News Items.

PRESIDENT OF THE BOARD OF HEALTH. Dr. Thomas Darlington, Commissioner of Health of the City of New York, January 1,

Dr. Darlington was born in Brooklyn, formerly Williamsburg, forty-five years ago. His early education was in the public schools of this city and in Newark, N. J., High School. After three years' course in scientific and engineering at the University of New York he entered the College of Physicians and Surgeons of New York, and graduated in 1880.

the New York Medical Record, also "The Effects of the Product of High Explosives, Dynamite and Nitroglycerin, on the Human System,' "Tunnel Poisoning," "The Climate of Arizona and the Effect of Hot and Dry Climates in Disease," literary and scientific articles for the Youth's Companion and Scientific American, editorial articles on hygiene and sanitation for the Mail and Express.

Dr. Darlington is a member of the New York State Medical Association, the Medical Society of the State of New York, the American Medical Association, the Harlem Medical Association, and the American Climatological Society, of which he is the first vice-president.

He is visiting physician to the New York Foundling Hospital, of which he was the president of the Medical Board for two years; visiting physician to the Fordham Hospital, to the St. John's Riverside Hospital, and to the Seton Hospital, and consulting physician to the French Hospital.

Dr. Darlington is a member of an old New York family, and is a member of the Society of Colonial Wars. He has always been interested in politics, and is one of the incorporators of the Jefferson Club. His interest in local affairs led him to be a member of the North Side Board of Trade.

He is the first medical man to occupy the position of President of the Board of Health of New York.

He practiced medicine at Newark, N. J., until 1882; at Kingsbridge until 1888; at Bisbee, Ariz., until 1891, and at Kingsbridge since 1891.

He was visiting assistant physician at St. Michael's Hospital, Newark, 1880-82; surgeon to the new Croton Aqueduct Corporation, New York, 1885-88; to Harlem Canal Improvement Works, 1888.

After his return to Kingsbridge in 1891 he became interested in the local affairs, and was appointed on the local school board, and has sat as a member of the board ever since.

His writings have been on "Pneumonia," in

STATE MEDICAL SOCIETY.

The 98th annual meeting of the Medical Society of the State of New York was held January 26th, 27th and 28th, at Albany. The following program was presented:

Executive Session-Opening prayer. President's inaugural address. Reports of officers and committees. Report of Committee of Conference and action thereon. Executive business. Election, by districts, of Committee of Nomination.

"Sciatica, Its Diagnosis and Treatment"; a report of 200 cases, Joseph Collins, New York; "Tic-Douloureux and Other Neuralgias from Intranasal and Accessory Sinus Processes," Sargent F. Snow, Syracuse; "Traumatic Hemorrhage Over the Third Anterior Frontal Convolution-Operation, Removal, Recovery," W. C. Krauss, Buffalo; "Enuresis," George E. Beilby, State Industrial School, Rochester; "The Toxemia of Tuberculosis"; Report of a case, Arthur W. Elting, Albany; "Alkaline Treatment of Recurrent Vomiting of Children," Irving M. Snow, Buffalo; "Dilated Urachus": Report of a case-specimen, C. F. Timmerman, Amsterdam; "Insufficient Pyloris," Mark I. Knapp, New York.

Symposium on Diabetes-"Pathology of Diabetes," betes," David Edsall, Philadelphia, Pa.; "Medical TreatR. M. Pearce, Albany; "Physiologic Chemistry of Diament of Diabetes," William H. Thomson, New York; "General Management of Diabetes," F. C. Shattuck, Boston, Mass.; "On the Synchronous Occurrence of Diabetes and Non-Diabetic Glycosuria," Heinrich Stern, New York.

Address "Conflicting Claims of General Education and Professional Education," Arthur T. Hadley, LL.D., president Yale University; "President's Address," Algernon T. Bristow, Brooklyn.

"The Submerged Tonsil," Thomas Harris, New York;

"Chronic Laryngitis," Z. L. Leonard, New York; “A Plea for More Accurate Knowledge in the Diagnosis and Treatment of Chronic Otitis Media," J. F. McCaw, Watertown; "Angina Due to the Bacillus Capsulatus of Pfeiffer," Charles Stover, Amsterdam; "Irritable Bladder in Women," R. L. Dickinson, Brooklyn; "Fifteen Years' Experience with Uterine Fibroids," W. E. Ford, Utica; "Results in Diffuse Septic Peritonitis Treated by the Elevated Head and Trunk Position,' Russell S. Fowler, Brooklyn; "Asthenopia: A Clinical Study," D. H. Wiesner, Brooklyn; "The Relation Between the Muscles of the Eye and Those of Other Parts of the Body," Lucien Howe, Buffalo; "Diagnosis and Treatment of Glaucoma," D. B. St. John Roosa, New York. Discussion by David Webster and Thomas R. Pooley. "A Study of the Climate of Long Island," W. H. Ross, Brentwood, L. I.; "Independent Primary Cancer in the Same Individuals," A. L. Benedict, Buffalo; "The Treatment of Cancer by Its Own Toxin," P. J. McCourt, New York; "Recent Researches in Radio-Activity and Electricity; Their Bearing Radio-Therapy-Legal Status," J. S. Wright, Brooklyn. "On Lesions in the Structures Surrounding the Knee Joint," Nathan Jacobson, Syracuse; "Report of 615 Surgical Cases Attended at the Albany Hospital from March 1, 1902, to March 1, 1903," with remarks, Albert Vander Veer, Albany; "A Case of Gunshot Wound of the Brain," John A. Wyeth, New York; "A Personal Experience in the Surgical Treatment of Mammary Cancer, with a Post-Operative Résumé of Cases," Willis G. Macdonald, Albany; "Tubercular Myositis": Report of a case, William B. Brinsmade, Brooklyn; “Associated Cases of Staphylococcus Aureus Infection," Arthur G. Root, Albany; "The Non-Operative Treatment of Trachoma, Frank J. Parker, New York; "Aphasia and Agraphia," Edward D. Fisher, New York.

on

Symposium on Abdominal Pain-"Abdominal Pain in General and That Due to Abnormal Conditions of the Stomach, Liver, Kidneys and Pancreas," John H. Musser, Philadelphia, Pa.; "Abdominal Pain Referable to the Abdominal Walls," Joseph D. Byrant, New York; "Abdominal Pain of Pelvic Origin," William M. Polk, New York; "Abdominal Pain of Intestinal Origin," F. H. Wiggin, New York. Discussion by M. H. Richardson, Boston; Robert F. Weir, New York; G. R. Fowler and Charles Jewett, Brooklyn, and W. H. Carmalt, New Haven.

President's reception at the Hotel Ten Eyck from 7.30 to 8.30. Dinner at 8.30 at the Hotel Ten Eyck.

"A Case of Recurring Membranous Stomatitis, Associated with Erythema Exudativum Multiforme (Hebra), Louis E. Blair, Albany; "The Hospital Car; Its Equipment, Uses and Importance," W. W. Sanford, New York.

Symposium on Nephritis-"Pathology of Nephritis," Francis Delafield, New York; "Renal Decapsulation from the Pathologists' Point of View," J. M. Van Cott, Brooklyn; "Surgical Treatment of Nephritis," G. M. Edebohls, New York; "General Treatment of Nephritis," Beverly Robinson, New York.

MEDICAL DIRECTORY.

The Medical Society of Pennsylvania is preparing to issue a medical directory of the physicians of that State. In urging its members to respond promptly, the journal of the Pennsylvania State society makes the following state

ment:

The New York State Medical Association has recently published the fifth edition of The Medical Directory of New York, New Jersey and Connecticut, a copy of which is furnished free to each member of that Association. Others can secure a copy by sending $2.50 to Dr. C. E. Deni

bushes grow;

And I tho't that the sagebush doctor, to the other could give the palm;

He could well afford to do it with feelings kind and calm,

For what has his city brother to pay him for all his pains?

Nothing, nothing, nothing, nothing but money and brains,

While we who toil in the country have blessings they never know,

With a world of brightness about us, where faces with innocence glow.

We of course do not get the money to be had in the larger marts,

But we have something better, for we have the people's hearts.

Toil on you city martyrs, there is Him who his blessings will give

To the overworked city doctor who exists but does not live.

-Wisconsin Medical Recorder.

Book Reviews.

A TREATISE ON ORTHOPEDIC SURGERY. By Royal Whitman, M.D., Instructor in Orthopedic Surgery in the College of Physicians and Surgeons of Columbia University, New York; Associate Surgeon to the Hospital for Ruptured and Crippled; Orthopedic Surgeon to the Hospital of St. John's Guild; Chief of the Orthopedic Department of the Vanderbilt Clinic, etc. Second edition. Published by Lea Bros. & Co. 1903. The fact of the first edition being so quickly exhausted is something of an indication of the popularity of this book. The sale of a text-book naturally depends, to a great extent, upon the recommendation of instructors, and, therefore, we expect books written for students, by teachers, to have a certain assured circulation. Nevertheless, the early sale of the entire first edition of this work can be accounted for only by the high esteem which it has won for itself from the profession at large.

This second edition is larger and better illustrated, but retains the general character of the first edition.

There are some 850 pages, including an index, and 507 illustrations. These illustrations deserve especial mention, because they are exceptionally fine and serve their purpose excellently. The paper, the type and the binding are all in keeping with the class of work done by the publishers. We do not believe such a large volume can be bound in cloth and stand the usual hard usage of a text-book, but that is not a criticism of the bookmaker, as he can only supply what is demanded.

A most striking omission is the first thing to attract our notice: No definition of the subject is given. A text-book which does not teach the extent and limitations of the field under discussion! Does the author refer the student to the Century Dictionary to learn that orthopedic surgery "is the correcting or preventing of deformity in any part of the body, especially in infantsa branch of plastic surgery"?

"Perfect definition is the summit of human knowledge in every part of science." A writer on some special branches of surgery might indeed hesitate before assuming to formulate a definition of his subject matter. A definition of orthopedic surgery, however, was given to the profession some thirteen years ago, and there is no known reason why students should not know what they are studying about.

"Orthopedic surgery is that department of surgery which includes the prevention, the mechanical treatment, and the operative treatment, of chronic or progressive deformities, for the proper treatment of which special forms of apparatus or special mechanical dressings are necessary." This definition was given in a paper read before the orthopedic section of the Tenth International Medical Congress, in Berlin, August 5, 1890, by Dr. Newton M. Shaffer.

A few pages of the history of the birth and growth of the subject would not only be of interest to the student, but is quite essential for his full appreciation and understanding of this branch of surgery. The author, however, after the bald statement of the subject, without any definition, without any history, without a word of introduction, plunges into the consideration of Tuberculous Disease of the Spine. This chapter and the succeeding one on Non-Tuberculous Affections of the Spine are the two best in the entire book. They are well worth the careful consideration of physicians and surgeons, whether interested in orthopedics or not.

Chapter 3 is on Scoliosis. Dr. Whitman, with many others, believes that faulty posture, especially among growing children, is one of the chief etiological factors in this disease. Although undoubtedly of great weight as a contributing agent, it is difficult to understand how an unsuitable desk and seat in a schoolroom can be the primary cause of these very marked and compound changes in the relations between the vertebræ. As has been suggested by other surgeons, it is much more probable that constant contraction, due to faulty inner

vation of one set of the rotatores vertebræ will some day be demonstrated as the basis of the deformity.

If teachers, in the classroom and in their text-books, would mention the opposing opinions of other scientists they would do much to interest the student and to excite his enthusiasm for original research.

Twenty-seven pages are devoted to exercises for the cure of scoliosis. No mention is made of exercises looking to the direct replacement of the rotated vertebræ. The exercises of Teschner, which the author extensively quotes, are excellent, as good as any gymnastics, for those in need of physical exercise, but it cannot be said that they are especially applicable for this disease. Fully twenty pages could here be saved from the bulk of the volume. In chapter 7, under tuberculous disease of the hip joint, Dr. Whitman admits that the causes of atrophy are somewhat obscure, but adds: "One cause, and by far the most important, is very evident. This is physiological disuse." Why is not mention made that many competent surgeons, both in this country and in Europe, believe the most important cause of atrophy to be nerve irritation, and that the functional inertia is secondary in its production. No mention is made of the altered electro-muscular contractility—an important symptom.

On page 438 Elongation of the Ligamentum Patellæ is described, but the normal length of the ligament is not given. No description of shortening of the ligamentum patellæ is given, although some cases have been recorded in medical literature.

On page 450 the symptoms of sprain of the ankle are given in four lines. We admire the easy way in which a most difficult subject-the diagnosis of a sprained ankle -is discussed.

It is not our purpose, in this review, to discuss nomenclature, but we cannot let the name "weak foot" pass without challenge. The reasons which the author gives for using the term are not at all sufficient. As a scientific name for a disease or deformity, it is entirely inadequate. It offers no light upon the pathological condition. There are many bones, tendons, muscles, ligaments and fascia which may be at fault.

"The names given to diseases should convey to the mind an exact idea of the morbid conditions which these names are designed to express, at least a strong endeavor should be made toward the attainment of that end."

"The methodical nosographer first describes a morbid condition. From this description he extracts the definition, and from the definition obtains the correct name of the disease which he accordingly classifies."

"The nomenclature of diseases, to be exact, should be based upon the true nature of morbid conditions and should be characterized by simplicity, brevity and accuracy." These three quotations are from that excellent work by Gouley: "Diseases of Man: Their Nomenclature, Classification and Genesis."

We cannot immediately change all the ill-advised names of diseases, but we can avoid coining more unscientific terms.

In attempting to write for both the student and the graduate Dr. Whitman has found it necessary to put in much that cannot interest both classes of readers. This, we believe, is a grave mistake. It is like a specialist who also practices outside his specialty. The field for a good text-book on orthopedic surgery offers a grand opportunity to him who understands the sciences of orthopedy and pedagogy, and who has a good literary training.

In comparison with other books in the same field, the volume before us is unexcelled, but that there is a good text-book on orthopedic surgery we are not ready to admit.

THE PHYSICIAN'S VISITING LIST (Lindsay & Blakiston) for 1904. Philadelphia: P. Blakiston's Son & Co., successors to Lindsay & Blakiston, 1012 Walnut street. Price for twenty-five patients, $1; for

fifty patients, $2.

This little book, which is in the fifty-third year of its

publication, is exceedingly compact and simple in its arrangement. It is divided into three parts-special memorandum, cash accounts and engagements. Besides these pages it contains a calendar, pencil, pocket, etc., making it a very complete as well as useful book for the physician.

BOOKS RECEIVED.

TRANSACTIONS OF THE SIXTEENTH ANNUAL MEETING OF THE NORTH DAKOTA STATE MEDICAL SOCIETY, Bismarck, N. D., May 21-22, 1903.

THE BLUES (Splanchnic Neurasthenia), CAUSES AND CURE. By Albert Abrams, A.M., M.D. (Heidelberg), F.R.M.S., Consulting Physician, Denver National Hospital for Consumptives; the Mount Zion and French Hospitals, San Francisco; President of the Emanuel Sisterhood Polyclinic, formerly Professor of Pathology and Director of the Medical Clinic, Cooper Medical College, San Francisco. Illustrated. New York: E. B. Treat & Co., 241-243 West 23d street. 1904.

THE SELF-CURE OF CONSUMPTION WITHOUT MEDICINE, with a chapter on the prevention of consumption and other diseases. By Charles H. Stanley Davis, M.D., Ph.D., Member of the Connecticut State Medical Society; Physician to the Curtis Home for Old Ladies and Children; Author of "The Training and Education of Feeble-Minded, Imbecile and Idiotic Children," etc., etc. New York: E. B. Treat & Co., 241-243 West 23d street. 1904.

TRANSACTIONS OF THE STATE MEDICAL ASSOCIATION OF TEXAS, Thirty-fifth Annual Session, held at San Antonio, Tex., April 28, 29, 30 and May 1, 1903. Austin, Tex. Von Boeckmann-Jones Company, State Printers.

1903.

TRANSACTIONS OF THE NATIONAL ASSOCIATION OF THE UNITED STATES PENSION EXAMINING SURGEONS. Second Annual Meeting, Washington, D. C., May 13 and 14, 1903, including an account of first meeting at Saratoga Springs, June 9, 1892. Vol. I. Published by the Association: Rochester, 1903.

SOCIAL DISEASE AND MARRIAGE, SOCIAL PROPHYLAXIS. By Prince A. Morrow, A.M., M.D., Emeritus Professor of Genito-Urinary Diseases in the University and Bellevue Hospital Medical College, New York; Surgeon to the City Hospital; Consulting Dermatologist, St. Vincent's Hospital, etc. New York and Philadelphia: Lea Bros. & Co. 1904.

THE TREATMENT OF FRACTURES, with notes upon a few common dislocations. By Charles Lock Scudder, M.D., Surgeon to the Massachusetts General Hospital. Fourth Edition. Thoroughly revised. With 688 illustrations. Philadelphia, New York and London: W. B. Saunders & Co. 1903. Polished buckram, $5 net; sheep morocco, $6.

or

A TEXT-BOOK OF LEGAL MEDICINE AND TOXICOLOGY. Edited by Frederick Peterson, M.D., President of the New York State Commission in Lunacy; Clinical Professor of Psychiatry, Columbia University, New York; General Consultant to the Craig Colony for Epileptics, Sonyea, N Y., and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy and Toxicology in Rush Medical College, Chicago; Professorial Lecturer on Toxicology in the University of Chicago. In two volumes, containing 1,500 pages, fully illustrated. Vol. II. Philadelphia, New York and London: W. B. Saunders & Co. 1904. Cloth, $5 net; sheep or morocco, $6.

REPORT OF THE MEETING OF THE NEW YORK STATE MEDICAL ASSOCIATION.

The New York State Medical Association held its twentieth annual meeting at the Academy of Medicine in New York City, October 19th to 22d, and proved to be one of the best attended, as well as most profitable meetings, from every point of view, since its organization. The program consisted of forty papers covering all departments of medicine, general and special, and written by men perfectly familiar with the subject in hand, a number of which were presented by men from other States.

One of the papers covering considerable original work was presented by Dr. Alfred T. Livingston, of Jamestown, N. Y., entitled, "Ergot in Alcoholism and Morphinism, and the General Class of Drug Habit Cases." The doctor stated at the outset that he did not consider morphinism and alcoholism as diseases per se, but that the continued use of these drugs is followed by a dilatation of the arterioles, particularly after the discontinuance of the drug; and it is in this condition that ergot comes in to counteract the effects of this indulgence. He does not believe in "tapering off," but stops the drug at once, teaches the patient that he can do without it-for moral effect-gives ergot, and the patient is often surprised to find the statement of his attendant true.

To quiet the nervous system and induce sleep, he finds the cold bath, galvanizing the spinal and cervical region, using ten to fifteen milliamperes of current for fifteen minutes of great service. He also finds the static spray for one-half hour, dry-cupping the spine and neck, also massage, to be of the greatest relief to the troublesome insomnia accompanying these cases. In addition to the use of ergot he advises free feeding with liquid beef and the whites of eggs at frequent intervals.

His method of administration of ergot is to make a solution of the extract, one dram to the ounce, of this injects one-half dram three to ten times per day, depending upon the requirements of the case.

Dr. Frederick Holme Wiggin, the president, presented his address at the beginning of the afternoon session of Wednesday, in which he took up the history of medical associations of this country, stating that the first physicians to form a society in the United States were those of Litchfield, Conn., the formation of which took place in 1760, from which time the growth of societies was traced to the present time. He referred to the importance of the study of the history of medicine, and advocated the establishment of a chair of History of Medicine and Ethics in medical colleges, the study of which should occupy the first year in each medical course. He also suggested the advisability of each State Society's owning and maintaining its own medical journal, should have its own business office, an editor and corps of typewriters, clerks, etc., the publication of which should be weekly. The address was concluded by reference to the fortunate outcome of the labors of members of both the Medical Society of the State of New York and New York State Medical Association in endeavoring to bring about a peaceful union of the two societies, and now that their efforts are about to be crowned with success the members of both societies have cause for sincere congratulation.

The efforts which have been put forth by the officers and members of both the Medical Society of the State of New York and The New York State Medical Association, to bring about a union of the two societies has of late taken on a more aggressive form, and now, from the standpoint of an outsider, there appears to be little left to do but the arranging of details.-Penn. Med. Jour.

Original Articles.

PROLONGED FASTING AS A FACTOR IN THE TREATMENT OF ACUTE DISEASES.1

With Special Reference to Affections of the Alimentary

T

Canal.

BY NORTON J. SANDS, M.D.,

Port Chester, N. Y.

HE experience of the writer with enforced prolonged fasting as an aid in the management of acute diseases of any great severity dates back twenty years. In 1883 I was called to take charge of a case of typhoid fever, in the person of a young adult, of two weeks' duration the previous physician having been discharged-in which the most distressing feature complained of by the patient was excessive and persistent diarrhea-"more than twenty movements a day," the mother said. I had hitherto allowed my typhoid patients the usual amount of liquid nourishment, but at this time, a little out of patience at being saddled with a serious case. at that stage of the disease, I roughly said: “Well, I guess if you will stop putting food in at one end of the alimentary canal it will have to stop coming out at the other." Acting on this idea, and fortified by the experience of Dr. Tanner in his six weeks' fast, all nourishment was forbidden, all medication stopped, and, in its place, I left directions that a cool pitcher of water be brought up a number of times a day, and the patient allowed to drink all she wanted.

A marked improvement in all intestinal symptoms began immediately, and in the course of two days the movements had ceased entirely. This patient went ten days without food, when, the general conditions warranting it, nourishment. was resumed, and she went on to an uneventful recovery.

Since this date, with few exceptions (and such to my regret), I have pursued this plan of treatment with all my typhoid patients, and have gradually extended it, until I have included it in the management of all acute illnesses of any grade of severity, whether of intestinal or other origin. From observing, too, that patients deprived of food, but furnished with plenty of water, do not lose flesh more rapidly than under the old régimé of feeding, I am pretty thoroughly satisfied that in diseases of any gravity the vital processes that go to the building up of the body are at an absolute standstill. The battle has to be fought out with the stock of tissue and vitality on hand at the outset, and, when that is not wasted, by adding a gastro-intestinal catarrh, with all its attendant troubles, to an already existing disease, it will be sufficient to carry the patient through more often than we think.

In the latter cases (as in pneumonia, influenza, Read at the Meeting of the Westchester County Medical Association, November 19, 1903.

after severe injuries, or after operations of any moment, and especially after laparotomies), while the results are manifestly not so apparent, I find that patients do better without nourishment, inasmuch as they are saved the gastrointestinal disturbance incident to the taking of food that a diseased system cannot manage.

The most convincing results, however, are obtained, as might be expected, in diseases of the gastro-intestinal tract, itself, whether of typhoidal, dysenteric, or other nature, whether in infancy, childhood or adult life. The presence of food acts as an irritant to the affected mucous membrane, increasing the existing congestion and inflammation, and aggravates the symptoms therefrom.

The duration of the fasting period varies with the nature and severity of the illness. Inasmuch as typhoid cases run the longest course, and there is here most ample opportunity to observe the effects of prolonged abstinence from food, I will go somewhat into detail in regard to my treatment of these patients, and my conclusions therefrom.

My rule, when called to take charge of a typhoid case, is to tell the family frankly at the outset that the patient will be kept on a strict "water diet" for from eighteen to twenty-one days, at the same time assuring them of a more comfortable illness and a more certain recovery. If seen early in the disease, I always direct that the patient shall be freely purged, thus removing from the alimentary canal as much infection as possible, and also, as is more important, taking away the culture medium for the growth and multiplication of the bacilli that are left behind. The amount of water which is ordered and insisted upon for the patient is two quarts in the twenty-four hours, until along in the third week, when, with the falling temperature, less may be desired, and the amount may be reduced a little.

With this method of treatment the abdominal symptoms are practically nil; there is no diarrhea, as a rule, after the first few days; there is no pain, no tympanites, and for the past. twenty years I have never had a case of profuse hemorrhage, nor one of perforation.

The effect on the temperature is marked; it runs from 2° to 3° F. lower than the average temperature of the text-books, and the employment of cold baths or sponging for its reduction is rarely necessary after the first week. pulse-rate is correspondingly slower.

The

The age of the patient has so far been no bar to this plan of treatment. I have recently had a patient of 58 who was starved for twenty-one days; and another, a child of not yet 3 years of age, who went eighteen days without food, and both made most satisfactory recoveries.

In diseases of the gastro-intestinal canal other than typhoid (gastritis, enteritis, dysentery, etc.), without mentioning other treatment, food is with