ordered nerves and heart an opportunity to recover themselves. To this end a large quantity of normal saline solution should be administered at once. Get it into the circulating medium as rapidly as possible, no matter which method you pursue (intravenous, subcutaneous, or by enema). This solution, bathing the corpuscles, as it were, prevents their running into rouleaux, facilitates osmosis, and assists in carrying away excrementitious matter; it increases the solubility of the proteids, promotes free secretion of urine, and directly stimulates the muscular walls of the heart. Hypodermoclysis in all prostrations of lowered blood vitality is proven of undoubted utility; then why not here? Dilate the arterioles by the use of nitroglycerin, by mouth if patient can swallow, or, preferably, hypodermically, thus lowering arterial tension and redistributing to the kidneys their blood supply cut off by the degeneration of the renal ganglionic centers; the capillaries of the skin are dilated, more blood is sent to the surface, and a reduction of temperature follows. Administer calomel, followed by large doses of phosphate of sodium, every hour, to free evacuation of the bowels. Other local measures will suggest themselves. On the recovery of the patient, any manifestation of malaria from a reinfection can then be treated with quinin. It is urged that the malarial parasite, being a protozoon, does not generate toxin. If this is so, what then precipitates an attack of hemoglobinuria through the destruction of the red blood corpuscles? If this destruction is produced by the sporulation, segmentation and rupture of the corpuscles by the microorganisms, then why should hemoglobinuria not be the result of each malarial paroxysm? We arrive at conclusions through the careful balancing of facts, and to deny the existence of a thing because we know not of it is preposterous. The results of chemical combinations and changes in a test tube, as compared with the complex mechanism of nature's laboratory, are a different proposition. Empirical therapeutics are ever obvious, and until that point of development through evolution has been reached wherein the human form shall have attained that degree of perfection, that pinnacle of a perfect being, beyond the pale and grasp of the human mind, it will ever be the basis and support of our knowledge. I can only hope, if I cannot myself make the practical discovery of the malarial antitoxin, to at least see the time when some student of medicine shall expound it to the world. PROGRESS OF MEDICINE. MEDICINE. UNDER CHARGE OF B. F. TURNER, M.D. The Causes and Varieties of Chronic Interstitial Pancreatitis. E. L. Opie (Amer. Jour. Med. Sc., vol. 123, no. 5) says: 1. Chronic interstitial pancreatitis is slightly more frequent in males than in females. Two-thirds of the total number of cases occur between the ages of forty and sixty years. 2. The most frequent cause of chronic pancreatitis is obstruction of the duct of Wirsung, due to pancreatic calculi, to biliary calculi in the terminal part of the common bile duct, or to carcinoma invading the head or body of the gland. Duct obstruction may be followed by the invasion of bacteria, which take part in the production of the resulting lesion. 3. Ascending infection of the unobstructed duet of Wirsung may follow an acute lesion of the duodenum or of the bile passages, and may cause chronic inflammation. In cases which have given a history of long, persistent vomiting, chronic diffuse pancreatitis may be found at autopsy, and is probably the result of an ascending infection of the gland. 4. General or local tuberculosis is occasionally accompanied by chronic diffuse pancreatitis, affecting chiefly the interstitial tissue of the gland. 5. Chronic interstitial pancreatitis is not infrequently dependent upon the same etiological factors, notably alcohol, which produce cirrhosis of the liver, and in about one-fourth of the cases the two lesions are associated. 6. Following duct obstruction and ascending infection the lesion affects principally the interlobular tissue, only secondarily invading the lobular tissue and sparing the islands of Langerhans. Diabetes results only when the lesion is far advanced. 7. Accompanying the so-called atrophic or Laennec's cirrhosis of the liver, the pancreas is at times the seat of a diffuse chronic inflammation, characterized by diffuse proliferation of the interacinar tissue, which invades the islands of Langerhans. A similar lesion accompanies hyaline degeneration of the islands of Langerhaus and the condition known as hemochromatosis. 8. Interacinar pancreatitis is usually accompanied by diabetes mellitus. When diabetes is absent the lesion is of such slight intensity that the islands of Langerhans are little implicated. Etiology of Paresis. A. W. Hurd (Med. News, vol. 80, no. 20) says: 1. Syphilis is the most common factor in the production of paresis. 2. It may cause it directly-an exciting cause. 3. It may cause it indirectly by bringing about such a devitalization of the system generally as to render other influences operative-a predisposing cause. 4. It is not usually the sole cause, but there is associated with it the deleterious effect of mental stress and over-excitement, dissipation and alcoholism, and heredity. 5. In a certain relatively small number of cases mental stress, worry or overwork may be the sole ascertainable cause. 6. Traumatism may also be the cause in a still smaller proportion of cases, but in many of them it acts as a developing or ripening agent of an incipient paresis in a syphilitic subject. The Intercommunicability of Human and Bovine Tuberculosis. M. P. Ravenel (Univ. of Pa. Med. Bul., vol. 15, no. 3) concludes an interesting paper thusly: The evidence at hand forces us to conclude that human and bovine tuberculosis are but slightly different manifestations of one and the same disease, and that they are intercommunicable. Bovine tuberculosis is, therefore, a menace to human health. We are not in a position at present to define positively the extent of this danger, but that it really exists canVOL. XXII -23 not be denied. In the past there has probably been a tendency to exaggeration, but however great this may have been it does not now justify any attempt at belittling the risk, and it is folly to blind ourselves to it. The eradication of bovine tuberculosis is amply justifiable from a purely economical standpoint; viewed in its bearing on human health it becomes a public duty. A New Study of Mitral Obstruction. T. E. Satterthwaite (N. Y. Med. Jour., vol. 75, no. 19) makes an interesting study of this subject, and reports a number of illustrative cases. He notes the following points: 1. Mitral obstruction is usually fatal before the age of forty is reached. 2. Females are a little more prone to it than males. 3. There is apt to be a marked contrast between a strong cardiac impulse and a feeble radial pulse. 4. The true presystolic murmur occurred in 15 per cent. of his cases. It comes and goes, but is usually inaudible in the last stage. 5. It is apt to have a loud rasping or sawing quality, but may be "gushing" or "whirring." It may also be faint or inaudible. 6. In about 40 per cent. there is some sort of diastolic mur mur. 7. These murmurs are best heard over a rather limited area. somewhat oval in form, having for its center an area between the fourth left space, inside the nipple and the apex, and extending an inch or so to the right or the left. Occasionally this murmur is heard best as low as the fifth, sixth or even seventh left space; more rarely is it heard as high as the second left rib. 8. In 10 to 35 per cent. there was a thrill over this area. 9. The first sound at the apex is short and abrupt. 10. The second pulmonary sound at the base is usually intensified. 11. Occasionally a murmur with the second sound at the base is heard over the left auricular appendix. 12. At first there is hypertrophy of the left ventricle. Then atrophy of it, with hypertrophy of the left auricle; then follow dilatation and hypertrophy of the right heart. 13. Mitral insufficiency must to some extent accompany mitral obstruction. 14. In distinguishing the presystolic murmur of mitral obstruction from the Flint murmur of aortic insufficiency, we should rely on the "long heart" and the strong impulse, or the " Corrigan" of insufficiency, rather than auscultatory signs. In case there is both aortic insufficiency and mitral obstruction a differential diagnosis is impossible, with the means we have now at our command. SURGERY. UNDER CHARGE of W. B. ROGERS, M.D. Professor of the Principles and Practice of Surgery and Clinical Surgery, Medical vs. Surgical Treatment of Cancer of the Stomach. At the recent session of the German Congress for Surgery, Krönlein (Med. Press and Cir., vol. 73, no. 3287) compared the medical treatment of cancer of the stomach with that by operation. Since the hopes raised twenty-two years ago by Billroth's first successful resection of cancer of the stomach, opinions were now again gradually becoming pessimistic. Even among surgeons there were doubts. He had thought therefore that an inquiry and a balancing of the results would be useful. Was operation curative or palliative? Could life be prolonged if not saved, or only made bearable for a time? He had collected notes of 264 cases, of which 195 had been operated on, whilst 69 were not operated on, 54 because operation was not admissible, 14 because they declined to submit to it. Exploratory laparotomy was performed in 71 cases with 7 deaths; gastro-enterostomy in 74 cases with 18 deaths, and gastrectomy in 60 cases with 14 deaths; total deaths 39, equal 19.4 per cent. As regarded permanent results, he had failed to obtain information only as to 4 per cent. of the cases. The average duration of time between the first appearance of symptoms and admission to the hospital was nine months. If |