To this, Dr. Hughes replied that the similarity was not a similarity, but that there was an exact reproduction in swine of the pathological appearances. The lesions of the disease in swine closely resemble the post-mortem findings in cases of tuberculosis in man. Dr. Hughes, in connection with the subject of tuberculosis in swine stated that there was no question that there was a great deal of it in swine and in cattle. Recent investiga

tions made since Robert Koch's famous speech before the International Tuberculosis Congress, held in London, 1901, tended to disprove many of his tenets, among them his belief that human tuberculosis is not communicable to animals, not that of animals to

man.

The above report merely epitomizes the extemporaneous address made by Dr. Hughes, and summarizes the answers to a few of the questions put to him after the address. At the close of the evening Dr. Hughes was given a rousing unanimous vote of thanks. The hope was expressed by many that he would soon again address the City Hospital Alumni on some phase of the government work.

In closing the discussion Dr. Taake stated that the treatment had been entirely symptomatic. The pain was relieved by morphine sulphate. A cough mixture was given to check the cough. The perspiration was so profuse that it was thought best to reduce it to some extent, which was done by the administration of tincture of belladonna. Purgatives were given when he took charge of the patients. Upon investigation it was found that the pork was still hanging in the smoke house. This was about one month

after the patients took sick. The pork was purchased from a near-by meat market, the proprietor of which secures his meat from a small packing house located in this city.

Dr. Taake thought that there were many cases of trichinosis which were not diagnosed. He substantiated the latter statement by citing several cases discovered in the operating room and a post-mortem. He believed that if the government officials knew of all the cases, a system of inspection would be enforced.

Severe localized pain after traumatism, especially in children, may be due to subperiosteal fracture, e. g., near the head of the humerus or the femur. Extreme localized tenderness is the chief sign; abnormal mobility and deformity are absent, and crepitus may not be elicited.

The Boston Meeting of the A. M. A.

EDITORIAL

IN the space at our comamnd it will be im. possible to do justice to the long-to-be-remembered Boston meeting of the American Medical Association, which was from all view-points an occasion of profit and pleasure. The opening session (and all the general sessions) was held in Mechanics Hall, a hall admirably suited to the association's purposes. The body of the hall was reserved for members of the association, in the balconies were ladies and friends. Seated on the platform at the opening session were the presiding officer, the special guests and the ex-presidents of the association, all in the front row. They were President Lewis S. McMurtry, with Governor Guild on one side and Rev. Dr. Hale on the other; Mayor Fitzgerald, President Elliot of Harvard University, President-elect William J. Mayo of the association, Dr. Arthur T. Cabot, president of the Massachusetts Medical Society; Dr. Herbert L. Burrell, chairman of the local committee of arrangements: and these ex-presidents of the A. M. A.: Dr. Wyeth, Dr. Keen. Dr. Reed, Dr. Billings, Dr. Mathews, Dr. Musser and Dr. Henry O. Marcy.

After a few brief exchanges of courtesies Dr. Lewis S. McMurtry, the retiring president of the association, stepped to the front and extended a cordial welcome to the association and its friends. Then he introduced Dr. Hale who pronounced the invocation.

Addresses of welcome followed by Governor Guild of Massachusetts, who welcomed the association to the commonwealth, and expressed the high appreciate of his people in the work of our association; President Eliot, of Harvard, and Mayor Fitzgerald, of Boston, who spoke felicitously and assured the asso

ours

ciation that every endeavor to the scientific and social success of the meeting was to command, a matter which all already felt. The retiring President, Dr. McMurtry, then introduced President Mayo.

The presidential address was quite what one would expect from Dr. Mayo, dealing largely with practical facts and existing conditions. He urged unity as a means to achievement; in this connection he said: "The present organization of the American Medical Association is but a beginning; we must further the interests of this body unselfishly, not for ourselves alone, but that we may better fulfil our sacred obligations to mankind. The people must be educated up to a point were they can understand the broad humanitarianism of modern medicine. Society appreciates the saving of a sick person's life by the skilled physician, but fails to see the priceless gifts to the human race made by preventive medicine and sanitary science. It views everything in detail and misses the perspective. We have failed to secure the support of the masses of the people to muchneeded sanitary reforms, because we have appealed to them as one individual to another without the weight of an authoritative organization.”

He also urged the education of the masses in the matter of infectious diseases, especially emphasizing tuberculosis. He held that there is no reason why a man who has become infected with typhoid from a city's neg lect should not sue for damages as he would for personal injury sustained from falling through a defective sidewalk. Unavoidable sickness is bad enough, but when we stop to consider that the life of the individual is worth $5000 to the State, and that those who recover under great disability and expense, the continuance of unsanitary conditions is criminal. The experience of Vienna, which was converted from a typhoid center to one of freedom from such outbreaks by bringing in a pure water supply, has now been repeated over and over again in every civilized land. Yet hundreds of deaths from this preventable source yearly attest that the lesson has not yet been learned.

In the matter of governmental interference and control, in the presence of contagious disease he said: "One of the few misfortunes of the individual freedom afforded by a republican form of government is that it enables the most ignorant man, through prejudice, to interfere with and delay needed legislation, with the result that by the time the law can be passed the immediate object to be obtained has often disappeared. In Germany compulsory vaccination has practically caused smallpox to

disappear from the army and country, a person properly protected being immune. In the State of Minnesota inability to enforce vaccination in the late smallpox epidemic permitted, from a few sources, 27,876 persons to become infected with this disorder; all due to a small but vociferous band of antivaccination agitators.

"Contagious disease in any place is not a matter of local or State interest alone, as the ease and freedom of freedom of transportation render local control impracticable and properly place it in the hands of the General Government. The keenness with which the American people are watching the affairs of Panama argues well for the future. The communication of Dr. Charles A. L. Reed awakened public interest. His portrayal of red tape and obstruction to sanitation in the Canal Zone has resulted in obtaining for that most able army medical officer, Colonel Gorgas, power to carry out the necessary reforms and has made the Canal Zone the most sanitary place in Latin America.

"The army and navy medical departments have worked intelligently against overwhelming odds. Their individual members have international reputations honestly achieved. Their schools for the special training of their men are in the highest degree efficient and deserving of every praise; but the departments have been so small as to be unable to act even as nuclei about which in time of war competent forces could be gathered and the militia of our country enter into conflict fearfully handicapped. The indications, however, are that these matters will now be rectified, and if so it will guarantee to the patriotic American that should he again be called on to serve his country his enemies will be in front and he will not be destroyed by his own side through neglect of sanitary laws.

Contract practice, fee division, commission giving, lodge practice and other evils were mentioned in condemnation. He urged the broadening of medical education that our schools may constantly graduate stronger men, and further, that graduates may not leave college to at once embark as specialists. "Graduation from a college, he said, is merely a commencement of a life study of medicine. Therefore, young men without special training under competent teachers should not be encouraged in wanton assaults on major surgical diseases unless justified by necessity. The future will demand schools for advanced training for those who desire to do special work. In the practice of medicine the student days are never over. There is so much to be learned that a long and industrious life leaves one with the feeling that he is but a beginner. The most important habit a young physician

can form is the "daily study habit." Let him put in even one hour a day with the reading of journals and books of reference and much can be accomplished. He should keep an account of the time, and if something interferes for a day he should charge himself up with it. The practitioner must make frequent trips away for the purpose of observation. In no other way can he avoid the rut of self-satisfied content, which checks advancement and limits usefulness. No amount of diligence as a student can take the place of personal contact with men in the same line of work.

At the second general session the orations on Medicine and Surgery were delivered. Dr. F. C. Shattuck, of Boston, delivered the address on Medicine, dealing with the development of the science rather than with any of its special phases.

Dr. Jos. D. Bryant, of New York, delivered the address on Surgery, chosing for his subject the "Nature and Progress of a Malignant Disease," referring to cancer. He pointed out the various known sources of this disease and said that it usually inflicted its ravages on old age, and seldom on youth. "The fish of the mountain springs and brooks, and also the product of the salty bodies of water, are sources of cancer," he said. "England and Germany through their crowned rulers are directing their efforts to learn the source of this disease, and benevolent humanitarians are gladly supplying the funds to pursue the work.

The work of the various sections was uniformally of such interest as to making the noting of features difficult, possibly the symposium on Tuberculosis and that on Venereal Prophylaxis were especially worthy of mention in the field outside surgery. The work of the various sections was featured by numerous and intensely interesting clinics at the many institutions which were rich in available material. This was an advantage not found in less populous meeting places.

SO

The social side of the meeting was eclipsed by its scientific features that many wholly lost sight of it, yet the entertainment was exceptional, and quite in keeping with the hospitality for which Boston is famed. There are so many points of historic and other interest within Boston's limits and within easy access that those who were tempted away from the sessions found the time full and well spent. The dinners, teas, concerts and other set entertainments were so arranged as not to interfere with the scientific work and were each and all delightful.

President, Dr. Joseph D. Bryant, New York.

First vice-president, Dr. Herbert L. Burrell, Boston.

Second vice-president, Dr. Andrew Smith, Portland, Ore.

Third vice-president, Dr. D. S. Fairchild, Des Moines, Ia.

Fourth vice-president, Dr. William S. Foster, Pittsburg, Pa.

General Secretary, Dr. George H. Simmons, Chicago.

Treasurer, Dr. Frank Billings, Chicago. Board of Trustees, Drs. M. L. Harris, Chicago; W. H. Welch, Baltimore, and Myles F. Porter, Fort Wayne, Ind.

Atlantic City was decided upon as the next place of meeting.

The association also passed resolutions apprecaitive of the hospitality shown to the members and friends of the association by the local physicians, all those in fact who have had to do with the arrangements for the week's programme.

Officers elected by the sections were:

Section of Surgery and Anatomy-Chairman, Dr. M. J. Schamberg, Philadelphia; vice chairman, Dr. E. W. Branigan, Boston; secretary, Dr. Eugene S. Talbot, Chicago; delegate, Dr. Charles V. I. Brown, Milwaukee, Wis.

Obstetrics and Diseases of Women-Chairman, Dr. J. Wellesley Bovee, Washington, D.C.; vice chairman, Dr. Edward Reynolds, Boston; secretary, Dr. W. P. Manton, Detroit; delegate, Dr. Walter B. Dorsett, St. Louis.

Hygienic and Sanitary Science-Chairman Dr. Prince A. Morrow, New York City; secretary, Dr. Elmer E. Hegg, Seattle, Wash.; delegate, Dr. W. Lewis, Chicago.

Diseases of Children-Chairman, Dr. J. Ross Snyder, Birmingham, Ala.; secretary, Dr. George Wentworth, Chicago; delegate, Dr. T. W. Southworth, New York.

Pathology and Physiology-Chairman, Dr. W. L. Bierring, Iowa City, Ia.; secretary, Dr. W. B. Cannon, Boston; delegate, Dr. W. S. Hall, Chicago.

Laryngology, and Otology-Chairman, Dr. S. M. Snow, Philadelphia; vice chairman, Dr. Philip Hammond, Boston; secretary, Dr. W. Sohier Bryant, New York; delegate, Dr. Otto F. Frier, Chicago.

Ophthalmology-Chairman, Dr. G. C. Savage, Nashville, Tenn.; vice chairman, Dr. A. A. Hubbell, Buffalo; secretary, Dr. A. E. Bulson, Jr., Fort Wayne, Ind.; delegate, Dr. S. D. Pisley, Philadelphia.

Stomatology-Chairman, Dr. Schamberg, Philadelphia; vice chairman, Dr. Branigan,

delegate, Dr. G. V. I. Brown, Milwaukee.

LONDON LETTER

(WRITTEN FOR THE MEDICAL FORTNIGHTLY.)

JUNE 1, 1906.

LONDON SCHOOL OF CLINICAL MEDICINE.

The opportunities for post-graduation post-graduation study in London have recently been much increased by the establishment of the London School of Clinical Medicine in connection with the Seamen's Hospital at Greenwich. It is a sister institution to the London School of Tropical Medicine, which has achieved so much success and has been founded by the same body, the Seamen's Hospital Society. The school is to be reserved entirely for qualified medical practitioners.

The "Dreadnought" Seamen's Hospital (so-called because it was formerly housed in the old wooden battle-ship, the "Dreadnought," moored in the Thames) which is the headquarters of the school is situated at Greenwich, about half an hour's journey from the center of London, e.g., Charing Cross, and is easily accessible by train, electric tram, and steamboat by a variety of routes. The hospital contains 250 beds and provides annually for 2000 in-patients and 10,000 outpatients. The out-patient department at Greenwich is supplemented by dispensaries in the East India dock road and at Gravesend, at which the annual attendance numbers 15,000 patients.

Three sessions of ten weeks duration are held in each year, and a short VacationCourse of instruction will be provided during September when a sufficient demand arises to justify its institution.

Every variety of disease may be studied in the wards and out-patient rooms of the hospital, at the dispensaries, and at the affiliated hospitals.

The supply of material affords exceptional facilities for practical instruction in operative surgery and in pathology on the cadaver. The hospital also offers a wide field for the study of venereal diseases, and there is a special department with open-air wards for the treatment of tuberculosis.

Male patients only are received as in-patients by the Seamen's Society, but arrangements have been entered into with the Royal Waterloo Hospital for the reception of postgraduates who desire instruction in diseases of women and children; with the Bethlem Hospital for those who require tuition in mental disease; and with the General Lyingin Hospital for the prosecution of study in midwifery.

These hospitals are situated on the south side of the river, are directly linked to the "Dreadnought" by both railway and tram

way, and are affiliated to the London School of Clinical Medicine.

For practitioners who desire, from time to time, to bring themselves into touch with the most recent scientific advances, as well as for graduates who are reading for the higher qualifications, there is ample provision for the acquisition of practical knowledge and technical skill in every departmennt of medicine and surgery.

The University of London recognizes the Dreadnought Hospital as an institution from which certificates of post-graduation study for the higher degrees are accepted.

The hospital contains a pathological museum and two laboratories which are fully equipped for study and research.

Tutorial classes are arranged, when required, on terms which may be ascertained at the office of the medical superintendent.

Residential accommodation can be procured in the neighborhood of the hospital. A list of respectable lodgings is kept in the medical superintendent's office for the convenience of those who desire to live in Greenwich.

A reading-room, reference-library, smokingroom, cloak-room and billiard-room are provided for the use of gentlemen who are studying at the hospital.

The physicians and surgeons attend the hospital every afternoon except Saturday.

The physicians and surgeons in charge of special departments attend the hospital on two afternoons a week.

The assistant-physicians and assistant-surgeons attend the out-patient department daily, in the forenoon.

The officers of the society in charge of the dispensaries in the East India dock road and at Gravesend attend daily at 12 o'clock.

Clinical lectures are delivered on five afternoons a week, in the lecture room and wards. Operations are performed daily.

Post-mortem examinations are conducted by the pathologist, in the morning, at 10 o'clock. Intimation of such examinations is posted on the notice-boards within the hospital.

The physicians are Sir Dyce Duckworth, Dr. Frederich Taylor, Dr. Rose Bradford, Dr. Tanner Hewlett and Dr. Guthrie Rankin; the surgeons Sir William Bennett, Mr. Mayo Robson, Mr. Albert Carless, Mr. William Turner and Mr. Lawrie McGavin; ophthalmic surgeon, Mr. Vernon Cargill; physician for diseases of the throat, etc., Dr. St. Clair Thomson; surgeon for diseases of the skin, Mr. Malcolm Morris; X-rays, Mr. Mackenzie Davidscn; dental surgeon, Mr. Kenneth Goodby, besides assistant physicians and surgeons and extra-mural lecturers on

The Harben lectures of the Royal Institute of Public Health have this year been delivered by Prof. Metchnikoff of the Pasteur Institute, Paris, and have proved very interesting and instructive. In the first lecture, Prof. Metchnihoff dealt with the "hygiene of the tissues." He directed attention to the fact that persons frequently carried in their persons pathogenic microbes without suffering any ill-effect, and from an analysis of many facts he considers that immunity must be due to a modification of certain living parts of the body, in particular of the phagocytes. Wright had recently sought to prove that the phagocytes exert a passive role, acting only on microbes exposed to the action of substances (opsonins) present in the blood and body fluids, but experiments quoted seemed to indicate that the phagocytosis occurred in the absence of opsonins. The influence of alcohol in reducing resistance to infection was alluded to, and it was suggested that alcohol, opium, and other similar drugs should be used with great caution in infective diseases. On the other hand serum and physiological salt solution stimulate phagocytosis, and Paris surgeons have been using serum lavage and infections with the greatest benefit in major operations.

The second lecture dealt with the "hygiene of the alimentary canal." Prof. Metchnihoff stated that there could be no doubt that microbes frequently found their way into the blood and tissues from the intestinal tract, even when the wall of the intestine was intact, and he suggested that digestive leucocytosis was a means of defence against such invasion. A good deal of evidence was adduced to show that intestinal worms were frequently the cause of appendicitis by sitting up inflammation followed by infection. Prof. Metchnikoff therefore considers that no food should be eaten raw, no salads, no fresh fruit, no raw milk, everything must be cooked! The third lecture dealt with the "hygiene of syphilis." Prof. Metchnikoff pointed out that by far the great proportion of sufferers from syphilis were innocent victims. After having found that apes could be infected with syphilis attempts were made to prepare anti-syphilitic sera and vaccines, but they were found to be impracticable. Next preventive measures were tried by treating the seat of inoculation with various

It

agents, particularly mercurial ointments. was found that in the monkey inunction at the seat of inoculation with an ointment composed of calomel, one part and lanolin three or four parts, prevented infection up to twenty hours after inoculation. A young man, a medical student who volunteered for the experiment, and four monkeys were inoculated with syphilitic virus, and an hour afterwards the man and one of the monkeys were rubbed with the calomel ointment, one monkey was treated twenty hours after inoculation, the two other monkeys were left untreated. The two untreated monkeys showed primary lesions seventeen days afterwards, the one treated twenty hours after inoculation developed primary symptoms in thirty-nine days, while the man and monkey treated one hour after inoculation developed no sign of primary lesions.

BRITISH MEDICAL MEETING.

May I remind our American friends that the annual meeting of the British Medical Association is to be held this year at Toronto, commencing August 21st. We hope that many of them may be able to attend.

RICHARD T. HEWLETT.

FRACTURES of the head of the radius are probably more common than generally supposed, being overlooked frequently because cf the absence of the ordinary signs of fracture.

SEA VOYAGES FOR INVALIDS.-The discussion on "Sea Voyages for Invalids," published in the Journal of Balneology and Climatology, January, 1906, provoked a number of opinions as to the advantages and disadvantages of sea travel for invalids. The consensus of opinion, including that of Dr. Robert W. Felkin, who opened the discussion, seemed to be, as a rule, against the treatment. He stated that the principal ailments which precluded a sea voyage are: (a) The strength of the patient-if there is too great exhaustion it is better to keep on land; (b) grave dyspepsia; (c) hepatic enlargement; (d) cardiac dilatation; (e) pyrexia or any inflammatory condition; (f) any tendency to hemorrhage; (g) epilepsy; (h) insanity; (i) pregnancy; (k) patients suffering from eye diseases; (1) any kidney disease; (m) phthisis, except, perhaps, in the very first stages. Dr. F. Sandwith's remark that: "The doctor who sent many patients to sea was generally one who had not done much travelling in bad weather," succeeded best perhaps in summing up the situation.—The Journal of Tropical Medicine.