Pathological Characters, Diagnosis and Epidemiology of Bubonic Plague.

insects, in California, Honolulu and Hong Kong, gives an extensive and very detailed discussion of all features of the disease in the Medical Record. Three clinical varieties are recognized and may be defined pathologically as follows: (1) The bubonic lymphadenal variety. This is a regional lymphadenitis "typical bubo, characterized anatomically by a chain of hemorrhagic-necrotic nodes embedded in sero-hemorrhagic edema. (2) The pneumonic variety. This occurs as a lobar or lobular consolidation essentially indistinguishable, histologically, from pneumococcal and other bacterial pneumonias. (3) The septicemic variety, which is a bacillemia without the association of pneumonia, lymphadenitis or other gross lesions resulting from bacterial activity. The facies and tongue are valuable diagnostic aids, the facial expression being characterized by great anxiety and congested conjunctivae, while the tongue is at first pearly white-coated and soon becomes covered with a thick, very moist, mahogany brown coating most marked along the center posteriorly. The borders are pale red and the organ is somewhat swollen. The early coexistence of such facies and tongue, especially when the severity of the attack is marked, is almost pathognomonic, particularly if there are very severe headaches. The bacteriology of B pestis is treated at length and it is stated that the examination of the feces affords a good chance for early diagnosis and should be made in every case.

The most troublesome associates of the pest bacillus are the colon

group organisms, and these may best be filtered out of the cultures by cutaneous inoculation of a guinea pig. Post-mortem cultures from the spleen or heart's blood will usually be free from contaminating organisms In considering the epideminology of the disease the author points out that suctorial insects. do not by biting inoculate bacteria, and that plague rats are dangerous chiefly by distributing their dejecta about the food and habitations of man, and not through their fleas. Scavenger insects have abundant facilities. both for acquiring and distributing the infection and the author believes that for the eradication of plague it is necessary to kill these insects, as well as rats, by shutting them off from human habitations, food sources, their breeding places and haunts, by screening doors and windows, closing cracks and holes in markets, houses and stables, etc., prompt removal of all garbage, refuse, etc., and attention to the marketing of sea-foodsfrom waters likely to be contaminated with infected sewage.

Some Painful Affections of the Feet.

DR. C. OGILVY discusses the commoner causes of foot pain, with the appropriate. treatment in the Medical Record. The diagnosis of "rheumatism of the feet" is often made, but is usually incorrect, the symptoms in most cases being due to some deformity, such, as eversion, or flat foot. In eversion, or what is commonly called "weak ankle," the foot is everted, the internal malleolus projects very prominently, the toes point outwards and the line of strain falls to the inner side of the foot, throwing excessive weight on the inner half of the longitudinal arch. This leads to loss of elastictiy of the arch, the foot breaks down and flat foot results. Flat foot in its first stages is not diagnosed correctly in 50 per cent of the cases, yet an early diagnosis is of the greatest importance, for it is difficult matter to transform an everted painful foot with a broken-down arch into one which is capable of performing all its functions without pain or discomfort. The treatment may require the use of the Thomas heel, the Whitman plate, the plaster bandage, operation, exercise and massage, singly or in combination according to the nature of the Metatarsophalangeal pain is due to weakness of the anterior arch and is treated by the application of a felt pad and adhesive plaster. Bursitis of the heel is less frequently met with and is treated by hollowing out the heel of the shoe or by dissecting out the

case.

bursa. The subject of proper footwear is also considered and the essential points of a well fitting shoe are enumerated.

The Portland Meeting of the A. M. A.

THE greatest gathering of medical men ever held west of the Rocky Mountains and one of the greatest gatherings ever held anyhere, will be that during the Lewis and Clark Exposition at Portland, Oregon, this summer, when the American Medical Association will meet in convention. It is expected that at least 2500 doctors will attend, and that these will bring with them their wives, families, and guests, to the number of 5000 more. The sessions of the Association will be held from July 11 to July 14, inclusive.

Dr. K. A. J. Mackenzie and other local physicians associated with him have organized the work of preparing for the visitors, and the plans already formed provide for a number of most attractive features. Social entertainments will be on a large and elaborate scale. Trips up and down Columbia river, where the scenery rivals any in the world, are among these. To enable delegates to appreciate thoroughly the river scenery, it has been arranged to hold one day's session on barges, which will be hauled by steamers down the Willamette river, a distance of eleven miles, to the Columbia, and then for a considerable distance up that world-famous stream. Facilities for such an excursion are of the best, the river steamers being powerful and safe and the barges fitted with every arrangement for the comfort of tourists.

The general sessions of the body will be held at the Exposition grounds, in Festival Hall, a building erected especially for such purposes, and other meetings will be held at various places throughout the city. The various sections of the association- medical, gynecology, surgery and anatomy, obstetrics, ophthalmology, diseases of children, nervous and mental diseases, cutaneous medicine and surgery, laryngology and otology, materia medica, pharmacy and therapeutics, pathology and physiology-will be provided with suitable separate accommodations. A special meeting place will be furnished house delegates, who transact the business affairs of the body.

Arrangements are being made for rooms and board for the visiting medical men, and no difficulty is anticipated in securing suitable accommodations. Portland is amply provided with scores of first class hotels and hundreds of family boarding houses. Besides these the houses of Portlanders will be

thrown open for the accommodation of visitors. A hotel within the grounds will accom. modate 600.

The railroad companies are lending assistance to the Lewis and Clark Exposition project with an enthusiasm that has not characterized their attitude toward earlier expositions, and have provided lower rates from distant points than were ever before offered for a similar event. Under the schedule already made out, a person living in the Mississippi Valley may come to Portland and return for $45. The rate for the round trip is $52.50 from St. Louis, and one fare from points farther east. The tickets sold will be good for ninety days, and will provide almost unlimited stopover privileges, thus making the chance to see the country as great an attraction to tourists as the Exposition itself. Yellowstone Park may be visited at small expense, and it is expected that arrangements will be perfected whereby a person may go one way by one of the northern routes and the other by way of California. Up and down the Columbia the scenery is magnificent, and there are many places of historical interest well worth visiting. A large number of handsome and comfortable river steamers will make regular trips to these points during the Exposition period, from June 1 to October 16.

OPPOSED TO THE CARBOLIC ACID LAW. — Pharmacists in New York are aroused by the recent amendment to the Sanitary Code prohibiting the sale of carbolic acid at retail in any more concentrated form than a five per cent solution. The complaint of the drug. gists is that the prohibition of the sale of the acid, while it will not make suicides more difficult, will inflict a great hardship on the public, who use carbolic acid more than any other agent for disinfecting purposes. At the same time they assert that an intending suicide can go to a wholesale drug house and buy the acid in the original package without question, and a child can do this as easily as an adult. But one who resorts to carbolic acid, usually a woman, for suicidal purpose, generally does so on the impulse of the moment, and if she had to go to a wholesale drug house to get it, she would either get over her wish to kill herself or would find some other means to effect her purpose. In the notice of the new carbolic acid regulation it is stated that if carbolic acid is found by the side of the dead in a bottle bearing the name of a drug firm, the department will take action against such druggist.-Med. Record.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

A TEXT-BOOK OF PRACTICAL THERAPEUTICS, with especial reference to the application of remedial measures to disease and their employment upon a rational basis. By Hobart Amory Hare. M.D., B.Sc. Tenth edition, enlarged. Thoroughly revised and largely rewritten Philadelphia: Lea Brothers & Co.

The tenth edition of this well known and very extensively used text-book, appears in its usual practical and up-to-date form. The more recent drugs and other remedial agents are also considered, and the conclusions formed, agree with those formed by well known clinicians and practitioners. New drugs frequently have physicians and manufacturers give glowing accounts of their value, and it is a great aid to physicians to have such a reliable book as this for a guide. The section devoted to the treatment of diseases comprises almost 300 pages and includes the more frequent diseases and the essential points of treatment. This latter section will be of service to the physician until he finds time to refer to works treating of this subject exclusively.

H.

A WONDER-WORKER OF SCIENCE.-Scarcely ten years ago Luther Burbank was denounced as an enemy to all true scientific progress, a misleading prophet of a new order of things that could never come to pass. Today he has become the foremost man in the world in the production of new and interesting forms of fruits, trees, flowers, vegetables, grasses, and nuts. California's pride in him is growing and manifesting itself. He is acknowledged abroad as a genius of high rank. Carnegie Institution has appropriated for his work $100,000, available in sums of $10,000 each year for ten years. This remarkable man and his unique work in creating new forms of plant life will be subject of two authoritative papers by William S. Harwood in The Century, the first article appearing in the March issue. Added to unusual opportunities for familiarity with Mr. Burbank and his work, Mr. Harwood has brought to his article on "A wonder-worker of Science" keen interest and warm enthusiasm. Numerous illustrations from photographs, many of them here shown for the first time, will add to the interest and value of the

account.

DR. MAYS recommends tincture of capsicum, to 1 dram every two or three hours for nervous depression, etc., in alcoholic

pneumonia.

The Operative Treatment of Cancer of the Breast.-J. Collins Warren (Annals of Surgery) reports his results of operative procedures in cancer of the breast. From a series of 100 cases 26 have been permanently cured after three years of observation. Duration of the disease the author naturally concludes, is the decisive point as to the prognosis. Axillary as well as cervical involvement make the prognosis less favorable. Cervical glandular enlargement is looked upon among German authorities as a contraindication to operation. In cervical glandular involvement in cancer of the breast we are always certain of recurrence. The author has devised a somewhat novel incision in amputation of the breast. The form of incision is described as "racketshaped, beginning at a point anterior and external the axilla a little above the insertion of the pectoralis major. The incision then sweeps in pear-shaped way downward encircling the breast. A secondary incision passes at first vertically outward from the middle of the primary incision for a short distance and then runs parallel to it until a point is reached opposite the lower point of the primary incision. The author in all cases performs the radical operation by removing the pectoral muscles.

He

Modern Bullet Wounds.-Foxworthy (Annals of Surgery) describes the results of treatment of modern. bullet wounds. urges expectant plan of treattment in many perforating abdominal wounds that occur on the battle field. Statistics quoted of operations in this class of cases show a greater moralitty after operation than if left alone. Recapitulating the most serious injuries in succession the author places them accordingly as follows: (1) Spleen wounds most fatal; (2) perforating wounds of small intestine and mesentery next; (3) wounds of stomach next (4) wounds of large intestine next; (5) wounds of bladder (6) liver; (7)

of kidney; (8) non-perforative wounds finally. From the above the splenic wound is considered most serious and that on account of hemorrhage. The fear of hemorrhage in mesenteric injury is also a reason why it is classed as the second most serious.

Internal and External Hemorrhoids. -Adler (J.A.M.A.) discusses the subject of the treatment of internal and external hemorrhoid. His review of the various operative measure is reasonably complete. In the treatment of external hemorrhoids the author recommend excision under cocaine anesthesia without ligature. The hemorrhage after this method is not very great and the technic simple. It consists first of infiltrating the hemorrhoid with solution of cocaine and the excising it with a curved scissors. This method though the simplest and best would not appeal to the timid surgeon on account of the fear of hemorrhage, though hemorrhage is generally very slight. Simple incision and removal of the clotted blood is cer

tainly for the time grateful to the patient, though recurrence of the hemorrhoid after this method is the rule.

Ligature is needless, painful and time consuming. For palliative purposes the author suggests the use 50% ichthyol ointment made up with lanoline and cold cream, equal parts. For palliation in internal hemorrhoids the author suggests the following suppository: Ichthyol..... Acid tannic. Ext. belladon

gr. v

aa gr. gr, x

Ext. stromomii.. Ext. hamamelis.. M. Ft. in sup. No. i. Under operative procedures in internal hemorrhoids the author inclines to the use of the clamp and cautery, at the same time discouraging the use of the "Whitehead operation. He disfavors the Whitehead for the reason of its liability to subsequent anal, stricture, claiming at the same time the clamp and cautery method to be radical. While the danger of anal stricture is possible those who have used this method report few authentic cases. The reviewer cannot conceive how the clamp and cautery method can be classified as a radical one in internal hemorrhoids. Should severe infection cause the stitches in the Whitehead operation to loosen or come out subsequent cicatrization may be harmful, but under strict asepsis how seldom is anything but primary union attained.

As

far as time consuming the patients are up and about in seven to ten days. The use of the clamp and cautery in internal hemorrhoids often leads to ulcerative proctitis. Dr. Charles M. Kelsey adds:

"If you wish to radically cure your patients with the least possible pain, loss of time, confinement to the house and risk of accident, use the clamp and cautery. If you wish to accomplish the same results with no more risk, but with more pain, more local and general disturbances, use the ligature. If you wish to take an hour to do what can as well be done in a few minutes, and gain nothing more by it in the results, use Whitehead's operation."

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Heart Bigeminus Following the Administration of Digitalis.-C J. Favconnet (Meunchner Med. Wochenschrift, No. 51. 1901) says that heart bigeminus with pseudo-bradycardia not infrequently follows the use of digi talis in cardiac incompetency, particularly in mitral and tricuspid lesions. In these cases fying cardiac palpitation, dyspnea, edema, the drug acts decidedly unfavorable, intensietc., and its continuation may be the direct cause of death (Huchard). The writer gives a thorough review of the literature, discuss. Wenckebach, Engelmann, Hering and others ing the theories advanced by Traube, Knoll, concerning the production of allorhythmia, accepting the latter's view, who regards heart bigeminus as entirely myogenic; the blood which regurgitates back into the auricle through the affected orifice issues a reflex muscular contraction of that chamber, emptying its regurgitated contents into the ventricle again, which in turn actuates ventricular systole. In the majority of instances, this secondary ventricular contraction is insufficient to cause a distinct pulse wave (pulsus bigeminus) resulting in an apparent or pseudo-bradycardia. The appearance of heart bigeminus resulting from the administration of digitalis in cardiac incompetency is explained in the following manner. amount of regurgitated blood previous to the administration of the drug is not of a sufficient quantity, owing to cardiac muscular insufficiency, to cause a reflex auricular systole. Digitalis strengthening muscular force, increases the amount of regurgitated blood through the defective valve in quantities sufficient to affect a reflex contraction. Favconnet's case, a woman 19 years old, with a history of having had rheumatism ten years ago, entered the medical clinical of Prof. Lichtheim, Königsberg, with a temperature 38.2 C., pulse 120, evidence of a diffuse pulmonary catarrh, and a considerably enlarged heart. A diagnosis of a recurrent acute endocarditis and a mitral regurgitation was made.

The

Tinc

ture of digitalis was given to relieve the threatening venous congestion, whereupon the pulse rate decreased to 50 beats, but on auscultating the heart it was found that the contractions numbered twice that amount (pseudo-bradycardia). Both subjective and objective symptoms became aggravated. On discontinuation of the digitalis the symptoms improved and the pulse increased to 96 beats, corresponding to the number of heart contractions. The same picture made itself evident with the administration of digitalis at a later date. The author's paper is illustrated by four sphygmographic tracings.

On the Healing of Tuberculosis (Clinical Features.) Herbert King (Medical Record, January 7, 1905) asks why the vast majority escape and only a comparatively small proportion develop a recognizable tuberculous lesion if all are subjected to the infection. He says that the first onset of a tuberculous infection usually antedates the appearance of clinical symptoms by months or even years. An exhaustive inquiry into the past history of such patients reveals illnesses of many sorts, as malaria or grip, which are presumptive evidences of systemic tuberculous reaction, as the result of autopsy findings would make them appear. The author identifies two cases of this type, stating it is probable that the initial lesion following a tuberculous infection is often obscure in its clinical manifestations and frequently escapes recognition. There is nearly always a prompt and very often successful tendency on the part of the organism to a more or less complete repair followed by an interval of apparent health. Following this interval, which may extend into a period of years, there is a strong tendency, to relapse. What is in reality a recrudecesnce of an arrested lesion is very frequently mistaken for an initial onset. Whatever may be the facts in an individual case, the safest and most practical policy lies in regarding every apparent recovery from tuberculosis as merely an arrest of the disease brought by an acquired im. munity which suitable conditions are very prone to destroy. Regarding the generally accepted prognostic significance of a diazoreactions in tuberculosis, it may be said its application implies chiefly, if not entirely, to the last stages of the disease, and when temporarily present in the early acute manifestations, or in acute exacerbations of chronic lesions need not necessarily indicate an favorable termination. Its disappearance, if present, is to be considered as one of the first clinical evidence of improvement.

un

An Experimental Study of Lactic Acid Formation with Special Reference to the Stomach.

E. Palier (American Medicine, Jan. 7, 1905) briefly describes his experiments in this connection, using either a plain solution of iron chloride or Uffelmann's reagent for the qualitative tests. He says, the presence of lactic acid in a fluid does not mean the entire absence of HCl, nor does it mean that the latter had never been there. When digestion takes place the free HCl gradually disappears and fresh HCl must be constantly added, and as the HCI disappears, bacteria and lactic acid make their appearance. Palier formulates the following laws on what takes place in the test tube, and, as he believes, in the stomach as well:

1. Lactic acid develops in all organic substances containing carbohydrates, whether sugar or starch; and in some instances even while yet in solid form, such as bread and meat, for instance, at certain seasons which are especially favorable for bacterial development, some lactic acid exists already and on dissolving such substances in water the lactic acid

reaction can be soon detected.

2. Lactic acid formation is due in all cases to bacterial development, even the so-called sarcolactic acid of meat. Furthermore, many kinds of bacteria can by their development bring about the formation of lactic acid in substances containing carbohydrates; but the bacteria usually vary in different substances.

3. Lactic acid does not give the usual reaction with the usual tests when an inorganic acid is also present in sufficient strength.

dered when there is an antiseptic present, 4. The lactic acid development is hinsuch as HCl, for example, acting against those bacteria which bring about the lactic acid development, but the lactic acid that has been formed before HCl was added is not destroyed when the latter is added. It is only masked as far as the ordinary reactions are concerned and its further development arrested.

5. HCI enters into combination with albuminoids, and after some time it does not give the usual reaction, though it was marked when it was first added; and then bacteria the latter in substances containing carbohyappear, and also lactic acid begins to form drates. The bacteria in the stomach, bringing about lactic acid formation, may be various; but whenever there is alimentary stasis with deficiency of HCl, there is usually a bacillus found, which Pailer calls the Vibrio geniculatus ventriculi. Regarding lactic acid as far as the stomach is concerned it may be said, that whenever the total acidity is 40 per cent or more after a test meal consisting of a roll of bread and a glass of tea, and the HCI is insignificant or entirely negative, there is alimentary stasis of the previous day or days.