supply of fruit in the tropics, had put it where it was useless! This is not so. Good, ripe fruit in a hot climate is healthful. Of all the varieties the banana is the most useful. This can support life of itself. The fruit must be in good condition because tainted fruit or decayed fruit would induce diarrhea, and diarrhea must be avoided.

Taken altogether the medical officers of our various armies have a grand opportunity to make studies of the various conditions existing in the West Indies and in the Philippines. If the United States retains any of these places, such knowledge will be of inestimable value. There will be likely to be an efflux of emigrants from the United States when the war is over, and at any rate we will be obliged to have troops stationed at the various colonies. In either case a knowledge of the climatology and of the diseases of our new territory will be essential.

Lumbar Pain is to be Differentiated From-1. Lumbago; 2. Disease of the vertebræ; 3. Disease of the kidneys; 4. Abdominal aneurism. In lumbago muscular effort is painful; the patient finds it difficult to stand erect, and even impossible to stoop forward. The onset is often sudden and it is uninfluenced by either emotion or menstruation. The clinical history in disease of the vertebræ is important; that of traumatism and constitutional bias is seldom absent. There is usually tenderness upon pressure over the affected part, and other local evidences of deformity and disease are rarely wanting. When kidney disease is suspected the only safe guide is a careful examination of the urine. Abdominal aneurism is a disease of middle life, and occurs more often in males. The physical signs of aneurism are rarely wanting.-Ibid.

Notes and Comments.

Army Appointments.-Offers for medical service in the army during the present war have become so numerous that the SurgeonGeneral has been obliged to issue a circular letter of reply. This letter states that: "No appointments are made in the regular army except after examination by an Army Medical Examining Board, and all applicants must be graduates in medicine, and less than twenty-nine years of age."

"The Surgeon-General of the army has nothing to do with the appointment of medical officers for the volunteer army.

"No female nurses will be sent to Cuba or to hospitals on the Gulf Coast."

All officers of the volunteer army are appointed by the governors. In New York, Governor Black has appointed an examining board, consisting of one old school physician, one homeopathic physician, and the army surgeon delegated to the State, to pass on the professional qualifications of all candidates for medical commissions. This board has approved of at least one and possibly more homoeopathic applicants.

Sanitary Precautions.-The health officer of an English town has suggested that certificates be issued to lodging-house keepers to certify to the sanitary condition of their rooms. This is an idea that might be adopted with advantage in other places. Especially is this true of summer and health resorts. The writer has known death to occur in a room in a summer hotel, and within two hours has seen the body removed and a new boarder put in the room in its place. The only change made was clean sheets. Boarding houses and hotels in resorts for consumptives rarely fumigate their rooms. Today a room may hold a patient in the last stages of the disease; tomorrow it may hold a person perfectly well. To be sure, authentic cases of contagion in this particular disease are rare. Nevertheless, cleanliness is of some value, and contagion may occur.

The Proper Proportion of Doctors.-The people of Buenos Ayres have the right idea! Now that the proportion of doctors is one to each thousand of inhabitants, it is proposed to close all the medical schools for five years. The medical licensing boards of this country do not compare in efficiency in protecting the dear public.

Not a Science. According to the British Medical Journal it was recently proposed by the Belgian authorities to establish a chair of Homoeopathy at the University of Munich. The question was referred to the University, but the proposed chair was declined on the ground that Homoeopathy was not a science. This is another in

stance of the fact that much learning does not of necessity mean a broad mind.

The Placing-Out Bill.--What to do with orphaned and homeless children is one of the serious questions of civilization. Orphan asylums are advocated by some, placing children with private families is advocated by others. Both systems have led to many abuses. Provided good homes can be found, the placing-out system is by far the preferable one. But it has been found unwise to farm out children without some authoritative supervision. With this fact in view the new Placing-out bill of New York State provides that no person or corporation can place out or receive a "destitute child" without a license from the State Board of Charities. Such license may be revoked at cause. This bill commends itself to the NORTH AMERICAN,

Measles. The London Lancet, in a recent issue, speaks of a severe epidemic of measles now in progress in and about London. For several weeks the mortality from measles has equalled the combined mortality of scarlet fever, diphtheria, and whooping-cough. The Lancet believes the epidemic to be largely due to a failure of the authorities to recognize its serious character and take prompt measures by closing the schools.

We sometimes have the same trouble in this country. Measles is unfortunately considered an innocuous disease by the lay public. There are many persons, especially in country districts, who believe that measles must come sooner or later, and so, when a case occurs in the vicinage, expose their children to it that the disease may be contracted. These person also believe that one attack is all that one patient can have. This is not so. Many persons have more than one attack.

Measles cannot originate de nova, it must be gotten from some preceding case. With proper quarantine, and with proper disinfection there is no reason why the disease could not be eventually stamped out. This can never take place until the public learns that measles is not a trivial ailment. Not only is the death-rate from measles itself considerable, but its effects on the patient are often far-reaching and may shorten life indirectly. When this is more generally understood fewer cases will be allowed to run their course without medical attendance, fewer secondary cases will occur-crgo, the sum total of cases will diminish.

The NORTH AMERICAN looks forward to the time when all contagious diseases will have ceased to exist. The present inhabitants of the world may not live to see that time, but it will surely come.

Malaria. In an exhaustive paper on Malaria, as a cause of other diseases, Dr. Rupert Norton ("American Journal of the Medical Sciences," 1898), closes his argument as follows:

In making a short review of what has gone before, there are several deductions which can be drawn: first and foremost, that malaria is not the cause of

so many evils as are attributed to it: secondly, that its favorite seats of attack after the blood and blood-making organs are the gastro-intestinal and the central nervous systems, and that other organs or systems are but rarely affected; thirdly, and not least important, that the cases supposed to be malaria should in the future be more carefully studied, and that hereafter it should not be given as a cause of existing evils without sufficient and abundant proof. If the blood cannot be examined then only a full history of the case should be accepted in which the fever, spleen, and effects of treatment are carefully noted. I will close by a brief quotation from Laveran's work; he says: "This great frequency of accidents occurring in malaria has been much exaggerated; some observers have come to attribute numberless complications to it, and in the diseases of warm countries see, so to speak, only various types of malaria. Authors have described an ophthalmia, a urethritis, a rheumatism, all due to malaria. All diseases may be associated with malaria; the condition of anæmia and the feebleness which it rapidly brings about cause of themselves a true predisposition for certain affections like pneumonia and dysentery. The error of those who attribute to malaria all the maladies which may complicate it, or even the greater number of those which have been observed in malarious countries, is certainly not small." This is as true now as when written in 1884, and does not speak well for the profession at large. The mistakes occur in all countries, but it is time their number was growing less rather than more.

Book Reviews.

The Diseases of the Stomach. By William W. Van Valzah, A.M., M.D. Professor of General Medicine and Diseases of the Digestive System in the New York Polyclinic School, and J, Douglas Nisbet, A.B., M.D. Illustrated W. B. Saunders, 925 Walnut St., Philadelphia. pp. 674, $3.50.

This book will be found above all a practical one. Although constituting a valuable contribution to scientific medicine, it is intended primarily as a working guide for the student and practicing physician. To this end the chief attention is devoted to the most approved methods of diagnosis and treatment. Space is not wasted by an extended discourse on anatomy nor by a theoretical discussion of general pathology; but beginning with a classificatory introduction, a chapter is devoted to diagnosis and diagnostic methods and one to general medication and treatment. After this the various diseases are taken up in order and treated in a logical way, beginning with etiology, and passing through the phases of pathology, clinical description, diagnosis, differential diagnosis, prognosis and treat

ment.

The methods of examination given and the apparatus recommended, while sufficient for special advanced stomach-work, are not too elaborate and complicated for the general practitioner. Indeed, the needs of the practicing physician are kept constantly in mind throughout the book.

There is an unusually complete and detailed presentation of the important subject of dietetics. The nutritive value of the various foods is fully discussed together with their special application in dis

eased conditions of the stomach. The diet lists for each disease are extremely full, and are so arranged that selections can readily be made to suit individual cases.

Diseases of the Stomach. A Text-Book for Practitioners and Students. By Max Einhorn, M.D., Instructor in Clinical Medicine at the New York PostGraduate Medical School and Hospital; Visiting Physician to the German Dispensary. Second Revised Edition, 1898. 502 pages. Price, cloth, $3.25, net. New York, William Wood and Company.

It is only of late years that the diseases of the stomach have been thoroughly studied, yet more progress has been made in this field. than in any other branch of internal medicine.

Dr. Max Einhorn's book is the first original work published in America which treats of this important subject, and as such it must fill a long-felt want. The new methods of diagnosis, which have made great advances of late, are here thoroughly and concisely described.

In discussing the different diseases of the stomach and their classification, the author shows great originality and has successfully endeavored to make the differential diagnosis as clear as possible.

The treatment and diet are fully given for each particular disease, and diet-lists stating the quantity of foods are often appended.

The book contains numerous original drawings of apparatus and microscopical specimens, thus greatly facilitating the conception of the text.

For every physician wishing to keep pace with the progress of the times the present book must be a welcome acquisition.

An American Text-Book of Genito-Urinary Diseases, Syphilis, and Diseases of the Skin. Edited by L. Bolton Bangs, M.D., consulting surgeon to St. Luke's Hospital, etc., etc., and W. A. Hardaway, A.M., M.D. Illustrated with 300 engravings and 20 full-page colored plates. W. B. Saunders, Philadelphia, 925 Walnut St., 1898. $7.00, cloth; $8.00, sheep; pp. 1,229. This fine volume is the joint product of many eminent medical writers and teachers, and may be justly said to be fully representative of the several departments of medical science with which it is concerned. By the division of labor as illustrated in this book, thoroughness, accuracy and the results of a mature experience are all attained. Special attention has been paid to diagnosis and treatment, and it is this feature of the volume that will render it of the greatest practical utility to the student and general practitioner.

It very often happens that works of much merit are marred by bad arrangement of contents, but in this text-book the convenience of arrangement for reference and consultation is notable. The illustrations are numerous and generally of a high order of merit. Many of them are original, being taken from the private collection of the authors. A careful and judicious condensation has enabled the authors to cover an extremely wide range of topics and present to the profession a modern one-volume treatise that completely covers the ground. It is one of the best of the American text-book series.