THE FIGHT AGAINST TUBERCULOSIS The antituberculosis war is raging, and the desire to prevent the disease is attracting attention all over the country. Minneapolis is doing her share through the antituberculosis department of the Associated Charities. The publicity department has been allotted space in all of the daily papers, and articles are presented in at short and interesting manner to attract attention. A campaign of education has been established all over the city, lectures, notices by the clergy. and circulars being the means of education. Thirty thousand circulars are being distributed by mail. These circulars contain simple direct statements with a few suggestions as to the prevention of tuberculosis. Colors are employed to attract the reader, and his co-operation is kindly urged.

The actual care of the tubercular cases is done by nurses employed by the Associated Charities, and physicians are in readiness at any time. Of course the whole effort is to educate the people, in order that they may understand the necessity of prevention of the disease. It is appalling to note the ignorance and filthiness of the consumptive, but it is gratifying to know that suggestions are adopted as well as respected. The work of the Associated Charities through its various operators and its committees will surely accomplish wonders.

The campaign of education is not solely among

instruction as well. The latter are called upon to aid the committees by their financial support. As yet no vast amount of enthusiasm has been encountered, but the rich will be gradually educated in giving, and eventually we may have a farm or a sanatorium for consumptives.

The general committee meets once a month, and the various needs are discussed. The subcommittees meet weekly, and carry on the work. The nurses' committee, composed of women, is active and energetic, the "gospel of prevention" is gaining converts, and results are already reported.

If you, kind reader, will do your share in educating your patients to spit only in proper receptacles, and urge some of your friends to contribute money for necessities, you will also be enrolled on the great committee.

THE ANNUAL MEETING OF THE HENNEPIN COUNTY MEDICAL SOCIETY Dr. J. Clarence Webster, of Chicago, will deliver the address at the annual meeting of the Hennepin County Society on the evening of May 1st.

His subject will be "Pelvic Disturbances as a Factor in Reflex Disorders," and will be ably handled, as Dr. Webster is professor of gynecology at Rush Medical College.

The meeting will take place, as usual, in the large dining-room of the West Hotel, as it is the only room large enough to properly accommodate the annual meeting. A banquet will precede the address, and a smoker will follow. The mayor and others will attempt to speak, if time permits.

The annual meeting is always enjoyable, for it brings out the full force of the society, and renews acquaintances and promotes good fellowship.

Applications for tickets may be made to the secretary, Dr. F. A. Knights, at his office in the Masonic Temple.

Every member is urged to communicate with the secretary as early as possible, in order that the committee may know how many to expect and provide for.

THE PORTLAND MEETING OF THE
A. M. A.

The meeting of the American Medical Association in Portland, Oregon, July 10th to 14th, promises well. The month is an ideal time for a vacation, and the trip will be an education for many who have never been into the great mountain regions. The Northern Pacific Railway offers an unusually attractive program, and its train service is incomparable. For a very modest sum the medical man will be carried on a special train to Livingston, Mont., and from there he may go through the Yellowstone Park, one of the two wonders of America. The trip through the Park will last five and one-half days, thus assuring sufficient time to see all of the wonders of that most wonderful region.

The train service is prompt, and, with the break at Livingston, the trip to Portland will not seem long. Stops of a few hours will be made at Spokane, Seattle, and Tacoma, thus breaking the journey in pleasant sections at pleasing places.

The program at Portland will be an interesting one, and the Easterner and Middle-West man will have an opportunity to meet his Western brother. Incidentally you may acquire a farm somewhere in the West, to which you may retire after active practice becomes a burden. To one who has never been in the far West, the opportunity is great; to those who have been there, this opportunity presents many attractions. It would seem best, under the circumstances, to write ahead and secure rooms for the week of July 10th.

EPIDEMIC OF CEREBROSPINAL MENINGITIS

The present epidemic of spotted fever in various parts of the country emphasizes the uncertainty of the virulence of any infectious disease. The past history of smallpox demonstrates how epidemics may be mild for a time,for years perhaps, and then assume a more active type with a high grade of mortality.

To the unread it would seem as if the epidemic of cerebrospinal meningitis had suddenly broken out, but as a matter of fact the disease is only more virulent than usual. This may depend

upon various causes, such as favorable means of spreading infection, bad hygienic surroundings, the influence of the seasons, and the activities of microbic diseases in general. The past year, like the year of 1892, has shown that certain diseases are more prevalent than usual, and is a strong argument in favor of being constantly prepared to combat epidemics of any kind.

In Prussia the epidemic is raging in various districts. In the Oppeln district 1,200 cases have occurred with about 50 per cent of fatalities. In some parts of Prussia it has been necessary to close the schools until the danger point of spreading is past.

New York City reports an unusually large number of cases, with many deaths. A few cases have appeared in Chicago, and a few also in the Mescalero Indian Reservation in New Mexico. The New York epidemic is under close observation, and every effort is being made to ascertain the means of transmission, and its prevention. A special commission has been appointed, and doubtless much valuable and reliable information will be obtained. Fulminant and apoplectiform cases have occurred in sufficient numbers to arouse the profession. The exciting agent is believed to be the meningo coccus intracellularis, discovered by Weichselbaum, in 1887, although the pneumococcus and streptococcus are found in some epidemics. In an epidemic that prevailed in Massachusetts in 1897, and which was reported by Councilman, Mallory, and Wright, the diplococcus intracellularis meningitidis was found to be the only cause. This confirms the findings of Weichselbaum, and particularly the work of Jäger, who first recognised this organism in an epidemic in Stuttgart.

Lumbar puncture seems to be the most satisfactory method of diagnosis aside from the clinical symptoms of meningitis. The mode of infection is still undetermined, but from recent accounts of cases in which physicians have become infected it is supposed that the infection gains an entrance through the nasal cavities, and their blood vessels and lymphatics, and thus are carried into the blood stream. Other diseases, however, may contribute in various ways, and it is probably from the distances between towns and cities that the infection may be carried by the air, personal contact, or by inanimate objects.

So far no reliable means of prevention other than strict segregation of cases has been discovered. Separation, isolation and fumigation are necessary, particularly as the epidemics occur in cold weather when people are more or less crowded together without sufficient fresh air and sunshine. The treatment of such epidemics is by stamping out the cases. A large number of deaths occur under the best form of treatment, hence many must be sacrificed by isolation to benefit the majority. The use of diphtheria antitoxin, from which so much was expected, has proven worthless. One case was trephined, and lived-perhaps as other cases live-by survival of the fittest. Cases are reported relieved and cured by repeated lumbar puncture.

During the last epidemic in Boston the patients were put through a thorough sweating process, which restored consciousness. Then followed a fast of forty-eight hours, during which time nothing is drunk except cold water, weak black tea, or weak lemonade. After this comes a cathartic, probably calomel or castor oil. This line of treatment seems rational, and offers the best suggestions. Drugs are useless as a rule. Eliminate through the skin, and intestinal tract, make the patient comfortable with morphine, and relieve the intracranial pressure by lumbar punc

tures.

THE LATE DR. SPRING'S ELECTRICAL APPARATUS

An advertisement in this issue of THE LANCET (in the news column) calls attention to the sale of all of the electrical appliances and office outfit of the late Dr. W. P. Spring. His office was conveniently located, and any one interested in -ray or electrotherapeutics or surgical work will find it an advantage to occupy the office as it now stands. Mrs. Spring is very anxious to dispose of all the office property, and will offer it for sale, either as a whole or she will dispose of the individual appliances. The price is so reasonable for the valuable books and instruments that some one will profit by it. Dr. Spring had all the new and modern methods for x-ray and electrotherapeutic work, as well as new devices in r-ray photography.

BOOK NOTICES

A TEXT-BOOK OF THE PRACTICE OF MEDICINE. For Students and Practitioners. By Hobart Amory Hare, M. D., B.Sc., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia; Physician to the Jefferson Medical College Hospital; Laureate of the Royal Academy of Medicine in Belgium and of the Medical Society of London. Author of A Text-Book of Practical Therapeutics; A Text-Book of Practical Diagnosis, etc. In one very handsome octavo volume of 1,120 pages, with 129 engravings and 10 full-page plates in colors and monochrome. Cloth, $5.00, net; leather, $6.00, net; holf morocco, $6.50, net. Lea Brothers & Co., Philadelphia and New York, 1905.

Every art and science has its voluminous writers, and, as a rule, they are a dangerous lot of padders. Dr. Hare is a notable exception. He knows how to write a book, and how to edit one that is written by another man, which is a rare accomplishment. In this work Dr. Hare brings. to his task the long experience of a successful teacher, and he gives us a one-volume text-book that is valuable both in and outside of the classroom. The prominence given diagnosis and treatment will also commend Dr. Hare's work, and the presence of illustrations, for illustrative, not show, purposes, adds much to the value of the work.

STUDIES IN THE PSYCHOLOGY OF SEX-Sexual Selection in Man. I, Touch. II. Smell. III, Hearing. IV, Vision. By Havelock Ellis. Pages xii-270. Extra cloth, $2.00, net. Sold only by subscription to Physicians, Lawyers, and Scientists. Philadelphia: F. A. Davis Company.

Dr. Ellis has given an immense amount of research to the work he is engaged in, and we are now informed that it will require five volumes to complete his task, although each volume is complete in itself. That such writing has great value no one will deny, and this is all the more evident when we examine the high standing of the men quoted in these volumes; yet we are inclined to believe that the greatest need is for a condensed volume containing the essential facts. gathered by Dr. Ellis, with his own conclusions

as to their use by the general practitioner. He deals with phenomena that are at the basis of man's happiness, at the foundation of society, and he deals wisely, in our opinion, with the modification above made.

That he is on very dangerous ground is shown by the fact that much of the matter recently condemned with great severity by a Minnesota federal court, came from one of Dr. Ellis' books; but Dr. Ellis never departs from the scientific line far enough to be in much danger.

NEWS ITEMS

Dr. J. A. McDougal, of Pine City, has gone to Colorado to practice.

Dr. Hans Johnson, who recently began practice at Spicer, has decided to locate in Murdock.

Dr. J. W. Andrist, of Ellendale, goes to Europe to visit the hospitals and do post-graduate work.

Dr. S. Douglas, of Park River, N. D., has been appointed pension medical examiner for that county.

Dr. O. H. Bakke, of Blooming Prairie, has moved to Minneapolis. Dr. Bakke is a graduate of Hamline.

Dr. R. I. Hubert, of St. Cloud, who has been in Minneapolis for treatment, has returned to his practice.

Dr. Roy M. Riggs has decided to move from Andover, S. D. This will leave Andover without a physician.

Dr. E. E. McStay, of Waterloo, Iowa, has accepted a position with Dr. R. S. Ramsey, of Grand Forks, N. D.

Dr. Adams Lyons, a graduate of Hamline, who is practicing at Pine City, has established a hospital at that place.

Dr. L. A. Brustad, of Park River, N. D., who has been doing post-graduate work in Chicago and New Orleans, has returned.

The $20,000 addition to St. Luke's Hospital at Aberdeen, S. D., was opened last month. It doubled the capacity of the hospital.

Dr. Jacob Kussart, of Park Rapids, has purchased the West Hotel property at that place, and he will fit it up for a hospital and sanitarium.

Dr. F. H. Hacking has given up practice at Granite Falls. He will spend some time at postgraduate work in Chicago, and then settle in Vancouver, B. C.

Dr. C. H. Hunter, of Minneapolis, has moved from the Syndicate block, where he has been many years, to 519 First Ave. So., next to the Minneapolis Club.

Dr. W. H. Twiford, of Owatonna, who has been in active practice considerably over 50 years, is recovering from a severe illness that gave his friends considerable alarm.

Dr. C. Q. Scoboria, who has practiced in Minnesota since 1883, much of the time at Elk River, has decided to move to North Yakima, Wash. Dr. Scoboria is a graduate of Harvard, and is a well equipped practitioner.

At the annual meeting of the Redwood and Brown County Medical Society, held early this month at Redwood Falls, the following were elected officers for this year: President, Dr. J. L. Adams, Morgan; vice-president, Dr. J. W. Wellcome, Jr., Sleepy Eye; secretary, Dr. W. A. Brand, Redwood Falls; treasurer, Dr. J. H. Vogel, New Ulm.

The citizens of Worthington held a very enthusiastic meeting on the 31st ult., to consider the building of a hospital. A building to cost $20,000 was talked of. One of the ministers suggested that in case of a deficit in running expenses the churches might have a "Hospital Sunday" each year, and take up a collection. The plan met with much favor.

OFFICE ROOM TO RENT TO PHYSICIANS.

Some very desirable rooms are offered to Minneapolis physicians and dentists on the remodelled second floor of the building at 519 First Ave. So., next to the Minneapolis Club.

HOUSE FOR SALE IN MINNEAPOLIS-GOOD LOCATION FOR PHYSICIAN

A modern house of II rooms, hardwood finish, and heated with hot water, in a very desirable location for a physician, will be sold at considerably less than its value, namely, for $5,000— $2,000 cash and balance on long time. Inquire of owner on premises, 116 East 27th St., Minneapolis.

FOR SALE VERY CHEAPLY

The very complete line of the best and latest electrical and r-ray apparatus and new books upon the subject, besides a line of surgical instruments, are for sale, as a whole or separately, by the estate of the late Dr. W. P. Spring. The offices occupied by him at 328 Nicollet Ave. are also for rent at a low price. Address E. K. Fairchild, 40 Minn. Loan and Trust Building, Minneapolis.

VOL. XXV

No. 9

We have six cases for our clinic this morning. Beginning with hernia, we have three right inguinal types in males. We shall operate on the congenital first.

CASE 1.-A. W, aged 5 years. The parents of this boy have tried to hold his hernia. in place by the aid of a truss. This is sometimes quite satisfactory, particularly if the truss is made as if the hernia were double, and great care is used to see that the rupture does not get away from the pad at any time. I have seen a few cases cured in young children, by the use of the truss alone, where the pressure was sufficient to cause inflammation and closure of the canal. In this case, we have a fat, wide, and short abdomen in a robust, active child, and his truss has been of much harm and discomfort since it permits the hernial sac to be filled, and simply squeezes its contents, making it tender and sore. The child was quite ready to have the operation made, when promised freedom from the truss.

We make the usual incision of the aponeurosis of the external oblique, and the hernia appears like the traditional third testicle, while the sac, with slight traction, brings out the right testicle from the scrotum. Our chief difficulty here is Our chief difficulty here is separating the tunic of the testicle from that of the hernia, tying and amputating the latter, avoiding the spermatic cord and vessels, and in passing and tightening the mattress sutures. We close the internal ring completely, like the Fowler operation, pushing the thin vas and vessels back of all sutures to emerge at right angles from the

Abstract of a clinic given before the senior class of the State University, at the Swedish Hospital, March 4, 1905.

A

external ring, now closed so as to gently constrict its contents. We use thirty-day chromatized No. 2 catgut for deep sutures, and No. I ten-day sterilized catgut for skin sutures. Dr. McArthur of Chicago splits a piece off each side of the aponeurotic incision for sutures, leaving one end attached above and the other below. guiding end of silk is tied to the fore end of each tendinous living animal suture, and he is enabled to satisfactorily close the hernia, approaching from each end of the incision of the aponeurosis, without any foreign suture material. CASE 2.-J. A., aged 46, laborer, single.

This case is of interest in showing the effect of the injection cure, which he took seven years ago. The method consisted of injecting a strong astringent alcoholic solution about the sac and into the pillars of the internal ring, keeping the hernia back by a closely fitting truss to be worn day and night. The patient thinks he was cured for a time, but now cannot control the hernia by any truss he is able to wear.

On deepening the incision, we find extensive tough fibrous adhesions to the sac, making it quite difficult to separate it from the hardened internal ring. However, it is finally accomplished, and ligated high as possible, and the sac amputated., Kocher uses the ligature here to suture the stump as far in toward the median line as possible to deviate pressure from the canal. The cord may here easily be placed in either position, but I have purposely made the incision through the aponeurosis, quite half an inch above Poupart's ligament, in order to show you Andrews' method, called by his Chicago friends the "frock-coat" method. The cord and spermatic