as much as the typical case which presents every symptom with such prominence that the most veritable tyro might not mistake. If these cases which give a positive Widall reaction of the blood are not typhoid, what are they? It is claimed, and I believe truly, that the Widall reaction will not occur in any other disease. We can not believe that it would be a logical conclusion to attribute to the malarial parasite the property of generating a toxine which would possess the power to paralyze a pure, fresh culture of the typhoid bacillus in from fifteen to forty minutes, and as we can not suspect any other complicating factor we believe that the only logical conclusion at which we can arrive is to regard all cases of fevers which continue to have fever for a period longer than one week after the thorough saturation with quinine as typhoid. We are cognizant of the fact that the Diazo reaction is not a diagnostic factor which can be relied upon with as much confidence as the Widall, from the fact that the Diazo may occur in several diseases that might under some circumstances be mistaken for typhoid fever; still, if the Diazo gives positive results after the Widall has shown positive, we can not be far off the right track in saying typhoid fever and sticking to it.

We recognize the fact that a series of only thirty cases, however positive, can not settle a disputed point in diagnosis on such a time-honored subject, and our hope must be that some one better fitted will take up this work and carry it to a successful end.

In conclusion, I wish to thank Dr. M. M. Cooley for the microscopical work which made this paper possible.

PADUCAH, Ky.

COLD CREAM. This common unguent is composed (St. Louis Medical Review) of five parts of sweet almond oil and one part each of white wax and spermaceti. Melt over a gentle fire until the wax is dissolved, stir until it becomes the consistency of cream, and then add slowly one pint of hot saturated solution of borax; continue to stir until the cream becomes stiff.— Denver Medical Times.

HAND STERILIZATION.-Simon Marx (Medical Critic) in obstetric work depends almost entirely on successive scrubbings with: 1, green soap and water with a sterile brush; 2, scrubbing with a 65 per cent solution of alcohol; 3, scrubbing and soaking the hands and arms in a 1:1000 solution of bichloride of mercury, and then thorough rinsing with a sterile salt solution.-Ibid.

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.

TYPHOID FEVER AND POLLUTED WATER.

The great increase of typhoid fever in our city recalls the necessity of closing the wells and placing water plugs in their stead. It is utterly impossible to prevent well water in Louisville from becoming contaminated, owing to the peculiar soil, which is sandy, and which permits all surface water to percolate down to a certain strata, where the pump water is obtained. Not only does the surface water find its way into the wells, but that from many of the sewers, which are not sufficiently tight to confine the water passing through them, and that from the thousands of vaults and cesspools located all over the city, hence the average well in Louisville is little else than a percolate from a series of privy vaults and cesspools. These facts have been published in the daily papers and made known to the public in various ways, and yet the average citizen fails to heed these warnings and continues to consume what is to our mind the most thoroughly polluted water to be found anywhere in the State.

Louisville has the name of being antiquated, and in this particular she is something more than three thousand years behind Rome, the water-supply of which excels any modern city, and which was constructed away back in the days when it is said that sanitation was unknown, but it is very evident that the men who devised and had the

great aqueduct built were considering something far more important than a supply of water for the baths.

If the council of Louisville were to do its duty there would not be another cent appropriated for wells, and those in existence would be closed up at once and water plugs located in their places. Until this is done the death-rate in Louisville from typhoid fever will continue high.

Current Surgical and Medical Selections.

DENSITY OF POPULATION.-The density of population in foreign countries has recently been computed (Philadelphia Medical Journal). Great Britain takes the lead, with 132 inhabitants per square kilometer. Then comes Japan, 114; Italy, 108.6; Germany, 104.2; Austria, 87; Hungary, 59.6; France, 72.2; Spain, 35.9; United States, 8.4; and Rusia, 5.9.Denver Medical Times.

THE SUPRAORBITAL REFLEX.-D. J. McCarthy (quoted in Philadelphia Medical Journal) has described a new reflex caused by light tapping over the distribution of the supraorbital nerve and resulting in a few fine fibrillary twitchings in the inferior fibers of the orbicularis palpebrarum. Practical clinical experience shows that this reflex has an established value in the pontine localization of lesions.-Ibid.

LEVASCHOFF'S METHOD OF TREATING PLUERISY WITH EFFUSION.— This method, first proposed eleven years ago at the International Congress, consists in partially removing the servus or scropurulent effusion and then irrigating with tepid normal saline solution. Tanfilieff (Vratch; Philadelphia Medical Journal) reports ten cases treated in this way, with prompt amelioration of the distressing symptoms and final recovery.-Ibid.

CHILLS IN TYPHOID FEVER.-In eight hundred and twenty-nine cases of typhoid treated by Osler during ten years at Johns Hopkins Hospital, the onset was accompanied with chilly sensations in two hundred and thirteen instances and with actual chills in two hundred subjects. Of the latter, one hundred and seven had a single chill, while ninety-three had two or more chills. He calls attention to the fact that fever with chills may recur for several weeks during convalescence without any local signs of trouble.-Ibid.

IN amputations, where there is danger of secondary hemorrhage, it is well to leave the Esmarch bandage loosely applied, so that it may be at once readjusted if bleeding recurs.—International Journal of Surgery.

PLEURAL Effusion of Enlarged LiveR.-To distinguish between a small pleural effusion and an enlarged liver or subdiaphragmatic abscess, Henry Jackson (Boston Medical and Surgical Journal) determines by percussion the upper line of dullness on the chest wall and then has the patient breathe in deeply and hold the breath. The upper area of dullnes will now be found at a lower level if the liver and not the pleura is involved.-Denver Medical Times.

THE DIFFERENTIAL DIAGNOSIS OF SMALLPOX AND CHICKEN-POX.In a letter addressed to a contemporary, Dr. G. S. Perkins calls attention to a simple means of distinguishing chicken-pox from smallpox which deserves to be more widely known. He points out that the vesicles in chicken-pox are unilocular, whilst in smallpox they are multilocular. The practical result of this pathological fact is that if a chicken-pox vesicle be pricked with a needle its contents can be completely evacuated and the cell will collapse, whereas in smallpox if one makes twenty pricks with a needle the vesicle will not collapse, because, being multilocular, it is impossible to empty it. There are, of course, many other points of difference between the two; indeed, smallpox is only likely to be mistaken for the less serious malady when the practitioner is not alive to the possibility of a mistake in the diagnosis. In smallpox, even in its modified form, varioloid, the initial constitutional symptoms are early and well marked, with a considerable rise of temperature and cerebral disturbance. In smallpox the eruption is most abundant on the face and limbs, whereas in chickenpox it is most abundant on the trunk and its distribution is more discrete and general. Moreover, in chicken-pox the eruption appears in crops and not, as in smallpox, within a few hours of the first appearance of papules. Then, too, there is the characteristic fall of temperature on the appearance of the vesicles. An absolutely characteristic feature of chicken-pox is the appearance on the body of vesicles of different degrees of evolution, some being fully matured while others have just made their appearance. In spite of these usually very distinctive features, cases now and then occur in which even the most experienced may hesitate to formulate a definite opinion. In such cases twenty-four hours' observation will almost invariably clear up the mystery and allow of a correct diagnosis.-Medical Press and Circular.

CARBOLIC ACID AS A DRESSING FOR BURNS.-On several occasions in the past the application of pure carbolic acid has been recommended in the treatment of burns. In view of the active escharotic properties of this substance the idea has never appeared to commend itself for adoption, but of late its use has again been advocated by practitioners in various parts of the world. Among recent advocates of the treatment Dr. Muench, of Washington, asserts that the application of the pure acid brings about healing much more rapidly than any other method of treatment. It also presents the advantages of suppressing the pain associated with this form of trau

matism, in virtue of its analgesic action. Dr. Muench states that the acid coagulates the serous exudation, forming an impermeable layer which effectually protects the injured surface from contact with the air, thus fulfilling one of the most important indications in the treatment of burns. He has employed this treatment in burns of considerable extent without ever having observed symptoms of absorption or the undue formation of cicatricial tissue. In the face of this evidence it must be conceded that the application of the pure acid is, at any rate, devoid of injurious consequences, and we commend it to the notice of our readers who have much experience in this class of injury.—Ibid.

AGGLUTINATION IN TYPHOID INFECTION.-A. Di Donna has found that the serum of normal rabbits can agglutinate the typhoid bacillus in the proportion of 1:30. The serum of an immunized rabbit agglutinates the bacillus with which it has been infected as well as other typhoid bacilli. The same serum may, in the proportion of 1:100, agglutinate bacterium coli which were cultivated on agar several months previously. With increase of the degree of immunity, however, there is decrease of the agglutinating power of the serum. The agglutinating power of a given serum is almost always in direct relation to the virulence of the bacillus with which the animal has been immunized. It is also greater when the intravenous method of infection is practiced than when any other method is used. It is infinitely greater than the agglutinating power of the organic juices. A temperature of 60° C., acting for three hours on the serum of an immunized animal, does not destroy the agglutinating power. It is, however, lost in course of time, varying from twenty-five days to three months or more.-Giornale Internazionale delle Scienze Mediche (Medical Record).

TRAUMATIC Strictures can practically never be treated by dilatation. As they nearly always occur in the deep urethra, such strictures, if they give any inconvenience, must nearly always be treated by a perineal incision.-International Journal of Surgery.

Special Notices.

CHEMICAL FOOD is a mixture of Phosphoric Acid and Phosphates, the value of which physicians seem to have lost sight of to some extent in the past few years. The Robinson-Pettit Co., to whose advertisement (on third cover page) we refer our readers, have placed upon the market a much improved form of this compound, "ROBINSON'S PHOSPHORIC ELIXIR." Its superiority consists in its uniform composition and high degree of palatability.

FOR shaking palsy nothing excels tinct. Aesculus Glabra, one half drachm, CELERINA, eight ounces. Teaspoonful every two or three hours.