provement in the general symptoms. No bad effects developed as the result of the administration of the antitoxin. Should the results in these cases prove to be consistently repeated in others, the author believes that to Dr. Wolf belongs the credit of having discovered the remedy for one of the most fatal diseases, and of having evolved a plan of treatment not second in its effects to the antitoxin treatment of diphtheria.-Medical Record, March 11th, 1905.

Radical Operation for the Removal of a Bullet Weighing 70 Grains, Embedded in the Internal Wall of the Middle Ear, with Decided Improvement in the Subjective Symptoms.-M. D. Ledermann describes a case which illustrates the remarkable resisting powers of the negro skull. The patient was a colored woman, who presented herself with the statement that three years before she had been shot in the left side of the head with. a 32-calibre revolver, held six inches from the skull. The bullet entered immediately above the tragus. Following the injury she was unconscious for three or four weeks, and since that time she suffered from deafness, vertigo and facial palsy. Examination after removal of a meatal polyp, revealed the bullet so firmly embedded in the internal wall of the middle ear that it could not be stirred. On performing the radical mastoid operation, it was found impossible to lift the bullet from its bed and it had to be chiselled away in shavings: The patient made a good recovery, attended by great improvement in the vertigo, deafness and facial palsy.-Medical Record, March 11th, 1905.

Voluntary Iris.-J. W. Sherer, Kansas City, Mo. (Journal A. M. A., May 6), reports a case of this rather rare condition. It was first noticed at the age of 9 when the child developed the power of voluntary rotating the eyeballs independently. After that it became a matter of common observation that the iris could be dilated at will, almost to the disappearing point. At puberty the right iris was for awhile twice the size of the other, but later they became equal again. The power to simulate convergent strabismus is possessed by the woman to a remarkable degree. Vigorous exercise of the iris movements seem to cause slight aching of the eyes, but no other inconvenient symptoms are reported.

X-ray Treatment of Cancer. The microscopic changes in the tissue, says E. G. Williams, of Richinond, Va., (Journal A. M. A.,; May 6), should be our guide as to the theraupetic possibilities in: the X-ray treatment of malignant growths. It is evident, he states, that the elements of the tissues are affected according to their vitality. Dead organic matter is unaffected, and the more active: the growth the greater the effect. Next to this is the accessibility: of the tissues to the rays. Hence the better results with superficial or skin cancers. That moderately deep tissues can be affected is

shown by experience, and the way to reach them without producing necrosis of overlying tissues is to lengthen the distance of the tube and the time of exposure. For deep growths, radical surgical measures should be recoinmended, as the patient should be given the benefit of the probability rather than the possibility of good results. In such cases, however, operation might be rationally followed by X-ray treatment to destroy what may remain of the malignant growth. Inoperable cases should be treated by the X-ray because remarkable results have been obtained and the most distressing symptom of pain relieved.

The Fear of Death.-J. Leonard Corning, New York (Journal A. M. A., May 6), discusses the morbid exaggeration of the fear of death, which he considers due to a neuropathic basis inherited or acquired. In animals the fear of death is dependent on its imminence; in man it is sometimes a permanent obsession, but it is even then usually absent in the actual process of dying, the dulling of consciousness at that time and other dominating physical conditions accounting for this fact. He reports a case illustrating what he considers the essential psychology of the morbid dread of death, in this case even exciting suicidal impulses-death to escape death. In treating this condition he would suggest the thought that sleep is a sort of death, and unconsciousness whether lasting or not, a boon. His treatment was to prevent sleep until it was sought imperatively, and was based on the theory of proving experimentally that the temporary unconsciousness of sleep is the remedy for curable shortcomings and convincing the reason that the more lasting unconsciousness of death is only the supreme antidote of the irremediable breakdown of the organism, and therefore supremely benevolent in its essential nature.

Treatment of Gonorrrheal Arthritis by Hyperemia.-Johannes von Tiling, Poughkeepsie, N. Y. (Journal A. M. A., April 29), has secured excellent results from Bier's method of damming back the circulation with elastic bands in several painful cases of gonorrheal arthritis. He advises the use of a thin, pliant rubber bandage, applied so as not to cause discomfort, but sufficient to produce very perceptible hyperemia. Blueness and coldness of the limb, white or vermilion spots and pain or paresthesia indicate that the bandage is too tight and should be loosened. Properly applied, the most marked first effect is relief of pain, but this is not all; damming, he claims, has a bactericidal effect, and dissolves away the adhesions which are completely removed by massage after the removal of the bandage. At first the bandaging should be of short duration, a few hours at a time, but later it should be increased until it reaches ten hours a day and ten hours at night. After removal of the bandage, massage lightly, then have the patient stand and move the joints. He claims that this method gives better results in most cases of gonorrheal arthritis tending to stiffness of the joints than any other.

Journal of Medicine and Surgery

Address all Communications, Correspondence, Books, Matter Regarding Advertising, and make all Cheques, Drafts and Post-office Orders payable to "The Canadian Journal of Medicine and Surgery," 145 College St., Toronto, Canada. Doctors will confer a favor by sending news, reports and papers of interest from any section of the country. Individual experience and theories are also solicited. Contributors must kindly remember that all papers, reports, correspon. dence, etc., must be in our hands by the fifteenth of the month previous to publication.

Advertisements, to insure insertion in the issue of any month. should be sent not later than the tenth of the preceding month. London, Eng. Representative, W. Hamilton Miln, 8 Bouverie Street, E. C. Agents for Germany Saarbach's News Exchange, Mainz, Germany.

TORONTO, JUNE, 1905.

Editorials.

DIVERGENT OPINIONS ON MATTERS RELATING TO
SMALLPOX INFECTION.

FROM the reports presented by Dr. Bell, Inspector of the Ontario Board of Health, at the second quarterly meeting of that board, it appears that many people living in the northern section of this province are in no great fear of smallpox. In fact, some of them

are more afraid of the methods adopted to prevent its spread than they are of the disease itself. For instance, in one municipality, the placard placed by the Board of Health on the door of an infected house was removed, on the plea that it might prevent people coming to the town. In another village, a man who kept a bakery sickened with smallpox; but continued to attend to his shop until compelled to take to bed. His wife nursed him in a room over the shop, and also waited on customers in the shop. No placard was put up. On visiting the patient, Dr. Bell found a fully developed case of smallpox. Another odd circumstance was recorded: A schoolmistress and a number of her pupils caught the infection, yet no isolation was practised. In another instance the inspector visted a man reported to have smallpox, and learned that the patient was working out of doors. The inspector interviewed the patient and, on asking him if he was not ill, was informed that "he had been ill, but was now better." At the time of the interview, this patient's face was covered with scabs from which pus was exuding. There may be something in the make-up of such people, causing them to scorn any ailment which does not threaten them with death. Besides, a physician accustomed to old-fashioned smallpox would say that these patients were not very ill. The disease they had was, doubtless, smallpox, but it was not dangerous to life. In fact, Dr. Bell admitted that the smallpox which prevailed in Northern Ontario was not dangerous to life, and that, during the past winter, he had witnessed but one severe case of the disease.

The anomaly of the matter is smallpox, one of the most dreaded diseases with which preventive medicine has to deal, is, and for several years back has been, peculiarly mild in Canada. Deaths are few, the mortality rarely exceeding over half of one per cent. of the cases. The Sanitary Inspector is, however, called upon to prevent its spread, and in doing so, he puts in motion the machinery required by law for the most formidable type of the disease. People who have been caught in the meshes of the epidemic, either as patients or suspects, endeavor for various reasons to conceal their misfortunes; municipalities with a few cases try to hush up the bad news lest the town should get an evil name. An impartial bystander would probably say, that the people living in the districts where the epidemic prevails are indifferent to what is one of the most disgusting of diseases. On the other hand, in view of its small mortality and the great private and public expense

caused by it, he might pronounce the hygienists too zealous, too much after the type of the man who used a trip-hammer to kill a fly. Another smallpox question, upon which divergent opinions prevail between physicians themselves, is the relation of smallpox hospitals to the surrounding community. Some physicians have asserted that the isolated position usually chosen for smallpox hospitals is uncalled for, and that this disease is not carried to any distance by the wind. A totally different opinion is expressed by the author of Parke's Practical Hygiene, published in 1902, who writes: "The exceptional incidence of smallpox, in the immediate neighborhood of some of the London smallpox hospitals in which were formerly treated during epidemic periods large numbers of cases, can admit of but one explanation, viz., that when a sufficient number of cases in the acute stages are collected together in one building on a small area of ground, the hospital becomes a centre of infection to the surrounding neighborhood."

site

An English Local Government Board circular, on "The Provision of Isolation Hospital Accommodation by Local Authorities," has, with a view to lessening the risks of infection from smallpox hospitals, laid down the rule that a local authority should not contemplate the erection of a smallpox hospital, first, on any where it would have within a quarter of a mile of it as a centre either a hospital, whether for infectious diseases or not, or a work-. house, or any similar establishment, or a population of 150 to 200 persons; and secondly, on any site where it would have within half a mile of it, as a centre, a population of 500 to 600 persons, whether in one or more institutions, or in dwelling-houses. Cases in which there is any considerable collection of inhabitants just beyond the half-mile zone should, says the circular, "always call for especial consideration."

This circular is, of course, founded on the theory of the aerial conversion of smallpox to a distance, in support of which many convincing facts can be adduced. Per contra, it is contended, that the incomings and outgoings of the staff, the calls of tradesmen and friends of the patients, and the bringing of the patients to the hospitals are all dangers which of necessity become intensified as the centre is approached, and may in themselves account for the circumstance that smallpox infection prevails more abundantly in the vicinity of a smallpox hospital.

We have not seen any Canadian evidence to substantiate the view that smallpox is conveyed considerable distances by the