employed only when none of the abovementioned disagreeable phenomena appear. Ablutions are preferable to baths and should be given but once daily. All "hardening" should be done gradually, in somewhat the same manner as electricity is clinically employed, and should follow the idiosyncrasies of the child. The process must not be begun too early. Nurslings are always to be kept warm. No child should be subjected to cold water baths until anemia and nervousness have been excluded, and all children should be submitted to a physician's examination before any hardening process is begun.N. Y. Med. Journal. The Importance of a More Radical Operation in Carcinoma Cervicis Uteri. John A. Sampson (Johns Hopkins Hospital Bulletin, December, 1902) says that carcinoma of the cervix may metastasize to small lymph nodes along the blood-vessels, and these nodes may have a diameter of not over 1 to 1.5 millimeters. As the nodes are very small it may be impossible to feel them, either in the parametrium or along the pelvic vessels. These metastases may be so minute and scattered that they can be discovered only accidentally or by cutting serial sections. In every case of hysterectomy for carcinoma of the cervix the lymphatics along the pelvic vessels, and also the parametrium, should be removed en masse with the uterus, because an enlarged gland is not necessarily an invaded gland, and cancer may be present in very small lymph nodes which cannot be palpated; therefore clinically it is impossible always to diagnose cancerous lymphatics. Should the ureter be adherent to the parametium, the lower portion of it should be sacrificed, and all the tissue from cervix to pelvic wall removed, for if the ureter is dissected free. two things are very apt to occur: (1) The disease will probably return; (2) a ureterovaginal fistula will probably occur from injury of the bloodsupply of the ureter. To the above should be added a last suggestion that in every case of hysterectomy for cancer of the cervix the lymphatics should be removed from the pelvic vessels from above downward, together with the uterus, and all the tissues lateral to the cervix from pelvic wall should remain undisturbed, including the lower four centimeters of the ureters; and the ureters should be implanted in the bladder. -Med. Age. The Law as to Self-Destruction, It is gratifying to know the United States Court of Appeals has made an end of the wrangles and quibbles and doubts as to the liability of insurance companies as regards suiciding policy-holders. In the case decided, the policy stated that "self-destruction, sane or insane, within one year from the date of the issuance of the policy is a risk not assumed by the society in this contract." The lower court had ruled that this was a proviso not limited to willful or intentional suicide, but included any self-destruction, sane or insane. This ruling is confirmed by the higher court, which says that "If the The assured caused his own death while sane or insane, that is the end of any right to recover, and there can be no looking into the condition of the mind of the deceased when he committed the fatal act. case might be different if the replication had stated that his death was due to an accidental cause, if for example, he had taken a poisonous draught, mistaking it for water; or walked through a window, mistaking it for a door. Then it would fall within the rule established by a number of cases, which hold that accidental or unintentional self-destruction is not within a condition forfeiting a policy for suicide."-American Medicine. Heat as a Means of Differential Lewin, of Berlin (Semaine Médicale, 1902), claims to have demonstrated that applications of heat may serve as a useful means of determining the presence or absence of pus in local inflammations. He calls attention to the well-known fact that the application of heat, as a fomentation, for example, to an inflamed joint, often gives most grateful and prompt relief; but maintains that this is true only when pus is absent. When pus is present, the heat greatly increases the pain. He presents numerous cases which seem to justify this conclusion. M. Lewin considers this method of differential diagnosis of special importance in appendicitis. In ten cases in which he applied heat, the pain was relieved, and the patients recovered; in two cases the hot application gave no relief. Operation was performed later, and pus was found present. Dr. Spohr, of Frankfort-on-the-Main, has treated, within the last two years, fifteen cases of appendicitis by means of hot fomentations, without employing any other medication. In all of these cases pain was relieved, and death occurred in only one case. In this case the appendicitis was due to tuberculosis. M. Lewin was also able to confirm the value of his suggestion in three cases of perimetritis. In two of these cases immediate relief was obtained by the application of heat, and cure resulted by absorption of the exudate in the course of twenty days. In the third case the pain, instead of being relieved, was increased. A month later a pelvic abscess opened through the vagina. Hot applications are by no means an indifferent therapeutic measure. They produce either very clearly marked relief or not less distinct increase of pain. They should be employed independent of opium and other narcotic agents. The patient should not be informed of the significance of the indications when an operation is apprehended.-Modern Medicine. The Necessity and Desirability of Inducing Abortion in Tuberculous Working Women. Dr. C. Hamburger (Berliner klin. Wochenschrift, November 17 and 24) says that the fight against pulmonary tuberculosis will be useless as long as the question is undecided: What shall be done with the pregnant working woman? The importance of this question is enhanced by the fact that in Prussia over 75 per cent. of working women have an income of not over 900 marks ($180), and are therefore compelled to live under conditions in which useful treatment, even during menstruation, is out of the question. Hamburger advises induction of abortion. in these women because it is a misfortune for them to be pregnant; because treatment during the time of the pregnancy (since they are compelled to work) is an impossibility, and is therefore time lost; and because their children are likely to be tuberculous and in their environment every additional tuberculous individual is an additional danger. The pregnancy is dangerous to the mother, to the family and to the community. He would limit the operation to those in whose sputum tubercle bacilli are found. The author concludes by saying that a great step forward would be made in the fight against tuberculosis if his attitude could be made clear in obstetric textbooks, and he recommends to the next congress on tuberculosis the adoption of this formula: "If a wife is suffering from tuberculosis recognizable by emaciation, loss of strength, constant cough, and purulent or bloody sputum, pregnancy is to be avoided by every known means. If the woman becomes pregnant, however, the physician is to have a consultation with another, with a written and signed agreement, to decide whether the continuance of the pregnancy is dangerous to the life of the mother.-N. Y. Med. Fournal." Why is Reciprocity Refused? A physician, a graduate of a reputable college recognized by the Pennsylvania Board, and licensed by the Illinois State Board of Health after examination, made application to the Medical Council recently for a license in Pennsylvania, based upon the Illinois certificate. In reply the applicant was informed that the Council recognized no licenses except those issued by New York, this leaflet accompanying the letter: "All applicants for license to practice medicine in Pennsylvania, with the exception of those holding certificates from the State of New York, are required to pass examination before one of the State medical examining boards." In the interest of a needed and just reciprocity we would like to know why the Pennsylvania Board refuses reciprocity with Illinois? The Illinois State Board of Health stands ready to recognize, at any time, licenses issued by the Medical Council of Pennsylvania, after examination, to graduates of medical colleges in good standing with the Illinois State Board of Health, providing, of course, that the Medical Council of Pennsylvania will recognize licenses issued by this board, after examination, to graduates of accredited colleges. Does the Pennsylvania Board contend that the requirements in Illinois and in several other States are not as high, are not even higher than in Pennsylvania? The entire profession has been clamoring for practical reciprocity; why do its agents and representatives deny it when it is possible, and every demand of justice is satisfied?—American Medicine. The Nutritive Value of Gelatine. Krummacher (Zeitschrift für Biologie, 1901), in a study of the nutritive value of gelatine, has shown the following: When burned, gelatine produces 5.36 calories for each gramme of pure substance. Taking account of the urinary and intestinal residue, he concludes that one gramme of gelatine will furnish 72.4 calories as compared with 74.9 for flesh and 76.8 for albumin. As regards the nutritive value of gelatine, that is to the extent to which it may replace albumin, the author agrees with Kirchmann that gelatine may replace albumin, although large quantities are required. The author concludes that of the 2,500 calories, daily expended by the organism, 5 per cent., that is, 125 calories, may be supplied by gelatine, the practical value of which is 3.77 calories per gramme of the dried substance. In other words, of the 70 grammes of albumin required for each twenty-four hours, 14 grammes may be replaced by 33 grammes of dry gelatine, thus reducing the consumption of albumin to 56 grammes. Modern Medicine. Instructions to Patients Affected With Follen Cabot insists that patients suffering from venereal disease should be given definite instructions concerning it; this is particularly true in dispensary practice. In his dispensary work he provides each patient having either syphilis or gonorrhea with the appropriate card of instructions such as: "Instructions to those Suffering from Syphilis.-Syphilis is a constitutional disease. It is in the blood.' Local remedies and taking medicine for a few months will not cure you. You must be treated for three years. The effects of this disease are far-reaching, and if treatment is neglected, much trouble and suffering may be caused, not only to yourself but to others. The following rules must be observed to during the first year: Sexual intercourse should not be indulged in. Alcohol in all forms should be avoided, as it always aggravates the disease. Do not smoke or chew tobacco. Sleep alone. Under no circumstances should any one be allowed use your toilet articles, as towels, brushes, combs, razors, shaving brushes, etc. No article that has been in your mouth should be used by others, as toothbrushes, tooth picks pencils, pipes, cigars, cigarettes, forks, spoons, drinking cups, etc. You must not kiss any one, especially children. Brush your teeth night and morning and keep your mouth clean. If you have bad teeth have them attended to by a dentist, and be sure to tell him that you have syphilis, so that he can take necessary precautions and avoid the possibility of infecting others. Acids in food and drink should be limited." A similar and appropriate card is given to those suffering from gonorrhea.American Medicine. A New Observation Upon Peptic Some recent very interesting observations have been made by Kruger (Zeitschrift für Biologie, 1901) respecting the amount of work performed in peptic digestion. The author noted that the quantity of digested products increased with the increase in the amount of pepsin, but not proportionately. The amount of digested products increased nearly in proportion to the amount of albumin. With the same quantities of albumin and pepsin, digestion was found to be more active in dilute than in concentrated solution. Other factors, such as the products of digestion, hydrochloric acid, neutral salts, are also found to exercise an influence upon the digestive work. The accumulation of the products of digestion lessens digestive activity proportionately to their quantity. This effect is due in part to the specific action of proteoses and peptones, and in part to their action in neutralizing the acids. Peptic digestion attains its maximum when the digestive mixture contains 18 to 40 per cent. of hydrochloric acid.-Modern Medicine. CIMICIFUGA is valuable for emissions; fifteen to twenty drops three times a day. -Med. Summary. Translations. PARISIAN MEDICAL CHIT-CHAT. BY T. C. M. Pastoriana et Nocardiana-A New Dis ease Transmitted by Fleas, i.e., Pyroplasmosis-More About HydrophobiaCauterization Still the True Remedy for Dog Bites, Instead of Giving the Malady by the Serum-The Combat Between Alcoholism, Tuberculosis and Syphilis. As the head lines indicate, this little chronicle is published simply to give the exposé of a recent discovery in the animal series by that joyous bacteriological sharp, Nocard, a disease baptized by him, with the co-operation of serum-therapy enthusiasts, by the poetic medical name of pyroplasmosis. Behold! it rhymes with phagocytosis, Pyroplasmosis, phagocytosis, wind, rain, frost, the latter three all rhyme with the first two in French, as one can see by scanning a dictionary (pyroplasmose, phagocytose, ventose, pluviose and gelose), and the sound, when emitted, gives all the delicious echoes of a Rabelaisan crapulation, but we spare the LANCET-CLINIC readers a further dissertation on merely philological lines. But there can be no harm in speaking of this extravagant novelty in this journal given to serious medicine, issued for the benefit of all real savants and the grand army of good fathers who compose the old guard of Regular general practitioners; so we will make known how we really enjoy the medical farce of "Microbiana," that serves not only to entertain but everlastingly amuse those who truly enjoy the comicalities of pseudo-scientific medicine. So we present, with a suggestive title by contrast, certain news regarding hydrophobia and its treatment, facts gathered from a séance held by the Society of Comparative Pathology, during which delightful period the subject of the famous pyroplasmosis was duly discovered. Let us say that this new malady is found characterized, from its first histological standpoint, by a considerable agitation of the white globules; from the clinical point of view, afterwards by a general and progressive weakness of the animal, by loss of appetite and discoloration of mucous membranes; it is finally found characterized, from the bacteriological point of view, by a hematozoaire having the form of a little wheel (there are usually numerous wheels in bacteriological skulls); now this little wheel increases in size, it carries a tail, too, and flagellum, and spins round and round, turlurette!-still preserving its entity, whereupon Alfort and the Academy jubilate. In reality, if we wished to speak plain to the veterinary doctors, and to relieve the new morbid expression of its masque, of its bacteriological smut, that is perceived on the laughing gluteal region of this smiling medical asininity, we observe that the new disease is simply an old-time malady, the ancient anemia. Why do they wish to disguise it? For the medical mountebanks who follow Pastorian medicine, it is needful, a part of the game. We see the masquerade; they must perpetuate their carnival time, because Guignol poses on a pedestal, and Guignol is king. In his history of pyroplasmosis (remember the name) the bacteriological medical gamester must attribute to all animals, if to one, the power of the free transportation of all dangerous microbes, for these have been produced even in their integral form by the eminent Nocard. This time it is not the mosquito that serves as the vehicle; it is dog fleas, the ticks alone, the sacred dog ticks. So it becomes necessary to destroy the dog ticks, like the noble Marine Hospital Service of certain lands would fain destroy all mosquitoes. If a mosquito hums in your bed, Hit the malaria right in the head. If on microbes you're a fly man Imitate the practice of Wyman. If by dog fleas one's made sick Slaughter the dogs and kill their tick. Thus new rhymes are added to the medical collection of the " School of Salerno." Truly, it appears strange, indisputably strange. We regret to say that only the physicians present at this meeting applauded this new invention, while the veterinarians present unanimously concluded that the new malady was only the old-time anemia, that very ancient type of anemia, too. This leads one to believe that the scientific mind and the sense of observation had undergone considerable atrophy among the princes of the science, these medical pontiffs, manufacturers of serums attacked by bacteriological mania, so they sought shelter in the camp of the real practitioners whose mission is to relieve all the sufferings of animality. What comes to confirm this supposition was the discussion on hydrophobia that terminated the session of the Society of Comparative Pathology. One medical orator recalled the fact, known to all learned physicians, i.e., the impossibility in which science actually finds itself in the detection of lesions in autopsies arising from hydrophobia. They describe the numerous observations made on men and animals bitten by dogs not attacked by rabies, and yet treated at Pasteur institutes. After these facts are confirmed they enumerate all a series of experiments in which animals and men never bitten by mad dogs, but inoculated with anti-rabic serum, have contracted hydrophobia there. from. Physicians should be careful, then, not to send patients to these quack institutes so full of peril. Physicians should return to the ancient and most valuable prophylactic remedy, i.e., cauterization of wounds inflicted by bites, for these cauterizations never engender hydrophobia, while the serum, as often proven, does. All the later official statistics prove that hydrophobia has not been diminished in France by Pasteur serum. Before Pasteur's time the annual mortality in France from hydrophobia was 14 per annum. Since Pasteur institutes have been started at Paris and inoculation with anti-rabic serum used the rate has increased to 200 per annum. And here let us remark, in a translator's interpolation, that while Chicago and Baltimore now, with Pasteur Institutes, note hydrophobia cases by the dozens, Cincinnati, in over thirty-five years, has had but four deaths recorded from hydrophobia. Out of these four cases two were seen by the translator in company with other physicians. One, in either 1865 or 1866, occurred on Plum Street near Front, in Cincinnati. In this instance several In this instance several children were bitten by a rabid dog. These children's wounds (with one exception) were cauterized, following the an cient method in vogue in this city. In the case not cauterized, that of a boy of seven or eight years of age, bitten in the face, hydrophobia was developed not long afterwards. The diagnosis in the case was made by Father Gilmore, priest of St. Patrick's Church, afterwards Bishop Gilmore, of Cleveland. Dr. P. T. Gillane, since dead, was called in, and in turn asked Dr. George W. Haile, of this city, and the translator to visit the case with him. This child died with all the terrible symptoms of the malady, and the official death record was made to the Health Department. The second patient seen by the translator was several years afterward. It was the case of an Irish shoemaker, who was bitten by a dog belonging to a druggist on the north-west corner of Sixth and Western Row (the latter street now known as Central Avenue). This case was in charge of the late surgeon Daniel Young, of this city, and was visited by the translator in company with the late Dr. Brent, if our memory serves us right, and Dr. Young. This patient died with all the symptoms of the rabies, and the cause of death was so recorded. Subsequently a famous and amusing law suit for damages against the druggist was filed, and is a matter of court record. In al Two other cases of hydrophobia are, the translator believes, the only officially recorded cases of the malady known in this city in the past thirty-five years. When one considers that not a single summer passes that bites of people from mad dogs is not a newspaper record, the slight mortality of the disease is noticeable. most every case of dog or other animal bite the general practitioners of this vicinity almost invariably cauterize the wounds inflicted. During a general practice extending over thirty-five years the translator has not seen a season that one, two or three cases of persons bitten by dogs or cats have been treated by cauterization, and never in any given case so treated has hydrophobia developed. The presence of Pasteur institutes is a sine qua non for the development of real hydrophobia in the vast majority of cases. axiom worth remembering is this: The malady known as hydrophobia increases in direct ratio as Pasteur institutes are established. The work of Lutaud on hydrophobia shows all the fallacies of anti-rabic An |