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DR. JOHN W. STEVENS calls attention to this subject as one of much importance to the general practitioner who first sees these cases (Med. Record, Aug. 18). They are not uncommon in asylums and in neurological practice. The patient may seem clear and rational on all other subjects, so that for some time she is considered entirely sane. The maniacal insane lovers differ in certain prominent features from those of the paranoid class. In the former group the origin of this love is always to be traced to the abnormal sexual excitement, increased sus

ceptibility to stimuli, facilitated release of impulses, and the lack of the restraining influence of the ethical sensibilities in the presence of the elation and sense of well-being. At the beginning of this condition delusions and hallucinations are nearly always absent. In the paranoid case this love is only a part of progressive and systematized delusional state. A strangely erotic element is not necessarily present. The maniacal patient often recognizes the abnormal nature of her impulses, while the paranoiac never does. The paranoiac is practically always monogamous, the maniacal often polygamous. In the latter the love disappears with the subsidence of the active symptoms of the individual attack, while in the former it remains throughout life. These patients should be carefully looked out for, not only for their own sake, but for the sake of their victims.

The Insane Lovers.

TRI-STATE MEETING.-The Tri-State Med. ical Association held its thirty-third annual meeting at Put-in-Bay, Ohio, July 31 and August 1 and 2. Dr. Charles D. Aaron, Detroit, Mich., was elected president; Dr. Theodore F. Wood, Angola, Ind., vice-president; Dr. William F. Shumaker, Butler, Ind, secretary, and Dr. Joseph A. Weitz, Montpe

lier, Ohio, treasurer.

THE AMERICAN ORTHOPEDIC ASSOCIATION. -The twentieth annual meeting of the American Orthopedic Society was held in Toronto, Ontario, August 20-23. The Association elected the following officers for the coming year: President, Dr. Joel E. Goldthwait, Boston; vice-presidents, Dr. Henry Ling Taylor, New York; and Dr. Ansel G. Cook, Hartford, Conn.; secretary, Dr. Robert B. Osgood, Boston; treasurer, Dr. E. G. Brackett, Boston; executive committee, Dr. John Ridlon, Chicago; Dr. D. R. Townsend, New York; Dr. H. Augustus Wilson, Philadelphia; Dr. Goldthwait and Dr. Osgood, exofficio.

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ORGANIZATION MEETING.-The Committee on Organization of the proposed "Medical Association of the Southwest," has called a meeting at Oklahoma City, for October 30 and 31, at which time joint sessions will be held with the Tri-State Medical Society of Texas, Oklahoma and Arkansas. Dr. F. H. Clark, temporary secretary, El Reno, Okla.

SLEEPING SICKNESS. -For the sleeping sickness there is no remedy, declared Professor Koch in a recent lecture on his return

from a journey of investigation in Africa. He hoped, however, that the infection might be ended by the extermation of the insect (which propagates slowly), by burning the undergrowth at its favorite home.

THE GERMAN BIRTH-RATE.--A statistical report recently presented to the German imperial chancellor is said to show that the birthrate Germany is receding rapidly at any rate in in the towns. In 1904 the birth-rate was 30.5 per 10,000 inhabitants against 30.9 in 1903, 32.1 in 1902, 33.4 in 1901, and 33.7 in 1900. The decrease, therefore, is continuous, and has begun to cause anxiety.

MISSISSIPPI VALLEY MEDICAL ASSOCIATION. The next meeting of the Mississippi Valley Medical Association will be held at Hot Springs, Arkansas, November 6, 7 and 8, under the presidency of Dr. J. H. Carstens, of Detroit, Mich. The annual addresses will be delivered by Dr. Frank Parsons Norbury, Jacksonville, Ill., in Medicine, and by Dr Florus F. Lawrence, of Columbus, Ohio, in Surgery. Dr. Norbury has chosen for the subject of his address, "Clinical Psychology," and Dr. Lawrence will discuss in his address, "Surgical Principles and Theories." In addition to these addresses there will be the annual address of the President, Dr. Carstens. Elaborate ar

rangements have been made by the local proiting doctors and their wives, the meeting fession of Hot Springs to entertain the visbeing held at the "Eastman" hotel, which will be specially opened in advance of the season to accommodate the Association. A cordial invitation is extended to every physi cian in the valley to attend this meeting for which a large number of interesting and valuable papers have been promised. The headquarters will be at the beautiful "Arlington," where reduced rates will be in effect for the occasion. We would urge our readers to make early reservation of rooms, and avoid the risk of being crowded out, as the attendance is sure to be large. Communications regarding papers should be addressed to the secretary, Dr. Henry E. Tuley, 111 W. Kentucky street, Louisville, Ky.


Books, Reprints, and Instruments for this department, should be sent to the Managing Editor, Century Building, St. Louis.

THE WORLD'S ANATOMISTS. Concise Biographies of Anatomic Masters from 300 B C. to the Present Time, Whose Names have Adorned the Literature of the Medical Profession, By G. W. H Kemper, M. D., Professor of the History of Medicine, Medical College of Indiana, Indianapolis. Ind. With eleven illustrations. Philadelphia: P. Blakiston's Son & Co.

This little booklet should be elaborated into a book of greater size and detail. There is a definite call for books dealing with medical history; these are days of increasing interest in the historical aspect of things generally and medicine is feeling the drift. Dr. Kemper has given us an admirable book, full of interest and artistically gotten up, and the only suggestion that occurs to us for its improvement is that it is too condensed for a work of its character.

A NON-SURGICAL TREATISE ON DISEASES OF THE PROSTATE AND ADNEXA. By Geo. W. Overall, A. B., M.D., Chicago. Chicago: The Rowe Publishing Co.

The good things which are in this volume are so many that it seems not a little unfortunate that there are some features which prevent giving it our unqualified approval. We cannot advocate the treatment of varicocele by the immersion of the scrotum in a medicated bath and passing an electric current through it, but we can approve of a vast majority of the practical suggestions of the author, and we regret that he has not been a little more conservative. Dr. Overall is unquestionably a clever and ingenious man; he largely devises his own instruments and they appear to be good if we may trust the illustration and description; however, from the contour of the bladder, as shown in these illustrations, we are not certain that the instruments are at all what they are pictured, the bladders though supposedly normal in contour, show an artistically perfect urachus widely patulous to its apex at the umbilicus.

If discriminatingly read in connection with larger treatises on these subjects, a vast deal of practical information which is available for immediate use will be found in the volume.

A COMPEND OF MATERIA MEDICA THERAPEUTICS AND PRESCRIPTION WRITING, WITH ESPECIAL REFERENCE TO THE PHYSIOLOGICAL ACTION OF DRUGS. By Samuel O. L. Potter, M.D., M.R.C.P. (Lond.) Seventh Edition Revised and Enlarged. Cloth. Pages 292. Philadelphia: P. Blakiston's Son & Co., 1912 Walnut street.


It is probable that few of our readers are unacquainted with this book, having possessed one or another of its earlier editions. Revision has increased its value and made it without question the best condensation of the subject procurable. There is no other one of the Blakiston Compends upon which the popularity of the series could with such

certainty depend, yet each of its fellows is a The book may be work of great excellence. unqualifiedly recommended to students and to physicians wishing a condensed handbook for speedy reference. It is accurate, upto-date, and presented in an attractive form.


"RUNNING WATER."- The September chapters of A. E. W. Mason's new novel in The Century, "Running Water," a tale whose scenes so far are set chiefly in the Thesiger, the girl of elusive charm and Alps, bring a hint as to the title. Sylvia doubtful antecedents, is on her way to her first mountain ascent, and there is chance meeting with Chayne, the fine, strong character whose love of the Alps and Alpine climbing is his one passion. "I shall hardly know whether I sleep or wake, with the noise of that stream rising through my window,' Sylvia tells Chayne, "for so far back as I can remember, I always dream of running water." The words laid hold upon Chayne's imagination and fixed her in his memories. He knew nothing of her really except just this one ourious fact-she dreamed of running water. Somehow it was fitting that she should. There was a kind of resemblance; running water was in a way an image of her. She seemed in her nature to be as clear and fresh; yet she was as elusive; and when she laughed, her laugh had a music as light and free. The fiction number will include also new chapters of Anne Warner's mirthful "Seeing France with Uncle John," and short stories from Edgar Jepson, Grace S. H. Tytus, Alice B. Morrison, Dorothea Deakin, and Maurice Francis Egan, who contributes another "Sexton Maginnis" tale.

MEDICINES BEST GIVEN ALONE.-Acetate of lead, nitrate of silver, iodide of potassium, and bichloride of mercury are all best prescribed alone, being incompatible, or at least ineligible, with almost everything, the acetate of lead and nitrate of silver may be prescribed with opium, and iodide of potassium and bichloride of mercury with sarsaparilla, or with each other.

DISINFECTING CONFESSIONALS.-On the advice of the Council of Hygiene, the Mexican government has ordered that the confessionals in all three churches of the city of Mexico must be regularly disinfected with the purpose of preventing the transmission of infectious or contagious disease. They are used by crowds of persons of both sexes and might easily become contaminated. Priests disobeying this order or showing negligence in carrying it out are liable to imprisonment.


Comprising the Regular Contributions of the Fortnightly Department Staff.



Jaundice, with Special Reference to its Diagnostic Value.-Hansel's (Medicine, July, 1906) paper discusses the clinical aspect of jaundice and for the purpose of description uses the terms direct and indirect as being more applicable than older classifications, as obstructive and non-obstructive or obstructive and toxemic, because in reality all jaundice is obstructive, the toxemia variety depending upon increasing viscidity of the bile or a swelling of the mucosa of the bile ducts which leads to obstruction. Under the heading of direct jaundice he applies to cases in which the original cause is within or immediately without the bile passages. All other jaundice due to causes originally remote from the liver and its bile passages, or in other words general conditions, may be classified as indirect. The former include those conditions which directly impede the excretion of bile, such as foreign bodies within the ducts consisting of gall stones, plugs of mucous, infective concretions and particles from the duodenum. These may cause a mechanical obstruction, or secondarily set up a cholangitis, which by swelling of the mucosa prodnces a narrowed lumen and arrests the biliary excretion. Gastroduodenitis by causing a swelling at the opening of the common duct may produce jaundice directly. Stenosis of the duct from cicatrices due to ulceration following biliary colic, stenosis from chronic inflammation of the duct wall, and impacted gall stones, all act mechanically in producing a direct icterus. Adhesions of adjacent structures, tumors in close proximity, and enlarged glands in the transverse fissure of the liver cause obstruction by direct pressure. Direct jaundice may also be caused by diseases of the liver, such as Weil's disease, acute yellow atrophy, passive congestion, cancer, biliary hypertrophy and common cirrhosis. Rarely a direct jaundice occurs in syphilitic, amyloid and fatty liver. Coming within the latter class (indirect) may be placed the slight and transitory jaundice due to fright, anger, anxiety and concussion of the brain; the icterus occurring in the course of infectious diseases, as scarlet fever and the like, and jaundice resulting from other sources, as snake bites, drugs, as chloroform, ether phosphorus, etc. With a brief description of the diseases associated with direct jaundice, the writer summarizes his article as follows: 1.

Jaundice due to gall-stones is accompanied 2. Jaundice with colic is due to by colic. gall-stones. 3. Chronic obstructive jaundice with an atrophied gall-bladder is generally due to gall-stones. 4. Chronic obstructive jaundice with a dilated gall-bladder is due to causes other than gall-stones, usually a tumor of the pancreas or the pylorus. 5. Repeated attacks of jaundice, in a patient who is well in the intervals, point to gall-stones or gastroduodenal catarrh-painful when due to stones and painless when caused by the catarrh. 6. Persistent jaundice with bile pigments in the stools, accompanied by enlargement of the liver and spleen and no ascites, indicates biliary cirrhosis or passive congestion. 7. Jaundice and ascites combined may be either common cirrhosis or cancer of the liver. 8. Jaundice, ascites and enlargement of the liver are almost pathognomonic of cancer of the liver.

These conclusions are rather far fetched (editor).

The Occurrence of Occult Hemorrhage in Typhoid.-Tileston (Boston Med. and Surgical Journal, July 12, 1906) examined the stools in 68 cases of typhoid fever by means of the guaiac and aloin tests for blood pigments. The technic employed was practically the method of Boas. The results of his examinations were: eighteen cases out of the 68 gave positive tests at some period during the course of the disease. One of these was complicated with enteritis to which the presence of blood was probably due, there remain 17 or 25 per cent which showed the presence of occult blood. In all, 422 stools were examined, of which 42 were positive, i.e., 10 per cent. A division into groups, according to the severity of the disease, gave the following resutls: fifteen mild cases, 3 positive, 20 per cent. Thirty-nine moderately severe, 10 positive, 26 per cent. Fourteen severe or fatal, 5 positive, 36 per cent. On the day of the positive reactions the temperature in most cases, was considerably elevated; in five, however, it had nearly or quite reached normal. In eleven cases diarrhea was present, while in six it was absent. From these examinations and the work of others, the author deducts the following conclusions: 1. Occult hem. orrhages may be detected by the guaiac and aloin tests in about 25 per cent of all cases of typhoid fever. 2. The application of these tests is of little value as a means of foretelling gross hemorrhages. 3. It is of very little value in diagnosis, owing to the inconstancy and comparatively late appearance of positive reactions. It seems probable that more complicated chemical methods would show a larger percentage of positive results, for the

separation of sloughs must always be at- ing" the urine with a saturated solution of tended by some hemorrhage.

"salt." (sodium chloride), acidulating with 50 per cent acetic acid, and heating to boiling; this throws down all traces of serum-albumin and prevents a nucleo-albumin reaction.

The Present Status of the Bedbug in the Transmission of Human Diseases.-Girault's (Journal A. M.A., July 14, 1906) paper is intended to point out what is now known regarding the carrying of disease germs by this insect, a question, he believes, should be of interest to all, especially those who live in large crowded cities, where its presence is becoming a serious factor. Scientists, medical men and entomologists have demonstrated beyond doubt, that fleas, house flies and mosquitoes carry and transmit certain dangerous diseases. Fleas carry bubonic plague; house flies, numerous pathogenic bacteria, including those of cholera, bubonic plague, tuberculosis and typhoid fever, also myasis and even some of the parasitic worms that live in the intestines of man; mosquitoes carry yellow fever and malaria and also that most horrible filarial disease known as elephantasis. Although the bedbug has been known for centuries and its literature comprising as high as five hundred odd articles, but very little, at present, is really known concerning its habits and life history. On the contrary, much has been conjectured. In addition to this, its host relations are entirely unknown. If it is able to live on the blood of man only its scope in potential transmission of disease is limited. But if it is able to subsist and breed also by attacking the small mammals found associated with man, such as mice and rats, its scope in potential transmission of disease is at once greatly enlarged. It is certain that blood comprises its only food, in spite of what has been said to the contrary. The experiments of the author seem to prove this question, as bedbugs were found feeding on dead mice. A closely related species, the foul bug, which associates with pigeons and chickens, which were found to be fond of human blood, readily attacked living mice. It would seem from the literature the author re

views as if the bed bug could be the carrier of relapsing fever, leprosy, bubonic plague, anthrax, tuberculosis, even syphilis and typhoid.

Albumin: Recognition of the Albumin Bodies in the Urine.-Hastings (Med. Rec., July 7, 1906) says that many of the abluminbodies which theoretically might occur in the urine may be excluded from consideration for various reasons: serum-albumin, nucleoalbumin, serum-globulin, and Bence-Jones albumose should be considered. For purposes of excluding false reactions due to bacterial disintegration the urine should be examined within six hours after voiding, unless the reaction is massive. The most reliable test for serum-albumin in the urine is that of "salt


E. S. MCKEE, M. D.

The Legal Conditions of the Medical Use of the Roentgen Rays.-Prof. Debove before the Academié de Médicine called attention in a valuable paper to the dangers to which man may be exposed through the use of the Roentgen rays by persons not legally authorized to practice medicine. A committee was appointed which has made a very full report on the subject. The following conclusions of the commission were unanimously carried by the Academié: "Considering that the medical use of the Roentgen rays may cause grave accidents, that certain practices may create a social danger; that only doctors in medicine, officers de sante and qualified dentists (in so far as concerns odontology) are capable of interpreting the results obtained from the point of view of diagnosis and of the treatment of disease, the Academie is of the opinion that the medical application of Roentgen rays by persons not holding the above diplomas constitutes an illegal practice of medicine."

Anesthesia Before the Law.-A recent trial in France has caused considerable interest on account of a man who was very much afraid of an anesthetic, dying after the administration of a few whiffs (kind not mentioned). Action was brought by his relatives and the doctor was condemned to pay 8,000 francs, about $1500. The judge ruled that the anesthesia was not absolutely necessary, as the man's life was not in danger. He said it was the duty of the medical attendant to warn the patient of the dangers which he was incurring in taking an anesthetic, but to assure him in proper cases that he can continue to live for a long time in partial comfort as he is. The patient had a tendency to syncope and to alcoholism. As it is well recognized that fear may cause death it may be well be imagined that the emphatic warning recommended by the judge might of itself cause death, in fact cases have occurred where the patient has died at the approach of the anesthetist. Velpeau addressing the judge in a similar trial shortly after the introduction of chloroform said: "You hold in your hands the future of surgery. The question concerns the public more than

the medical practitioner. If you condemn the surgeon who uses chloroform none will ever use it again. No practitioner knowing that for an accident impossible to foresee he will be held accountable, will ever administer it. It is for you to maintain the abolition of pain or to restore it."

The Examination of Prostitutes not Privi

leged. Before the French Society of Legal Medicine M. Butte argued that no violation existed. The medical men who are attached to that particular department in question of the State are not, so far as these duties go, practising medical men. They act simply as experts and as delegates of the police, just in the same way as do other inspectors. The woman who comes to him does not confide in him, she comes because she must. This being so there is no secrecy about the matter, and consequently no violation. It is claimed by some objectors to the police examination of prostitutes that the medical man whose duty it is to carry out the examinations can. not without violating his oath of professional secrecy, legally fulfill such duties.

The Signs of Death by Drowning-Vieira before the International Congress at Lisbon considered when a body is found in the water was death due (1) to asphyxia consequent upon immersion, or (2) to some other cause. Most writers believed death from other reasons than asphyxia to be rare. Vieira on the contrary, thought it relatively frequent. When death was not due to asphyxia, that is took place so suddenly that the person had no time either to draw water into the lungs or to swallow it, the post-mortem appearances due to this must be absent. There are at present, he said, hardly any evidences to determine whether death under such circumstances is due to respiratory syncope, to cardiac syncope, or to meningeo-encephalic congestion or hemorrhage. To illustrate, he described the following case: The body of an infant was found in a well. The parents when brought to trial said that the body of the infant was not thrown into the well until it had died a natural death in their

arms. The body was that of a healthy infaut, there were no signs of strangulation. and post-mortem appearances did not warrant the making of a more definite statement than that the death might have been due to respiratory syncope. The parents were therefore acquitted.

Damages for Death of a Dentist.-A dent. ist, an acqaintance of the writer, by name of Morhard, residing in New York, went into the cellar to see what was wrong with the electric lights and was electrocuted. His

wife sued the electric light company and obtained judgment for $40,000. The case was appealed and the Supreme Court affirms the decision of the lower court. It says it does not think this amount excessive, it appearing that the dentist was 37 years of age at the time of his death; that his income from his dental profession had been from $17,000 to children, the eldest being 11 years of age, $20,000 per annum, and that he left three besides a posthumous child born six months after his death. It would be interesting to learn how much of this, finally, the lawyers allow the widow and orphans.

Prescription Not Competent Evidence of Insanity. The case of Ames vs. Ames the Supreme Court of Nebraska holds that the fact that the attending physician prescribed for the patient certain drugs which are administered to the insane is not competent evidence tending to establish the insanity of the patient. Assuming that the patient was under treatment, as indicated by the prescription for some disease affecting the mind the court ruled that it only reflected the opinion prescription was given. If instead of a preof the prescribing physician at the time the scription addressed to the pharmacist the physician had written him a letter in which he expressed the opinion that he was insane, will it be claimed that such a letter would be admissible in evidence on the question of the patient's sanity? The prescription certainly stands on no better footing.

The Man Who Snores.-The Supreme Court of Alabama says that sleeping cars are not obliged to admit persons of gross and vulgar habits, the insane or persons suffering from contagious diseases. How about the man who snores?

Reciprocity. Dr. William Warren Potter, of Buffalo, editor of the Buffalo Medical and Surgical Journal, wrote for that most excellent series of prize essays in the N. Y. Medical Journal, on the subject of Reciprocity. His essay very justly took the prize. He thinks that when the preliminary or entrance requirement, the length of term and method of collegiate training, and licensing examinations are placed upon an uniform basis throughout the country, the problem of reciprocity in medical licensure will be solved. This, he thinks, to be the only equitable solution of the perplexing question: Of what avail is reciprocity unless founded on justice? Surely an enforced interchange of licensing courtesies would be worse than none; it would be irritating, unfair and ephemeral; whereas if founded upon uniformity of standards, it would be pleasing, just and enduring.

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