best to exclude the cases of tuberculosis treated with tuberculin and infections due to the gonococcus, as the number of cases of the former class is as yet too small to warrant conclusions and our results in the treatment of gonococcus infections were reported last year in a paper by Hartwell.

This report will, therefore, be confined to infections due to the colon bacillus and the pyogenic cocci. The cases dealt with in this report have been rather carefully selected, with the view to utilizing only such as have been thoroughly studied for a considerable period of time. Practically all the cases have been examined by means of preliminary cultures from the urine, guinea pig inoculations to exclude tuberculosis, examination with the cystoscope and ureter catheter where indicated, X-ray and finally cultures from the urine at a considerable period after cessation of treatment. They may therefore be regarded as showing the end results.

In estimating the therapeutic value of vaccines, or bacterins as they are now commonly called, surprisingly different results may be obtained, according to the point of view of the investigator. Thus the general practitioner who is particularly interested in the relief of symptoms will be impressed by the success or failure. in the relief of symptoms, while at the other end of the line the clinical bacteri

doubtedly renders the patient liable to a recurrence of the symptoms.

RESULTS.

Site of Infection in the Urinary Tract. It is not easy to determine at what point the disease is primary, but it is generally possible to locate it either in the upper (kidney and ureter) or lower (bladder, prostate and urethra) urinary tract. The upper urinary tract was definitely involved and was believed to be the primary focus in fifteen cases. Of the remaining fifteen, seven had obstructive lesions of the lower urinary tract, prostatic or urethral, while the remainder are cases of chronic cystitis in which the origin of the infection is not clear.

Of the three cases showing sterile cultures all were infections of the upper urinary tract, one of which may have been associated with stone.

Bacteria. In the thirty cases here considered, the colon bacillus was the infecting organism in twenty-two. The colon bacillus mixed with the streptococcus or a staphylococcus was found in three. The streptococcus in two. The staphylococcus albus and streptococcus in two. The staphylococcus albus in one. great predominance of the colon bacillus in these infections is about the same as that reported by other observers.

The

Operative Cases. In thirteen cases vaccines were given after operation in

of this form of treatment to rid the urine of bacteria. The very varied conclusions of different observers have been largely due to this different bias. In fact, several cases in this series have already been reported as cured, by other men, though

the infection. In eight the symptoms were relieved. The bacteriuria was cured in one.

Sex. Of the thirty cases, thirteen were males, seventeen females, so that the basis of comparison is fairly equal. Of the thirteen males, eight were relieved of symptoms. Of the seventeen females, eleven were relieved.

Duration of Vaccine Treatment. The

duration of the treatment by vaccines varied from two months to two years, the average being ten months minus. All of the cases were under observation for a considerable time, both before and after treatment by this method, so that a sound estimate of the effect on the symptoms can be given.

Effect on Symptoms. In nineteen cases there was a definite relief of symptoms, varying from marked improvement to complete symptomatic cure. In the remaining eleven cases there was no definite or permanent relief, though many of them showed transient improvement which may or may not have been due to the treatment.

Effect on Bacteria. In all cases the culture has been obtained from two months to two years after the cessation of the treatment. Three are and have remained free from bacteria, the remaining twenty-seven all showed bacteria and were therefore not benefited as to the presence of bacteria.

Conclusions. The study of these cases seems to warrant the following conclusions:

1. The use of vaccines is followed by improvement of the symptoms in more than half the cases.

2. Vaccines have little effect on the bacteriuria.

3. The results are practically the same whether the lesion is in the upper or the lower urinary tract.

Current Literature

Kreutzmann, Henry J., San Francisco: "Management of Labor in Cases of Contracted Pelvis." (California State Journal of Medicine. May, 1911.)

In the first place, strictest observance of anti or aseptic measures was followed

nant or parturient woman must never be done except with well disinfected hands. My practice is to concentrate all the energies on personal disinfection; vulva and entrance of vagina only is carefully washed with soap and lysol solution after the hairs of the pubes have been clipped. I disinfect my hands just as if I were going to perform a laparotomy; I examine frequently, and every time I touch. the genitalia of the parturient I put my hand in lysol solution.

I believe in letting matters alone under close observation; as in every field of medicine, so in midwifery interference should be undertaken only when necessitated by some indication. The fact that an operation is done once, twice or a dozen times with success is not in itself a justification of such an operation. And nowhere in medicine is operation without proper indication more to be condemned than in handling confinements, because delivery is a physiologic process and undue interference only tends to render it pathologic.

It is necessary that the one in whose care delivery of a woman is given, examine during pregnancy the pelvis of the gravida; just as we must acquaint ourselves with the condition of the kidneys, heart, etc., so it must be our duty to know whether a woman has a normal pelvis or not. In this way only can the proper course be followed and unpleasant surprises at time of delivery avoided. It is certainly desirable that women with contracted pelves be confined in hospitals or maternities.

We must keep well in mind the fact that neither in obstetric practice nor in other branches of the art of healing, does there exist such a thing as exactness. Delivery is composed of a multiplicity of factors, of many of which we have no

ure the pelvis fairly well, the exact size of the head remains unknown. Miller's impression into the pelvis can indicate that a head may pass the pelvic inlet, but if we fail to impress the head then we are not justified in saying that the head cannot pass the inlet; the configurability of the fetal head is unknown to us and is of paramount importance. The presentation, furthermore, cannot be presaged; we know nothing of the power and force of the labor pains, such an important factor, nor of the endurance of the parturient. In our actions we have to be guided by our judgment, based on knowledge and experience.

We must bear in mind that the parturient has the right to decide whether or not she should take the slightest risk, when we propose any operation upon her. We can neither force her, nor should we persuade her to submit to that which we want to do. In the conflict between life of mother and life of fetus, there cannot be any doubt for unprejudiced people that preference should be given the mother.

Beebe, Theodore C., Boston: Liquid Air in Surgery.-(Boston Medical and Surgical Journal.)

The value of liquid air in various affections of the skin, both congenital and acquired, has been so definitely proved by many observers, that it now has a very positive place in the means at our disposal for the treatment of such lesions. The range of usefulness includes the many varieties of nævi, epitheliomata, lupus erythematosus, birthmarks of all varieties, warts, calluses and some forms of chronic inflammation. Of all forms of benign affections, the various birthmarks are the cause of more mental suffering to their unfortunate possessors than almost any other abnormality. By means of liquid

air it is possible to remove these blemishes in almost every case in a way which causes practically no pain and which leaves practically no scar. It is of the greatest importance that these lesions be treated early in life while the tissues are soft, in order to obtain the best result. Port-wine marks, in particular, are much harder to eradicate in adults than in young children. Spongy nævi, if not taken early in life, are very prone to enlarge to a point where even excision with a knife is impracticable. Such cases, it is true, leave some scars, but nothing comparable to those following the usual treatment by means of the actual cautery. As for lesions on the face, no treatment yet devised is so satisfactory as liquid air. The use of carbon dioxide snow is attended by great pain, as attested by several of my patients; requires many more applications, and is inferior in all ways to liquid air. X-ray treatment of surface lesions is a long-drawn-out process, with very problematical eventualities. The recurrence of such lesions as epitheliomata and lupus erythematosus among my early cases was due to too short and too light applications of the liquid air. With growing experience and knowledge of the possibilities of liquid air, such recurrences are becoming more rare. It must be distinctly understood, of course, that the writer refers only to such cases where there is no metastasis or glandular involvement. Applications to the mucous membrane of the mouth can be made easily and safely, and in one case several applications to the sclerotic coat of the eyeball have been made with no harmful results. A short history of several typical cases will be given showing the possibilities of this method of treatment.

Some men would go to Hades cheerfully, if given a pass.-Lippincott's.

THE ...

from the depot on their arrival by inter

REPORT OF THE JEFFERSON COUNTY MEDICAL SOCIETY MILK COMMISSION.

The Jefferson County Milk Commission is desirous of keeping the society posted as to its affairs and to that end submits a report of its recent activities.

An accurate system of bookkeeping has been installed in the office of the Secretary, and the accounts of the Commission will be regularly audited by a public accountant. In this connection we would remind the Society that the Commission has not been any expense to it since its organization, in fact has added its contribution to the deficit when the society's needs were pressing.

It has been customary for the Commission to have regular weekly bacteriologic counts and butter fat tests made of the milk and cream from each certified dairy, and extra counts made when the count exceeded the Commission's standard. Samples for these tests were obtained one week from the central distributing plant of the Neill Roach Dairy Co. and the next

track of the icing of the cases at the farm.

Inspection of the various dairies have been made at irregular intervals by members of the Commission and the bacteriologist, Dr. Harvey Barret.

At the request of the Commission, Mr. R. M. Allen and his staff from the Food and Drug Division of the Kentucky Agricultural Experiment Station has undertaken a thorough inspection of all the certified dairies, and a report of five of the seven which have been inspected has recently been received.

To those unfamiliar with the method of scoring a dairy farm, we would call attention to the following regarding the thoroughness of the work. A special blank patterned after the government score card has been prepared by Mr. Allen. On one side is given the complete historical data of the dairy, description of the dairy, cows, milkers, summary and recommendations for improvement; upon the other side is a detailed score of equipment, including cows, as to their health, special stress being laid on the tuberculin test, comfort, food and water; stables, location, construction, floor, light, ventilation, air space; utensils, their construction and condition, water, small top milking pail, facilities for hot water or steam, milk cooler, and clean milking suits; milk room, location and construction, under methods is scored the cleanliness of the cows, stables, milk room, utensils and milk, and the handling of the milk. 100 is a perfect score and the following scores were made:

No. 1-G. M .Fenley, 92.5
No. 2-G. W. McClaskey, 90.5
No. 3-J. L. Shallcross, 99
No. 4-Not scored

No. 5-F. C. Dixon, 87.15
No. 6-Not scored

No. 7-W. S. Parker, Jr., 99.3

In explanation of these scores it may be stated that No. 1 was scored for some manure being allowed to accumulate too near the barn, uneven distribution of light in the barn, tardy putting in screens in the milk house, water from milk house not being carried far enough from the building; 7.5 points being deducted from a perfect score by these faults which will be remedied at once.

In No. 2, six points were deducted because more than a year had elapsed since the herd had been retested for tuberculin and because two cows were thin. This delay was due to the Commission and not the dairyman and will be considered later. Some mud was found on the floor of the barn, tracked in by the cows, as it had been raining hard the day of the inspection. This deducted 1⁄2 point. The method of milking two or three cows in one pail before cooling, has been the custom at all the dairies; the score card allows a score of 2 if the milk from each cow is cooled at once, hence this amount was deducted from a perfect score. This dairy has had difficulty in properly cooling the milk either from too rapid flow of milk over the cooler or insufficient icing of the water in the cooler, and was scored 4 instead of 5 on this item.

No.3 was scored 1⁄2 point because of

some accumulated litter under one end of the barn outside, 4 point each because the stanchions and the windows were not perfectly clean.

No. 5 was scored 1⁄2 point because of a pond in the barn yard, which is the pride of the owner, he claiming that his aeration of the water in this pond makes it perfectly sanitary. The Commission will have the State laboratory analyze this water and if impure will have it drained. A horse under the same roof with the cows, though completely separated by sealed walls, scored 14 point, and the wood mangers 4 point; cooling of milk from two cows was scored 1 point, the cleanliness of the milk room, windows, ceiling and mangers in the barn 3 points.

No. 7 was scored 4 point each on windows in barn and barn yard not being. clean, and point on the milk not being removed from the barn quickly enough after being milked.

These details are brought to your notice to show how carefully these investigations are being made, details being scored which would not be noticed by the ordinary observer.

Another feature of the inspection is the result of the bacteriologic counts of the milk and cream at the different dairies at various times during its production and hauling. Two of these are given. in full:

J. L. SHALLCROSS, Anchorage, Kentucky.

Samples taken April 28, 1911, by J. W. McFarlin and W. R. Pinnell.