the old Good Samaritan building. It was also proposed to improve the eruptive hospital near Lexington by constructing a number of small buildings for the care of patients suffering from tuberculosis. and eruptive diseases. The county will give $3,000 for those improvements and a liberal offering has been given by James B. Haggin.

The Charities Committee of the City Council of Lexington has fixed the sum of $32,484 to be expended upon the charities of the city during 1912. It has also appropriated $1,200 to aid the Moral Improvement League, an organization which was formed recently by a number of persons for the purpose of improving the moral conditions of Lexington. An increase of $500 was made in the appropriation to the Anti-tuberculosis Association. The nurse of this association showed in her report that 5,155 visits had been made, that 637 cases of the disease had been treated and that there had been 112 deaths from tuberculosis.

Book Reviews

Infections of the Hand. A Guide to the Surgical Treatment of Acute and Chronic Suppurative Processes in the Fingers, Hand and Forearm. By Allen B. Karavel, M. D., Assistant Professor of Surgery, Northwestern University Medical School. Illustrated with 133 engravings. Philadelphia and New York: Lea & Febiger, 1912.

The introductory chapter of the book gives the scope and classification of the types of infections and history of this portion of surgery. Classification is made as follows: (1) Simple localized infections and allied minor clinical entities, and (2) Grave infections. The latter is discussed under (a) Diagnosis and treatment in general; (b) Tenosynovitis and fascial space abscess; (c) Acute lymphangitis and allied infections; (d) Complications and sequelae of acute infections.

Felons, paronychia and subepithelia abscesses are described in the first chapter, carbuncular infections in the second. The latter contains a number of illustrations.

The chapter containing a description of the serial cross-sections and fascial spaces, is very interesting and shows the importance of a careful study of the anatomy of this part of the body in relation to the subject under discussion.

The book is well worth while.

The Practitioners' Visiting List, 1912.
Philadelphia and New York: Lea & Febiger.

The review of this book was prepared and misplaced, and a very useful book not called to the attention of our readers. It should have been published earlier in the year.

It is a most complete book, and useful for the purpose for which it was designed. It contains instructions and signs in use of list, many valuable scales, tables and data, analysis, weights and measures, tables of eruptive fevers, poisons and antidotes, table of doses, etc., and an ample daily record of visits, charges, collections, registers, etc.

Diseases af the Ear, Nose and Throat. Medical and Surgical.

By Wendell Christopher Phillips, M. D., Professor of Otology, New York Post-Graduate Medical School and Hospital, New York. Illustrated. Philadelphia: F. A. Davis Company.

This book will be found of interest and value not only to the otologist and laryngologist, but to the general practitioner and surgeon.

Only modern methods have been included in the book. The author has placed the section on the ear first in the book in order to give emphasis to the fact that the space devoted to the ear is not a mere addendum. The section on the nose and throat is also complete.

Part first which takes up general considerations includes the description of

office equipment; methods of examination, carefully illustrated with a very excellent system of case records including a reproduction of tests for hearing and the general symptomatology of the ear. The same careful attention has been paid to the other chapters. This is especially true of the chapter devoted to Diseases of the Nasal Accessory Sinuses, a portion of this specialty which is receiving very properly more and more attention. Special commendation should be made of the author's chapter upon the tonsil, especially that portion which deals with what he calls radical tonsil operation (tonsillectomy). This portion is gone into in all of its details with consideration of the complications at the time of operation and subsequently. The book can be very thoroughly recommended.

A Manual of Practical Hygiene for Students, Physicians and Health Officers.

By Charles Harrington, M. D., Late Professor of Hygiene in the Medical School of Harvard University. Fourth edition, revised and enlarged, by Mark Wyman Richardson, M. D., Secretary State Board of Health of Massachusetts. Illustrated, 12 plates and 124 engravings. Philadelphia and New York: Lea & Febiger, 1911.

While at work on a revision of this book Dr. Harrington, while in Europe, died unexpectedly, but had completed the chapter on Milk and Disinfection.

Much more attention has been paid to this important field of medicine in late years than formerly, and Dr. Harrington's work has been a standard one since its first publication.

The first section is devoted to the Nutritive Value of Foods. Section 2, Animal Foods; Section 3, Milk and Milk Products. It is this chapter which is of so much interest, as Dr. Harrington in his work as Health Officer had great opportunity of observing this important article of diet in its relation to the health of communities. Milk in all its phases is considered, with full descriptions of various tests. It seems queer that in so full

a chapter no mention is made of Certified Milk or the work of Milk Commissions.

Air, Soil, Water, Habitations and Schools, Garbage, Sewage, Disinfection, Military and Naval Hygiene, Vital Statistics, Personal Hygiene, Infection, Susceptibility and Immunity, Vaccination and Smallpox Quarantine, and Disposal of the Dead are the chapter headings.

Electricity: Its Medical and Surgical Applications, Including Radiotherapy and Phototherapy.

By Charles S. Potts, M. D., Professor of Neurology, Medico-Chirurgical College, etc., Philadelphia; with a Section on Electro-physics, by Horace Clark Richards, Ph.D., Professor of Mathematical Physics in the University of Pennsylvania, and Section on X-rays, by Henry K. Pancoast, M. D., Professor of Roentgenology, in the University of Pennsylvania, Medical Department, Philadelphia. With 356 illustrations. Philadelphia and New York: Lea & Febiger, 1911.

The author has endeavored to mention all the ways, direct and indirect, in which electricity may be of assistance in the diagnosis and treatment of medical and surgical affections. He emphasizes the necessity of a prior knowledge, before application of electricity as a remedial agent, of the changes in the tissues and functions of the various organs of the body, which he terms electro-physiology. He has grouped the therapeutic uses of the various currents according to their effect. This method, he claims, presents the subject of electricity from the standpoint of its clinical uses, instead of following the arrangement customary in books on physics and bringing in the medical applications incidentally and disconnectedly.

Electricity, Electro-physiology, Electrodiagnosis and Electro-prognosis, General and Special Electro-therapeutics, Methods of Obtaining General and Local Effects by the Indirect Action of Electricity, and the Application of the Roentgen Rays in Medicine are the chapter headings of the book.

The book is very attractively illustrated. and should have a wide sale.

VOLUME 18

Original Contributions

INFANTILE PARALYSIS (ACUTE AN-
TERIOR POLIOMYELITIS).
BY CUTHBERT THOMPSON, M. D.,
C. M., Edin.
LOUISVILLE, Ky.

I use this name as it is the one officially recognized in the Mortality Statistics, published by the United States Govern

ment.

Up to the year 1909 this disease was not specially mentioned in the reports; in that year 569 deaths were reported under 24 different names.

Both these names are misleading as we will see later, as the disease affects others besides infants, and it is not the cells in the anterior horn of the cord that are primarily affected.

The name Poliomyelitis is taken to mean an acute infective disease, having a special selective action on the nervous system, which gives rise to a variety of symptoms, dependent on the portion of the nervous system affected.

HISTORY.

This disease was first mentioned in 1784, next in 1840, then in 1868.

In 1881 Bergevholz, a Swede, reports the first epidemic, but the first important description dealing with the clinical symptoms was published in 1908 by Wickman,

Read before the Medico-Chirurgical Society.

NUMBER II

and the pathology has been worked out by Flexner, Lewis and others since that time.

EPIDEMIOLOGY.

The study of the 70 epidemics during these 30 years has led to these conclusions:

1. That epidemics of infantile paralysis have very greatly increased in several parts of the world in the last five years.

2. That it is more prevalent in cold than hot countries.

3. That the northern part of the United States has suffered more than any other part of the world.

4. In places where the disease is endemic, children are almost entirely affected; where it is epidemic, adults are often affected with fatal results.

In the five years, 1900-04, 349 cases were reported, the largest number up to that time, whilst from 1905-09 8,054 were reported; 5,514 occurred in the United States, 2,500 of these occurring in New York in 1907. In 1910 5,093 were reported, with 825 deaths from 31 states.

The disease seems to be endemic in Scandinavia. From there it spread to the Atlantic seaports. New York and Massachusetts suffered most, and from there it spread to almost every state in the Union. The disease is more prevalent in the northern part of the United States in the months of August, September and October; indeed more than 50 per cent. of

the cases occur during these months. In the southern parts it occurs in winter and spring.

About 70 per cent. of the cases occur in patients under 5 years old, but the second and third years seem to be the worst however, this disease frequently affects older people, hence the misnomer, "infantile paralysis."

The death rate in infants under one year and in people over ten years old affected with the disease is higher in proportion than in children between one and ten years old.

Between one and ten years old the death rate is four per cent., under one year it is sixteen per cent. and in patients over ten years it is twenty per cent. The average death rate is about eight per cent.

The majority of fatal cases are usually of brief duration, 81 per cent. being under one month, in some as short as two or three days. Males seem to be more subject to the disease than females. Negroes are subject to the disease.

RECURRENCE IN THE SAME DISTRICT.

The disease often reappears in the same district the year following an epidemic, usually a fewer number being affected.

NATURE OF THE VIRUS.

Infantile paralysis is an infectious and probably contagious disease caused by a living organism.

The infective agent belongs to the class of filterable viruses, similar to the virus of rabies, yellow fever and pleuro-pneumonia.

The virus cannot be grown outside the body (parasitic); at least paralysis has never been produced by inoculations of cultures grown outside the body.

The disease can be communicated to monkeys by inoculation of an emul

sion in salt solution, of the spinal cord of human beings and monkeys who have died of the disease into the cranial, spinal or peritoneal cavities, or into the anterior chamber of the eye, or into the circulation directly.

It has also been produced by the direct introduction of the emulsion of the diseased cord into the stomach, and by rubbing the emulsion on the scarified mucous membrane of the naso-pharynx. The virulence of an emulsion is not impaired by drying, by freezing, nor by suspension in glycerine for months. A dilute solution of 1 to 1,000 is capable of producing the disease. A temperature of 45° to 50° C (113° to 122° F) destroys its action in half an hour.

Flexner and Lewis have transmitted the disease through twenty generations of monkeys and have obtained a virus that is more active than it was at the beginning. The virus has been found in the central nervous system, intervertral ganglia of affected human beings and monkeys; in the mesenteric glands, in the tonsils, and naso-pharyngeal mucosa. The virus has not been found in the blood of human beings, but it has been found in the blood and spinal fluid of monkeys at the height of the acute disease. The portal of entrance of the virus into human beings has still to be ascertained, but the indications are, that the virus may both enter and leave the central nervous system by way of the nasal or naso-pharyn-` geal mucosa (Flexner and Lewis).

The virus of the disease has been found in the nasal mucosa of monkeys weeks, and even months after inoculation, but this is exceptional as it usually disappears two or three weeks after the appearance of the paralysis.

Flies subject to contamination with the virus have been found to be capable of harbouring the virus on their bodies in

a living and infectious state for at least 48 hours. The virus also survives within the viscera of the insects for some time (Flexner). It is generally admitted that one attack of this disease confers immunity.

In monkeys, following an experimental infection, the period of incubation is from 6 to 30 days. The incubation period in human beings is not known; it is, however, generally stated as from three to fifteen days.

PATHOLOGY.'

From Strauss' work it seems that the virus first attacks the pia and archnoid in which it develops, causing a round cellular infiltration and exudation that affects especially the blood vessels, causing a partial obstruction, leading to secondary changes in the nerve tissue itself.

The virus may also act on the ganglion cells, but this is less frequent than the action on the meninges. The leptomeningitis is most marked in the lumbar and sacral regions of the cord next in the cervical. The posterior root fibres and the pia-archnoid covering the spinal ganglia are also infiltrated.

Hence the pathological process in the cord is primarily dependent upon vascular changes, and secondarily on changes in the cells in the anterior cornua. The degenerated cells always lie in an area of marked infiltration, but normal cells are often found in infiltrated areas, so we infer that the disease is interstitial not parenchymatous.

Inflammatory edema is present around the diseased area and accounts for the transient paralysis. The degenerated cells and neuraxons cause the permanent paralysis. The disease may involve the medulla pons or basal ganglia or the cerebral cortex.

The other organs of the body show

The disease has often an acute febrile onset, usually with sore throat or digestive disturbance, irritability. General hyperesthesia, pain on moving back or neck, profuse sweating. May have delirium and convulsions. Sometimes, on the other hand, the patient is apathetic from the first. Paralysis may occur at once, but usually from one to seven days after febrile symptoms. The pain is most severe in the area of the body in which the paralysis subsequently develops. The pain usually subsides on the appearance of the paralysis.