structural shortening will ensue. We must not confuse muscles which for years have been useless with muscles that are positively paralyzed. The operation of tendon transplantation and arthodesis are also noted in relation to spinal paralysis. The nearest efficient. tendon should be employed if sufficiently strong rather than one from a distance, and the selection should be made, if possible, of a re-enforcing muscle the mass of which is parallel to the re-enforced. If the tendon is to be spliced by tendon, it should be done as near its insertion as practicable, to avoid as much as possible a yielding of the paralyzed section, which is apt to occur. If possible to transplant into the periosteum he has found that the best way. The proximal part of the re-enforcing tendon should be fixed into the paralyzed tendon so that it can be maintained as tense as possible, if we are to have it do its work. He describes the operation of arthrodesis, and speaks of its advantages, in flaillike joints. Cerebral paralysis of the spastic type is also discussed at length by Jones, who puts the idiot, the microcephalic, and the the violent irritable type of diplegic outside of the class which can be successfully treated. The treatment of any condition short of this may be undertaken with varying success, allowing that it may require a long period. The treatment of the hand and arm in infantile hemiplegia is less promising than the diplegic cases. If the spasm is never relaxed treatment is futile. He speaks particularly of the importance of flexing the elbow superficially, hyper-extending the wrist as the dominant deformities are pronation and carpar flexion. may be taken as a rule that the fixation of the spastic muscles in a position opposed to their contraction les

It

sens the severity of their spasm. This is perhaps the best explanation of how the good results occur. In the latter period of treatment tenotomy or tendon transplantation may be required, and no opportunity should be lost in proper cases of performing tenotomy. The treatment of spastic paralysis involves operative, mechanical and educational stages. If the surgeon is not satisfied after the case has been under his care for twelve months, he would do best to leave it alone.-American Journal, March 7.

Dr. Robert Maguire, physician to the Brompton Hospital, London, stands very high, both as a physician and bacteriologist. Moreover, he is one of the foremost English authorities on tuberculosis. He has been experimenting with formaldehyde, and he asserts very positively that in it we have a specific for consumption. The remedy must be used hypodermically, and the injection must be made in or about the elbow. It had been demonstrated that a solution representing the strength of one onehundred-and-seventieth was fatal to the bacillus of phthisis. He employed the agent in this strength with the most astonishing results. He believes this treatment will cure the dread malady in any stage.

Maxime Gogan, the richest citizen along the shores of the Gulf of St. Lawrence, has recently passed away at Cocagne, N. B., at the wonderful age of one hundred and eight years and seven months. His grandfather. Louis Gogan, fought under Montcalm in the defense of Quebec in 1759. He drank for more than sixty years a quart of brandy and a pint of extra dry champagne every day. Until he was eighty years old he could lift a larger load than any man he had ever met. Last April, when he was one hundred and eight years old, he walked to the spring in the rear of his home, and. holding his full weight on his hands and toes, drank from the pool without letting his knees touch the ground.-Medical Times, New York,

The Increase of Pneumonia.

Commissioner of Health Reynolds, of Chicago, in a recent address delivered before the Michigan Board of Health, declared that while the fatalities from consumption were on the decline those from pneumonia were gradually increasing. Dr. Reynolds showed from statistics compiled from reports extending over several years, that pulmonary tuberculosis had decreased from 18.21 per 10,000 of population in 1880 to 14.44 in 1900. Pneumonia for the same period showed an increase of almost one per 10,000 of population, the death rate in 1900 from this disease being 13.49 per 10,000. Statistics from the federal census for the last twenty years, the whole country over, show a decrease of twenty and three-tenths per cent. in the deaths from pulmonary tuberculosis and an increase of seven and four-tenths per cent of deaths from pneumonia.

Polypoid growths in children are a more common affection than is generally supposed, says L. H. Adler in the January issue of the Pennsylvania Medical Journal. He also contends that these protrusions at the anus are often confused with prolapse. Spontaneous cure results in many without having come under the notice of a surgeon. They vary in size from a pea to that of a butternut. Intussusception is a complication which may occur when the growth is high up in the intestines.

cases

There are usually no symptoms attending the polypus located high up in the rectum, but when situated low down in this part of the bowels there is generally a sensation of fullness and distress, and hemorrhage, too. often is of diagnostic importance.

The only conditions simulating this affection are hemorrhoids and prolapse. Careful examination after an enema will eliminate these. The treatment insisted upon by the author is removal.

The author's method is to apply a forceps to the pedicle and another to the body of the polypus and by twisting the latter a separation is accomplished with little pain and hemorrhage. Tearing the polypus is likely to result in bleeding and the clamp and cautery are rather formidable.

Grape-juice and the Typhoid Bacillae.

The Chicago Board of Health after testing the action of various fruit juices on the typhoid bacillæ, state that while lime juice, ap

ple juice and the juice of the grape fruit, all had a more or less inhibiting effect on the growth or action of these bacillæ, bottled grape-juice gave the most conclusive results. The advantage of the grape juice is that while it is as nutritious and generally as easily digestible as milk, one per cent. is sufficient to affect the bacillæ, a quantity so small as not to disturb the feeble digestion.

Antitoxin in Diphtheria.

Kerley, in a paper read before the American Pediatric Society (Archives of Pediatrics, Oct., 1902), lays down the following rules:

1. With a visible membrane inject at once, and take a culture.

2. In croup inject if there is inspiratory and expiratory obstruction.

3. Patients should be seen at twelve-hour intervals.

4. Reinject in twelve hours, unless there is marked improvement.

5. Unless improvement is continuous, reinject at twelve-hour intervals until membrane disappears.

6. Dosage: Two thousand units to a child under one year, amount to be repeated if necessary; to a child over one year three thousand units under same conditions.

The Typhoid Epidemic at Ithaca.

The State Board of Health has been investigating the cause of the outbreak of typhoid fever at Ithaca, and the means of preventing a recurrence. The recently issued bulletin of the Board says that "by what means either of the three small streams furnishing the water supply became infected thus to produce this abrupt, unseasonable outbreak has not been determined to full satisfaction, but, of unusual conditions, there was located upon the ravine-like banks of one a body of foreign laborers during the fall and early winter building a dam, who departed with advent of frost. Among them were probably carriers of typhoid germs, which the first soft weather carried into the stream. A bill has been introduced into the legislature providing for the prevention of pollution of all streams in the State. The measure will give authority to the Health Commissioner to force all municipalities and em

ployees of large bodies of men to dispose of all refuse matter and sewage in such a way as to render the pollution of water supplies impossible. It is estimated that there have been over 500 cases of typhoid fever at Ithaca, but the number of new cases is rapidly decreasing, and it is believed that the epidemic is practically at an end.-Medical Record, New York.

A New Dressing.

Springer (Centralbl. f. Chirugie) applies a thin covering of paraffin over a wound to prevent the possibility of adhesion of the gauze dressings, and has found it admirable for that purpose. It always retains its shape, neither melts nor becomes rancid, and is a good fit without adhering to the wound. A lump of paraffin is boiled in water for about ten minutes and then set in a pan of cold water to cool. When the gelatin has hardened and spread out in a thin layer on the surface of the water, the pan containing the gelatin is set in a pan of warm water until the paraffin is flexible. The sheet of paraffin is then cut and trimmed to the exact shape desired, perforated with a hot needle and transferred to the wound with forceps, the water surface down. The wound can be easily uncovered and cleaned, and it is shielded from all kinds of irritants. The gauze covering remains unimpaired. The light can also penetrate the thin paraffin sheet to exercise a beneficent influence.

Dr. Lucien Lofton, of Belfield-Emporia, Va., has successfully treated seventeen cases of external and internal hemorrhoids with injections of hot decinerneae salt solution, and thinks results as good as with other injections which have been used, and far safer. He uses the water at boiling point, and there is very little pain felt by the patient.

Hypodermoclysis:

Dr. M. Kahn in American Medicine for February 7 reports a case of pneumonia in which the patient had a pulse of 160, a temperature of 105.5, Cheyne-Stokes respiration, pronounced cyanosis, and was apparently moribund. The usual agents had been employed, and further medication seemed useless. Hypodermoclysis was then used, about three pints being given within six hours in

four injections. The immediate effect was astonishing; the pulse became slower and of better quality, the temperature dropped, cyanosis disappeared, respiration became regular, consciousness returned and diuresis was marked. Rectal injections of the salt ́solution were given at intervals for two days following, and the patient recovered. The author of the paper believes that the best safeguard against heart failure in pneumonia is to diminish the toxins, and at present this is best effected by the exhibition of subcutaneous salt injections.

Serum Therapy of Typhoid Fever.

Chantemesse (La Presse Medicale, December 24, 1902) reviews the statistics of the hospitals of Paris, excepting that under his charge, and shows that the average mortality from typhoid fever is 19.3 per cent. The lowest mortality rate was 12 per cent. In the hospital under his own charge, where serum-therapy is resorted to in all cases. there were but 7 deaths in 186 cases (3.7 per cent.). The other treatment employed was the same in all the hospitals. Three of the seven deaths were due to perforation, one to purulent peritonitis, and one to intestinal haemorrhage. All these patients came under treatment late in the disease. Chantemesse has noted no complications in patients coming under treatment early. He considers that it is well to give 2 c.c. of the serum even before the diagnosis is certain. So far, in Paris, 356 patients have received this serum treatment, with but 17 deaths (4.7 per cent.). Chantemesse explains the effect of this serum in that it is both antiinfectious and antitoxic, but above all excites phagocytosis. Thus, it is almost specific in typhoid fever. He also considers the isolation of typhoid fever cases a very important means of prophylaxis. (Phila. Med. Journal, January 24, 1903.)

HOPEFUL CO-OPERATION. To the Editor of Medical Dial, Minneapolis, Minn.

Dear Sir: At the last (fifty-third) meeting of the American Medical Association, held at Saratoga Springs, June 10-13, 1992, a joint resolution from the Sections of Cutaneous Medicine and Surgery and Hygiene and Sanitary Science was introduced in the House of Delegates as follows.

"Whereas, There is a burning necessity to check the spread of venereal diseases. and, assuming that the States cannot with impanity ignore the condition, it lies in the province of the medical profession to discuss and recommend to the respective State Legislatures and Municipalities means not regulamentative, but social, economic, educative and sanitary in their character, to diminish the danger from venereal diseases. Resolved, That the Section on Cutaneous Medicine and Surgery of the American Medical Association invite the section on Hygiene and Sanitary Science to co-operate with the Section on Cutaneous Medicine and Surgery in bringing about a propaganda in the different States, looking toward a proper recognition of the dangers from venereal diseases, and to arrange for a national meeting under the auspices of the American Medical Association for the prophylaxis of venereal diseases, similar to the International Conference for the Prophylaxis of Venereal Diseases, which meets again this year at Brussels, under the authority of the Belgian Government."

This was later submitted to the House of Delegates, which endorsed the action of Section and adopted the following:

"Resolved, that a joint committee of six from the Sections of Hygiene and Sanitary Science and Cutaneous Medicine and Surgery be appointed by the President to stimulate study in, and uniform knowledge of the subject of the prophylaxis of venereal diseases and to present to the American Medical Association a plan for a national meeting, similar to the International Conference for the Prophylaxis of Venereal Diseases, which meets again this year in Brussels, under the auspices of the Government of Belgium."

The Committee on Prophylaxis of Venereal Diseases consists of Dr. Henry D. Holton, Chairman, Brattleboro, Vt.; Dr. Ludwig Weiss, Secretary, 77 East 91st St., New York; Dr. George M. Kober, 1600 "T" St., Washington, D. C.; Dr. W: H. Sanders, Montgomery, Ala.; Dr. L. Duncan Bulkley, 531 Madison Ave., New York City; Dr. Frank H. Montgomery, 100 State St., Chicago, Ill.

The peculiar social, racial and political conditions of our country are so different from those on the continent that they necessitate an expression of solely American

The Committee desires the support of the medical profession and the aid and powerful collaboration of the medical press of the country to help them in this work. It takes the liberty of soliciting expressions and views editorially and otherwise, and would be glad of personal correspondence from those supporting the movement and who will contribute by papers, etc., to make it a success in case the house of delegates should favor the holding of such a congress.

By giving this a place in your esteemed paper, the committee feel that you will have aided materially in forwarding the work entrusted to them. I remain with thanks. Very truly yours, LUDWIG WEISS, M. D., Secretary of Committee.

Perforating Ulcer of the Foot.

A man of 50 years. The ulcer appeared early in the autumn of 1902. The calloused skin was thick and non-sensitive. Recently the ulcer had perforated the dorsum extending from the plantor surface between the fourth and fifth metatarsal bones. The fourth was carious and its distal extremity broken.

Pressure alone is presumably not a sufficient cause to produce perforating ulcer; some suspect a nervous origin, in all probability they act conjointly.

The prognosis is rather unfavorable. The callous on the undersurface was removed and the ulcer thoroughly curetted and swabbed with pure carbolic acid. This was afterwards neutralized by alcohol, and the foot bandaged. The wound is to be dressed with balsam of Peru every other day. L. LIMA.

Sarcoma of Right Axillary Glands.

The patient, a robust man 43 years old, presenting a soft tumor the size of a fist in his right axillary space. It had existed for three years, but grown markedly for the last year. No other glands were involved, and there was no lencocytosis. The tumor felt somewhat like a multilocular cyst. On cutting into it a soft, lobulated mass protruded, which dissection disclosed to be considerably more extensive than was first assumed. The lobules extended underneath

both pectoral muscles, the subscapularis. and the great axillary vessels almost to the coracoid process. It was dissected away en masse. To accomplish this an incision had to be made from the axilla toward the sterno-clavicular articulation and the pectoralis major and minor muscles divided. The axillary vein was much dilated, due to the pressure exerted by the tumor, and great care was exercised in the dissection around this structure. Vessels and nerves coursed through the mass and were cut. Having removed all the tissues involved, the muscles were sutured and the wound closed, leaving a drain of iodoform gauze. Coley's fluid is later to be used as precautionary means.

The removed glands were very soft, some as large as a goose-egg, others very small. During the first week subsequent upon the operation much straw-colored fluid was exuding. The patient left the hospital at the end of the second week.

American Urological Association.

This association meets the first Wednesday of each month, except July, August and September.

Annual meetings: The last day of the American Medical Association's meeting and the day following. This year's meeting: New Orleans, May 8th and 9th. President: Ramon Guiteras, M. D. Secretary: Ferd C. Valentine, M. D., 31 West 61st St., New York.

Necrology, Dr. C. M. Skinner.

Dr. C. M. Skinner. who died Saturday evening at Oconomowoc, Wis., just as he was sitting down to a Masonic banquet, was well known in Minneapolis, having resided here for several years. He was for a time proprietor of a drug store at Tenth and Washington avenues S., later at Fifteenth and Washington avenues S., then 1718 Fourth avenue S., and finally at 713 Third avenue S. He was also at one time professor of surgery of the Minneapolis College of Physicians and Surgeons which has since been merged into Hamline university as its medical department. Dr. Skinner was for many years identified with the South Side Gun Club.

The Deaf Shall Hear.

Five patients from the New York institute for the instruction of the deaf and blind attended a performance at the Metropolitan Opera house, March 30, and were enabled to hear perfectly by the aid of the "acousticon," the invention of Miller Reese Hutchinson, of Mobile, Ala. with which the initial experiments were recently made here with success. The appliance is in three pieces. The reverse side of the disc is hollow and filled with gases, the nature of which Mr. Hutchinson alone knows. The ear piece, which resembles that of a telephone, and the vulcanized disc are connected by wires and an electric storage battery that is easily carried in a pocket supplies the current that connects the disc and the ear piece.

The Dietetic and Hygienic Gazette, commenting upon the dietetic value of Iron, says:

"Pathologists have given pointers as to the special condition of the iron in the system and in the circulating medium, and the newer preparations aim to imitate that condition. Most of them have a brief day of fame and then drop out of sight for the reason that they lack some element of eligibility. Few are standing the test of time and the critical ordeal of the clinicians. Foremost among these it is safe to name Gude's Pepto-Mangan. It is probably the nearest approach to a physiologic reproduction yet devised. It deserves its universal popularity, and its manufacturers do well to restrict its sale to strictly ethical channels."

Dr. Acken, of New York, reports twentythree cases of anaemia in which he exhibited Neoferrum-the new iron, at the West Side Dispensary. His deliberate judgment is that this preparation far surpasses any of the various forms of iron and manganese on the market. Neoferrum, the new iron, is prepared by The Maltine Company, which in itself is evidence that the latest advances in medicine, chemistry and pharmacy have been utilized.