mouth, throat and testicles of a man of forty, high fever, pulse of 140, dyspnea and other signs, indicating central pneumonia of embolic origin and secondary pleurisy with extreme weakness of the heart, followed the injection. He ascribes this syndrome to dislodgement of a thrombus in the gluteal muscle following the injection of a very acid solution; nothing about the syndrome suggested local infection at the site of the injection. In two other cases there was considerable disturbance of the heart's action, the pulse running up to 120 and 160, and the area of dullness spreading to the right with accentuation of the second sound. These findings persisted for a few days. and then gradually subsided. In another case there was a slight albuminuria. No visual disturbances were ever observed. He knows of a case in a Bonn institution in which the patient died suddenly the night after the injection. Ehrlich adds

the details of this last fatal case as he obtained them by telegraph. The patient, he says, was a woman of thirty-three with syphilitic apoplexy, paresis of lower extremities, tachycardia, dysphagia and accelerated breathing. The condition in this case should have forbidden the use of "606," he declares, as he has expressly rejected all responsibility when the remedy is given to those who have organic lesions in addition to syphilis. He also excludes the metasyphilitic diseases from treatment with "606." He reaffirms that when given in the correct manner and with proper indications, the remedy is free from danger and does not induce any appreciable by-effects. Ehrlich now. has the records of over 3,000 cases.

Later unauthenticated communication state that Ehrlich is endeavoring to refine this preparation with the view of perfecting its application and of reducing its toxicity. His latest modification is said

to be "606 hyper-ideal" or "Hy-606." This preparation is reported as being onethird less toxic than the original, as has been demonstrated by experiments upon animals, and can safely be given in larger doses. Its use in man is followed by less marked local and general reaction than that produced by the original drug.

Current Literature

Schmidt, Louis E., Chicago: The Gonorrheal Vaccine Treatment and the Antigonococci Serum Treatment in Reference to Gonorrhea and its Complications, but With Particular Reference to Joint Involvements. (Therapeutic Gazette September 15, 1910.)

1. That the site of injection of either a vaccinie or a serum is of no importance as to the therapeutic action, yet on account of local symptoms that may arise the deep or intramuscular mode of administration, particularly into the gluteal region, is both the most desirable mode and place for the injection...

2. That the technique to be followed is the one which requires strict asepsis.

3. That satisfactory results have been noted with the use of serum as well as with vaccine in the various kinds of

cases.

4. That antigonococcic serum seems to be used to the greatest advantage in acute or subacute gonorrheal toxemic casesthose cases which are so often referred to as "gonorrheal rheumatism;" that serum is of no practical value in the inveterate, long standng cases.

5. That the vaccine mode of therapy has shown satisfactory results in truegonorrheal arthritic conditions-where undoubted metastatic conditions are present and where gonococcemia is probably present. In the very acute attacks especially good results were noted. Yet it is also to be recommended in the subacute and chronic cases of this type.

6. That serum therapy has not been of as great value in the metastatic or gonococcemic conditions; that vaccines are to be used in these cases with greater expectations.

7. As to the dosage of serum, that it is desirable to commence with small dosages, as 2 cc., to repeat or even to increase to 4 cc., on the second or third day; if no improvement is noted, to increase to 6 or even 8 cc., to be given the fifth day. In general, the smaller the dose the more quickly can it be repeated; the larger the dose, the greater the interval between injections. Furthermore, the large majority of cases require fully 30 to 50 cc. of

serum.

8. That the dosage of the vaccine must vary as to the case-comparatively small doses, 10,000,000 to 30,000,000 bacteria, to the acute gonorrheal joints are usually sufficient. In the subacute or chronic cases 30,000,000 to 50,000,000 bacteria have shown the best results. In both instances I am inclined to believe that the best results were noted when injections were given about five days apart.

9. That by looking over the percentage figures as cured it will be noted that they are small; the improved class is high. Undoubtedly many cases could easily be placed in the cured column and make the results look a great deal more favorable.

White Chas. J. Boston: Alopecia and Seborrhea. (Journal A. M. A.. September 24. 1910)

1. Alopecia accompanied by dandruff is the commonest type of loss of hair.

2. Women are more prone to alopecia than men, in the proportion of 54 to 46.

3. The possible and principal causal factors of alopecia are heredity in 30 per cent., dandruff in 79 per cent., systemic depression in 20 per cent., fever in 11 per cent., and maltreatment of the scalp in 50 per cent.

4. Alopecia simplex develops before the

age of 30 in 84 per cent. of the men, but in only 33 per cent. of the women.

5. Dandruff behaves in a similar manner and before the age of 25 attacks 61 per cent. of its future male victims but only 32 per cent. of its female.

6. The loss of hair in alopecia furfuracea comports itself with these previous two findings, appearing before the age of 25 in 67 per cent. of the men, but only in 34 per cent. of the women. .

7. Summarizing paragraphs 2, 4, 5, and 6, we find that men are attacked earlier than women with alopecia and with seborrhea, but that eventually women. rather than men fall victims to these conditions.

8. When dandruff is present it is apt to be abundant rather than slight, oily rather than dry, and to be accompanied by itching.

9. With alopecia we find well-marked cases rather than mild ones, located in the great majority of the cases in the frontal and temporal regions and accompanied by hair which is apt to be dry, split, short, and fine.

10. The drugs most successful in the treatment of dandruff and loss of hair are euresol, bichlorid of mercury, tannic acid and chloral hydrate.

11. The final results of treatment in these affections are almost disheartening, but judged from a temporary point of view, we may expect good or very good response in 48 per cent. of men and in 56 per cent. of women.

12. Seborrhea may exist for years without entailing any appreciable loss of hair nevertheless, dandruff does seem to be followed or accompanied by alopecia twice as often as not.

13. Seborrhea simplex is a disease of childhood or early adult life, developing before the age of 30 in 71 per cent. of men and 96 per cent. of women.

14. Other seborrheas of the skin such as acne vulgaris, acne rosacea, eczema seborrheicum and Fordyce's disease, may accompany loss of hair and dandruff. Their percentages of concomitance, however, vary, and consist of 12 per cent. in alopecia furfuracea and 57 per cent. in seborrhea simplex.

15. Dyspepsia, on the other hand, exists in surprisingly small percentages in these cases, being present in only 3 per cent. in alopecia simplex, 8 per cent. in alopecia furfuracea, and 17 per cent. in seborrhea simplex.

16. From the preceding two paragraphs we may deduce that seborrhea simplex is a truer form of dandruff than that accompanying loss of hair.

17. In alopecia areata and in ringworm of the scalp, the region most affected is the occipital.

18. In alopecia areata dandruff is a frequent accompaniment and we also find that one attack of the disease is apt to be followed by one or more later outbreaks.

Correspondence

CAMP WALLACE, UNION, P. I., August 8, 1910.

DEAR DOCTOR.-Two years before graduation I had determined upon a career in one of the public services, preferably the army.

After spending several months in Providence Hospital on the house staff I stood the preliminary examination for the army passed, went through an eightmonths' course of instruction at the Army Medical School at Washington; was sent to the Army General Hospital at the Presidio, San Francisco, for three months, then to Fort Logan, near Denver, Col., for four months; then to the Philippines. Division, where I have been for the past five months. For three and a half half months I was stationed at the Division

Hospital, Manila, where nothing occurred out of the ordinary as practically all of the patients there are Americans.

Now, I'll have to take that last statement back. In my ward, I had cases of beri-beri, dengue, dysentery, insanity, malaria, typhoid. Of course malaria is here in its most severe forms.

I was also the pathologist and became somewhat of an expert on examination of blood and feces. I believe I can distinguish every form of malarial parasites except the distinction between the socalled parasite of quotidian and tertian. aestivo-autumnal. If you took the time you could always find uncinaria in every native's stool.

Every patient who was admitted to the hospital, regardless of condition or ailment, has his urine, blood, and stool examined.

I heard quite a bit of comment on the short labors in the tropics, especially of a white person who had recently arrived. Twice while I was officer of the day I had labor cases. The first one was normal as to duration, etc. This was the first child. The second came within two hours after the first pain. The patient. was rushed to hospital, put to bed, examination made and cervix found dilated a little larger than a silver dollar. Thinking it would be at least an hour or so before I would again be needed, I went to lie down. It seemed it was only a few mnutes until I had a hurry-up call and by the time I arrived upon the scene, which was only three or four minutes, the child was born. The patient told the nurse she felt something pressing down. The nurse had just arrived from the States and just tried to reassure her, but the patient insisted so that something was wrong when upon examination there was considerable bulging. Relaxation of tissues in tropical climates is the usual explanation offered for this condition over here.

I was ordered from Manila up here about two months ago. They were in the midst of a typhoid epidemic at the time. The native doctors said malaria, - some American doctors said dysentery for there were dysenteric symptoms; I thought typhoid. I invited a member of the Board for study of Tropical Diseases of Manila up here to investigate. He came and got positive Widals in over 90 per cent. of specimens. Not only that, but the organism was isolated and from a patient that had a negative Widal. Naturally we are keeping this one under observation for a positive, as it has been observed that Widals are delayed frequently. There is an impression that Filipinos don't have typhoid. They had a mortality of 33 per cent. Entire families were stricken, and few are the houses that didn't have one or more deaths.

If you could only see the way they live; their wretched personal hygiene, you would think the mortality low.

When a new arrival is expected in the Filipino home, no physician is sent for. All the old grannies (male and female) congregate; tie a grass rope with a pad in front around the abdomen above the child. As the child descends the rope and pad follow, so as not to lose the downward gain. Of course, the patient is on the floor or a mat.

Such was the condition inside when called to see a placenta previa. The whole village congregated on the outside, peeping through windows and cracks in the bamboo. All except two I chased away; took off my immaculate white uniform, got down on all fours and proceeded with the examination.

Doctor, I don't know whether or not you have proceeded in this fashion, but being my first effort, it was very awkward.

My troubles only began here. When starting to make the examination such a

howl I have never heard as was emitted by my patient. Nothing to do but hold her down with my free hand until I had finished. I found the cervix dilated about an inch with much clotted (semi) blood. I got out of her family that she had had pains for the past 24 hours and had passed at least two large chambers full of blood. I packed her the best I could under the circumstances and gave her morphine. She died that night.

Were it profitable to practice medicine among the people it would be very discouraging among such cattle for a civilized medico. We are rather isolated here, away from a railroad, with one. boat a week from and to Manila.

Arise

Maybe the military side of my job may be of some interest to you. at reveille and hold sick call shortly afterward; then my morning report of sick and wounded is made to the commanding officer. Wards are visited at eight. Inspection of hospital including dispensary, operating room, laboratory, lavatories, kitchen, mess-room and barracks. Then instruction of enlisted men, by lecture or drill. Also I am responsible for the discipline, clothing accounts, ration requisitions for my men and patients, to say nothing of the tri-monthly, monthly and bi-monthly reports and returns. I am also the recruiting officer. Naturally, I am held responsible for the sanitation of the post. That means a daily inspection of a native village or the reservation, a biological examination of water used and frequent inspections of baths, stables, quarters of men, kitchen, veneral, teeth, feet and beri-beri.

I hope you won't think there is too much egoism in this letter. If your time permits, I should feel honored to have at letter from you.

Very respectfully,

GEORGE D. HEATH, JR., 1st Lieut. Med. Corps, U. S. Army.

.THE...

John N. Hurty, Sec. State Board of

at

Among the exhibits will be one of the Babies' Milk Fund Association of Louisville, which has done such excellent work in Louisville during the season of 1910. A special report on birth registration is being prepared under the direction of Dr. Cressy L. Wilbur, Chief of the Division of Vital Statistics of the Bureau of the Census, for this meeting. The report of the committee on Birth Registration will be presented the session on Municipal, State and Federal Prevention, of which Dr. Wm. H. Welch is chairman. The members of the committee on Birth Registration inIclude in addition to Dr. Wilbur: Dr. Wilmer R. Batt, Commissioner of Vital Statistics, Harrisburg, Pa.; Dr. Charles V. Chapin, Commissioner of Health, Providence, R. I.; Dr. John S. Fulton, Sec.-General Int. Cong. on Hygiene and Demography, Washington, D. C.; Dr.

Woodward, Health Officer, Washington,

D. C.

The meeting will open with a general session on November 9th. On the 10th and 11th there will be four special sessions as follows:

Municipal, State and Federal Prevention-Chairman, Dr. Wm. H. Welch, Johns Hopkins Medical School, Baltimore; Secretary, Dr. John S. Fulton, Sec.-General Int. Cong. on Hygiene and Demography, Washington.

Medical Preventon-Chairman, Dr. L. Emmett Holt, 14 W. 55th Street, New York City; Secretary, Dr. Philip Van Ingen, 125 East 71st Street, New York City.