think too much stress should be laid upon that point because very careful observations that have been made recently show that it is not uncommon for tonsillitis to be followed by kidney lesions. I recently read an article on this subject in which a number of cases were reported. I had quite a number of cases one winter in which I examined the urine every day and, while it is true that it is not the same character of nephritis as that which follows scarlet fever, and most of the cases were transitory (in some lasting only one day during the course of the disease) still, I think that, in 23 cases of tonsillitis, I found acute nephritis, with casts and albumin, in 19 of them.

DR. BEN CARLOS FRAZIER: Nephritis and pyelitis are quite different conditions. We may frequently find a few casts and some albumin in the urine in a good many acute infections.

In regard to the case of diphtheria, I am like Dr. Boggess. If any criticism is to be made, it would be that the child was not given enough anti-toxin. I am inclined to believe that if he had been given a second dose of three or four thousand units, it would have prevented the recrudescence.

DR. TULEY (closing): The condition. of the first child following the administration of the anti-toxin was that which we always see when a sufficient dose has been given. The swelling subsided, the membrane absolutely disappeared and the Ichild was dismissed. Nine days afterwards, it began again in the same tonsil. I expect to see this child again in a few days and make a culture, simply to ascertain whether he may now be permitted to associate with other children. I do not believe that anybody would have given a second dose of anti-toxin in the first attack, in view of the improvement which

followed the administration of 5,000 units.

In the second case there was a pyelitis that had existed for a week or more before second examination of the urine was made, and this was probably the explanation of the temperature. The acute nephritis developed after the rash

One point that Dr. Pfingst called attention to that I did not mention was the facial paralysis which developed. This has now entirely cleared up.

Current Literature

THE TREATMENT OF BACILLARY DYSENTERY.

F. S. Meara, New York (Interstate Medical Journal, September), in discussing the treatment of dysentery limits himself to that type produced by the bacillus (or group of bacilli) spoken of as the bacillus dysenteriae. Rest in bed which takes away most of the stimulus to increased peristalsis, is desirable in all cases, though in the milder cases the patient will often not accede to such plan. In the more severe cases, however, this becomes imperative, and special stress is laid by the author upon the selection and arrangement of the sick-room and bed. Milk meets the dietary requirements better than any other food. The writer's routine practice has been to put the patient on a milk diet, ordering the milk boiled and given every two hours, the patient to take what he will of 8 ounces. When the temperature disappears and the stools have lost their diarrheal character. barley jelly and thoroughly boiled rice, and later toast, then egg-and gradually the resumption of normal diet. Water should be given freely and all food must be given warm. A dose of castor oil, from 1⁄2 to 1 ounce is especially recommended

For the colicky pains hot fomentations are often of value. Comfort may also be afforded by warm rectal irrigation at 100 degrees-105 degrees F. of physiological salt solution. About 2 quarts may be used at a time, in some cases even more. The irrigation may be followed by an astringent, the best being silver nitrate. It should be used in increasing strengths, 1 to 2,000 at first and increasing up to 1 to 500. If the solution of silver gives great pain it is too strong and may be neutralized by salt solution. The treatment must be intermitted occasionally to let the mucosa recover from any possible irritation by the silver. At times the chronicity of the disease may be due to the irritation these very measures keep up and a cessation of local measures is followed by rapid recovery. If the tenesmus is very severe the following suppository is recommended:

soups should all be used. Beef, mutton and chicken and the purees of the vegetables may also be allowed. Undernutrition is to be carefully avoided.

Obituary

Dr. Frank P. Foster, the dean of American Medical Journalism, died on August 13, 1911, at the age of 70 years. No man has been so prominently identified with medical literature for nearly half a century as Dr. Foster, for thirtyone years editor of the New York Medical Journal, which has always been looked upon as an authority, the editorial pages of which have been dignified, authoritative and conservative.

Besides his journal work, Dr. Foster edited Foster's Encyclopedic Medical Dictionary; The Reference Handbook of Practical Therapeutics, in two volumes, and the 1902 edition of Adler's German and English Dictionary. Dr. Foster was eminently qualified for this kind of work, as he was a master of Latin and Greek and an authority on medical nomenclature. Because of this ability he was chosen as Chairman of the American Medical Association Commission to revise Medical Nomenclature and wrote the reports of 1909, 1910 and 1911. He will be greatly missed.

A noteworthy meeting of the American Association of Obstetricians and Gynecologists was held in Louisville, September 26, 27 and 28, under the presidency of Dr. H. E. Hayd, of Buffalo, the genial Chesterfield of the Association. Dr. X. O. Werder, of Pittsburgh, was elected President, and Drs. Louis Frank, of Louisville, and M. A. Tate, of Cincinnati, VicePresidents. The 1912 meeting will be held in Toledo, O.

SMALLPOX IN THE UNITED STATES. A reprint from the Public Health Reports, by Assistant Surgeon General John W. Trask, contains some valuable statistical information regarding this preventable disease. One impressive thing the report brings out is the inadequacy of the statistics available from nineteen states, Kentucky being one of these. It is to be hoped that with the increased facilities of the State Board of Health of our own State for recording the morbidity and mortality statistics, the next report will include Kentucky in the list. of states reporting the prevalence of the disease in our own borders.

Comparing 1909 with 1910, the reports received by the Surgeon General totaled 24,099 cases with 150 deaths in 1909, and 30,352 cases with 415 deaths in 1910. This shows an alarming increase in both the number of cases and deaths during the past year, Florida being one State in which the cases increased from three in 1909 to 1,286 in 1910. This would evidence a laxness in compulsory vaccination or quarantine on the part of Florida

and the other States which report in

creases.

Fortunately, smallpox epidemics have been very mild in the United States for the past ten years, which would indicate partial immunity to the disease through vaccination years before or a very mild and but little virulent type of infection Surgeon General Trask believes that the mild type of the disease in this country is due to a less virulent strain of infection. Only 11 localities showed a high death rate during 1910, and in most instances these were apparently distinct outbreaks, clearly differentiated from the cases of milder type of the disease which prevailed in the same localities previous to the onset of the more severe type and which occurred in some afterwards, as

well.

The report emphasizes first, the need of careful reporting of all cases and the record available for statistical purposes, and, second, the need of a thorough enforcement of compulsory vaccination by all cities and states.

THE NASHVILLE MEETING OF THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION.

No meeting of this live organization ever had brighter prospects than the one to be held in Nashville, October 17-19, 1911.

Under the Presidency of Robert H. Babcock, of Chicago, who has labored. unceasingly for the success of the meeting, ably assisted by the Vice-Presidents, Drs. Chas. E. Barrett, of Ft. Wayen, and Arthur D. Holmes, of Detroit; the Treas

urer, Dr. S. C. Stanton, of Chicago, and Dr. Earl Harlan, of Cincinnati, the program, which is published herewith, is an evidence of that work.

The symposia are notable. They are upon Cholecystitis, Visceroptosis, GenitoUrinary Diseases, and a Special Therapeutic Symposium.

Mention should be made of the special addresses on Pellagra and the Bubonic Plague, by special representatives from the Marine Hospital Service, Surgeons Grimm and Rucker, and the orators in medicine and surgery, Dr. J. C. Wilson, of Philadelphia, and Joseph D. Bryant, of New York. Dr. C. W. Suckling and Mr. Wm. Billington, of Birmingham, Eng., will attend specially to take part in the Visceroptosis probram. The profession is cordially invited to attend.

1. Pellagra:

PROGRAM.

By

(By

Its Epidemology. Assistant Surgeon R. M. Grimm. Assistant Surgeon R. M. Grimm, Washington, D. C. (By invitation.)

2. The Prevention and Eradication of Bubonic Plague. By Passed Assistant Surgeon W. C. Rucker, Washington, D. C. (By invitation.)

3. Typhoid Vaccination and Its Practical Application as it Concerns the General Practitioner. By W. T. Harpole. Chicago.

4. The Medical Aspect of Chronic Typhoid Infection (Typhoid Bacillus Carriers). By Willard J. Stone, Toledo, O.

5. Diseases Produced by the Colon Bacillus Diagnosis and Treatment. By Fenton B. Turck, Chicago.

THERAPEUTIC SYMPOSIUM.

1. General Management of Pulmonary Tuberculosis. By Thomas D. Coleman, Augusta, Ga. Discussion opened by William Porter, St. Louis, Mo.

2. Treatment of Hemorrhage in Pulmonary Tuberculosis. By C. L. Minor, Asheville, N. C. Discussion opened by Silvio von Ruck, Asheville, N. C.

3. Diet in and General Management of Typhoid Fever. By George Dock, St. Louis, Mo. Discussion opened by Clarence H. Vaught, Richmond, Ky.

4. Treatment of Hemorrhage in Typhoid Fever. By W. F. Boggess, Louisville, K. Discussion opened by J. A. Witherspoon, Nashville, Tenn.

5. Dietetic and Hygienic Management of Hyperarterial Tension. By A. R. Elliott, Chicago, Ill. Discussion opened by A. C. Croftan, Chicago, Ill.

6. Treatment of Cerebral Apoplexy. By E. M. Hummel, New Orleans, La. Discussion opened by Hugh T. Patrick, Chicago, Ill.

7. Collapse in Pneumonia. By Frank Jones, Memphis, Tenn. Discussion opened by Robert B. Preble, Chicago, Ill. 8. Concerning Digitalis. By Frederick Tice, Chicago, Ill. Discussion opened by G. W. McCaskey, Fort Wayne, Ind.

GENITO-URINARY SYMPOSIUM.

1. Diagnostic Aids in Surgery of the Renal Pelvis, and Ureter with Special Reference to Pyelography. By W. F. Braasch, Rochester. Discussion opened by John T. Geraghty, Baltimore, Md.

2. Diagnosis of Prostatic Obstruction. By Bransford Lewis, St. Louis, Mo. Discussion opened by E. G. Mark, Kansas, City, Mo.

3. Cancer of the Prostate. By Robert C. Bryan, Richmond, Va. Discussion opened by L. W. Bremerman, Chicago, Ill.

By

4. The Influence of Stricture of the Urethra on the Development of Hypertrophic Changes in the Prostate. Hugh Cabot, Boston. Discussion by Louis Schmidt, Chicago, Ill.

5. Operative Treatment of Gonorrheal Epididymitis. By Francis Hagner, Washington, D. C. Discussion opened by J. W. Handley, Nashville, Tenn.

6. Calculous Anuria. By Dean Loree, Ann Arbor, Mich. Discussion opened by C. M. Harpster, Toledo, O.

7. Post Operative Anuria. By E. O. Smith, Cincinnati, O. Discussion by Wm. N. Wishard, Indianapolis, Ind.

8. Strictures of the Male Urethra at Bulb. By G. S. Peterkin, Seattle, Wash. Discussion opened by Carl Wheeler, Lexington, Ky.

SPECIAL SYMPOSIUM ON CHOLECYSTITIS.

1. Pathology and Complications.

H. M. Richter, Chicago, Ill.

2. Frequency and Etiology.

Charles N. Smith, Toledo, O.

By

By

By A. Ernest Gallant, New York, N .Y.

5. Indication for Surgical Procedure and Method of Applying. By Earl Harlan, Cincinnati, O.

6. The Surgical Treatment of Nephroptosis-300 Patients and 500 Nephropexis. By Wm. Billington, Birmingham, England.

7. Principles Underlying the Treatment of Visceroptosis. By Wm. MacI. Thompson, Chicago, Ill.

Discussion by M. L. Harris, Chicago, Ill.; W. B. Coffey, Portland, Ore.; A. H. Cordier, Kansas City, Mo.

GENERAL TOPICS-MEDICAL.

1. The Importance of Chronic Kidney Inflammations. By D. M. Hall, Memphis, Tenn. Discussion opened by Wm. Witt, Nashville, Tenn.

2. Eclampsia, with a Study of the Kidney Efficiency by the Aid of Phenolsulphothaline. By Harold A. Miller, Pittsburgh, Pa.

3. The Freudian Doctrines. By Frank Parsons Norbury, Hospital, Ill. Discussion opened by Curran Pope, Louisville, Ky.

4. Cerebritis With Effusion. By Albert E. Sterne, Indianapolis, Ind.

5. The Value and Importance of Correct Medical Expert Testimony Before Courts and Juries. By C. H. Hughes. St. Louis, Mo.

6. Cases of Protracted Intervals Between the Birth of Twins. By W. W. Vinnedge, Lafayette, Ind.

7. The Role and Methods of Psychoterapy in the Care of Psychasthenia which Tends Towards Inebriety; The Functions of the General Practitioner.

By Tom Williams, Washington, D. C.

8. Some Popular Fallicies on the Treatment of the Gastro-Intestinal Diseases of Infancy. By I. A. Abt, Chicago,