dividual and phthisis in the family may be exercised in one of three ways, namely, by inheritance of bacilli, by inheritance of susceptibility, or by contagion.

Lehman has reported a case of congenital tuberculosis, where a mother died three days after the birth of the child, of tuberculous meningitis. The child lived but twenty-four hours. In its spleen, lungs, and liver were found nodules resembling tubercles and containing tubercle bacilli in large numbers.

Hahn has collected and reviewed some cases of tuberculosis where they were undoubtedly congenital. The semen may also become infected and thus transmit the disease to the fetus. Gärtner caused tuberculosis in young mice by injecting the mother with tubercle, either into the peritoneal cavity or into the blood stream.

Baumgarten detected the tubercle bacillus in the ovum of a female rabbit which he had artificially fecundated with tuberculous semen.

Infection by Milk.-There is no longer any question of the possibility of infecting the lower animals by the injection of tuberculous milk, but direct evidence of transmission of tuberculosis by milk in man by ingestion is not yet positive, except in cases of udder tuberculosis.

In cows with tubercular disease of the udder, the Royal Commission found that the milk was in every case infective, and the experiments made by inoculation in every case gave positive results. As regards feeding, 27 animals were fed with varying quantities of milk from cows with tubercular udders. Of these 27 animals, 19 developed tuberculosis. The brunt of the disease in these cases fell on the abdominal organs, showing the alimentary origin, but in some cases also there was a more generalized infection. The glands about the mouth and angle of the jaw were also found sometimes tubercular.

Dr. Martin, in speaking of these experiments, says: "The milk of cows with tuberculosis of the udder possesses a virulence which can only be described as extraordinary. In those cows where the tubercle bacilli were found in the milk, the feeding experiments were uniformly positive as well as the inoculation experiments. It is noticeable, too, that a small dose of the milk diluted four times gave tuberculosis to all the animals fed, and that a dose of even .05 to .I cubic centimeter diluted with non-infective milk was sufficient to produce tuberculosis."1

It is well known that many cattle are affected with tuberculosis in this country, that the milk goes into the general supply, and that tubercle bacilli may be found in the milk in cases of udder tuberculosis, and that rabbits inoculated with infected milk or fed upon infected milk, become tuber

1 T. P. C. Kirkpatrick: The Spread of Tuberculosis by the Milk Supply, Dublin Journal Medical Science, May, 1897.

culous. Dilution with non-infected milk attenuates the bacilli, and the dishonest practice of watering is, therefore, not without its compensation.

Dr. Gehrman, of the Chicago Health Department, after testing the milk from tuberculous cows, writes: "In only one specimen of milk was it possible to demonstrate the presence of the tubercle bacillus microscopically, but in thirty-eight injections of the milk in animals we had the transmission of tuberculosis demonstrated six times."

Infection by Tuberculous Meat.-Tubercle bacilli have been found in the flesh of horses, cattle, and swine. Birds and fowls also become infected, and when dogs and cats become infected it is said that they become so by reason of eating flesh of tuberculous animals, but this lacks corroboration by extended experiment.

The review of the recent reports on this branch of the subject corroborates the former view that careful cooking of meat and boiling of milk before eating or drinking these articles will prevent them from doing positive harm, but few would relish food if it were known to be tuberculous, even if cooked by a Lucullus. An act passed this year by the Maine Legislature provides for the killing of all diseased animals, the injection of kerosene oil into their cartoid arteries, and the burial of the carcasses within twenty-four hours or their reduction to fertilizing material within fortyeight hours.

To sum up, it appears that the greatest danger is from the dried sputum, and that other causes, while they exist, are of much less importance: The local infections that are found in the bones and internal viscera are produced by invasion through the circulation, while the infection of lymphatic glands doubtless takes place by direct absorption through the lymph channels. Every surgeon has noticed without doubt that tuberculous glands become successively affected; it is the exception to find a whole chain of glands simultaneously affected. When the tubercular lesion is found in the skin the point of invasion is an abrasion, or a center beginning in the hair follicle.

The means of prevention of the spread of tuberculosis are then sufficiently apparent after we have taken our observations on the methods of infection. The factors in successful prophylaxis are: (1) The guarding against infectious food or drink being issued to the people anywhere. (2) The prompt destruction of cattle proved to be tuberculous. (3) Proper notification to the sanitary officer of the occurrence of cases of pulmonary consumption.

Marriage of the Tuberculous Should be Opposed. The law prevents marriage within certain degrees of consanguinity; no account is taken of the physical state of the contracting parties, although in many States certain physical causes are sufficient reason for divorce. If chronic and incur

́able disease be sufficient ground for separation, how much more reason is there for the prohibition of the marriage rite. The insane and incurably diseased should not be allowed to propagate their species, unless we confine our sympathy to the individual instead of the whole people. The heredity of the disease has at last been fairly proved by scientific investigation. Public opinion should now do the rest.

Richardson's "City of Hygeia," that beautiful fabric of a vision, as one of our countrymen has said, "was blown away by the winds, but they blew it all over the earth." So the wide dissemination of correct knowledge concerning the cause and propagation of tuberculosis cannot but tend to still further restrict its ravages, and thus add to the sum of human happiness and the prolongation of human life.

The following officers were elected for the ensuing year:

President, Dr. George M. Sternberg, Washington, D. C. First VicePresident, Dr. Joseph M. Mathews, Louisville, Ky. Second Vice-President, Dr. J. L. Thompson, Indianapolis, Ind. Third Vice-President, Dr. J. W. Wiggin, New York, N. Y. Fourth Vice-President, Dr. T. J. Happel, Trenton, Tenn. Treasurer, Dr. Henry P. Newman, Chicago, Ill. Assistant Secretary, Dr. W. A. Jayne, Denver, Col. Librarian, Dr. George. W. Webster, Chicago, Ill. Chairman Committee of Arrangements, Dr. J. W. Graham, Denver, Col.

Board of Trustees: Dr. J. T. Priestley, Des Moines, Ia.; Dr. Joseph Eastman, Indianapolis, Ind.; Dr. Truman W. Miller, Chicago, Ill.

Judicial Council: Dr. D. W. Crouse, Waterloo, Ia.; Dr. T. D. Crothers, Hartford, Conn.; Dr. Wm. T. Bishop, Harrisburg, Pa.; Dr. R. C. Moore, Omaha, Neb.; Dr. G. B. Gillespie, Covington, Tenn.; Dr. C. H. Hughes, St. Louis, Mo.; Dr. Ida J. Hieberger, District of Columbia.

The annual addresses were allotted as follows: On General Medicine, Dr. J. H. Musser, Philadelphia, Pa.; on General Surgery, Dr. J. B. Murphy, Chicago, Ill.; on State Medicine, Dr. S. C. Busey, Washington, D. C. Adjourned to meet in Denver, Col., in 1898.-Boston Medical and Surgical Journal.

RICHMOND ACADEMY OF MEDICINE AND SURGERY.

Regular Meeting held June 22, 1897.

Dr. J. N. Upshur, President, in the chair; Dr. Mark W. Peyser, Secretary and Reporter.

Dr. Mark W. Peyser read a paper on "Digestive Agents." [See page 67.]

DISCUSSION.

Dr. H. H. Levy thought Dr. Peyser correct concerning the too free use of pepsin and the pancreatic enzymes, and that stimulation, rather

than help, was better for the proper activity of the digestive organs. The conditions for secretion should be made more favorable by administration of acids and alkalies. In conclusion, he said the test meals afforded a scientific diagnosis-whether the fault lay in hyperchloridia, hypochloridia, etc.

Dr. J. S. Wellford thought that, as trypsin and the other pancreatic enzymes were nitrogenous in character and, therefore, likely to be acted upon in the stomach, it was useless to give them, unless they could be so prepared as to be made invulnerable until the duodenum was reached.

Concerning pepsin, it should never be administered in combination. with bismuth, as the latter exerted a katalytic action upon pepsin, which should always be given in an acid solution.

Dr. Levy wished to ask why pepsin, which was also nitrogenous, was not acted upon by the gastric juice?

Dr. Wellford replied that he could conceive of no other reason than that pepsin was a natural ingredient of the juice, and therefore not likely to be acted upon.

Dr. Peyser, in closing the discussion, said one of the very points that he wished brought out in his paper was involved in Dr. Wellford's remarks. The stomach, not being acid in the beginning of digestion, the pancreatic enzymes could be given in solution at the beginning of a meal with the almost perfect certainty that they would reach the duodenum before they could be acted upon in the stomach.

As for the balance of the paper, he was glad to know. he was in such accord with the Academy.

Regular Meeting held May 11, 1897.

Dr. J. N. Upshur, President, in the chair; Dr. Mark W. Peyser, Secretary and Reporter.

Dr. W. S. Beazley read a paper on "Some of the Evils that Threaten the Medical Profession." [See page 69.]

REPORT OF CASES.

Dr. Geo. Ross reported the following cases:

Malignant Disease in Child's Mouth.-Boy, age 8 years. Father, mother and uncle died of consumption. Aunt has it. Grandmother died of apoplexy. An abscess in the lower jaw, due to a decayed molar, was opened several times, and, now, in the cavity, there has appeared a foreign growth, about the size of a guinea-egg, and apparently of a malignant character. He reported the case because of the rarity of malignant growths in childhood.

Myelitis and Paraplegia. Partial Recovery. Then Right and, Later, Left Hemiplegia. Paralysis of Diaphragm and Death.-Male, white, aged about 58 years; wore low quartered shoes the whole of one

rainy day, and in the afternoon, without changing them, put on rubber shoes. The next morning he complained of chilliness and malaise. Walking became more and more difficult until the fifth day, when it was an impossibility to walk. A diagnosis of acute myelitis was made with paraplegia paralysis of the bladder and rectum, etc. He removed South, remaining an ataxic, then went North, and consulted various authorities, Dr. Seguin among others.

Six

About twelve days ago, while in the city again, he became absolutely paralyzed on the right side, and was taken to the Virginia Hospital. days ago there was a second paralytic attack involving the left side and the diaphragm. In twenty-four hours articulation became impossible, and he died.

The patient was a student and literary man, with no spyhilitic or gouty history, and of regular habits.

The President said Dr. Ross's case was very interesting, especially because of the absence of gouty or syphilitic history. He thought there must have been some condition, back of the myelitis, tending to produce tissue change. The patient might have inherited gout, and along with it slow changes in the vascular system, as deficiency of the elasticity of the vessels, or a change due to the cold going to the brain and slowly acting upon the nervous tissue.

He reported the following case:

Suppurative Salpingitis. Recovery Under Medical Treatment.Woman, age 23 years; unmarried; seen January 26, at which time she had been confined to bed for five months. She complained of pain at all times; and between 12 M. and 3 P. M. of violent attacks in the hypogastrium.

There was also dysmenorrhoea. Digital examination revealed the fact that she was not a virgin. The uterus was firmly fixed in the pelvis, and its body could not be outlined. In the cul-de-sac, a mass was found as large as an orange, and boggy to the touch. A dirty discharge came from the cervix. There was occasional difficulty with micturition. After tonic treatment and the use of douches at home, she was taken to the Old Dominion Hospital for operation, and Dr. J. W. Long was called in consultation. They agreed that the case was suppurative salpingitis, due in all probability to gonorrhoea. Twice daily douches of normal saline solution, as hot as could be borne, were given, followed by the introduction of a tampon anointed with 25 per cent. ichthyol unguent.

At the end of six weeks, the effusion had entirely disappeared, and the only evidence of pelvic trouble was the dirty discharge.

Menstruation at this time was still irregular, but not attended by pain. Ten days ago the uterus was dilated and curetted (there being hardly any