moved was about the middle of the ileum, and, of course, I had to go well back into the mesentery to get rid of it. He has exaggerated reflexes; no pain; no loss of motion in the hip-nothing except the "trigger-leg."

So far as his general condition goes he is above the average. He is heavier than he ever was in his life, but he does not seem to be able to improve his walking. While sitting down he feels as well as any one, but when standing up he feels badly and tires very easily.

DR. VANCE (after patient had left room): I only wish to add that the tumor that was removed was a carcinoma, causing obstruction of the bowels.

DISCUSSION.

DR. JNO. J. MOREN: I believe this is a case of dorsal myelitis, with the trouble confined more to the pyramidal tract than any other portion, and that it belongs to the old class of spastic spinal paralysis.

In regard to the cause, it may possibly be due to his malnutrition, or there may be some arterial changes. These cramps in the calves, pains in the joints, and the absence of sensory symptoms, I think, makes the diagnosis of dorsal myelitis.

The question also arises, whether there is a tumor growing in the cord, or around the meninges. However, in the absence of the sharp-shooting pains that are characteristic of tumors of the cord, I would be inclined to believe that the trouble is myelitis rather than due to a tumor.

DR. CUTHBERT THOMPSON: I agree with what Dr. Moren has said, although I believe that there is a possibility of some pressure here. The trouble may have been myelitic at first, but it looks to me as if there is some pressure now.

Dr. Moren said that there are no shooting pains present. However, this gentleman told us that, at times, the pain is so

sharp as to cause reflex contraction of the muscles.

I am inclined to the opinion that, while there is a myelitis here, there is something pressing upon the upper neuron.

DR. DAVID C. MORTON: On account of the very markedly exaggerated knee jerk in the apparently sound leg, it strikes me that this is a progressive condition in which the other leg will be involved before long. I would say that it is a myelitic degeneration, which is progressive and will attack the other side before long.

CERVICAL RIBS-REPORT OF CASE. BY AP MORGAN VANCE, M. D., LOUISVILLE, KY.

Recently a gentleman friend of mine, and his wife, brought their little daughter to my office. A couple of years ago, while I was attending his father, this gentleman had told me that he had a child with lumps in her neck. This was the girl he had brought to see me, and he told me that several doctors had told him that the child had tuberculosis glands, and wanted me to cut them out. This young girl was just rounding into womanhood. I put my hand on the right side of her neck and felt a mass which felt very much like a rock. I then suspected that it might be exostosis of the rib, but it turned out to be two cervical ribs.

This is the third or fourth case that I have seen and recognized. It is a very rare condition. I looked up the subject in Keen's surgery, and he says that there are 143 cases on record. Many of them go along without any trouble. Occupation seems to play an important part.. I advised this girl to not even play tennis. so as to avoid anything that may cause irritation. Removal of the ribs is attended with great difficulty and gravity, as we are liable to open the vault of the

pleura. My advice was to let it alone as long as it let her alone.

DISCUSSION.

DR. W. O. ROBERTS: I have never seen a case of cervical rib, but some time ago I operated upon a woman for the removal of a malignant breast, and a short time after that she began to complain of a good deal of pain in her arm, as these patients very frequently do. She went east, to Hartford, Conn., where some X-ray pictures were taken, and came back here with a statement from the doctor that she had a cervical rib. She brought the picture back with her, but even with that I was unable to make out a cervical rib. I had Dr. Vance and Dr. Sherrill to see her with me, and neither of them was able to detect a cervical rib. However, another gentleman here did make it out very plainly, and operated on her, but did not find it. She was in my office recently, and was in about the same condition as when I sav her before.

DR. J. GARLAND SHERRILL: I have never had the pleasure of seeing a case of cervical rib, but I saw the case that Dr. Roberts mentioned, and also saw the skiagraph, and was unable to make out a rib at that time. I am very glad to know that my opinion was proven to be correct by the gentleman who operated. The case Dr. Vance reported presents an entirely different picture to the one Dr. Roberts had.

PERMANENT HAEMIANOPSIA IN A PATIENT LONG SUBJECT TO MIGRANE WITH TEMPORARY HAEMIANOPSIA.

By S. G. DABNEY, M. D.,

LOUISVILLE, KY.

Some time ago Dr. Boggess read a paper on migraine, and the question of

*Reported to the Medico-Chirurgical Society.

ocular symptoms was discussed. A short time after that a lady from the Southeastern part of the State was sent to me with a rather interesting history. This woman, who belongs to the upper class of life, is now 79 years of age. In early years she was subject to headaches of the character which we discussed on the night referred to, preceded by a zigzag line of line, then becoming dark on one side, then the headache, nausea, vomiting and finally relief. As the years went on she ceased to have these headaches, but would be subject to attacks of half-sightedness of a few minutes or longer duration, which persisted for a number of years. Last summer she suffered an attack of illness which her physician called gastric fever, and during that attack she lost the sight of one-half of her field of vision, and this time it did not return.

The interesting part of it, I think, is the light that such a case may throw upon the pathology of migraine. Upon measuring this lady's field of vision, I found that she could see absolutely nothing to the left in each field; in fact, the line was so sharply drawn as to indicate a cortical lesion.

The generally accepted view of the pathology of these cases of half-sightedness is that they are due to disturbance of circulation in the cortex of the brain, and it would be at least plausible to suppose that in this old lady, who had been subject to temporary disturbances of circulation over a long period of years, producing first headache and then half-sightedness, as the years passed on the arteries became more and more brittle, until she now has either occlusion of a vessel or possibly a rupture.

I think it is interesting in that it bears out the theory that cortical hæmianopsia, as it is called, is due to disturbance in circulation.

Society Proceedings

MINUTES OF THE KENTUCKY MIDLAND MEDICAL SO IETY,

Held at the Country Club, Louisville, Ky., July 13, 1911, as the Guest of Dr. Louis Frank.

With thirty-four members and guests present, the sixty-second quarterly session of the Kentucky Midland Medical Society was called to order by the President, Dr. W. C. McCauley, at the Louisville Country Club, the society being the guest of Dr. Louis Frank.

Dr. G. H. Heilman, of Frankfort, was elected to regular membership and Drs. S. J. Meyers and Curran Pope were elected as honorary members. Dr. Geo. W. Chinn, of Frankfort, was elected as an honorary life member.

An address was then delivered by Dr. U. V. Williams, in whose honor this meeting was held. Dr. Williams having concluded, Drs. Clark, Cheatham, Cecil, Frank and Boggess made brief talks commenting on the address, each expressing his pleasure in being present on this occasion and recalling the long-time friendship that had existed between him and the speaker of the day.

Dr. Frank: Moved that committee of Drs. Williams, Clark, Cheatham, Minish and Demaree draft resolutions on the death of Dr. E. E. Hume, of Frankfort. Motion carried.

Dr. Frank: Moved that Dr. Williams' address be incorporated in the minutes of the meeting. Motion carried.

Dr. Boggess: Moved that resolutions. expressing the Society's regard for Dr. Williams be drawn up and either engraved or embossed and a copy sent to Dr. Williams and a copy put in the minutes of the meeting. Motion carried.

The President appointed Drs. Cheatham, Boggess and Cecil.

The President appointed the following committees: Program-Drs. Tuley, Holloway and Austin. Location-Drs. Dougherty, Wheeler and Frank.

The afternoon session convened with Dr. F. C. Clark in the chair.

Committee on program reported as fol

lows:

Tonsillectomy-Dr. W. B. McClure,

Lexington.

Dissociation of Personality-Dr. Curran Pope, Louisville.

Rupture of Uterus-Dr. Neville S. Garrett, Frankfort.

Treatment of Pneumonia-Dr. O. B. Demaree, Frankfort.

Committee on Location reported that the next meeting would be held in Frankfort.

Dr. C. W. Kavanaugh then read a paper on "The Doctor Twenty-five years Ago and Now." The paper was discussed by Dr. Dougherty.

Dr. Dougherty: Moved that the Society thank Dr. Frank by resolutions. Carried by standing vote.

Dr. Dougherty: Moved that LOUISVILLE JOURNAL OF MEDICINE AND SURGERY be made the official journal of the Society. Motion carried.

The Committee on Resolutions, expressing sympathy for Dr. William Bailey, appointed while the Society was at dinner, reported as follows:

"When the heavy hand of death rests upon us, when only a few heart throbs separate us from the distant shores of eternity, when the shadowy boatman calls to us for our last trip from this earthly sphere, the knowledge of the high esteem, the love, the affection of those comrades in arms, who know and understand what our life has been, is a beacon light to cheer and help us on our journey. The pen is powerless to picture emotions, to tell those feelings we would express, but

the Kentucky Midland Medical Society wishes to convey to Dr. William Bailey, of Louisville, the deepest sympathy, its warmest appreciation of him and his life. work, and to convey to him its unanimous expressions of esteem and regard, and to extend to his dear wife, who has labored and assisted at his side all these years, its sympathy in this time of anxiety and sor

row.

"U. V. WILLIAMS, "FRANK CLARK,

"CURRAN POPE,

"W. F. BOGGESS,

Committee."

Committee was instructed to purchase flowers and send them with copy of resolutions to Dr. Bailey.

Dr. Frank: Moved that Secretary make an assessment for the purpose of defraying expense necessary to the purchasing of engraved resolutions for Dr. U. V. Williams. Motion carried. The meeting then adjourned.

CHAS. C. GARR, Secretary.

THE VITAL IMPORTANCE OF PURE MILK.

So seldom is it that the lay press gives space to so important a topic as Milk, that we take pleasure in reproducing the following from the editorial page of the Lexington Herald, with the heading given above:

The division doing the pure food work at the Experiment Station issues a chart. entitled "Milk Routes." One illustration is called "the short route," the other, "the long and dangerous route." The "short and safe route" consists in taking the milk from each cow, milked in a dust and odor free stable, into a clean milk room and cooling and bottling as quickly and with as little handling as possible. Once in the bottle and the bottles well

chilled the milk can be delivered to hotel, restaurant, hospital and to the home pure and wholesome.

"The long and dangerous route" shows unclean barns and milk rooms and the exposure of the milk, in open cans, and from can to can, or pipe to pipe to vat, until the milk is finally poured from the faucet of the wagon can into the consumer's open receptacle, in street dust and impure city air. It is a long line of needless cans and handling. The too many utensils used by dairymen and dealers in the "long route" are never thoroughly cleaned. The result is, of course, contaminated milk, swarming with all manner of bacteria, many of which produce or encourage disease.

The chart states: "A majority of babies under one year of age are bottle fed. The death rate among bottle-fed babies is six times greater than breast-fed babies. The death rate among babies bottle-fed on milk from the short route is about one-half the death rate among babies fed on milk from the long route. The long route should be prohibited by law; many of its practices already are. It can be broken up, however, when consumers, in their homes, the hotels and the restaurants, demand bottled milk from the short route. The cleanly methods necessary at the dairy of the short route can be financed out of the costs saved from many needless practices in the long route. But should the price advance to consumers one quart from the short route it will be found much more wholesome and nutritious than a quart from the long route. And, with some organized charity, self-sustaining distributing stations can be established, which will put pure milk within the reach of the people who must practice strict economy in purchasing food.

That the deaths among babies fed upon

milk can be reduced by one-half through the protection of the milk supply, is a matter for the most vigilant and co-operative efforts on the part of the state pure food authorities, the local health officers, the dairymen and the consumers themselves, especially during the summer months. Each has his duty to perform in accomplishing good results, and the work for pure milk will be incomplete unless each does his duty. The pure food authorities should see to it that the milk inspection is kept in operation during summer months in all parts of the state. The local city and county health officers. should conduct a constant inspection of their respective jurisdictions. The dairymen should inform themselves as to the equipment and methods necessary in the production of pure milk, and the consumer should see to it that no milk is received except in bottles, that the milk is bottled at the dairy immediately after milking, that the bottle is removed from the door-step to the ice box as soon as it is received, that the ice box in which the milk is kept is clean and wholesome, and that the milk is not exposed in any way whatsoever until it gets into the baby's bottle or the consumer's glass. Consumers owe it to the dairies and other consumers to thoroughly scald the bottles to be returned, and to notify the dairymen immediately if there is any dangerous disease which is likely to be transmitted in the exchange of bottles.

The active milk inspection work in Kentucky was begun in 1906, when the pure food authorities of the Experiment Station rounded up 100 or more of those conducting the foul swill dairies in and around Louisville, and abolished the practices with jail sentences from Magistrate Hollis' court. Since then, several inspections have been made of all the dairies in the State, and the present system of in

spection includes the list of the equipment and methods of the dairy on a uniform score card plan, agreed to by all the dairy inspection workers throughout the country. From reports given out by the Food and Drug Division of the Experiment Station, it is evident that the Kentucky dairies are already in the lead with respect to the per cent. scored. The dairies around Lexington show an average score of 60 per cent.; in Paris, 60.3 per cent.; in Frankfort, 55 per cent.; in Richmond, 53 per cent.; in Georgetown, 72 per cent.; in Danville, 70 per cent. The average score of Kentucky dairies is stated to be about 59 per cent.; the average score of the United States, as collected from statistics available, is about 49 per cent., and the Louisiana Pure Food Department reports the score of that state at about 24.9 per cent.

The reports show that the Food and Drug Division is extending its milk operations during the coming summer along broader lines than ever before. The field workers include a chemist, a bacteriologist, an inspector to take samples and three inspectors to score and inspect the dairies. This force, in co-operation with the local health authorities, has already done considerable work in central Kentucky. The other points from which it will work will be Covington and Newport, Paducah, Bowling Green, Owensboro, Louisville, Ashland and Middlesboro, including the parts of the State adjacent thereto. The samples are being taken, not only from the dairies and the delivery wagons, but at the railway stations, milk depots, restaurants and hotels

The bacteriological examination of Lexington's milk supply shows 15 dairies in which the bacteria count ranges between 5,000 and 100,000, in many of which the counts are as low as 10,000, 14,000, 15,000, 20,000, 25,000 and 30,000,