Bacteriologist for the Philippines.-Dr. Charles B. Hare of Ann Arbor has accepted the appointment of government bacteriologist in the Philippines, at a salary of $1,500. He contracted the bubonic plague at one time, while working in the laboratory of the University of Michigan.

Philadelphia Spitters.-War has been begun against the defilers of sidewalks in Philadelphia, and many men have been arrested recently and fined for spitting on them in defiance of the law. It was announced in the papers some time ago that a similar campaign had been begun against these nuisances in New York, but no results are yet evident. Too Many American Congresses on Tuberculosis.— We received some time ago a circular signed by Dr. Daniel Lewis of New York, as president, announcing that the American Congress on Tuberculosis would not be held in St. Louis in 1904, for the reason that the International Congress on Tuberculosis would be held in Paris the same year. We have also received a circular signed by Dr. E. J. Barrick of Toronto, as president, announcing that the American Congress on Tuberculosis would be held in St. Louis in 1904. We assume that the two congresses are antagonistic, since we are warned in one of the circulars that no communication is genuine without the signature of the secretary of that individual congress, yet we find that Dr. Barrick of Toronto is the president of one congress and the third vice-president of the other, and that Dr. J. G. Adami of Montreal is an honorary president of one and a member of the committee on pathology and bacteriology in the other. That is almost as confusing as the overlapping of membership in the two New York County medical organizations.

Dr. Henry W. Berg.-Through one of the inexplicable accidents which happen in even the best regulated printing establishments, the name of the author of the article on "Chronic Postdiphtheritic Laryngeal Stenosis as a Cause of Persistent Intubation of the Larynx," published in the MEDICAL RECORD of August 1, was printed Henry W. E. Berg. The initial "E" inserted itself without reason and to the regret of author and editors.

The Chicago Board of Health.-The Civil Service Commission of Chicago recently made an investigation of the Health Department of that city, and, as a result of its findings, brought specific charges of laxity in the methods of the department. Among other things, the report of the commission found that: "Complaints made to the department are not, at the time they are received, entered in any permanent record, but they are distributed in the boxes of the various inspectors, who then sort them over and reject such as they see fit to reject, making investigations of the remainder. These latter are entered in a permanent record book. When a complaint is turned over to an inspector there is no system by which the work of the inspector is supervised. It is wholly within the discretion of the inspector whether the nuisance complained of is abated within six days or six months, or whether it is abated at all. The 'stay book' shows that after prosecutions have been begun action is stayed at the discretion of almost any one connected with the department, not of one responsible officer, and there is no supervision of a case after it is stayed, so that in most cases when a stay is ordered it is an equivalent to a nullification of the complaint. Not only have a number of people in the department the authority to grant stays, but these officials act in most instances at the suggestion of persons wholly outside of and in no way connected with the department." The Commission holds the Health Commissioner, Dr. Reynolds, directly responsible for

what it calls this "mischievous policy of delay and concession," and it adds that the health inspectors have become careless in their work and discouraged, since there is no incentive to good work, action being so seldom taken on their reports. Dr. Reynolds has denied most of the accusations against the department, and explained others by saying that the necessary improvements would in many cases be so costly that the carrying out of the inspectors' suggestions would amount practically to confiscation of the property. The Mayor has sustained the Health Commissioner in so far as to retain him in office, but has warned him that the work of his department must be bettered.

The Health of Pittsburg.-It is feared that typhoid fever will become epidemic in Pittsburg unless the condition of the water supply soon shows an improvement over what prevails at present. The number of new cases of the disease amounts to from sixteen to twenty a day.

The Vanderbilt Memorial Hospital in Newport.— The hospital erected at Newport, R. I., by Mrs. Cornelius Vanderbilt, in memory of her late husband, was turned over to the trustees of the institution on August 1, the transfer being made by Mrs. Vanderbilt by letter. In the letter Mrs. Vanderbilt also announced that she would endow the building. The building is of Indiana limestone, three stories high. The ground floor is devoted entirely to the out-patient department. On the second floor are the committee rooms and several wards. The third floor contains several wards for children.

Plague in San Francisco.-It was believed that a plague had been eradicated from Chinatown in San Francisco, only two cases having been discovered there during the first six months of this year. In July, however, a slight recrudescence occurred, four cases being reported during the month. The health authorities of the city are employing the same rigorous measures to stamp out the disease that were inaugurated in compliance with the determination of the convention of health experts in Washington last November. A regular inspection is made of the quarters occupied by the Chinese, many of the rooms are disinfected, the sewers are being flushed, and a bounty is paid for dead rats.

Obituary Notes.-Dr. ALBERT JEREMIAH SCHUREMAN of Newark, N. J., died on July 28 in the home of his brother, Dr. Charles A. Schureman, in that city. He was seventy-five years of age. His death was due to a general physical breakdown. He was a graduate of the Medical Department of the New York University in the class of 1872. He was well known not only as a physician but as a writer and an artist.

Dr. FRANCIS F. MILES, a well-known practitioner, died in Baltimore on July 30, at the age of seventysix years. He was born near Charleston, S. C., and was graduated from the Medical College of the State of South Carolina in 1849. He served through the Civil War in the Confederate Army. He had practised in Baltimore since 1867.

He

Dr. GOTTHOLD PAPE died at his home in Hoboken on August 2, at the age of sixty-one years. was born in Germany and obtained the degree of Ph.D. from the University of Göttingen. He came to this country just before the breaking out of the Civil War and served in the Union Army in the Thirteenth New York Independent Battery of Light Artillery. He was graduated from the Medical Department of the New York University in 1880 and settled in Hoboken, where he practised medicine up to the time of his death.

THE special session of the General Medical Council met on Wednesday. The chief object of the meeting was to consider the impulse created by the conduct of the two royal colleges. You will remember that these have repudiated for a long time the control of the council over the teaching institutions they may recognize. The dispute has been discussed at intervals for the last nine or ten years, but last year it seemed more likely to come to a head. The recalcitrant colleges stood on what they held to be their legal rights under their charters. Most people think if it comes to a fight between royal charters and acts of Parliament the latter must prevail. That would be good for medical education which, with all its faults, the council has done much to improve. The report of the committee which exposed the valuelessness of the first year's education at schools for boys accepted by the colleges was, after discussion, adopted.

Dr. Moore told the council that the College of Physicians considered the council had no power whatever in regard to the regulations, but viewed the General Medical Council as a criticising body-as such they considered its criticisms with the utmost deference and respect.

That being the position of one college, the other disputes its action and looks upon the interference of the council as ultra vires. You see, the matter has made no progress. Sir Victor Horsley who is not afraid to follow his opinions by action, proposes to represent to the Privy Council that these preliminary examinations are inadequate. The matter is being discussed as I write.

The open-air treatment is making renewed progress with the public. On Wednesday Lord Roseberry opened the new pavilions of the Victoria Consumption Hospital, near Edinburgh, which has been at work for some seven years. The extensions are to cost about £7,000, the original property having been purchased for £17,000. Dr. Philip said the expenditure on the institution would be £3,000 in excess of income. All the beds but eight are free. The eight are for those who can afford to pay £1 Is. per week, which sum does not cover the cost. In fact, the cost per bed is from £100 to £120 per annum. Dr. Clouston, President of the Edinburgh Royal College of Physicians, in his speech, dwelt on the educative value of the hospital.

Lord Roseberry said it must have been a shock to many to be told that consumptive patients were to be exposed for their cure to all the worst that the climate of Scotland can do, and yet it is an undoubted fact that that exposure has been of the greatest benefit to many cases. Some slept in the open air all last winter, and sometimes snow had to be taken from under their beds in the morning. With the facts before us, said his lordship, "we may lift up our hearts with thankfulness to the Almighty, who has let us into the secret of this great healing prescription, and to those men who have given their lives and their time to the relief of this form of disease." He concluded with an eloquent appeal for more money, and donations were announced amounting to £1,489.

Deciduoma malignum has occupied the thoughts of gynecologists for several weeks. Dr. Teacher brought the subject before the Obstetrical Society, which gave two evenings to it last month. In 1896 a committee of that society reported that there was nothing in the specimens submitted to justify the name or the supposition that they were of decidual origin. In 1902 Dr. C. Lockyer read a paper which impugned this conclusion, and induced some to accept the view of Marchand that these tumors originate in the corionic epithelium.

Dr. Teacher's elaborate paper presented much more evidence to this effect, and those best able to judge seem to have become convinced. As an eminent professor writes to me "it is now almost unanimously agreed that there is a special form of malignant growth, taking its rise to metastatic deposits." origin from the fetal elements of the decidua, and giving

The question of the nomenclature of these growths was raised at the society and several names proposed, but deciduoma malignum has been so long and so generally clinical term, although pathologically incorrect. applied that it was felt to be hopeless to displace it as a

be

appointed and the medical department of the Local Government Board enlarged and made into a health ministry occasioned a rather lively debate in the Sanitary Congress

last week. On the one side it was said the minister should not be a politician but should attend the cabinet when health questions were discussed. On the other it was said a minister would only hamper the medical officers of health, who most of all needed freedom-freedom from the influence of property owners on local councils. A cabinet minister would be chosen as a party man-not for special knowledge. From this point the discussion degenerated into a talk about the qualifications of politicians and cabinet ministers-a talk which could have no influence on the powers that be.

A paper was read on the work of the West Riding Rivers Board which held out the prospect of purification as most hopeful. When the sewage of the boroughs has been removed the rivers will again be fit for fish.

Another paper by a medical man contended that overfeeding rather than over-crowding is the chief cause of fevers. He is reported to have declared that twice a day is often enough to feed an infant, and adults from twentyone to fifty years of age should be content with one meal a day. After seventy-five they should know themselves what was good. I wonder if he has brought up babies of his own.

Prof. Clifford Allbutt's address was one of the most interesting events in the congress. He entered a tilt against the theory of the survival of the fittest. If the most vigorous in body were really the salt of society the elimination of the unfit by disease would be too rough a method of compassing the survival of the fittest. When philanthropists raised the cry of degeneration, physicians were not to submit to be told that medicine must bear

part of the blame. To proclaim that preventive medicine could improve all bad stocks up to the average and the good ones infinitely above, was more than he dared to suggest; but he called upon the congress to declare that public health would do it better than public disease, and to urge the Darwinian to study his own origin more closely than he had yet done, and so learn that even unfitness is not uncaused, so that it would be more to the purpose to search for its various causes than to look to blind readjustments after degenerative influences had done their work.

Major Ronald Ross, C.B., gave a lecture in which he related the success of a French company which had followed his advice as to the extermination of mosquitos, with the result that malaria began to decrease within six months. The suppression of the insects has been nearly complete.

The Institute of Preventive Medicine is henceforth to be named after Lord Lister. The name of Jenner, as I reported to you, had to be given up on account of its prior use by another body.

The scheme to amalgamate the Royal and the National Orthopedic Hospitals has been approved by the governing bodies.

The Journal of the Royal Army Medical Corps has made its appearance under the editorship of Major R.H. Firth. The first number contains many things of interest to the profession generally, and, of course, is full of that especially interesting to the corps.

Two inquests on medical men in one week are rare. Drs. S. A. Bernays, aged fifty years, died at St. Thomas's hospital while under an anesthetic. At the post-mortem he was found to have been suffering from chronic tuberculosis and death was supposed to be due to cardiac failure.

The other inquest was on Dr. A. E. Wainwright, a young man of twenty-five years who was acting as a locum tenens. He was seized with abdominal pains and rapidly succumbed. The inquest was adjourned for an analysis, but that shed no light on the case, and at the adjournment an open verdict was returned.

THE PROFESSIONAL NURSE.

TO THE EDITOR OF THE MEDICAL RECORD: SIR: The so-called "Professional Nurses" have been making strong endeavors, in different States, with some success, for direct professional registration in the laws of the land and State registration on the same or similar lines to those accorded to the medical profession. That this is a justifiable move is beyond question. It should guarantee to the public a means of distinguishing between the trustworthy and competent person and the contrary by signifying the graduated from the nongraduated nurse. The guarantee, however, is, by no means, infallible. Some "training schools for nurses are still too much "trade schools," even as there are still too many such among our medical schools. The question at issue is, how much fundamental knowledge should a professional trained nurse have. By fundamental is meant scientific knowledge, fundamental acquaintance with the 'theories" of the work and the “reason why" of his or her

acts. That a man or woman can be trained or drilled to be reliable in work, and yet know little or nothing of the science of it, even as a soldier can be drilled in his duties and still know nothing of the science of war is not only self-evident, but practically even more than the present training schools have generally attained to. A writer on this subject has recently claimed that the trained nurse should be competent to make every clinical test of urine, blood, or diseased product. That can be done even as an engineer can be taught to run a locomotive and yet know nothing of the science of mechanics. Another question is, who should decide on the standard of education of the professional nurses-the nurse organizations, the faculties or managers of the training schools, or the medical profession? It would seem that that question should be entirely in the hands of the medical profession. If the physicians and surgeons do not know what is required of the nurse, who does? As to the "faculties" of training schools, their opinions are not worth much where those schools are sort of independent institutions, having hospital connections, but not a part of great public hospitals. The training schools are more or less like the medical. Too many of them are of a semi-private nature, for the "good" of those directly interested, the public and the student-nurses being consistently and persistently exploited for that "good" and little else.

The Organization of Professional Nurses, like many a medical society, have also the same weakness. They are liable to get under the control of ambitious persons who desire to shine before the public. What is worse, these "leaders" are saturated with a "will-o'-the-wisp" idealism which is pure moonshine, shadowed by intellectual cloudiness.

To return to that fundamental question--does the professional nurse require a more or less profound education in the scientific bases of medicine in connection with an exact training in practical routine? If so, how much, and where is the nurse to get that scientific instruction? Certainly not in any of the existing training schools as now organized. The "probation course" of two, three, or six months, or even a year, generally demanded is of little or no use except to obtain a very general idea of the student's fitness, physical more than mental. It is largely comparable to the "one year's reading with some practitioner," now traditional, that formerly prevailed in our medical education. If the medical profession and public service require scientifically educated nurses, then that education must and should be given in institutions entirely free from any hospital connections, and should be free. In other words, the respective States should establish a State normal or preparatory school for nurses where these fundamentals and all laboratory drilling should be taught. The term should be of two years' duration, with three months' vacation between the first and second year. Graduated students should then be apportioned out to the respective public hospitals and institutions for another term of two years. Finally, on receiving a certificate of competency from the hospital, the student-nurses should be examined by a State board, registered, and given their diploma of competency. While private, or semi-public (endowed) hospitals might have the privilege of employing uncertified attendants they should be strictly forbidden issuing any certificates indicating any kind of proficiency to any such employees, and if requiring "professional" nurses should be obliged to apply to the State Board of Registration for them. Complaints as to unfitness or improper conduct of registered nurses should be made to the State Board of Registration, which should have the power to place the nurse on "probation," or to withdraw a certificate altogether in warranted cases. MEDICUS.

A Pathognomonic Sign of True Chronic Maxillary Sinusitis. -G. Mahu calls attention to the fact that in true chronic maxillary sinusitis, the mucosa rapidly increases in thickness even during the early stages, so that it becomes spongy and myxomatous in appearance. As a result, the capacity of the sinus is considerably reduced. This is determined in the following way: The patient sits erect, and after the pus is washed out of the antrum a syringeful of water is introduced into the cavity, care being taken to drive the piston home. Next the water is sucked out of the cavity and the quantity is measured. It represents the capacity of the antrum up to the level of the ostium. Mahu concludes that when the quantity of fluid withdrawn in this manner is less than one and a half cubic centimeters, the case is one of true chronic sinusitis. --Journal of Laryngology.

Progress of Medical Science.

The Boston Medical and Surgical Journal, July 30, 1903. Efforts to Abate the Mosquito Nuisance in Brookline.H. Lincoln Chase describes his efforts in this direction. All pools, ponds, ditches, and other breeding places, including catch-basins, were located upon the town map. The approximate areas were determined, and the number of catch-basins ascertained. Breeding places of culex and anopheles were determined in order to learn the proper intervals for treatment, whether every three or four weeks. The public dumps and other places where accidental receptacles of water were to be found were located. Light fuel oil was used. In ponds and pools one ounce of light fuel oil was used to fifteen square feet. If there was luxuriant vegetation in them, an excess of one-quarter of the original amount was added. If there was a clear water surface, one-sixth more than usual was added. After spreading the oil, a puddler violently agitated the water with a hoe. The shallow pools, if not large, were filled in. Many small pools were drained or filled. The results of this work were most favorable.

The Need of a Supplementary Lantern Test for the Proper Examination of Color Perception.-Charles H. Williams declares that a very extended use of the Holmgren test in the hands of many examiners is now showing that some cases are able to pass this test correctly and without hesitation, who, when examined with the lights from a distant signal, may be unable to distinguish the red or green with any reasonable degree of certainty, and, in fact, often confuse these colors. This occurs most frequently in cases of acquired defect in color-vision caused by excessive use of tobacco or alcohol or by a combination of the two. In such cases there is often a small defect in the central part of the retina, so small that the retinal image of the skein of worsted is large enough to be formed partly within the affected area and partly beyond it, and if at any part it falls on healthy retina its color can be at once recognized. If the object is small, like a distant signal light, the retinal image is formed wholly within the affected area, and the color is not recognized. In addition to the test with different colored lights, it is important to make the test with a light whose intensity can be varied by fixed amounts; for in some cases the defect depends upon the intensity of the light. The writer, for this purpose, has made an electric lamp with a specially constructed rheostat in the base, through which the current for the two incandescent lamps can be passed. The resistance can be varied from nothing to 150 ohms. This lantern test is now used on certain roads in addition to the Holmgren worsted test. With these two tests carefully made it is reasonably certain that no dangerous case of defective color-sense will be passed. When the defect is acquired, improvement may come from removing the cause. But in the congenital cases no treatment will be of much use.

Journal of the American Medical Association, Aug. 1, 1903.

Acute Epiphysitis Causing a Condition Subsequently Simulating Congenital Hip Misplacement.-John P. Lord reports an illustrative case occurring in a child of two years. The Lorenz-Hoffa cutting operation was undertaken, and this showed the original trouble to have been a healed funnel-shaped depression over the capsular ligament, marking the site of the former sinus through which the destroyed epiphysis had been discharged as pus and débris. The capsule had been converted into a dense ligamentous structure. The opinions of several orthopedic surgeons are cited to show that there is small prospect of success from treatment in many of these cases, and that active surgical intervention is of doubtful utility.

Tuberculosis of the Mammary Gland.-A. H. Levings shows that tuberculosis of the mammary gland is not an infrequent condition, but one which goes unrecognized, a statement which is confirmed by the fact that up to 1898 only fifty-seven well-authenticated cases had been reported, and yet he has himself seen seven cases during the past two years. He summarizes his paper as follows: The process may remain for months or years in the form of hard, irregular, and fairly circumscribed nodules. Liquefaction and pus formation are secondary and later processes. The disease attacks the breast most commonly during menstrual life, and occurs with the greatest frequency in single women. The condition is more often primary than has been generally supposed, and both glands are often implicated nearly simultaneously. Palliative treatment may be practised when the process is circumscribed, but when diffuse, radical measures should be recommended.

The Treatment of Uncinariasis.-Thomas A. Claytor says that as the primary infecting agents, the eggs, are found in the evacuations, and it is well known that the embryos can not live without air, it is advisable to adopt Sandwith's suggestion regarding prophylaxis, i. e. the use of trench latrines outside of infected villages. The infection of human beings takes place chiefly through infected water or food, or through contaminated hands carrying the parasite to the mouth. Thymol is the remedy par excellence in this disease. It is best given in two doses of thirty grains each, at 8 and 10 A.M., and this should be followed two hours after the second dose by magnesia or castor oil. Thymol being a poison, its action should be carefully watched. Ordinarily two or three doses are sufficient to effect a cure, but occasionally an obstinate case is encountered. The author closes his paper with an account of an investigation made upon dogs to determine the best method of administering the thymol. An alcohol solution gave rise in dogs to aspiraation pneumonia, while the dry powder caused no serious results. He thinks it probably safe to give 2 to 4 gms. of thymol to a human being, followed by one or two tablespoonfuls of brandy, and later by a purge. The alcoholic solution causes a more rapid expulsion of the parasites. The stools should be examined weekly for eggs, and the thymol treatment continued so long as they are present.

Medical News, August 1, 1903.

Pustulation and Its Accompanying Secondary Fever a Complication and Not an Essential Symptom of Smallpox. -Jennie C. Drennan states that, unfortunately, instead of vesiculation being the final cutaneous lesion in smallpox there is a subsequent one, pustulation, which the writer believes is the result of a secondary infection by pus organisms, which are ever present in the skin. On the cessation of the excretion of the toxins of the smallpox germs by the death of the latter, these pyogenic organisms will find the vesicular fluid a suitable medium in which to flourish. This vesicular serum soon becomes turbid from the rapid development of these pus germs and the vesicle becomes a pustule. Secondary systemic irritation results with a rise of temperature and a second inflammatory reaction around the foci of infection. In the treatment of smallpox, injection of a toxic serum obtained from a cow suffering from the initial symptoms of cowpox should be given in the stage of invasion. Cleanliness and disinfection of the skin, and the internal administration of calcium sulphide to prevent pustulation, are indicated, also opening of all vesicles. The prevention of pustulation will abolish pitting. Symptoms should be treated as they arise.

New York Medical Journal, August 1, 1903. Dhobie Itch.-Charles F. Mason distinguishes three varieties, two mycotic and one bacterial. The former are easily recognized by the festooned rings with raised margins and by the microscopical findings. The latter is characterized by an eruption of vesicles, usually about the axillæ or groins, unattended by constitutional disturbance. This form demands thorough cleanliness of the parts and of the underclothes, sponging twice daily with 1 to 1,000 bichloride solution, and dusting with a powder composed of equal parts of zinc oxide, boric acid and starch. In the mycotic varieties the edges of the rings should be painted with tincture of iodine, or an alcoholic solution of corrosive sublimate, or a 10 per cent. salicylic-acid ointment should be applied. The word "dhobie" in India means laundryman, and indicates the popular belief that this is a filth disease.

An Improvised Method of Operating for Varicocele.— Lucien Lofton takes up the cudgels in defence of the old operation of ligation, and describes his method of doing this operation. The spermatic cord and artery are carefully separated from the mass of veins, and the latter is then transfixed with a large curved surgeon's needle, armed with catgut. The essential point of the operation is to make the needle describe a half circuit of the interior lining of the scrotum, and come out of the original opening. By this procedure the veins are immediately anchored to the inner side of the scrotal wall, and the patient is thereby enabled to continue his business without a day's interruption. The tying of the ligature should be done gradually, so that if the cord and artery are by chance included in the ligature the severe pain produced will call attention to this fact at a time when it can be remedied. Recovery takes place in about four weeks, and complete atrophy in about six months.

The Death Rate of Pneumonia.-Thomas J. Mays gives an interesting study by the graphic method of the vital statistics regarding pneumonia, heart disease, and phthisis. For the most part these figures cover the period from

1876 to 1902, and are taken from the States of New Jersey and Rhode Island, the District of Columbia, and from eleven prominent cities. The tracing from Chicago is peculiar in that it shows an increase in the death rate from pneumonia of 350 per cent., and from heart disease of 450 per cent. A composite chart, built on the combined average death rate for all the places mentioned, shows the total increase of pneumonia to be not quite 10 per cent., and of heart disease, 85.85 per cent. The author concludes that there is no good reason for alarm concerning the ravages of pneumonia, because its highest death rate occurred in 1896, and since then has declined 21.17 per cent. In all of the places considered there has been a reduction in the phthisis rate from the early eighties to 1898, and since then a general net increase. The natural average decrease in the death rate of phthisis is shown to be between 2 and 3 per cent. The figures also show that deaths from heart disease are increasing.

American Medicine, August 1, 1903.

Bradycardia as a Symptom.-Roland G. Curtin states that bradycardia has been observed as occurring during the course of many acute and chronic diseases. A symptom which is so common, and which occurs in such a multitude of widely different diseases, can be of but small diagnostic value. As an aid in prognosis it would appear that, given a constitution not undermined by disease, and a gradual subsidence of the primary cause of the slow pulse, bradycardia need not necessarily be regarded as a particularly grave symptom. On the other hand, if it is associated with or caused by a depressing chronic condition, especially of the cardiovascular system, it becomes a most serious symptom. When accompanied by anginose symptoms it is frequently followed by sudden death.

Appendicitis as an Incident in Development.-Woods Hutchinson believes that a survey of the conditions of the cæcoappendix in different forms of life points irresistibly to the conclusion that in our own ancestry, beginning as a large, voluminous, and actively functional pouch, the concentration of nutritive qualities of the food-supply, the dropping of the purely herbivorous or granivorous diet in the rodents, the acquisition of a diet of chiefly fruit, nuts, insects, small birds and their eggs in the lemur and in the monkey, and finally of a diet almost purely of nuts, fruit, and small birds, in the anthropoid apes, have resulted in its constant and steady diminution in size and importance, and unfortunately for us, in the last two steps of the process in a markedly disproportionate degree of recession in the distal two-thirds of the pouch. The process goes on in the direction of eliminating and completely obliterating a superfluous and no longer useful part of our alimentary tract. Any remnant of tissue, no matter how insignificant, which no longer serves a useful purpose in the struggle for existence, is sooner or later doomed to complete extinction.

The Lancet, July 25, 1903.

Susceptibility of Criminals to Atmospheric Changes.W. Norwood East, as a result of an inquiry extending over three years, and comprising observations on 700 prisoners, concludes that, with the possible exception of temperature variations, the criminal is unaffected by atmospheric changes. The fact is emphasized that the normal individual is often materially influenced by such changes, and that the results of this investigation afford additional confirmation of the author's former contention that the criminal is insensible to external impressions.

Influence of Locality and Surroundings on Recurrence of Malignant Disease after Operation.-D'Arcy Power reports seven cases occurring in his own experience, and then suggests that certain modes of life, certain kinds of diet, or, in short, conditions leading to a lowering of the general standard of health, are especially favorable to the development of malignant disease. He considers it extremely probable that the recurrences in malignant diseases are not really so capricious and arbitrary as they now appear to be, and solicits the coöperation of those who are favorably situated for such observations in solving this problem.

Hepatectomy for the Removal of Riedel's Lobe.Charles Barrett Lockwood describes the various forms which this rather rare abnormality of the liver may assume, and then reports a case in which he was compelled to resort to excision of this lobe in order to relieve severe and persistent pain. At first the young woman was supposed to be suffering from a displaced and movable kidney; subsequently the symptoms pointed so strongly to appendicitis that the appendix was removed, but was found to be normal. After keeping the patient under observation for a number of months it was considered justifiable to excise the tumor, and this was done on

February 28, 1903, with complete and permanent relief of the pain. The excision was done in such a way as to leave two flaps of liver tissue, which were sutured together with twisted silk. Hemorrhage was easily controlled by an encircling suture buried in the liver substance. It is interesting to note that the gall-bladder was perfectly healthy.

Enzymes in Tumors.-Arthur Harden and Allan Macfadyn present a preliminary communication on a conjoint research made by the bacteriological and chemical departments of the Jenner Institute on the intracellular physiology of the epithelial cells in health and disease. They made use of fresh cell juices, obtained by cold grinding methods, from normal as well as from diseased epithelial tissues, and studied the nature of the enzymes present as far as possible by quantitative tests. The control experiments were made upon the normal tracheal epithelium of the ox, and resulted in revealing the presence of an invertase, an amylase, a maltase, and a proteolytic enzyme. So far, lactase and rennin have not been detected. The diseased epithelial tissues were chiefly cancerous tumors of the human breast. The enzymes discovered in these tissues are: an invertase, a maltase, an amylase, proteolytic enzymes, acting in acid and alkaline solutions respectively, a catalase and an oxidase, together with traces of a lipase and possibly of a peroxidase.

British Medical Journal, July 25, 1903.

Treatment of Atrophic Retina with Retinal Extract.Robert W. Doyne says that, so far as his observations go, improvement by this method of treatment can be expected only in cases of retinal atrophy in contradistinction to nerve atrophy. The cases in which he has had marked improvement have been retinitis pigmentosa, retinal degeneration in high myopia, retinal degeneration in choroiditis, and tobacco amblyopia. Cases of asthenopia from functional exhaustion should be benefited.

Two Cases of Fracture of the Base of the Skull, in Which Recovery Followed Venesection.-Stephen Paget reports two cases of this nature. In one case, that of a young man, there was profound unconsciousness thirty-six hours after fracture of the base of the skull, with a temperature rising rapidly to 104°, and the intensest degree of CheyneStokes breathing. He was dying. But as he was bled to 20 oz. plus 12 oz., he began to get better and made a complete recovery. If venesection in such

soon as

cases could restore consciousness more or less for a few hours only it would still be a valuable method, but these cases show that it may bring about recovery.

The

The Causes of Acute Abdominal Pain in the Healthy, Exclusive of Traumatism.-J. Lynn Thomas states that unbilical or circum-umbilical pain is a common sign of grave abdominal lesions in any locality. He attaches little significance to the absence of hepatic dulness. Of more importance is the degree and continuity of rigidity of the abdominal muscles under prolonged examination with the patient's thoughts diverted. frequency and condition of the pulse are of considerable value in estimating the gravity of the patient's illness. Temperature is a factor of questionable value in forming an opinion as to the necessity of surgical interference. Vomiting is one of the least significant symptoms, from a purely surgical standpoint. The writer concludes by reviewing cases of gallstone, thrombosis of the superior mesenteric veins, extrauterine pregnancy, and gastric ulcer.

Influenzal Orchitis.-R. Clement Lucas reports three cases. The first case was that of a married man who had a severe inflammation, attacking each testicle in succession, following upon an attack of influenza. The other two cases were in boys, one aged eight, and the other three and a half years. These three cases occurred within a few weeks during the severe autumn epidemic, and suggested the idea that, perhaps, in certain epidemics the tendency to testicular complications may be more common than in others. The acute inflammation which occurred in the younger boy's case closely resembled the acute inflammation, with redness and oedema of the scrotum noticed in the case of the man. It was an acute inflammation of both the body and epididymis of the left testis, extending through to the scrotum, causing oedema and redness of the superficial tissues. From these cases it is concluded that: Inflammations of the testes may occur as the result of influenza following close upon the fever; and that after one testis has recovered the second may be attacked. When there is an epidemic of influenza in the neighborhood, sporadic cases of orchitis probably occur as the result of the influenza organism, though it may be difficult to trace the relation of the orchitis to the preceding infection.

Münchener medicinische Wochenschrift, July 14, 1903.

Koplik's Spots in the Early Diagnosis of Measles.— Aronheim, during a recent epidemic, saw at least 150 cases before the eruption had appeared. Careful examination was made for the presence of Koplik's spots, but in only nine were they found. From this it would appear that they do not occur in anything like the proportion of cases as has been supposed, and that their value in the early diagnosis of measles has been very much over-estimated.

Protection of the Healthy Skin During the Application of the Röntgen Rays.-G. Holzknecht and R. Grünfeld have devised a protective covering for the skin for use during the application of the Röntgen rays. It consists of a sheet of tin which is covered on both sides with a thin layer of hard rubber. The plate thus made may be of any size and shape desired and perforated by as many apertures as wished. It is very flexible and may be easily adapted to the various curvatures, etc., of the body. It is light and easy to handle, and may be sterilized, washed, or heated without damage. Its extended use shows that it affords a complete protection to the healthy skin from the burning and other annoyances which frequently attend the use of the application of the Röntgen rays.

Aortic Regurgitation Following Traumatism.-Th. Struppler reports a case in which an aortic regurgitation first developed four months after a severe traumatism (crushing) of the breast. It seems certain that the cardiac lesion was due to the traumatism, since previous examination had shown none to be present, and at no time had the patient suffered with any condition which might act as an etiological factor in the development of the insufficiency. The especial peculiarity of the case consists in the low tone and variable intensity of the murmur. As a rule, traumatic lesions of the aortic valves give rise to loud and constant murmurs. This, however, is not always the case, since in this patient the murmur on different days was very variable, on some being very loud, and on others scarcely appreciable, so that if auscultation were practised on the latter the heart would, in all probability, have been pronounced sound.

Deutsche medicinische Wochenschrift, July 9, 1903.

Active Immunization against Pest by Means of Non-virulent Cultures.-W. Kolle and R. Otto say that experimentally in animals much more complete and permanent immunity against pest is obtained by the inoculation of non-virulent cultures of pest bacilli than by the products of virulent cultures which have hitherto been used for this purpose. The inoculation of rats and guinea-pigs, by the authors, with such non-virulent cultures produced a complete immunity in 80 per cent. of the former and 60 per cent. of the latter animals. Furthermore this immunity was still present three months after the inoculations. For this purpose only one inoculation was practised in each animal. As will be seen, these results much excel those obtained by Haffkine and others from inoculation with the products of virulent cultures.

Antitoxin Treatment of Diphtheria.-W. Pulawski has treated many hundreds of cases with antitoxin with a marked reduction in mortality over all other forms of treatment. All of the fatal cases had laryngeal complications, and many also showed affections of the trachea, bronchi, or lungs. Laryngeal cases were treated successfully with great regularity, unless they first came under treatment at too late a period of the disease. Purely tonsillar cases usually run an abortive course if the inoculations are given early in the course of the disease. In none of the cases were any of the so-called antitoxin rashes observed, nor did any complications of a serous nature develop. There were no local infections at the site of the inoculations. As a rule, the most prompt results were obtained in those cases in which, in addition to the antitoxin, the ordinary medical and surgical measures, when indicated, were also used. The mortality for the laryngeal cases was 12.7 per cent.

Berliner klinische Wochenschrift, July 13, 1903. Treatment of Hay-fever with Dunbar's Antitoxin.Robert Immerwahr has been a sufferer with hay-fever for twenty years, and has tried the usual methods of treatment with ill success. He has recently used Dunbar's antitoxin, but did not obtain any appreciable relief therefrom. During a portion of the time that he used it the symptoms were somewhat improved, but this was during rainy and cloudy weather and without any treatment the symptoms are lessened under such conditions. It is probable that if he had remained indoors during the treatment the results would have been better, but he was forced to be continually out of doors. The direct application of the antitoxin is difficult of application and for many reasons unsatisfactory, and it is to be hoped that its subcutaneous use will soon be perfected.