 19-26. 14 cases, 2 deaths. 

Utah: Salt Lake City, April 19-26. 1 case. 

Washington: Tacoma, April 13-20, 3 cases. 

Wisconsin: Green Bay, April 20-27, 6 cases: 
19-26, 1 case. 

April 19-26. 83 cases: Hudson County. in 
April 6-27, 107 cases, 18 deaths; Plainfield, 

: New York, 
April 18-25, 1 cas. 
Cleveland, April 19-26, 

April 19-26, 
cases, 6 deaths; Scranton, 

Janesville, April 

Austria: Prague, April 5-12, 8 cases. 
‘Barbados: April 12, 5 cases. 

Relgium: Antwerp, April 5-12. 9 cases. 

Canada: Quebec, April 12-19, 9 cases, 2 
March 29-April 19, 18 cases. 

China: Hongkong, March 8-22, 7 cases, 7 deaths. 

Colombia: Panama, April 21, present. 

France: Rheims, March 31-April 6, 5 cases, 3 deaths. 

Gibraltar: April 6-13, 1 case. . 

Great Britain: Dundee, April 5-12, 1 case; Edinburgh, April 
5-12, 1 case: Glasgow. April 11-18. 11 cases, 2 deaths: London, 
April 5-12, 274 cases. 73 deaths. 

Greece: Athens, April 5-12, 1 case. 

deaths: Winnipeg, 

India: Bombay, March 25-April 1, 10 deaths; Karachi, March 
23-30, 5 cases, 2 deaths. 

Italy: Palermo, April 5-12, 40 cases, 5 deaths. 

Mexico: Vera Cruz, April 12-19, 5 cases, 2 deaths. 

Russia: Moscow, March 29-April 5, 14 cases. 3 deaths: (dessa, 
April 5-12, 3 cases; Warsaw. March 29-April 5, 2 deaths 

Spain: Corunna, April 5-12. 1 death. 

Uruguay: Montevideo, March 8-15, 71 cases, 5 deaths; Monte 

video, March 22-29, 70 cases, 3 deaths. 
Mexico: Vera Cruz. April 12-19, 12 cases, 5 deaths. 
Venezuela: Puerto Cabello, Feb. 8-15, 1 case, 1 death, 
Canton, March 19, present, 
March 8-22, 23 cases, 19 deaths, 
Bombay, March 25-April 1, 3 deaths. 

China: Canton, April 24, malignant outbreak ; 
8-22, 1 case, 1 death. 

India: Bombay, March 25-April 1, 
23-April 30, 119 cases. 92 deaths. 

Zanzibar: Nairobi, March 20, 20 cases, 


9 deaths among Europeans, 

Hongkong \lareb 
909 deaths; Karachi. \arcb 


itis 0 

by th