961; March, 997; April, 976: May, 948; June, 933; July, 973; August, 1145; September, 1031; October, 1092, November, 1032; December, to date, 1137.

The following diseases claimed the greatest number of victims during 1905: smallpox, 59; diphtheria, 110; typhoid fever, 127; pneumonia, 969; phthisis, 1250; heart disease, 907; suicide, 179; homicide, 77; accidents, 434. During 1904 there were 227 suicides, 105 homicides and 525 accidental fatalities.

The report prepared by the mortuary clerk for the week ending at noon on December 30th shows a total of 317 births, the largest number for one week during the year.

Report of the Society for the Prevention of Tuberculosis.

THE St. Louis Society for the Prevention of Tuberculosis in its recently issued annual report shows that the interest in this very important work is growing in a satisfactory manner, though the people of St. Louis have as yet to reach that degree of appreciation of the worth of preventive measures which has resulted in the large decrease in the death rate from tuberculosis in New York, Philadelphia and Cleveland. The following is a brief summary of the work done by the society during the past year:

The preparation and successful adoption by the city of an ordinance giving St. Louis its first legislation for the control of the disease. Nothing in this law can offend physician, patient or family. Properly enforced, its operation will be beneficial in the highest degree.

There were prepared, printed and distributed, under many forms and in many ways, about 250,000 leaflets, brochures, cards, etc., instructing the public about the disease, its treatment and prevention. Special attention was given to warnings about careless spitting. The posting of special cards in most of the street cars was found the best way to call the public mind to this tremendous evil.

Lectures in various parts of the city were given during the year under the auspices of the society and the league. At the solicitation of the society and the league, the public press assisted the work by much publication of relevant matter.

Its purposes

for the future are:

4. More suitable provision for the care of poor consumptives by the city, such as:

Special hospital accommodations in present institutions for bedridden cases. A "rest cure" hospital for the non-bedridden cases during prostrating attacks of the disease.

66

'open-air" hospital for treatment of all cases where a cure is possible. Adequate public dispensary facilities, with definite hours for treatment and advice.

5. The freedom of the public health service from partisan political influences in order that the best men may render the best service.

In accomplishing this it is working with the Civic Improvement League. Every physician in our city should unite himself with one or both of these organizations. The Society for the Prevention of Tuberculosis elected to office the following gentlemen for 1906:

Francis G. Eaton, chairman; Dr. William Porter, vice-chairman; Jordan W. Lambert, treasurer; G. R. Blickhahn, secretary; Ashley Cabell, Dr. J. R. Lemen and Dr. Albert Merrell

DR. J. F. JENKINS, Tecumseh, Mich, (Jour. A.M.A., December 23) insists on the recum

Typhoid Fever.

bent position from the beginning in typhoid fever. He states that milk preferably given with pepsin and hydrochloric acid and two soft-boiled eggs every twenty-four hours, occasionally alternating with barley or rice water for a change, makes a very efficient diet during the whole course cf the fever. In the later stages a little old whiskey, as a stimulant to a flagging pulse may be added to the milk. In the early stages, fractional doses of calomel, followed by a small dose of Rochelle salts or sodium phosphate are indicated; in some cases they may be repeated from time to time during the first and second weeks. Intestinal antispetics are of value, he states, in checking putrefaction and relieving diarrhea and tympanitis, and, therefore, should be prescribed. When the temperature rises to 102.5, cold sponging or tubbing should be resorted to, and it is advisable to follow up the bath by vigorous frictions. Frequently a small amount of stimulant is indicated after the bath. When there is delirium or coma the ice bag to the head will relieve and

2. The proper and effective compliance with the recent law for controlling the dis

ease.

3. More intelligent methods for cleaning streets and sidewalks.

valescence a tepid sponge bath of alcohol and water, equal parts, he thinks, has a beneficial effect. One should insist on the patient taking from a quart to a quart and a half of boiled water every twenty-four hours as the typhoid patient does not usually demand

water, even when the temperature is high. Diarrhea, when excessive is often checked by reduction or change of diet and full doses of bismuth subnitrate will usually be effective. For restlessness in the late stages Jenkins has found Hoffman's anodyne a very useful remedy. In the later stage stimulants are required for supporting the feeble heart action and during convalescence he advises hexamethylenamin in 5 gr. doses, three times a day, to destroy the bacilli in the urine.

The Curative Treatment of Pneumonia, with Points on Hydrotherapy and Therapeutic Fasting in Fevers.

DR. CHARLES E. PAGE enters a strong protest against what he terms the non-curative, not to say killing, treatment of pneumonia, which is the prevailing one and includes drugs and forced feeding plus the mischievous effects of hot poultices on hot lungs. The essential features of bis own plan (Med. Record, Dec 23) consist in the use of cool applications to the chest and abstinence from practically all nourishment except water. In this way the disease when taken early is frequently aborted, and the normal death rate becomes five per cent for private and hospital cases combined, while in private practice alone it is about two per cent. For pneumonia the procedure recommended is as follows: large towel, coarse linen or cotton, is folded lengthwise in the middle then folded crosswise in the middle, and one-half the length of this four-ply towel is wrung tightly from ice-water, or the coldest water obtainable, and again folded crosswise, so as to give four thicknesses of damp towel next the skin, and the same, dry, outside. The damp folds should be freshened as often as they become at all hot, whether this be in ten, twenty, or thirty minutes. At first, in severe cases, the changes will be as often as every eight or ten minutes, the intervals lengthening more and more as the inflammation subsides, and breathing consequently becomes deeper and easier. When the patient is able to breathe naturally, and the compress no longer becomes hot, and before it is felt to be an uncomfortable treatment, this local cooling should cease. In some cases hot applications are also made to the legs. The author emphasizes the untoward results attending the employment of forced feeding, and points out the great advantages of keeping the patient on a diet of warm water until convalescence is established. The mortality from typhoid fever has shown no improvement dur

ing the past seventy-eight years according to the records of the Massachusetts General Hospital, and the author attributes the bad results largely to the over-feeding practised.

IN performing subcutaneous infusion do not allow too much fluid to accumulate at one area, otherwise necrosis may occur. Shift the needle to various parts not by swinging it from side to side, but by partly withdrawing it and reinserting it to another area.

THE NICHOLAS SENN CLUB.-The professional friends of Dr. Nicholas Senn have organized a Nicholas Senn Club of which Dr. Fernand Henrotin has been elected president and Dr. Arthur MacNeal secretary. Some time ago Dr. Byron Robinson suggested that the most appropriate testimonial to Dr. Senn in commemoration of his services to the niedical profession would be a "Festschrift" after the custom of the German profession in honoring their great men. The club is the result of this suggestion. The publication of the "Festschrift" will be the first work undertaken by the organization. Dr. Robinson's idea is to collect in this testimonial volume one article from each country where scientific medicine is taught, and to publish them each in the native tongue of the writer. The general object of the club is to surround Dr Senn with a small coterie of personal friends, whose duty and pleasure it shall be to assist him in carrying out any work which he may from time to time initiate.-Med. Standard.

TONSILLITIS.-R. M. Niles, in discussing the treatment of this affection, says that the patient should be isolated, should receive broken doses of calomel, followed by a saline laxative or croton oil, quinine in tonic doses. Strychnine, aconitine, sodium salicylate, guaiac and anodynes may also be required. Hot alkaline gargles and a spray of hydrogen peroxide are useful. Chlorate of potassium has little value. Often the application of the tincture or vinegar of capsicum produces the most brilliant results. Congestion and edema are reduced, the separation of sloughs is facilitated, granulations are stimulated, vasomotor inertia is overcome, and normal tissue metabolism is re-established. Tincture of capsicum, full strength or diluted with cod liver oil should be applied to the Schneiderian mucous membranes in the treatment of the rhinitis, which is a frequent concomitant of the tonsillar involvement. The nasal mucosa is first cocainized, and the capsicum is then applied with a cotton-covered applicator.-Med. Record, December 23, 1905.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

CLEFT PALATE AND HARE-LIP. By W. Arbuthnot Lane, M.S., F.R.C.S., Surgeon to Guy's Hospital and Senior Surgeon to the Hospital for Sick Children. Great Armond St., London: The Medical Publishing Co., Limited.

In the above volume the author embodies his resumé of years of experience in the treatment of hare-lip and cleft palate. The text is clearly written and the type used appeals very gratefully to tired eyes, especially if stricken with refractory errors. The author illustrates by photographic prints the various 'deformed temporomaxillary joints and bites that are present in cleft palate. The operative treatment is explained and inany useful points are brought out in this connection. Much stress is placed on the size of the tongue and its future accommodation in the above treatment. For completeness and lucidness of the subject of hare-lip and cleft palate this volume merits commendation.

ANNOUNCEMENT.-Messrs. Lea Brothers & Co. have pleasure in announcing for publication early in January, 1906, a completely new work on Dietics adapted to the use of practitioners and students of medicine, nurses and the laity. "Food in Health and Disease. By Robert F. Williams, A.M., M.D., Professor of Principles and Practice of Med icinein the Medical College of Virginia, Richmond. The volume will be a convenient 12mo of about 350 pages. Its price has not yet been fixed, but it will probably be about $2.00, net, delivered to any address. It is divided for convenience, into two parts: Part I dealing with Food in Health, and Part II with Food in Disease. In Part I the needs of the body for different kinds of foods and the manner in which they are utilized are explained. The principles of cooking foods and detailed descriptions of the different articles of food in common use are given, with chapters on the proper nutriment of infants, children, adults and the aged. Part II deals with Part II deals with the variations from the normal diet in health, necessitated by the more common diseases, and includes a chapter on general methods to be observed in feeding the sick, as well as the special directions for nourishment in diseases of different kinds. There exists today a need for a small practical books on foods and how they should be used, which will give the facts, as known today, in a brief and clear manner, with the fewest possible technical terms. The importance of a work of this kind, which is simple enough for a child to read and yet absolutely trustworthy and based upon the scientific achievements of accepted leading authorities, is obvious.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

One Day Pneumonias.-Bechtold (Muench. Med. Wochenschrift, No. 44, 1905) briefly reviews the literature of ephemeral pneumonia, epitomizing the history and diagnostic data of ten such cases occurring among a total of 1057 cases of croupous pneumonia treated in the Würzburger medical clinic during the years of 1887-1905. The symptoms were those ordinarily common to an acute infectious disease; an initial chill followed by high fever, headache, vomiting and general lassitude. In all the cases the temperature ended by a more or less typical crisis, usually associated with profuse sweating. Pain in the side was present in eight of the ten cases. The objective signs were inconstant. Palpation offered no diagnostic information in a single instance. The percussion note varied from normal to a slight diminution in the volume and duration, sometimes with an associated tympany, and in some instances to a distinct dullness. In two cases a presumptive diagnosis of croupous pneumonia was made on the general symptoms, the correctness of the diagnosis being verified by the subsequent appearance of bronchophony and changes in the respiratory murmur (roughened breathing, crepitation, etc.). In two other patients the percussion note remained normal until twenty-four hours after the initial chill. The ausculatory findings are even more, variable than those of percussion. Bronchial breathing was present in two cases. In some instances the only evidence of a pulmonary disturbance was diminished or harsh vesicular breathing, or rales, sparing in number, limited to localized areas. ritic friction appeared later in the course of the disease in two cases, signifying an extension of the pneumonia process to the surface of the lung. The friction sound in one of these cases persisted for some time. Bronchophony apparently seemed to be the most constant auscultatory phenomena, being present in four cases. The sputum lacked all characteristics, save in a single instance, where it was rusty brown, while another case presented a bloody tinged expectoration. In the remaining cases it was either mucous, muco-purulent or absent entirely. It is difficult to determine whether the morbid process in these cases passes through the different pathologic stages or remains stationary, as such cases rarely come to autopsy. While

Pleu

Bechtold is of Leube's opinion, who holds that the abortive factor depends on an energetic reaction of the economy in producing an excessive formation of antitoxine, his observations also prove that the degree of attenuation of the virus is another prime factor.

The Accumulative Effects of Digitalis and Its Prevention.-Casares' (Rev. de Med. y. Ar. Pract., July 28, 1905) experience with digitalis coincides with that of Eichhorst and Hoffmann who claim the universal fear of accumulative effects of digitalis is unwarranted and very much exaggerated. The author says there is little danger of the drug accummulating so long as there is free diuresis. He advocates the administration of digitalis in combination with a diuretic, preferably diuretin. He reports a case where 0.1 gm. of the powdered digitalis leaves had been administered three times a day for three consecutive weeks without any ill effects whatsoever.

A Case of Extreme Bradycardia. Frey (Muench. Med. Wochenschrift, No 41,1905) reports in detail an instance of this kind in a man, 56 years old, with a history of syph ilis. Remarkable about the case was that for fifty hours before death the heart contractions registered on the average thirteen beats per minute with no circulatory disturbance in the internal organs or extremities, and only in the last eight hours did a disturbance in the cerebral circulation evidence itself, which presumably was the direct cause of death. Although no autopsy was made, the presumption is that the condition was a progressive degeneration of the heart muscle, on a syphilitic basis, with a sudden exacerbation.

Blood Investigations in Leukopenic Splenomegaly.-L. d'Amato (Zeitschrift f. klin. Medizin, Bd. LII, 1905) made a hematologic study in a number of diseases with splenic enlargement as the predominating feature. In two cases of so-called Banti's disease, two cases of chronic malaria and a case of hepatosplenic syphilis he noted a decrease in the number of leucocytes. In only one of these the leucocytic formula approached the normal, while in the remaining four there was a decrease, in the polymorphonuclear variety. There was a slight diminution in the lymphocytes in all five cases, and in two cases a small number of myelocytes were present. leucocytic formula, for some unknown reason may vary in the same individual. Doubtless the etiologic factor in the production of splenomegaly has some influencence on the leucocytic formula. Digestion influened a slight increase in the number of leucocytes in four cases, while in one it de

The

creased the number with changes in the leucocytic formula. Irritation, as blistering, hemorrhage and suppuration only moderately increased the number of polymorphonuclear cells. Splenic faradization increased the lymphocytes, probably by causing the organ to contract and forcing them into the circulation. The blood serum of these patients possessed but slight agglutinating power, but contained no hemolytic or leucolytic properties. d' Amato's investigations warrants him in concluding that the cause of splenomegalic leukopenia lies in a disturbance of the leukopoietic organs, especially the spleen and bone marrow. That the bone marrow undergoes myeloid transformation in a large number of cases is evidenced by the appearance of melocytes. No plausible reason can he give why there should be a diminution in the leucocytes or the sluggish reaction of the organism to substances which ordinarily proniote an increase in the number of white blood cor

puscles.

Tuberculosis of the Appendix.- Sitsen (Weekbl. voor. Genessh., No. 19, 1905) holds that a tubercular affection of the appendix is a rare occurrence, and according to postmortem statistics is always associated with tuberculosis of other organs (lungs, intestines). In his opinion the appendix is never the primary seat of the trouble, and says that the reported cases of amputation of a tuberculous appendix with an absence of clinical manifestations of a tuberculosis elsewhere fails to prove that the appendix was primarily

diseased.

A Case of Hysterical Singultus.-Makelarie (Spitaul, No. 19, 1905) reports a unique case of hysterical hiccough in a girl 16 years of age resulting from fright. The attacks appeared daily, usually between the hours of four and six in the afternoon, numbering about 100 contractions of the diaphragm during each attack with absolutely no response to the ordinary medicaments. The therapy consisted in suggesting that the attacks will gradually diminish from day to day with the result that in six weeks the patient completely recovered. Later, a transitory exacerbation occurred from a psychic emotional effect.

Remarks on the Etiology of Tetany.— Chvostek (Wiener klin. Wochenschrift, No. 38, 1905) discusses the theoretical problems of tetany, and concludes that it can neither be regarded as a diseased state of the central nervous system, nor one of systemic poisoning. Animal experimentation, with the associated clinical evidence, warrants

him in considering tetany as a distinct clinical entity having its origin in a disturbed functionation of the parathyroid glands. This epithelial impairment may be either congenital or acquired, permanent or transitory. It is probable that the causative factors of endemic and epidemic tetany are analogous to those of endemic struma. Among the different exciting agents which also produce the specific tetany reaction in individuals with this constitutional anomaly, are gastric dilation, pregnancy, etc.

Acute Dilation of the Stomach.-Neck (Centralblatt f. d. Grenzgebiete der Med. und Chir., Nos. 14-17, 1905) critically reviews the literature on acute gastric dilation, analyzing the 64 recorded cases, among which are 44 with autopsy findings. In the majority of cases the organ extended to the pubic bone, and in some instances to the floor of the pelvis. The onset was usually sudden without any previous evidence of a stomach disturb.

ance.

In 28 of these cases the distention occurred after chloroform anesthesia. It is possible that in 17 of this number the stomach might have been injured during the operation (laparotomy), but it is more than probable the chloroform injuriously affected the walls of the stomach, as in the remaining 11 cases the possibility of having injured the stomach at the operation is out of the question, the operations having been on the extremities, as knee, elbow, foot and hip. The author cites the following case to illustrate a probable idiosyncrasy of the stomach against certain drugs, possibly acting as exciting factor of the distention: A man, who on several occasions had undergone chloroform anesthesia without any after effects suddenly de. veloped an acute gastric dilation two hours after the taking of a single dose of 0.1 gm. of veronal. In other cases the distention followed indiscretions in food or drink-in one case four bottles of champagne, and in another two bottles of lemonade. Cases of acute gastric enlargement have also been observed following abdominal contusion or other injury. The symptoms are quite deceptive. Pain may be acute at various points; vomiting generally occurs, but it may be absent or cease abruptly. Sometimes the symptoms suggest the action of toxines. The temperature remained normal in all but two cases. As a rule it is difficult to differentiate this condition from acute intestinal obstruction and peritonitis. Recovery occurred in only 17 out of the 64 cases. Concerning the treatment, the use of the stomach tube three times daily has proven most efficient, but must be continued until the stomach has returned to its normal size and the proper functionation

of the organ restored. Neck recommends elevating the pelvis when siphoning the stomach, as this procedure facilitates evacuating the organ. The distended stomach sometimes interferes with the function of the bowel. This can be obviated by the patient lying face downwards or changing to the knee chest position every two hours, and remaining in this posture fifteen minutes each time. Surgical interference is a last resort. Gastroenterostomy might be tried, but in the four cases thus treated, it was too late to benefit the patient.

SURGERY.

JOHN MCHALE DEAN, M. D.

Local Effects of Peritoneal Drainage.Yates, in Surgery, Gynecology and Obstet. rics, publishes the results of peritoneal drainage after a series of experiments on the dog, and later clinically on patients. While the results were obtained on healthy peritoneal cavities, yet the results would not materially differ in diseased conditions. His conclusions are best expressed in his own words, as follows: "Drainage of the general peritoneal cavity is physically and physiologically impossible. The relative encapsulation of the drain is immediate. The absolute encapsulation occurs early (less than six hours in dogs), and can be retarded, but not prevented The serous external discharge is an exudate due to the irritation of contiguous peritoneum by the drain. There is a similar inward current from the potential into the general cavity. This external exudate diminishes remarkably with the formation cf encapsulating adhesions. These adhesions, under approximately normal conditions, form about any foreign body. Their extent and density depend on the degree and the duration of the irritation of this body. Primarily fibrinous, these adhesions become organized in a few days (three days in dogs). If the irritation persists, they become progressively more mature fibrous tissue. After irritation ceases, their disappearance depends principally upon a mechanical factor-the ability of the involved surfaces to pull themselves or to be pulled loose. Drains should be the least irritating, and should be gradually and finally removed as soon as possible. Irrigation through drains is futile to prevent adhesions, and dangerous. After a drain is inserted, all intra-abdominal movements should be reduced to a minimum. As soon as the drain is removed, intra-abdominal activity should be stimulated, to aid in the disappearance of the remaining adhesions. Peritoni