Parker, Jr., dairyman-4,500 bacteria per cc.

552-Certified cream-W. S. Parker, Jr., dairyman-2,000 bacteria per cc.

Application was made of the Bureau of Animal Industry for an expert veterinarian of the Department to make tuberculin tests of cows in all certified herds which had not been tested during the year, it being the rule of the Commission to have a test made once every year. Considerable delay was experienced in obtaining authority from the Department for this work and in having a proper agreement blank made to be signed by the dairyman permitting the government to make the test; the regular blank being used by the Department for this work was so lenient in regard to slaughter of animals which reacted to the test and other points that the Commission asked for a special blank and this request has been granted. Dr. J. C. Burneson, of the Department, has been detailed and is in Louisville ready to begin work on the arrival of the agreement blanks. This delay was the cause of scoring of Dr. McClaskey's dairy of six points, and credit as already mentioned should be given him for this test.

Identification cards are being prepared, which will give a full and detailed description of every cow now included in a certified herd, the dates and results of each tuberculin test, and the final disposition of the cow. Dr. Burneson will start this record for the Commission, and it will be very easy to keep up in the future. As a cow is tested for tubercu

losis a number is tattooed in the ear, each herd being designated by a letter, and a record is easily kept of each cow in this way.

The Commission feels justly proud of the result of this scoring and bacteriologic counts which we believe will compare favorably with certified milk produced any place in the country.

THE JEFF. CO. MILK COMMISSION.

Book Reviews

Food and the Principles of Dietetics.

By Robert Hutchison, M. D., Edin., F. R. C. P., Physician to the London Hospital, Physician with Charge of Out-Patients to the Hospital for Sick Chudren, Great Ormond Street, etc. With Plates and Diagrams, Third Edition. New York: William Wood & Co., 1911. $3.00 net.

One of the most interesting and valuable parts of this book is that devoted to the patent and proprietary foods.

One turns to the chapters on The Principles of Feeding in Infancy and Childhood with interest. One statement which can hardly be coincided with by experienced pediatrists in this country is the following: "It may be said that abundance of fat should be the main characteristic of the diet of infancy; important though an abundant supply of fat is, one must take care not to give it in excess, for under these circumstances it is a frequent cause of vomiting and diarrhea. A milk which contains more than 61⁄2 per cent. of fat may always be expected to produce these results." What breed of cow can they have in England, and what breed of baby that can take care of 61⁄2 per cent. of fat?

The reading of this book will prove both valuable and interesting.

A Treatise on Diseases of the Nose, Throat and Ear.

By William Lincoln Ballenger, M. D., Professor of Laryngology, Rhinology and Otology in the College of Physicians and Surgeons, Chicago. New (3d) edition, thoroughly revised. Octavo, 983 pages, with 506 en

gravings, mostly original, and 22 plates. Philadelphia and New York: Lea & Febiger, 1911. Cloth, $5.50 net.

Three editions in three years is the history of this book, the latest being brought thoroughly up to date by the author keeping in touch with the work done by colleagues throughout the world.

A distinctive feature of the book is the profuseness of illustrations which is specially noticeable. The colored plates are excellently produced. The medical and surgical treatment of the regions of the nose, throat and ear have been thoroughly discussed and described.

The chapter on Operations on the Tonsils is very thorough. It is interesting to note the remark of the author on the remote effects of complete operations, viz:

amount of detail correspondence. It will be valuable, also, to those States contemplating similar legislation.

Diseases of Children for Nurses, Including Infant Feeding, Therapeutic Measures Employed in Childhood, Treatment for Emergencies, Prophylaxis, Hygiene and Nursing.

By Robert S. McCombs, M. D., Assistant Physician to the Dispensary and Instructor of Nurses at the Children's Hospital of Philadelphia. Second edition, revised. Octavo of 470 pages, illustrated. Philadelphia and London: W. B. Saunders Company, 1911. Cloth, $2.00 net.

This book is the outgrowth of a plan of the author to publish the notes of his original lectures to the nurses of the Children's Hospital, and has reached its second edition in a short time.

In the first two chapters are given the Peculiarities of Children's Diseases, and

about 6,000 cases, in which the tonsils were removed in their entirety with the investing capsule intact, that subsequent inflammations have been exceedingly rare, while recurrence of the tonsillar tissue has never taken place." The author uses a tonsil ecraseur as a substitute for the snare in tonsil enucleation.

Lack of space prevents further comment. The book is heartily recommended. in every respect.

State Registration for Nurses.

By Louie Croft Boyd, R. N., Graduate of Colorado School for Nurses. 12 mo. of 42 pages. Philadelphia and London: W. B. Saunders Company, 1911. Price, 50 cents net.

This brochure contains a compilation of the laws governing State registration in the various States in which registration is compulsory. It gives a summary of laws, registration requirements, fees and their disposition, exemptions and restrictions, violations, revocation, reciprocity, recording certificates and compulsory laws.

The book is of considerable value to those who are contemplating a move to a different State, and will save a large

ters on diseases of the various systems of the body, Infant Feeding, Therapeutics, etc.

Unfortunately nurses graduating from general hospitals have too little practical training in the actual care of sick children, and only obtain a theoretical knowledge. If the latter is all that can be had; some such book is essential to the proper understanding of the subject and is an excellent class room guide.

The nurse will find the chapter on Artificial Feeding very practical. Not enough stress has been laid on the subject of cows' milk-its production, chemistry, etc. Baner's formula for home modification has been explained and illustrated fully.

Gonorrhea in the Male.

By Abr. L. Wolbarst, M. D., New York, Consulting Genito-Urinary Surgeon, Central Islip State Hospital; Professor of Genito-Urinary Diseases, New York School of Clinical Medicine, etc. New York: Published by the International Journal of Surgery Co., 1911.

The author presents this little work as a plea for more gentle and conservative methods in the treatment of gonorrhea. We quote from his preface: "He believes that considerable damage is being done

by the prevalent method of treating gonorrhea, particularly in the respect of our remedies being too strong, and being used with a vigor that is far too heroic for the delicate and inflamed tissues to bear with impunity. If this work will be accepted as a plea for greater gentleness and conservatism in our therapy, not only as to drugs we employ, but also as to the instruments we use, as well, it will have accomplished all that the author could have hoped for."

Diagnostic methods, bacteriology and differential diagnosis are given in satisfactory detail. In the outline of treatment the following objects are emphasized, to destroy the gonococci and other germs that may have lodged in the various portions of the genito-urinary tract, and to restore the affected parts to their normal condition.

The author does not recommend the abortive method of treatment by injection of a strong solution of nitrate of silver, as it is painful and frequently increases. discharge. He divides the treatment into hygiene, internal and local. He uses methylene blue internally as an adjunct. to local measures. To begin with a 21⁄2 per cent. argyrol solution is advised, locally.

The book is a very excellent resume of the treatment of this disease and its complications.

Modern Treatment, the Management of Disease with Medicinal and Non-medicinal Remedies.

Edited by Hobart Amory Hare, M. D., Professor of Therapeutics and Materia Medica, Jefferson Medica College, Philadelphia, Assisted by H. R. M. Landis, M. D., Director of the Clinical Department of the Phipps Institute, etc. In two volumes. Volume II. Philadelphia and New York: Lea & Febiger.

The following list of contributors to this volume is guarantee sufficient that the articles in it are strictly first class and up to date: Drs. Brooke M. Anspach, S. P. Beebe, Charles F. Craig, John C.

DaCosta, Jr., F. X. Dercum, George Fetterolf, Howard Fox, Wm. S. Gottheil, H. F. Harris, Elliott P. Joslin, James Hendrie Lloyd, D. J. McCarthy, James MacKenzie, Herbert C. Moffitt, Arthur Newlin, Major T. L. Rhoads, Jos. Sailer, Wm. F. S. Lanahan, S. MacCuen Smith, James Thorington, James Tyson.

The contents of this volume are as follows: The Treatment of Diseases Due to Parasitic Infections; Diseases of the Circulatory System; Diseases of the Digestive System and Allied Organs; Diseases of the Respiratory System; Diseases of Nutrition and Diathetic Diseases; Diseases of the Nervous System; Diseases of the Genito-Urinary System; Diseases of the Skin; Non-Surgical Treatment of Diseases of the Eye; Diseases of the Ear and Tympanic Membrane.

It is to be regretted that a work so authoratative could not have contained more data upon "606" in the treatment of syphilis, but in October, 1910, nothing. very definite was known.

In the article on hemoglobinuric fever, some very excellent rules are laid down as to the administration of quinine. The author states that "true hemoglobinuric fever has often been confused with hemoglobinuria following the administration of quinine, and malarial infection, for it is well proved that in certain individuals both quinine and the malarial plasmodia may cause attacks of hemoglobinuria; but these attacks are not true black-water fever, and vary greatly from the clinical picture of that disease as observed in its endemic regions."

The section on Diseases of the Heart and Blood-vessels is very interesting and instructive. As a work of reference this volume and its predecessor can be thoroughly recommended.

Original Contributions

CHRONIC DYSPEPSIA.*

BY CHARLES G. LUCAS, A. B., M. D.,
LOUISVILLE, KY.

The term chronic dyspepsia has acquired a new significance in the past few years. That these patients have "difficult digestion" is a fact beyond dispute, but this difficulty does not always originate in the stomach itself. We may roughly divide chronic cases into three classes:

first, those of undoubted nervous origin; second, those the result of alcoholism and persistent errors in diet; third, those that are reflex in disturbances or changes in the gall-bladder, appendix, peptic ulcer, gastric or duodenal, and abdominal adhesions with various mechanical changes.

It is with the third class that I propose to deal in this paper. These cases may go on for a long time improving at times. under treatment, but having exacerbations which may become more and more marked. They may have a variety of symptoms during the exacerbations. For a typical case of this class I report the following:

Mr. M., a farmer, who was first seen January 24, 1911. He had measles as a child; fever at five, "possibly typhoid;" he has always had delicate stomach; had grippe twice at intervals of several years, each attack lasting about two weeks

*Read before the Medico-Chirurgical Society.

NUMBER 2

He

with apparent perfect recovery. had just recovered from an attack of typhoid fever, having been in bed four weeks, and had only been up and around for the past two weeks. His weight was 1371⁄2 pounds; his average being 140. Blood pressure 158; pulse and respiration normal at the time of examination. For the past ten years he had sought advice for the relief of a burning sensation in the stomach. This was always present but worse after meals. For a short while would be improved by eating, but was never made worse. It was present in the morning on an empty stomach, never disturbed him at night, and during the exacerbations he would get a little relief in the recumbent posture. His diet had been limited; bowels constipated; appetite poor, and occasionally suffered from nausea. never vomited, and was a poor water drinker. Physical examination: heart and lungs were normal; decided guard over the gall-bladder with marked tenderness in the median line between the umbilicus and the ensiform; urine was normal, and the stool was negative to tests for occult blood. As this patient had undergone treatment at the hands of many physicians, and had never succeeded in obtaining relief except for a short while, I suggested to him the possibility of a lesion either in the gall-bladder or the duodenum that would account for all his trouble, and urged that he should con

He