pus cells. This would naturally lead us to believe there is a villous tumor of the bladder walls, or tuberculosis of the bladder, ureter or kidney. The patient being a young woman, I searched carefully for tubercle bacilli and failed to find them in three or four specimens. Dr. Satterwhite brought me another specimen which looked entirely dif ferent from the others. I called his attention to it, especially the sediment at the bottom. I noticed quite a number of pus cells in this specimen, and upon examination found a large number of tubercle bacilli. Naturally being suspicious that the organism might be the smegma bacilli or something else, I placed them in alcohol after decolorizing for twelve to twenty-four hours-a method which I had noticed in a German medical journal-this being the manner of making a differential diagnosis between tubercle and smegma bacilli, and the organisms were proven to be tubercle by the staining process. I later examined another specimen and found no pus cells, but found, just as I had in the other specimens, pure blood. The negative finding of pus cells would demonstrate that the trouble was not cystitis. We know that these cases will sometimes improve; there is a quiescent stage that seems to come on, the kidney lesion does not seem to advance, and the patient seems to get almost well. How this occurs I do not know. I have no doubt that at the time the tubercle bacilli were found a little caseous mass in the kidney had broken down, because pus cells were found at no other time.

In regard to the use of adrenalin solution, I saw a case in consultation not long ago-a bladder tumor of the bald type. I advised against operation, and the physician in charge washed out the bladder thoroughly and tried adrenalin solution internally, reporting very good results, but he could not entirely check the hemorrhage. I saw him a few days ago and he said that the woman was about dead; that the growth had infiltrated the vaginal wall, the uterus, and other structures, and as soon as he was able he would bring me the postmortem specimen.

Referring to Dr. W. H. Wathen's remarks concerning resection of the bladder and removal of the entire organ: Dr. Mann speaks of this as the extreme measure, and advises total removal of the bladder only in certain cases. The bladder is usually the last structure involved in cancerous infiltration of the pelvic structures. Cancer will involve some of the broad ligament, a few of the glands, the uterus, maybe some of the vaginal wall, and later on we notice in performing a vaginal

hysterectomy, for instance for cancer, that infiltration has extended along the line of the bladder wall, the bladder becomes involved, and this is usually the first indication of return of cancer after vaginal hysterectomy. Supposing this to be the point of greatest danger, if we can remove a small section of the bladder wall at the time of the hysterectomy we might relieve this cancerous patient, and I think in wellselected cases it would be of great benefit to the patient to remove a portion of the bladder wall; but I do not believe that after cancer has involved all the surrounding structures, after it has spread out, involving the broad ligament, etc., that removal of the bladder for the cure of the disease is ever indicated.

The paper was necessarily made brief, as I could not take up all the points along this line, but I merely wished to bring out a few modern ideas in regard to bladder surgery.

P. F. BARBOUR, M. D., Secretary.

Reviews and Bibliography.

A Manual of Venereal and Sexual Diseases. By WILLIAM A. HACKETT, M. B., Ph. G., M. C. P. S. (Ont.), and N. E. ARNSTAM, M. D., Ph. G. G. P. Engelhard & Co., Publishers, Chicago, 1901. 200 pp. Price, $1.00.

This volume is nicely printed, and has a handsome appearance. It deals with practical points in a concise manner and discusses the modern appliances used in this line.

The first part treats of gonorrhea; the second of chancroid; the third of syphilis, and the fourth of the psychoses of the sexual system. The illustrations are not quite up to the high standard of the rest of the book. We heartily recommend it as a condensed and up-to-date manual on this subject.

Uric Acid as a Factor in the Causation of Disease. By ALEXANDER HAIG, M. A., M. D., Oxon., F. R. C. P., etc. Published by P. Blakiston, Son & Co., Philadelphia, Pa. After a long series of experiments and observations on his own person, in hospitals, and in private practice, the illustrious author has given to the world the "children of his brain" in his book on "Uric Acid as a Factor in the Causation of Disease." The cause of many of the infirmities that heretofore was shrouded in darkness he has shown in the clear light of science to be a deranged metabolism due to an excess of uric acid in the body.

His painstaking investigations, diagramatic and other illustrations, tend to leave in the mind of the reader no doubt as to the accuracy with which he has produced so many important truths. We believe that in due time the book will be read by every physician, and that such reader will join with us in a deep sense of gratitude to its author.

The Four Epochs of Woman's Life. A Study in Hygiene. By ANNA M. GALBRAITH, M. D., Author of "Hygiene and Physical Culture for Women;" Fellow of the New York Academy of Medicine, etc. With an Introductory Note by JOHN H. Musser, M. D., Professor of Clinical Medicine, University of Pennsylvania. 12mo volume of 200 pages. Philadelphia and London: W. B. Saunders & Co. 1901. Cloth, $1.25, net. Women have at last awakened to a sense of the penalties they have paid for their ignorance of those laws of nature which govern their physical being, and to feel keenly the necessity for instruction in the fundamental principles which underlie the epochs of their lives.

This is pre-eminently the day of preventive medicine. The physician who can prevent the origin of disease is a greater benefactor than he who can lessen the mortality or suffering after the disease has occurred. Any contribution, therefore, to the physical, and hence the mental, perfection of woman should be welcomed alike by her own sex, by the thoughtful citizen, by the political economist, and by the hygienist.

In this instructive work are stated, in a modest, pleasing, and conclusive manner, those truths of which every woman should have a thorough knowledge. Written as it is for the laity, the subject is discussed in clear, comprehensible language, readily grasped even by those most unfamiliar with medical subjects. A valuable and commendable feature of this handy volume of instructive information is a comprehensive glossary of those medical terms necessary to a thorough understanding of the subject under discussion. Without doubt it is a book that should receive the thoughtful consideration of every woman.

Essentials of Physiology. Prepared especially for Students of Medicine, and arranged with questions following each chapter. By SIDNEY P. BUDGETT, M. D., Professor of Physiology, Medical Department of Washington University, St. Louis. 16mo volume of 233 pages, finely illustrated with many full-page halftones. Philadelphia and London: W. B. Saunders & Co. 1901. Cloth, $1.00, net.

This is an entirely new work, and a worthy accession to Saunders' excellent series of Question Compends. It aims to furnish material with which students may lay a broad foundation for later amplification, and to serve as an aid to an intelligent consultation of the more elaborate text-book. The subject of physiology is covered completely, and the author of the work being a teacher of wide experience the salient points are particularly emphasized. An important feature is the series of well-selected questions following each chapter, summarizing what has previously been read, and at the same time serving to fix the essentials facts in the mind. Nearly all the illustrations are full-page halftones, and have been selected with especial thought of the student's needs. In every way the work is all that could be desired as a student's aid.

"NEC TENUI PENNÂ.”

VOL. 33.

FEBRUARY 15, 1902.

No. 4.

H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors.

A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid.

This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors.

Books for review, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAn Practitioner and News, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky.

SOUTHERN MEDICAL COLLEGE ASSOCIATION.

In another part of this issue we publish the Constitution of the Southern Medical College Association as adopted at the meeting in Richmond, November, 1901. We note with pleasure the determined effort of the Southern colleges to adopt a curriculum fully equal to that adopted by the Association of American Medical Colleges, and we hope that all the schools of the association will literally conform to the requirements in the constitution. It would appear, however, that there is now no reason why the two associations should not merge into one, so that this entire country might unite in laudable efforts to elevate the standard and the dignity of medical education.

In one respect the Constitution of the Southern Association is more far-reaching than that of the Association of American Medical Colleges, in that it deals with the financial question between the college and the student. Associations in the past, and many State boards, have contended that legislation in regard to the amount of fees the student should be required to pay into the school should not be adopted or made effective.

Just here lies the greatest evil that confronts the efforts at reform in medical education, for so long as medical colleges are permitted to publish a schedule of fees such as is adopted by high-grade schools and

afterward write letters clandestinely and promiscuously over the country trying to bribe students-offering to take them at any price they may name-low-grade schools and disreputable methods will continue, and students who are in no sense-intellectually, morally, or in education-prepared to study medicine will be graduated.

If the high-grade and reputable schools of the United States would join in a determination to recognize no school that admits any student at a minimum fee less than matriculation, $5.00; professors', $75.00; examination of graduation, $30.00; and each of the laboratories $10.00 (unless compelled to do so because of endowments or State laws), and the various State medical examining boards would do likewise, within five years fifty per cent of our colleges would cease to exist and the remaining high-grade schools would procure better material and do better work, and the profession and the people would be protected against the great evil resulting from the ignorance and disreputable practices of many physicians now being graduated.

Were such requirements adopted, each applicant for an examination before a State board should be required to furnish an affidavit that the school from which he graduated had conformed literally to the minimum requirements of the boards, the school having previously filed a similar affidavit.

PROFESSOR EMIL SCHEFFER.

He

The recent death of Professor Emil Scheffer removes from our midst one of the most noted men in the State. His life was a quiet, unassuming one, but withal he did much for the good of mankind. was an earnest and ardent student of pharmacy and chemistry, and his labors were rewarded in 1872 by the discovery of a new method of obtaining pepsin. Prior to that time the acetate of lead had been used in isolating the pepsin, and the discovery by Professor Scheffer that common salt was much better than the lead salts and free from the dangers that were incurred by their use, and much more economical, made his discovery one of the most important of its kind in modern times. Had he been avaricious and selfish he might have died a millionaire, but he was modest, and contented to give his discovery to the world unhampered, and as the result of his generosity many manufacturing chemists of this country have been able to add much to their