bacillus grows upon culture media, it is necessary to resort to animal inoculations in order to determine its thermal death point. It is probable that the tubercle bacilli in milk, which are so attenuated as to be unable to cause tuberculosis when injected into the peritoneal cavity of a young guinea pig, would be harmless when ingested by man.

In these experiments upon guinea pigs it is important to differentiate the lesions produced by dead tubercle bacilli, which closely resemble those caused by living tubercle bacilli. In doubtful cases, it is necessary to inoculate the products of the lesions into another animal to determine the presence or absence of living micro-organisms.

The writer states that the cultural experiments upon thermal death points are surrounded by many sources of error, and numerous pitfalls, all of which must be avoided to get accurate results. In order to get results of accuracy, conditions of practical pasteurization were imitated. in the experimental work done by Rosenau. The micro-organisms were heated in open test-tubes, and the temperature and other factors accurately controlled. Scum formation was disregarded, as it was the intention of the experimenter to reach results that might be applied with confidence in practical pasteurization on a large scale against natural difficulties. Results of nine series of tests upon guinea pigs, with five cultures, plainly show that in milk the tubercle bacillus loses its virulence and infective power when heated at 60° C. for twenty minutes; in other words, it may be considered dead. When heated to 65° C., a much shorter time is necessary. The results correspond, in the main, to those previously recorded by Yersin, Theobald Smith, and others. It should be remembered that the milk in these tests was very thoroughly infected with virulent cultures, indicated by the prompt death of the control animals. Milk practically never contains such an enormous amount of infection, under natural conditions. Therefore, if milk of this kind is rendered innocuous by twenty minutes' heating at 60° C., it is safe to assume that ordinary market milk slightly infected with tubercle bacilli, is also rendered innocuous by the

same means.

There was ample evidence to show in these tests by Rosenau that typhoid bacilli in milk are killed after being subjected to twenty minutes' heating at 60° C. The great majority of typhoid bacilli are killed after the temperature reaches 59° C. The diphtheria bacillus usually dies after the temperature reaches 55° C. The cholera vibrio is also destroyed at 55° C. Only once did it survive until the temperature of 60° C. was reached. The dysentery bacillus is slightly more resistant than the typhoid bacillus, requiring a temperature of 60° C., maintained for five minutes, in order to kill it. At 60° C. all the organisms of Malta fever are killed. Milk heated to 60° C., and maintained at that temperature for twenty minutes may, therefore, be considered safe, so far as conveying infection with the micro-organisms tested is concerned.

Congenital Unilateral Absence of the Urogenital System and Its Relation to the Development of the Wolffian and Muellerian Ducts. Henry E. Radasch (The American Journal of the Medical Sciences, July, 1908) says that congenital absence of the urogenital system was mentioned by the older writers, Aristotle, Vesalius (1543), Eustachius (1707) and others, but no distinction was drawn by these observers between atrophied, fused and undeveloped kidneys. Mosler first systematically drew up a list of the cases and tabulated fourteen cases of absence of the kidney, in seven of which the ureter failed to develop, and in two the kidney was rudimentary. In Beumer's collection of forty-eight cases observed from 1853 to 1878, in forty-four cases the kidney was absent, in four it was rudimentary, genital defects being present in thirteen instances. (eight females and five males), in three of the males the seminal vesicles and vas were absent, in one case the testicles were absent; in the other the normal genitals were present, but in addition there existed a 38 mm. vagina and a 25 mm. uterus, on the right side. In females, the malformation of the genitals was mostly a bicornate uterus and absence of one tube or one-half of the uterus or vagina. The ovaries were present in all cases.

Again, Ballowitz collected 213 cases up to the year 1895, finding that the left side was more commonly affected than the right, a proportion of 117 to 88, with eight undifferentiated. The condition occurred in the male more often than in the female. There was the usual compensatory hypertrophy of the remaining kidney. In seventy-three there were defects of the genitalia, the efferent system, derivatives of the Wolffian and Muellerian ducts, being more affected than the ovaries and testicles, derivatives of the afferent system. In eighteen the uterus was bicornate, in five the uterus and tubes were absent, in ten the uterus was bicornate and contained a double cavity, while in two a double vagina existed. The external genitals were seldom affected. In the male the vas and seminal vesicles were usually affected; both were absent in thirteen instances, while in two the vas was wanting and the vesicles atrophic; in three the vesicles were absent and in four the ejaculatory duct was missing. In two the testicles were absent, while in eight they were atrophic and small. Numerous other cases were reported by other writers. The condition has also frequently been observed in animals, Radasch reporting one case in a cat where there was an entire absence of the right kidney, ureter and genital tract of that side.

In considering the embryology, account must be taken of the pronephros, the mesonephros and duct, and the duct of Mueller. The earliest organ to appear is the pronephros. This is a longitudinal tubule developed from the mesoderm, opening caudally into the cloaca, and a few transverse tubules at the cephalad end of the duct. The cephalad extremity opens into the abdominal cavity by means of a trumpet-shaped

expansion. This pronephros functionates in the larval stages only of the amphibians, and gives way to the mesonephros or Wolffian body, which consists of transverse tubules that connect with the phonephric duct, and the latter became known as the meonephric or Wolffian duct. The mesonephric duct opens caudally into the cloaca. From this end the metanephric evagination, which becomes the permanent kidney, ureter and pelvis, appears. Also, in the male this duct gives rise to the body and globus minor of the epididymis, the vas, seminal vesicles and ejaculatory duct, but nothing of importance in the female. In the female the ducts of Mueller fuse for over half their length and ultimately form the uterus and vagina, while the unfused portions constitute the oviducts.

Absence of the kidneys may be due to the following causes: (1) Failure of the metanephric evagination to appear, even though the mesonephric duct and body be perfect; (2) appearance and early retrogression of the metanephric evagination; (3) failure of the pronephros, and therefore also the mesonephros, to appear. In the first instance, absence of the kidney in the male would be attended with few, if any, genital defects, and these would be coincidental and not sequential. In the second instance, the resultant conditions would be the same. In the third all such cases would be attended by absence of the kidney, ureter, efferent ductular system of the testicle, vas and vesicle on the affected side. In the female, in the first and second instances, there would be no genital defects, whether we assume the Muellerian ducts are derived from the mesonephric duct or are independent; such defects would be coincidental. In the third cause, if the Muellerian ducts are derived from the mesonephros partially or entirely, then as a result of its absence the entire internal genitals should be absent. Yet this has not occurred in any case, the uterus being absent or bicornate in but one-third of the cases. The facts as found in the adult body seem to indicate that the Muellerian ducts have an independent origin and are not derived from the mesonephric duct by segmentation, at least not in the higher vertebrates.

A PUS-REACTION OF DIFFERENTIAL-DIAGNOSTIC IMPORTANCE.

S. Wideroe (Norsk. Mag. for Laegevid, No. 8, 1907, Archives Diagnosis, Vol. I, No. 1, 1908) says that tuberculous pus dropped into Millon's reagent causes formation of lumps as described by Mueller; distinct red coloration of Millon's reagent by the pus points to the absence of tuberculosis.

SIR OLIVER LODGE has been an inveterate golfer for thirty years.: He learned to play at St. Andrews, under Professor Tait, who advised him: "You don't play golf with your muscles; you play with your morals." "But I hope," observed Sir Oliver, "no one will consider my morals as bad as my golf."

EDITORIAL

THE ESOPHAGOSCOPE AS A DIAGNOSTIC AND THERAPEUTIC AID IN ESOPHAGEAL OBSTRUCTION.

Jesse S. Myer (Medical Record, August 1, 1908) presents an admirable contribution to the literature upon the subject of just how much information one can obtain in using the esophagoscope and just how much of a help it is in removing foreign bodies which obtain lodgment in the esophagus. He states that this instrument, like all other mechanical aids. to diagnosis, depends for successful results upon the operator's technique and his ability to interpret his findings, just as we find it with the operator of the X-ray, the cystoscope, the endoscope or the proctoscope. In other words, to be a successful esophagoscopist requires frequent use of the instrument. And I take it the intent of the paper in hand is to show you just how easy it is for one to become an expert with this most useful instrument. Myer gives a review of the literature showing the development of the first esophagoscope of Mikulicz of the days of '81 down to the presentday modifications of Kelling, Kraus, Gottstein, Gluecksman, Killian and von Schroeder. Tubes of various lengths are used, with a hard rubber obturator, having a soft rubber tip. Killian and others use bougies instead of this obturator with a soft tip. There is a complete set of instruments especially prepared for removing foreign bodies of all kinds and shapes from the esophagus, as well as curettes for scraping off the surface for microscopic examination, instruments for applying drugs to ulcerated areas, and even a lens arrangement for photographing pathological lesions.

By means of the esophagoscope, foreign bodies may be readily removed from the esophagus with comparative ease. This brings back to the internist a group of cases which have been handled lately almost exclusively by the surgeon, and that, too, with greater glory for the internist, for the removal of foreign bodies by the aid of the esophagoscope is brilliantly successful and without danger. Their removal by the surgeon, on the contrary, has not always been successful, and the operation has always been fraught with the greatest danger to the patient.

Myer reports three cases of foreign body in the esophagus which were successfully relieved by the removal of the particular offending material through the medium of the esophagoscope. He also details the history of a case of benign stricture of the lower end of the esophagus; also, the history of a case of carcinoma of the esophagus and stomach, where the diagnosis was confirmed by means of this instrument.

Turning now to the practical application of the instrument, it must be borne in mind that the upper third of the esophagus lies between the vertebral column and the trachea; it then crosses the left bronchus, coming in direct contact with the aorta, passing slightly to the left of the vertebral column and then through the hiatus esophagus in the diaphragm, running for a distance of two and one-half cm. intra-abdominally. The total length of the esophagus from the teeth to the cardiac orifice of the stomach is forty cm.; from the teeth to the cricoid cartilage is usually a distance of from fourteen to seventeen cm., and from this point on, where the esophagus practically begins, is a distance of twenty-five cm. The cervical portion of the esophagus is closed, the thoracic portion is open a and enlarges with each inspiration. The portion between the diaphragm and the cardiac orifice is closed. The width of the tube varies from twelve to twenty mm. The narrowest portions, above which foreign bodies usually lodge, are (1) at the cricoid cartilage, twelve mm.; (2) at the hiatus esophagus, twelve to fourteen mm., and (3) at the crossing of the bronchus, seventeen mm.

Myer used the Killian instrument, with the patient in the sitting posture, rather than in the reclining posture upon the back or upon the side. The patient sits upon a low stool with some one in a chair behind him, supporting the back, pushing the chest forward and throwing the head back as far as possible. In this manner the mouth, pharynx and esophagus are brought into one line. Anesthetize the pharynx thoroughly with a ten per cent solution of cocaine. Tell the patients not to swallow immediately after the cocaine appliances are made. The bougie is introduced, extending six inches beyond the esophagoscope, with the head bent forward. As soon as the top of the bougie passes over the epiglottis, have the patient bend the head back as far as possible, and the instrument is slowly pushed over the cricoid cartilage.

When this occurs, the bougie is removed, while the esophagoscope is held in position. Light is thrown into the instrument through the aid of the panelectroscope, or the Kirstein lamp. It is then slowly introduced under the guidance of the eye. Provided aneurysm has been excluded, there is no danger from this introduction.

Among other details of this technique, Myer calls attention to the advisability of cocainizing the larynx as well as the pharynx to prevent coughing, which would call for the withdrawal of the instrument. General anesthesia is rarely necessary, except in the case of children or for prolonged examination in adults. Again, saliva and mucous accumulations at the end of the instrument frequently blur the picture. Myer overcomes this by dropping a small rubber tube down to the end of the instrument, removing the accumulation of saliva by suction by means of a bulb at the proximal end of the rubber tube. Two great obstacles in