pneumonias. In an ordinary case of bronchopneumonia we put the patient on a light d'et, give expectorants and stimulants, and probably try to control the fever with hydrotherapeutic measures. Not so in our case. The diet must be rich, as stated before. Expectorants are liable to cause another hemorrhage, and are better omitted entirely. Stimulants are likewise liable to injure the patient by raising his blood pressure, and should be administered in cases of real need only and with great caution, if possible under the control of the sphygmomanometer. For the control of fever it is not always possible to use hydrotherapy. At times it is better not to move the patient too much, and in such case it is wiser to use an antipyretic. Pyramidon has proved the best in similar emergencies.

To sum up, in any kind of a hemorrhage morphine and cracked ice had better not be given at all. In small hemorrhages put the patient to bed and apply ice bag. In large hemorrhages annly elastic bandages to extremities, give amyl nitrite, also nitrites and calcium chloride internally. In recurrent hemorrhages try hypodermic injection of gelatin. Always reduce amount of liquids and give rich food, which must not be too warm nor too cold.

Landis, in Volume X of the Proceedings of the Pathological Society of Philadelphia, gives his results as to experiments in agglutination in tuberculosis. Our knowledge of agglutins being so imperfect, it is always of interest to note the opinions of competent investigators. We know at present comparatively little of immunity, though Ehrlich and Metchnikoff and Wright have blazed the way. In reference to the agglutinating reaction, Landis draws the following conclusions from his experiments:

1. That the reaction is valueless as a diagnostic agent.

2. That it forms an available means of estimating the degree of immunity attained in tuberculosis by means of tuberculin and other forms of treatment.

3. That the absence of the agglutinating reaction in fluids containing but little albumin, such as cerebro-spinal fluid, renders it highly probable that the agglutinins are closely allied to the albumins.

NECROLOGY.

Dr. Z. F. Guerin, Columbus, O., aged eighty

seven.

Dr. Hal. F. Crockett, Americus, Ga., aged sixty.

Dr. J. T. Houseman, Fostoria, O., aged sixty. Nephritis.

Dr. H. L. Weedon, Eufaula, Ala., aged seventy-three.

Dr. Herman J. Smith, Lowell, Mass., aged seventy-one.

Dr. J. C. Driver, Atlanta, Ind., aged seventysix. Carcinoma.

Dr. L. G. Van Scoyo, Los Angeles, Cal., aged fifty. Mitral regurgitation.

Correspondence.

THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION.

LOUISVILLE, Ky., September 19, 1908.

EDITOR LANCET-CLINIC:

It will be interesting to your readers perhaps to know that arrangements are rapidly being perfected for the meeting of the Mississippi Valley Medical Association in Louisville next month, and those who contemplate attending are urged to make reservations for rooms at the Seelbach at an early date, as desirable space is rapidly being taken. The advantage of having all of the meetings, exhibits and entertainments under one roof will be greatly appreciated, we are sure, by those in attendance.

The beautiful Country Club will be the place of entertainment at luncheon of the ladies, and the other entertainments projected also include the ladies. These are a general smoker and vaudeville performance in the celebrated Rathskeller of the Seelbach on the first evening, and a musicale, reception and dance on the evening of the second day. A number of private luncheons and dinners by the local profession have already been planned, and we feel sure the entertainment feature of the association will be well looked after. Already enough space has been reserved by the physicians of Chicago and neighboring territory to warrant the running of a special train from Chicago, escorting President Elliott to Louisville.

A meeting of the Executive Committee, which is composed of the present officers and past-presidents, has been called by the president for noon of the first day, for the transaction of business of the association, and they will be entertained at luncheon by the secretary, transacting the necessary business during that time.

The final programme of the meeting will be issued on the first of October, and it will prove one of the best and most attractive that has ever been offered.

It is hoped that the new home of the Jefferson County Medical Society and the Jefferson County Medical Library, on the seventh floor of the Atherton Building, will be completed by the time of the convening of this meeting, that open house can be kept for the visiting doctors during their stay in Louisville.

A rate of two cents per mile in each direction from Central Passenger Association territory, good going and returning via same route only, to be sold on October 11, 12, and 13, return limit October 17, 1908, is to be enforced.

Delegates expected from points in other territories should take advantage of the one-way

rates to the eastern gateways of the Southwestern Excursion Bureau, at which points they can repurchase at the reduced rates authorized therefrom.

The Southeastern Passenger Association has also been asked for reduced rates.

Very truly yours,

HENRY ENOS TULEY,

Secretary.

"ESSENTIALS" OF REFRACTION.

CHICAGO, ILL., September 20, 1908.

EDITOR LANCET-CLINIC:

I trust your sense of fair play will permit of my saying a few words through your columns in regard to Dr. Vail's review of my "Essentials of Refraction" in your current issue. I judge from the initials that Dr. Vail is the reviewer.

The animus of Dr. Vail's criticism of my book is that it is addressed to other than oculists, by whom he hastily assumes me to mean the non-medical refractionist-an assumption for which there is absolutely no warrant except in my use of the word "refractionist," which appears to irritate the reviewer. What word, pray, should I use, when I am admittedly dealing with nothing but refraction, even though I am addressing medical men?

Dr. Vail's interpretation of my motive in writing the book is a petty misconception-so petty as to appear almost wilful. I do not regard it as a "great evil”. that "errors of refraction are corrected by the skilled oculist." But in view of the fact, which Dr. Vail must surely recognize, that skilled oculists are too few and far between to permit of their consultation by everybody who needs a pair of lenses, I do consider it unfortunate that the general practitioner, whom I regard as perfectly competent to do this work, should totally neglect (as he usually does) the study and practice of -eye-refraction under the impression that he cannot practice refraction unless he is an eyespecialist. It was to combat this idea, and to stimulate the practice of refraction by the general practitioner, that this little book of mine was written. The fact that a knowledge of the groundwork is taken for granted in the book-which Dr. Vail uses as a point against it should have told him that it was not addressed to those who know nothing about the

eye.

The explanation of the chapter-title about which Dr. Vail is so sarcastic is simple enough. As an oculist and staff-editor he should have understood that this is a typographical error; it ought to read "Diseases of the Eye Connected with Disturbances of Vision." If he

did know it, then it would have been in far better taste if he had courteously pointed it out, for which author and publisher would have been properly grateful. I am glad to have it brought to my attention anyway.

If Dr. Vail does not think the general practitioner ought to be trusted with refraction work, then he and I differ, that is all. But his difference of opinion with me on that point is hardly a proper factor to enter into his judicial review of my book.

Very truly yours,

THOMAS G. ATKINSON.

PARIS LETTER.

PARIS, FRANCE, September 15, 1908. EDITOR LANCET-CLINIC:

I went down to the Rue Bichat to-day to renew my acquaintance of long ago with the Hospital Saint Louis. Henry IV of France laid the cornerstone of the hospital in July, 1607. It was intended as a hospital for patients afflicted with the plague, and it was dedicated to the memory of the king's grandfather, who died a victim of the plague in Africa. It is the great hospital for skin and venereal diseases here. It contains 1,357 beds; 994 of these are for cutaneous diseases, 253 for surgical cases, and 110 for confinement cases. The hospital and court yards occupy altogether 93,190 square meters of ground. The staff doctors get 1,200 francs a year in salary, or about $240 in our money. The internes commence with a salary of 600 francs per year, or $120 in our money, besides board and washing.

Dr. Rochard has the chief charge of the department of gynecology. Dr. Demoulin is the head abdominal surgeon, and Dr. Besornier has charge of the division of surgical diseases of the abdomen. Prof. Gaucher gives a practical course in dermatology and venereal diseases, lasting from October 12 until December 19, 1908. The course costs 150 francs, and is open to French doctors and students, as well as foreigners who are matriculants in the Medical Department of the University of France.

At the Hospital Broca there is a practical clinic in gynecology under the direction of Drs. Loewy and Bender, two clinical chiefs in the hospital. The course consists of twelve lessons given during the vacation in September, and costs 50 francs. It is open to foreigners as well as Frenchmen who are matriculants of the medical department.

There are summer courses in almost all departments of medicine and surgery here. They last about five weeks, and cost 50 francs, or about $10 each. There is a special course in

laryngology, rhinology and otology given here by Dr. Castex. It consists of eighteen lessons, beginning September 10. Clinic is open every day except Sunday.

I enclose a photograph of the magnificent new Academy of Medicine, situated in the Rue Bonaparte, in this city. It is built of white stone that resembles marble.

The other day I went out to the Pere la Chaise, the most celebrated cemetery in Paris, to get a view of the tombs of Dr. Nelaton and Dr. Baron Larry, the great French surgeons, who are buried here. Nelaton was one of the greatest surgeons in France in h's day, and Larry was the surgeon-general of Bonaparte's armies. The following inscription on the magnificent tomb of granite shows what Bonaparte thonght of him: A Larrey, L'Homme Le Plus Vertueux Que l'aie Connu.-Testament de Napoleon."

With kindest regards from

FRANCIS DOWLING, M.D.

WITH the enactment and approval of a new ordinance, entitled "An ordinance to prevent the sale of milk from animals infected with tuberculosis," the city of Jacksonville, Fla., now has in force one of the most stringent laws regulating the sale of milk in the United States. The new ordinance to prevent the sale of milk from animals infected with tuberculosis was passed by the city council on September 2, and approved by the mavor the same day, is as follows:

Be it ordained by the mayor and city council of the city of Jacksonville:

Section 1. It shall be unlawful for any person or persons within the corporate limits of the city of Jacksonville, to sell or to expose or to offer for sale, or to have in any wagon or other place where it is usually carried or kent, milk for sale, any milk or milk products, taken from any animal which animal has not within one ear next preceding been tested with tuberculin and found by a representative of the city or State Board of Health, free from tuberculosis, and so certified by such representative. Any person guilty of a violation of this ordinance shall be punished by a fine not exceeding $500 or by imprisonment not exceeding ninety days.

Sec. 2. Any person convicted the second time of a violation of this ordinance shall not be permitted to obtain a license to sell milk in the city of Jacksonville. It shall be the duty of the mayor to have published for thirty days in a newspaper in the city of Jacksonville a notice of the second conviction should anybody be convicted a second time of the violation of this ordinance.

ACCORDING to the Journal of the American Medical Association there were 5,623 Fourth of July fatalities this year. It is probable that the total is even larger, as it is certain that many cases were not reported.

MODERN MEDICINE: ITS THEORY AND PRACTICE. Volume IV, in Original Contributions by American and Foreign Authors. Edited by William Osler, M.D. Philadelphia, Lea & Febiger.

One remarkable feature of this volume is the absence of contributors who are connected with the Johns Hopkins Medical School.

The first chapter of Part I on "Diseases of the Circulatory System," is devoted to a discussion of the general considerations in cardiovascular disease. To him who has given particular attention to the study of the later literature on the cardio-vascular physiology and pathology, the article furnishes profitable reading, because the author illuminates the most salient features of such study in a way to stimulate this class of readers to further investigation. In twentyfour pages Dr. Hoover demonstrates his extensive reading and thorough familiarity with the subject., Possibly under the impression that most of his readers approximate him in knowledge of his subject, probably because he was limited to such brief book space, has he failed to create a comprehensive treatise. The rather abrupt ending, therefore, tends to leave the general, omnivorous reader with his appetite whetted, but hunger unappeased.

A rather satisfactory discussion of "Diseases of the Myocardium," by Babcock, always reliable when dealing with diseases of the thoracic organs, is followed by a series of chapters, which give the entire volume the right to a prominent place in one's library. "Acute Endocarditis," by Osler; "Hypertrophy of the Heart," by Gibson; "Insufficiency and Dilatation of the Heart," by Gibson; "Diseases of the Valves of the Heart," by Osler and Gibson; "Diseases of the Arteries, and Aneurism," by Osler, are brilliant illustrations of the art of text-book writing, and the plan of each chapter evidently logically mapped out, the discussion of the various phases of each subject concise when possible, elaborate in detail when needed, always comprehensive and up-to-date, the under graduate, the busy general practitioner, the teacher of medicine will commend these articles for the knowledge they contain and the admirable ease of presentation. Not only do these two authors compel our admiration for their general knowledge and facility of expression, but demonstrate their special power as judges of the requirements of the general medical reader.

Chapter XII of Part I, on "Thrombosis, Embolism and Phlebitis," is well worthy of our close reading, because of its exposition of the

latest investigations in these conditions. Prof. George Blumer, of the Yale Medical School, is the author.

Aligned with the foregoing, and equaily well arranged and written, is an article on "Purpura and Hemophilia," by Joseph H. Pratt, of the Harvard Medical School.

Into eighty-five pages in Part II, Prof. Richard C. Cabot has crowded a condensed filtrate of the contents of his larger text-book on the same subjects, and of his additional publications. The articles furnish splendid opportunities for ready reference to him who would be well posted on diseases of the blood and bloodforming organs.

The final part of the volume is composed of chapters on "Diseases of the Spleen," by Lyon, of Buffalo, and "Diseases of the Thymus and Diseases of the Lymphatic Glands," by Warthin, of Ann Arbor.

G. A. F.

THE ECLECTIC PRACTICE IN DISEASES OF CHILDREN. For Students and Practitioners. By William Nelson Mundy, M.D., Professor of Pediatrics in the Eclectic Medical Institute, Cincinnati, etc. Second edition, revised, rewritten and enlarged. Cincinnati: The Scudder Brothers Company, 1908. The author of this valuable text-book does not hesitate to express his belief in the efficacy of therapeutics, giving the therapeutic nihilist little encouragement. His opinions are stated in clear-cut language, which, though avo'ding the conceit of dogmatism, leaves little to be desired in point of clearness, though perhaps lacking the elegance and grace of other works on the same subject, such as Holt, and the more pretentious English translation of Pfaundler and Schlossmann's "Diseases of Children." It is easily understood, plain and direct, every redundancy of expression rigorously pruned away, giving the essentials and as much theory as seems required to explain the subject under discussion.

Every general practitioner must, in the very nature of things, become a pediatrist. His success often depends upon the result of the diagnosis and treatment of diseases which attack the little ones. The nursing period especially requires the utmost tact and care on the part of the medical attendant. It is a pleasure to state that Mundy has devoted especial attention to elucidating problems confronting one in this difficult mater of infant feeding. The chapter devoted to this subject deserves a careful perusal.

In the lifetime of men and women now practicing medicine, the question of the removal of adenoids has assumed the importance which a consideration of the effects of mouth-breathing, otitis media, enuresis, and stunted mental and

physical development demands. The author, however is conservative, and expresses the belief that internal medication and change of climate may induce absorption. Operations .re too lightly undertaken, but when demanded they should be done without hesitancy, as the author advises.

Most writers do not agree with Dr. Mundy in his remarks anent feeding in cholera infantum. The various articles of food he mentions are uncalled for. Also there is a serious difference of opinion as to the propriety of giving a long list of remedies indicated in diphtheria, with only a mere mention of antitoxin. It gives undue prominence to methods that are positively reprehensible, when it is known that antitoxin is a specific. And so with the treatment of cerebrospinal meningitis. Flexner's anti-serum is not even mentioned in the chapter devoted to the treatment of this terrible disease, although statistics prove it to be a specific whenever the diplococcus meningitidis intracellularis is present, and it usually is. However, it may be said in justification of the omission that the average practitioner in rural communities would find it difficult to secure the serum, and in addition a competent specialist to administer it.

The book, however, is generally a safe guide for the practicing physician. It is also a work of reference, where the data necessary are easily found, and usually trustworthy. It is interesting, carefully written, well-printed and illustrated, and is a distinct and valuable addition to the literature on infantile therapeutics.

Ar last the long-looked for thing has happened and everyone breathes easier! A quack institution at Chattanooga, Tenn., has reports from its agents that "confidence is completely restored." Here is an admission that the public has been somewhat dubious, and had its trust and confidence shaken. At any rate, read what the following news item from the Chattanooga Star (September 10) says: "The traveling salesmen for the Southeastern States for the Chattanooga Medicine Company, some thirty or forty, have been in the city for the past two or three days conferring with headquarters concerning plans for fall business. The majority of the salesmen report that confidence is completely restored throughout the South and that the prospects for fall business through the cotton country is extremely good.

Dr. Oliver P. Holt has been appointed succesor to the late Dr. Joseph Eichberg, who was Professor of Theory and Practice of Medicine at the Miami Medical College. Dr. John H. Landis, although an alumnus of the Medical College of Ohio, received the appointment of Professor of Hygiene.