MISSOURI.-St. Louis, 645,000—40,000 colored. Report for January, 1903: Total deaths from all causes, 919-216 under 5 years; death rate, white, 16.16; colored, 26.0: 21.8. Deaths from smallpox, 1; measles, I; scarlatina, 7; diphtheria and croup, 32; whooping cough, 6; typhoid fever, 15; phthisis, 86; bronchitis, 44; pneumonia, 118; Bright's disease and nephritis, 52; cancer, 36.

NEW JERSEY.-Newark, 266,000. Report for the week ending March 7: Deaths, 108-21 under 5 years; death rate, 21.11. Deaths from scarlet fever, 2; la grippe, 5; phthisis, 13; gangrene, lung, 16; empyema, 6. Contagious and infectious diseases reported: Diphtherian-croup, 17; scarlet fever, II; typhoid fever, 3; smallpox, 3.

NORTH CAROLINA.-Bulletin of State Board reports for January, 1903: Twenty-six towns with an aggregate population of white, 83,250; colored, 58,850: 142,100. Aggregate deaths, 178 -83 colored; 39 under five years of age; still born, 9. rates, white, 12.2; colored, 18.9: 15.0.

9. Death

Deaths from typhoid fever, 5; malarial fever, 2; diphtheria, 3; consumption, 20; pneumonia, 32; smallpox reported in 31 counties, an aggregate of 316 cases, no deaths; varicella, many cases in Cumberland County and several in Jones.

OHIO. Cleveland, 420,000. Report for February, 1903: Deaths, 549-202 under 5 years; annual death rate, 15.68. Deaths from typhoid fever, 23; smallpox, 8; diphtheria and croup, 16; tuberculosis of the lungs, 44; bronchitis, 17; pneumonia, 55; broncho-pneumonia, 14; organic disease of the heart, 15; Bright's discase, 16; cancer, 15.

PENNSYLVANIA.-Philadelphia, 1,349,712. Report for week ended February 28, 1903: Deaths, 639-186 under five years. Deaths from consumption, 69; typhoid fever, 22; diphtheria and croup, 14; whooping cough, 7; smallpox, I; cancer, 8.

Pittsburg, 354,000. Report of the Bureau of Health for week ended February 28, 1903: Deaths, 136-59 under five years; annual death rate, 19.97. Deaths from typhoid fever, 5; whooping cough, 13; diphtheria and croup, 6; measles, 23; smallpox, 6; consumption, 6; pneumonia, 27; cancer, I.

Cases of infectious diseases reported: Smallpox, 15; diphtheria and croup, 24; scarlet fever, 12; typhoid fever, 34.

WASHINGTON.-Seattle, 115,000. Report of the Department of Health for January, 1903: Total number of deaths, 91-10 under five years. Death rate, 9.52. Deaths from pulmonary consumption, II; pneumonia, 8; typhoid fever, 3; cancer, 3.

WISCONSIN.-Milwaukee, 300,000. Report for January, 1903: Deaths, 355-191 under five years. Annual death rate, 13.27. Deaths from typhoid fever, 7; whooping cough, 15; measles, 2; diphtheria and croup, 12; tubercular diseases, 32; bronchitis, 20; pneumonia, 66; cancer, 20.

Cases of infectious disease reported: Smallpox, 21; tuberculosis, 2; diphtheria, 59; scarlatina, 20; typhoid fever, 10.

PORTO RICO, 953,947. Superior Board of Health reports for January, 1903: Total deaths, 2,173-859 under five years. Death rate, 27.3; still births, 115. Deaths from cerebro-spinal fever, 22; diphtheria, 2; typhoid fever, 6; pneumonia, 68; puerperal fever, II; diarrhoeal diseases, 34; anemia, 538; bronchitis. 103; tuberculosis, 112; heart diseases, 37; accidents and violence, 23.

SANITARY CONDITION OF HAVANA.

Briefly summed up reports of the Military Governor of Cuba for the years 1899 and 1900 show that Havana was practically converted from a very unhealthy into an exceedingly healthful city through a very comprehensive system of cleaning the sewers, cleaning the streets, cleaning the public buildings, cleaning the hospitals, orphan asylums, and similar institutions, and placing them in sanitary condition by plumbing and sewerage systems; by creating isolated hospitals and placing cases of infectious diseases therein; by a continual thorough disinfection of the sewers. and streets by the use of electrozones; by the inspection of stables, bakeries, butcher shops, hotels, cafés, stores, etc.; by a house-tohouse inspection, whereby all the houses in the city were inspected every two months; and by the installation of a sanitary system of plumbing wherever the sanitary condition of a house demanded the same, and in the construction of all new houses. As this system brought about, to a great extent, healthful conditions in Havana, it follows that the relaxation of that system will bring about the former unsanitary conditions to a greater or less degree. It is believed that such a relaxation is gradually but surely taking place. -Consular Reports.

BOOK REVIEWS.

THE INTERNAL SECRETIONS AND THE PRINCIPLES OF MEDICINE. BY CHARLES E. DE M. SAJOUS, M.D., Fellow of the College of Physicians, Philadelphia; Member of the American Philosophical Society, the Academy of Natural Sciences, Philadelphia, etc.; Knight of the Legion of Honor and officer of the Academy of France; Knight of the Order of Leopold of Belgium, etc. Formerly Lecturer on Laryngology, Jefferson Medical College, and Professor of Laryngology and Dean of the Faculty, MedicoChirurgical College; formerly Professor of Anatomy and Physiology in the Wagner Institute of Science. Volume First: Physiology, General Pathology, General Therapeutics, Immunity. With Forty-two Illustrations. 8vo, pp. xxvi-800. Price, in Cloth, $6.00 per vol.; In half Russia, $7.00 per vol. Two vols., respectively, $12.00 and $14.00. Philadelphia: F. A. DAVIS COMPANY.

A book of new ideas on an old subject, particularly the pituitary body, which always has been a subject of interest, not only to the medical profession, but to naturalists as well, but never before so thoroughly investigated as it has been for several years by the author of this volume. It bears evidence throughout of the author's mastery of all contributory knowledge to his purpose by other investigators, as a means of opening his way and strengthening his conclusions. "Tissue respiration," he says, prefatorily, "being obviously the dominant factor of all the problems we hoped to solve, we thought it advisable to leave the beaten paths and seek clues among subjects which had never been associated with this physiological function.

.. Among the subjects which had received attention during our preliminary inquiry was the physiology of the ductless glands. We deemed it advisable to ascertain, first of all, whether the physiological functions of the adrenals were sufficiently similar in all vertebrates to warrant the use of experimental data obtained with lower animals in the study of these organs in man. Such proved undoubtedly to be the case, and we cannot but fec! that the results of our investigations-those we will now submit-are based upon solid premises.

... The secretion of the adrenals was traced as far as the pulmonary alveoli, but not beyond. Here it was found to hold in.

combination the various constituents of hæmoglobin, and to endow both the latter and the plasma with their affinity for oxygen. Prevailing views as to the chemistry of respiration were thus radically transformed, and our knowledge of the manner in which the blood-pigments were held together, likewise. We likewise ascertained that methæmoglobin (hæmatin) and hæmatoporphyrin (hæmatoïdin) were the component bodies of hæmoglobin thus held in association, and that hæmoglobinuria, methæmoglobinuria, and hæmatoporphyrinuria indicated successive stages of hæmoglobin dissociation incident upon adrenal insufficiency. We subsequently ascertained that the red corpuscles were secondary factors in this important function, i. e., mere carriers, pack-mules, as it were, and that it was the oxygen-laden adrenal secretion dissolved in the plasma itself which carried on all the oxidation processes of the organism.

"The many physiological problems awaiting solution then appeared to us in quite a new light. The ease with which the oxygen carried by the plasma could penetrate the minute vascular net-works of all cellular elements not only furnished a clue to the physiological chemistry of the latter, but it also led to the discovery that various structures the functions of which were unknown were in reality blood-channels, or rather plasma-channels. The overwhelming importance of the internal secretion of the adrenals having been determined, the functions of the other ductless glands were studied. Our investigation then showed that the adrenals were directly connected with the anterior pituitary body through the solar plexus, the splanchnic nerves, and the cervicothoracic ganglia of the sympathetic. Indeed, this diminutive organ, hardly as large as a pea, and now thought to be practically functionless, proved to be the most important organ of the body, as governing center of the adrenals, and, therefore, of all oxidation processes.

"In general diseases what has been termed the patient's 'vitality,' or 'vital resistance,' thus became ascribable to fluctuations in the anterior pituitary body's functional efficiency. In other words, overactivity of this organ, by correspondingly enhancing the production of adrenal secretion, was found to increase metabolism and the activity of all functions in proportion; while depression of its normal activity, by inhibiting the production of adrenal secretion and thus reducing the quantity of oxygen distributed throughout the entire organism, proportionally lowered the activity of all vital processes. But the manner in which the

functional efficiency of this organ was maintained had also to be elucidated. This led us to the thyroid gland, whose physiological purpose, we found, was to sustain the functional efficiency of the anterior pituitary body up to a certain standard by means of its secretion iodine in organic combination. Excessive production of this secretion, by causing overstimulation of the anterior pituitary body, gave rise, when prolonged, to ‘exophthalmic goiter'; while reduced production of thyroid secretion, by inhibiting the functions of the anterior pituitary body, caused myxedema. The thyroid gland, the anterior pituitary, and the adrenals were thus found to be functionally united: i. e., to form an autonomous system, which we termed the 'adrenal system.'

"Further investigation in this direction showed that the action. of thyro-iodine upon the anterior pituitary body represented that of any poison introduced into the blood-stream. In other words, it became evident that, instead of acting directly upon the blood or cellular elements, poisons either stimulated or depressed the functional activity of the adrenal system, thus increasing or reducing the production of adrenal secretion, and, therefore, of oxidizing substance in the plasma. Radical changes in prevailing doctrines as to the manner in which general infections, or other forms of poisoning, produced their effects on the organism thus seemed to impose themselves. In fact, the mass of confirmatory evidence found on all sides (including the effects of removal of the adrenals, the thyroid, or the anterior pituitary body, and of the use of adrenal and thyroid extracts) proved to be incontrovertible. We were thus led to conclude that what are now considered as symptoms of infection or poisoning are all manifestations, more or less severe, of overactivity or insufficiency of the adrenal system. Indeed, the physiological action of remedies was also traced to the anterior pituitary body, the governing center of this system. "The bearing of this discovery upon the prevailing interpretation of the pathogenesis and treatment of disease is well shown by the manner in which it at once elucidated our knowledge of even the greater scourges of humanity. The symptomatology of Asiatic cholera, for example, was found to be a counterpart of the symptom-complex of advanced adrenal insufficiency, and due to the effects of cholera-toxins upon the anterior pituitary body. The only treatment of any value whatever, as is well known, is early and active stimulation: i. e., the use of agents which, as does the thyroid's active principle, reawaken the functional activity of this organ. Cholera infantum, arsenic poisoning, various toxalbu