Dr Funkhouser. I do not suppose anyone who has ber that I opened a man's belly many years ago in the had any experience would question the advisability of hospital. He had had dropsy, and I had tapped him the operation. There is no question but that the tumor several times and taken out a bucketful of water each should have been removed. But it is of interest to de time, and after he died he went to the dead-house and termine what this tumor is. We all know that these we made a post mortem and one of the young men cases of appendicitis have more or less liquid and stink came to me and said "that man has no guts." I went ing material thrown out. The fact is I have never seen down and there the belly lay wide open and not a thing a case which did not have the odor connected with it could be seen in the abdominal cavity—it was one big an odor wich you can not wash off, and alcohol will cavity. Scratching through the layer of lymph I found not kill it. I recall one of the most pronounced cases the intestines and other organs, but they had all been that I operated on in Illinois, and it was an appendix pushed aside. That is the very condition of things we that was not over half an inch in length, in which would expect where the appendix is covered with plastic there was considerable liquid thrown out in the cavity material. in which the appendix was lodged. I can understand how the contents of the tumor may be solidified, in the same way that we may find in these cases of degenerated ovaries where there may be from a dozen to sixty cysts. Although they may be fluid at the time of abla tion, still after they are put into alcohol or any hardening fluid the contents may become semi solid and appear very similar to sebaceous material. It is nothing more nor less than albuminous material. It would be interest ing to have the cyst wall and its contents examined under the microscope, and see if we can find any intes tinal fibres. We know that Greig Smith records a num ber of cases where the diverticulæ have been separated -not been connected with the lumen of the intestine, and I do not think it would be absurd or at all farfetched or unlikely that such a thing might occur in connection with the cecum, if, as has been proved by him and others, tumors of the diverticula have been connected with the intestines in any part of the course.

DR. MAYFIELD.-I will say that this tumor felt very much like a floating kidney; I will say further that one of the physicians penetrated it with his hypodermic needle and carried off some of the contents for the purpose of making an examination. I have not yet heard the result. I am inclined to think like Dr. Prewitt that it is a dermoid cyst, but there is not a shadow of doubt in my mind that it was attached to the appendix. I shall be pleased to show the patient to any of the gen tlemen who will come out and they will see that the tumor came out from an incision between the umbilicus and the anterior superior spine.

NOTES: AND ITEMS

St. Louis Medical Society.-The following is the programme of the St. Louis Medical Society for the meeting of Saturday evening, May 29, 1897:

SYMPOSIUM: "MALARIAL DISEASES."-Continued.

1 Malarial Manifestations in the Alimentary Sys tem, Dr. W. G. Moore.

2. Malarial Manifestations in the Genito-Urinary System, Dr. Bransford Lewis.

4. Malarial Manifestations in Pregnancy, Dr. W. B. Dorsett.

Discussion by Drs. C. B. Ewing, J. Ellis Jennings, H. C. Fairbrother and others.

H. W. LOEB, Chairman,)
R. H. FINLEY,

M. F. ENGMAN,

Executive Committee.

DR. PREWITT.-I agree with Dr. Lutz that there can be no question about the propriety of the operation. I 8. Malarial Manifestations in the Skin, Dr. M. F. did not suppose that question would be suggested. Dr. Engman. Mayfield certainly did perfectly right in operating and I can readily understand how a difference of opinion might exist about the thing until it was opened but since it has been opened I think there is no question about it; it is a clearly defined dermoid cyst, and I think it is undoubtedly congenital, and if the woman had been examined ten years ago I think it would have been discovered. It is a well-defined dermoid cyst, contains sebacous matter hair, etc. It can not be any thing else. The cyst probably long remained innocuous until perhaps a rotation on its own pedicle led to its de A Most Successful Year.-The Missouri and tatchment, when it was loosened, and of course would Illinois State Medical Associations have completed a set up a certain amount of plastic inflammation and so most successful year, and their Presidents, Dr. J. H. be surrounded by a layer of lymph. I can understand, Duncan and Dr. A. C. Corr, deserve much credit for too, how the appendix might be hidden away and not their excellent administration. We extend our most be discovered: it is under the layer of lymph. I remem- cordial congratulations and best wishes.

The Committee on Dispensaries and Clinics will present a supplemental report.

Dr. L. C

Death of Dr. L. C. Ingersoll. Ingersoll, of Keokuk, Iowa, died May 24 from paralysis, aged 74 years. He had a wide acquaintance in the Mississippi Valley. His father was one of the founders of Oberlin College, Ohio, from which Institution the Doctor graduated in 1846.

Illinois Board of Health. — At a meeting of Hospital, will be missed from that Institution. He left the new State Board of Health of Illinois held May 24, a few days ago on a tour of Eastern cities, where he at Springfield, Dr. J. A. Egan, of Chicago, was elected will visit the various hospitals to gather knowledge of Secretary, vice Dr. John W. Scott, of Springfield, term use to the City of St. Louis should the time ever come expired. when a new hospital will take the place of the present structure. During his tour Dr. Sutter will also endeavor to gain the rest of which he is in need, and he hopes to return in better health than he was when he left. Among the hospitals he will visit are the Emergency in Boston, the Bellevue and Sisters of Mercy in New York, the Alexis and Fremont in Philadelphia, and the Stewart in Baltimore. Dr. Sutter was accom. panied to Union Station by a number of friends, who Fire at the Missouri Medical College.-bade him bood bye with many wishes for a pleasant While the members of the Missouri and Illinois State journey. Medical Associations were enjoying themselves during their joint session on board of the Grand Republic, fire broke out in the Missouri Medical College, which was extinguished, however, within twenty minutes after its discovery. The fire caused a damage, according to the daily papers, of about $5,000.

Death of Dr. E. M. Powers.-Dr. E. M Pow

ers, who for many years has been house physician at the Southern Hotel, died at midnight Wednesday, May 19, of dropsy. He had been been ill for a number of months, and before his malady became serious, he went to Kirkwood, thinking that the country air would prove Dr. Otto Schmidt's Skiographs. At the beneficial. Dr. Powers was about 70 years old, and meeting of the St. Louis Medical Society of May 22, lived in the city most of that time. He was born in Dr. Otto Schmidt, of Chicago, showed many excellent Ireland, but came to this country while a young lad. skiagraphs of the skeleton and soft parts in health and Dr. Powers served all during the Civil War, first as a disease. The excellent photographs presented showed surgeon in the First Missouri Regiment, and later in that the Doctor had considerable practical experience the same capacity on Gen. Frank Blair's staff. Through in skiography, the exhibition of which was a great treat the influence of the latter he was appointed a member to the Society. The thanks of the Society were tend of the Board whose duty it was to examine surgeons to ered Dr. Schmidt for his courtesy. determine their fitness to serve in the Army. After the war Dr. Powers returned to St. Louis and resumed pri. vate practice. Dr. Powers was a member of the St. Louis Medical Society and a favorably known practitioner.

Dr. J. B. Murphy, of Chicago, was one of the participants in the joint steamboat excursion of the Illi nois and Missouri State Medical Associations. We were much pleased to meet the Doctor after an interval of fourteen years. In 1883 we had the pleasure of first meeting the now distinguished surgeon at the various surgical clinics of the University of Berlin. We take this opportunity of congratulating Dr. Murphy upon his most successful career and well deserved fame.

Decreasing Birth Rates in America. — French economists are consoling themselves for the gradual depopulation of their country by pointing out that many of the American States, including the whole of New England, are still worse off. The birth rate in France has fallen from 33 per 1000 at the beginning of the century to 22 per 1000, and is less than the death rate, so that, if the present conditions continue, in about 200 years the French race will have become extinct. In

Births and Deaths in St. Louis.-The total number of death reported for the week ending May 22, was 171, as compared to 171 the week before, and 166 the corresponding week last year. Based on an estimany of the United States, however, matters are even mated population of 600,000 the death rate last week was 14.8 per 1,000 per annum. One hundred and fifty. eight births were reported during the week.

The contagious disease report for the past week is as follows: Small pox, no new cases, 1 death; diphtheria, 18 cases, 3 deaths; croup, 2 cases, 1 death; scarlatina, 7 cases, no deaths; typhoid fever, 4 cases, no deaths; measles, 18 cases, no deaths; whooping cough, 2 cases, 1 death.

Will Inspect Eastern Hospitals. For the next twenty days Dr. Sutter, Superintendent of the City

more serious. The birth rate in Nevada is 16.30 per 1000, so that, even if no more people should emigrate from that State, its population would die out completely in less than 100 years. Maine comes next with a birth rate of 17.99 per 1000, which gives its race about a cen. tury longer to exist. New Hampshire is third, with 18.4 per 1000. Vermont is fourth with 18.5, and, strange to say, California, which comes next, has a birth rate of 19.4 per 1000, or nearly 12 per cent less than that of France. This fact, in view of the favorable cli. mate, ample area, and diversity of interest and employ. ment characteristic of the State, is most striking. Fol

but 19 6. It will be noticed that the death rate in the lowest city of Europe is 16 50, or exactly the same as that of St. Louis. The highest rate in Europe is 15.50 higher per 1000 than that of the most unhealthy city of the United States.

lowing California is Connecticut, which has a birth rate Berlin's 21.6, and St. Petersburg's 28.4. Moscow shows of 21.3 per 1000. Massachusetts has 21.5. Rhode a death rate of 40.3, while the rate in Calcutta is but Island has 22.5, a somewhat higher rate than the French, 28.5. The rate in Rome is 33.4. Stockholm's rate is but still insufficient to prevent the extinction of the present race within two or three centuries. Wyoming, with its 21.8, comes between Massachusetts and Rhode Island, while Oregon has a rate of 22.5. In most of the States, even those which have a low birth rate, the population is kept up, or increases, but the new blood comes from immigration. The conclusion to be drawn from statistics compiled is simply that, within a period vary ing from 60 to 200 years, according to circumstances, the Anglo Saxon race of inhabitants of New England and the Pacific Coast will be replaced by another.

St. Louis a Healthful City. - St. Louis citi zens may congratulate themselves upon the report of the last Census Committee on vital statistics. The re

port deals with the death rate in the twenty-eight cities of this country with a population of over 100,000 in 1890, and compares this rate with that of foreign cities. In the comparison St. Louis is outclassed by but three cities of the twenty-eight, and all of these three are cities with less than a quarter of the population of this city. The table shows that Newark, N. J., has the highest death rate, exclusive of still births, her rate be ing 27.40 per 1000 inhabitants. New York comes next with 26.45, and the other cities follow:

PUBLISHER'S DEPARTMENT.

Dr. Nat. W. Williams, Laws Hill, Miss., writes as follows to The Gotham Company, 82 Warren Street, New York: "Our baby is an advertisement in herself for 'The best' Nurser. She has not had colic since we

began using it; and before, it was a nightly affair. No nipples suit us like the 'Clingfast.'"

Where Are You Going This Summer? The Charming Summer Resorts of Wisconsin and Michigan are reached by the Northwestern Line. Send for free copy of "Hints to Tourists," giving full information as to locations, hotels, boarding-houses, etc., to A. H. Waggener, T. P. A., 7 Jackson Place, Indianapolis, Ind., or W. C. Kniskern, G. P. & T. A., Chicago & Northwestern Railway, Chicago.

A New Lake and New Trout.-Rear Admiral Beardslee of the Pacific Coast Squadron U. S. N., about a year ago brought to the attention of tourists and anglers a beautiful lake in Northwestern Washington, that contains new varieties of monstrous trout.

President Jordan of Stanford University, California, an authority on fishes, pronounced them entirely new to science. They are very large, weighing from 10 to 13 pounds and ranging from 10 to 30 inches in length. They are caught by trolling, at a distance of 30 feet or more below the lake's surface, and are the gamiest sort of trout, full of fight. Already anglers have gone from the far East to Lake Crescent to enjoy the rare sport found there.

A long chapter on this beautiful lake and its finny inhabitauts, located in the heart of the Olympic Mountains, is found in the Northern Pacific New Tourist Book, Wonderland '97. Send 6 cents for it to Chas. S. Fee, General Passenger Agent, St. Paul, Minn.

Dr. Frank Edward Artaud, of New Iberia, Louisiana, says: This morning I had an opportunity of putting the "Funis Ring Applicator" to test. I was charmed with the results. The persons standing by expressed themselves more than pleasantly surprised, and said this was the neatest and most delicate manner of securing the cord that they had ever seen. The Ring Applicator comes up to my expectations in every respect.

MEDICAL REVIEW,

A WEEKLY JOURNAL OF MEDICINE AND SURGERY.

ST. LOUIS, MO., JUNE 5, 1897.

The hæmamœba malaria of St. Louis has to be divided flagellæ are nothing else but the chromosomes of the into two large groups, viz.:

Of a different origin are the pseudopodia; they are 2. The spring and summer variety, or the large protoplasmic projections; these, too, may cut loose and spherical species.

to the assumption that sporulation takes place in some I will, as soon as opportunity offers, repeat his exper internal organs, but I have only negative proofs. What iments, which seem to me very convincing on account of their simplicity. His theory explains best some organic manifestations which have hitherto been riddles to the clinicist and pathologist.

strikes the observer at once with this variety is the long duration of the ecto-globular life. I have seen sporidia free in the blood 12 hours after the chill, others were found attached to the red cells at the same time. AS A case of febrile hives which I had occasion to exsoon as it enters the red disk it assumes the ring form, amine a few days ago prompts me to ask you a great fawhich it preserves for a considerable time. A careful vor; I would feel very much obliged to any gentleman scrutiny of each blood-cell will only disclose its presence who would be kind enough to make a few cover glass to you during the fever and sweating period; whereas specimens and send them down to me; due credit will the spring variety has already deposited by this time be given for the courtesy extended. pigments, this species is quite free from it. As the At the request of some gentlemen I have exhibited parasite grows it will cling to the ring form and after specimens where you will find every phase in the life of exhibits the most grotesque figures. The pigment is the hæmamoeba malariæ. much finer and is distributed all over the parasite. Whenever the spring variety occupies about half of

System.'

BY T. C. WITHERSPOON, M D., ST. LOUIS.

the blood disk, the latter has lost a great amount of Malarial Manifestations in the Circulatory its hemoglobin, it takes the eosine stain only faintly. The small ring variety will occupy half the blood-cell, and the latter is deeply stained by the eosine. This va riety gives origin to the crescents; the latter sometimes show a very delicate line stretched across the concave side of the parasite; this is probably the rest of mem brane of the red cell. The pigment is mostly situated in the center; sometimes you may find it close to one extremity and, as a rule, you will notice some change in the shape of the crescent also. One extremity is more pointed, sometimes crooked; other crescents are of a more oblong form. You will notice that the very extremities in some specimens are not etained at all and exhibit the same ocular appearance as the center of the parasite; some take these crescents for sterile forms, while others vindicate to them the sporulation process. I have noticed in some specimens, shells, so to speak, of crescents. My attention was attracted to these spots by layers of loose pigments, as I at first thought.

The origin of the crescents may be observed in the living blood. An endoglobular parasite assumes al! of a sudden, with a jerk, a kidney-like figure; the pigment shows a current-like motion, while the pararite executes a few spasmodic contractions; after a while it lays mo tionless and the pigment is grouped around the center. Let me tax your patience for a few more minutes with a short reference to the so called irregular fevers. Of all the attempts at a solution of the problem, the two following ones seem to me to have the most prospect of acceptance.

Sacharoff explains the irregular type of the fever by the assumption that the sporidia infect the hematoblasts at different stages of their development. He applied the results of his studies of malaria in young birds to the human pathology; his arguments have some weight, and the photographs and drawings which he gives are alluring enough.

In the discussion of those manifestations which evidence a malarial disturbance of the circulatory apparatus, I fear I shall have to get into the territory of others. Upon the programme Section 3 calls for manifestations in the spleen; 4, in the chest; 6, in the digestive apparatus; 7, in the nervous system; 8, 9, 10 and 11, in the rest of the body, and as these local changes depend largely upon circulatory disturbances, vaso motor or direct blood changes (thrombi, emboli and hemorrhage), my field seems to be a general one in which rather an outline than detailed points should be considered.

As in all infectious troubles there are certain pro nounced manifestations observed in the circulatory system when the economy becomes intoxicated. In malarial disease there is no specific mode of manifesting the peculiar intoxicant by which the disease, at any time, is essentially different from the majority of other febrile diseases. The character of the disturbances will depend upon the activity of the infecting agent. In the acute attacks, remittent and intermittent, the disturb ances follow the febrile manifestation, though in the chronic (cachectic) malaria they are more or less con stantly manifest. In the study of the disturbances, therefore, which are found to be present in the varying forms of malaria it will be necessary to consider them under the two heads, acute or transient and chronic or

persistent.

The acute manifestations are best studied in recent

intermittent attacks, but somewhat modified in the remittent fever. If the malarial intoxication has long been kept up as manifested by repeated chills and fevers the cachexia usually develops and superadded to the transient disturbances do we find permanent vascuSenkowicz, on the other hand, seems to have proved lar alterations. The acute disturbances are characterthat there exist two separate families of hemameba-ized by well marked vaso-motor irregularities with the endo globular and ecto-globular variety; the former causes the regular fever, while the ecto-globular variety is responsible for the irregular fevers.

1Read before the St. Louis Medical Society, Saturday Evening, May 8, 1897.