glove appeared, representing the last degree of refinement of the art, it seemed to have overset the whole system. The use of the rubber glove necessitates comparatively slow work, the employment of long incisions and work by sight. Geologists tell us that the constant accumulation of snow and ice at the antarctic pole may cause a sudden changing of the axis. of rotation of the earth. The rubber glove was the last snowstorm of the pathologic era of surgery, and the sun is now to shine on what is perhaps the most fertile area ever exposed to light.

Our faces are now turned toward Metchnikoff and Wright, with their descriptions of phagocytes and opsonins, and of the natural protective forces of the patient. We are at the dawn of the fourth, or physiologic, era in surgery. We are to conserve the natural resistance of the patient and to turn him over to his phagocytes and opsonins as helpfully as we can. We are to leave the patient in his best condition for manufacturing phagocytes and opsonins, through the shortest possible method of anaesthesia and the least degree of surgery which will suffice to turn the tide of battle between bacterium and leucocyte.

That is the new principle-turning the tide of battle only and leaving the patient with his physiology as nearly intact as possible. The first object lesson in support of the new idea was perhaps furnished by the physician who did not believe in operations for appendicitis, and whose patients sometimes recovered, even though they had pus in the peritoneal cavity. These cases required explanation, and we now have the explanation. The patient attended to the bacteria and to the products of infection. Our surgery of the pathologic era had a tendency to damage the patient to such an extent that he could

not destroy his own bacteria and products of infection. The object lesson furnished by the patients of the physicians who did not believe in operating for appendicitis, and the object lesson furnished by the results of operations which neglect the details of the art of the pathologic era, are lessons sufficient for a basis of the coming art of the physiologic era in surgery.

The Annual Meeting of the British Medical Association.-Rarely has a more successful meeting of the British Medical Association been held than that which was concluded at Sheffield on July 31.

Yorkshire hospitality, lavish in its generosity, was seen at its best, and was appreciated to the full by the visitors; the weather was that of the Italian Riviera, and throughout the week there seemed no possibility of hitch or interruption in the continuous round of garden parties, festivities, golf matches and so forth.

And after all, apart from the momentous questions discussed by the reverend seigneurs of the association at the representative meeting, the picnic element is the predominating feature of the annual meeting. Some 1000 visiting medical men with an entourage of some 500 ladies were said to be stopping in Sheffield, and the social aspirations and expectations of this harmonious medical medley were most abundantly satisfied by the really magnificent welcome extended to them by the town, the citizens and the medical profession in Sheffield.

The work of the various "Sections" was up to the usual standard, many distinguished men spoke, many interesting discussions took place, and some valuable papers were read.

Edinburgh was honored in the person of Professor Chiene, upon whom the honorary degree of D.Sc. was conferred by

the university, and in the sectional meetings the number of men resident in Edinburgh taking part in the proceedings was quite noticeable.

In the anatomy, physiology and pathology sections strenuous discussions took place among the scientists. In the section of physiology the questions of purin metabolism were most ably set forth by various eminent authorities on the subject, and the net result of the discussion was a really valuable focussing of the present day views and knowledge of the subject. The subject of cerebro-spinal meningitis commanded much time and attention among the pathologists, and was the theme of interesting papers by Professor Kolle and Professor Emmett Holt among others. In this section also an interesting discussion took place on regenerative and compensatory changes in the liver, in

which Dr. Lindsay Milne of Edinburgh took a leading part.

Scurvy and fatty acid intoxication were subjects discussed before large audiences in the section of diseases of children, and Dr. Logan Turner's paper on "Antral Suppuration" was much appreciated in the section of laryngology, otology and rhinology.

Taken as a whole the meeting was a huge success. Next year the venue is Belfast. Irish hospitality is proverbially bounteous, and the social side of the meeting is certain to be eminently inviting; while it is hoped and expected that Edinburgh, and more particularly the younger generation in Edinburgh, will contribute to the serious side of the business and demonstrate once more that in the realm of medicine Edinburgh stands where she did.-Editorial, Edinburgh Medical Journal.

Neuralgia of the Rectum

Albu (Berl. Klin. Wchschrft., No. 51, 1907). In the course of the last few years the author was enabled to observe five cases of this uncommon disease, and two other cases in which rectal neuralgia was more or less closely simulated. One of these patients had cancer of the prostate and the other, a tabetic individual, was suffering from "anal crises." The author points out that the diagnosis of rectal neuralgia can be rendered by exclusion only, namely after all organic affections of the rectum and its surroundings have been carefully excluded. The condition is characterized by pain in the rectum, anus and vicinity. These pains are extremely distressing in certain cases, and may radiate into the buttocks,

sacrum, perineum, sometimes along the thighs. The cause is referable to neuralgia of the middle and inferior hæmorrhoidal nerves. Inflammatory conditions, or neuritis, of these nerves may be excluded, and there is probably no more than a functional irritability on their part. In other words, nothing definite concerning the character of the disease can be stated at the present state of our knowledge.

The treatment is purely symptomatic, and should consist in compresses, hot sitz baths, douches of steam and hot water, the introduction of bougies, for the purpose of stretching the nerves, and the administration of analgesic remedies per rectum, subcutaneously or by the mouth. F. R.

TWO DOLLARS A YEAR, when paid in advance, otherwise, 82.50, in the United States, Alaska, Cuba, Porto Rico, Mexico, the Hawaiian and Philippine Islands. In Canada, $2.50. In Great Britain, 10 Shillings. In France, 12 Francs. In Germany, 10 Reichsmarks.

These rates include postage only on subscriptions paid in advance. Extra postage will be charged on subscrip tions not paid within four months, to conform with the new postal laws and regulations pertaining to the second class of mail matter.

The address tab on the wrapper of each copy sent by mail shows the date to which the subscription has been paid.

Money can be sent safely by registered letter, bank draft, check, postal or express money order.

Make all remittances payable to the order of MEDICAL REVIEW OF REVIEWS COMPANY.

OCTOBER 25, 1908.

THE PROTRACTED USE OF
DIGITALIS.

An article with this title appears in the Lancet June 6, 1908, written by Dr. R. E. Achert, in which the writer considers the employment of digitalis in various cardiac affections. It is an excellent paper, giving a historical account of Frankel's first experiments on animals, and the late investigations by Cloetta, which show the frequent cumulative action of the drug in many cases, and the lack of definite effects in others. While the cumulative effects have been often noted after prolonged administration Cloetta has apparently cleared away much uncertainty by showing that digalen digitoxinum solu

ble (Cloetta) is never followed by cumulative action. His experiments are the first to reliably demonstrate the fact that this preparation possesses no dangerous or disagreeable cumulative action, such ast vomiting, salivation anorexia or arrhythmia.

We experimented with digitalis in the treatment of scarlet fever and found that a fresh infusion of the English leaves could be administered to children in teaspoonful doses for three weeks without any untoward effect. which seems to indicate that Cloetta is correct in attributing the cumulative action to the fact that the preparation has been crystallized.

These findings are of great value, because in cardiac diseases it is usually necessary to give the drug for long periods, and if digalen can be used as well as the fresh infusion to which we have referred, it will be much better, for the infusion must be freshly prepared, otherwise its efficiency soon becomes impaired.

The author emphasizes the fact that digitalis is indicated for chronic affections of the cardiac muscle and the valvular diseases resulting therefrom. In fatty degeneration it does not, as a rule, agree, for even digitalis cannot restore a destroyed muscular fibre. The most im portant indications for its prolonged use are myocarditis in any stage regardless of the pathogenesis, myasthenia cordis chronica with or without dilatation and hypertrophy and cardiac weakness in the case of hypertrophy of the left side of the heart after nephritis of long standing. Our own experiments indicated that the effect upon the kidney was to contract the arterioles and thus reduce the amount of blood in the organ, thereby reducing the inflammation.

This theory advanced by Bartholow was not verified by autopsy, but there was a notable absence of acute nephritis in

scarlet fever and a very low mortality when the cases were treated with the fresh infusion of the English leaves.

GOAT'S MILK.

It is gratifying to note that the Lancet has been discussing the use of goat's milk for food and recommends its employment on the ground of its quality and purity.

Its richness in butter-fat, as well as in proteids, is well known, and the animal is much more cleanly than the cow, and is practically free from tuberculosis.

of the International Congress on Tuberculosis at Washington.

Dr. Koch reiterated his well known belief that the tubercle baccillus found in cows is not identical with the human baccillus, and supported his views by referring to the equally well known fact that tuberculosis of the alimentary tract is very seldom found in patients who have almost habitually used milk from tubercular cows. Every clinician assures us that post-mortem examinations corroborate this view.

Dr. Koch stated that he desired the co

All this is in line with an editorial in the REVIEW Several months ago, which was based upon a report by the United States Department of Agriculture.

When it is understood that care in the choice of food for the goat is all that is required to insure a pleasant flavor to the milk the advisability of much more general employment as a substitute for cow's milk is to be commended.

BACTERIOLOGY BY POPULAR VOTE.

If published reports be true, a very vital bacteriological problem was solved by a popular vote at the recent meeting

and declared that, while he had seen tuberculosis of the intestinal canal occa

sionally, he believed that the number of

cases so far observed was too small upon which to base a strictly scientific statement. All who know Professor Koch believe that his opinion would be promptly modified to correspond with satisfactory evidence that his present views are in

correct.

Thereupon the congress voted for or against the identity of the human and bovine baccilli and the former won by a large majority. We are not informed. whether the non-medical members voted, but they probably did, which makes this method of solving a great bacteriological problem nothing short of ridiculous.

Honorary Physicians and Surgeons to the King. The King of England has been pleased to make the following appointments: Dr. David W. Finlay, M.D., F.R.C.P., London, Professor of the Practice of Medicine in the University of Aberdeen, to be one of the Honorary Physicians to His Majesty in Scotland, in

the room of Sir Thomas McCall Anderson, M.D., deceased. Sir William Macewen, F.R.S., M.D., Regius Professor of Surgery in the University of Glasgow, to be one of the Honorary Surgeons to His Majesty in Scotland, in the room of Sir Patrick Heron Watson, M.D., deceased. Dr. James Little, M.D., Regius

Professor of Physic in the University of Dublin, to be one of the Honorary Physicians to His Majesty in Ireland, in the room of Sir John Thomas Banks, K.C.B., M.D., deceased. Mr. William Black Alexander, L.F.P.S.G., has been appointed Surgeon Apothecary to His Majesty's Household at Holyrood Palace.

Mme. Curie, who with her husband discovered radium, has been elected a corresponding member of the St. Petersburg Academy of Sciences. Mlle. Gaussel, M.D., has been appointed director of a clinic of Montpelier University-the first time a woman has occupied such an office.

Free Public Lectures at the Harvard Medical School.-Free public lectures on medical subjects, which have proved a success for the past two years, will be continued this year. These lectures are given on Saturday evenings and Sunday afternoons, beginning in January and ending in May. The aim which has been. for the most part successfully attained heretofore is to present medical subjects of popular interest in such a way that those untrained in medicine may derive a clearer idea of its methods and objects.

Death of Becquerel.-Henry Becquerel was professor of physics and applied physics at Paris, and has made notable. contributions to science besides his discovery of the rays from uranium salts, which have made his name famous. He held honorary degrees from four British and one German university, and was a member of the scientific academies of Rome, Berlin and Washington. Besides the Rumford, Burnard and Helmholtz medals, he shared the Nobel prize for physics in 1903 with the Curies. At his death, August 25, he was 57 years old.

New York and New England Associa tion of Railway Surgeons.-The eighteenth annual meeting of the New York and New England Association of Railway Surgeons will be held at the Academy of Medicine, New York city, on November 17 and 18, 1908, under the presidency of Dr. F. A. Stillings of Concord, N. H.

Tabitha Hospital Dedication.-Tabitha Hospital, Lincoln, Neb., was dedicated with appropriate ceremonies on Friday, September 4, 1908. This institution is located near the home of the Hon. W. J. Bryan, the Democratic nominee for President. It is the property of the Evangelical Lutheran Church (G. S.) of the United States, but draws its church support chiefly from the States of Nebraska, Kansas, Colorado and Iowa. In addition to the hospital there is here a home for aged people and an orphanage.

The hospital is in a large measure a local enterprise, a large part of the cost of inaugurating it being borne by the citizens of Lincoln and vicinity. The estimated value of the entire institution is approximately $65,000. It is capable of accommodating easily 100 patients. The staff includes the ablest physicians and surgeons of the city of Lincoln.

Diphtheria Mortality and Antitoxin in London. The annual report of the metropolitan asylums board for 1907, which has just been published, supplies further testimony of the value of antitoxin in diphtheria. In the quinquennial period, 1887-91, the death rate in the cases admitted to the board's hospitals was 33.6 per cent., and in 1893, the year before the introduction of antitoxin, 30.1 per cent. During 1907 it was 9.6 per cent., and during the quinquennium 1902-06, 9.3 per cent. The significance of these figures is