PNEUMONIA AND THE USE OF LIQUORS.

[To the Editor]-The other day a gentleman said to me: "It appears from statistics that pneumonia is more prevalent and more fatal now than it was fifty years ago. Does this accord with your experience?"

I replied: "In the eastern half of Adams County, Illinois, where I have practiced for more than fifty years pneumonia is neither as prevalent nor as fatal as it was in my early experience. There are good and sufficient reasons for this. In 1858 there were ten times as many cases of malarial fever in this region than there were in 1909 or 1910. In those days malarial fever often ran along into the winter. After one had been reduced to an anaemic condition by this disease he was a good subject for pneumonia and unable to withstand an attack of lung disease.

Fifty years ago almost every village in this county had one saloon, some more; now I do not know of a saloon in the county outside of Quincy. In this region, for a generation, the individual responsibility and culpability of the drunkard has been emphasized and a public sentiment against the drink habit has been cultivated. About twenty years ago the town board of Camp Point sold a license to sell intoxicants for one thousand dollars. At the end of nine months the saloonist went to the board and said to them: "Gentlemen, my business is not paying me; if you will refund me one-fourth of what I paid you for license I will get out of here." They accepted his proposition. From that day to this no man has applied for license to sell liquor in Camp Point.

Were the moral educators of the land to keep constantly before the minds of men the truth that "He that soweth to his flesh shall of the flesh reap corruption," and were physicians, one and all, in season and out of season, to teach that in health man does not need alcoholic liquor as a beverage; that the habitual use of such a beverage tends to impair health and shorten life; and were the civil magistrate to prove, as he should, a terror to evil-doers, such as dethrone their reason with alcoholic stimulants or who spend for intoxicants money needed to supply their families with the comforts of life; and were every Amer

"THE TITLE OF DOCTOR."

St. Louis, Mo., Feb. 14, 1911.-[To the Editor] -The title of Doctor, the customary prefix by which all qualified physicians are known to the public, is no longer the distinctive designation it was some years back, since the laxity of our laws allows the graduates of osteopathy and optometry and others to assume a similar privilege whereby to trade on the dignity and prestige of the regular profession.

This indisputable fact has prompted the editors of the Interstate Medical Journal to publish the enclosed editorial in the February issue, so that enough interest will be aroused to cause a further discussion, with the result that a remedy may be found, of an abuse that has been too long tolerated by the medical profession. We hope that you will comment on this subject. Very truly yours,

The forceful editorial to which Dr. Ball refers, after stating somewhat in detail the reasons for the decline in significance of the title of Doctor, concludes with this well-considered suggestion:

"Are we wrong in saying that it would be advisable for the qualified practitioners to take the matter in their own hands, if they hope for a fruition of the desire to elevate the title of doctor of medicine to the heights upon which it rested until it was dragged through the mire by the unscrupulous? Would it be futile to evolve a plan such as this: All qualified practitioners be compelled to write doctor of medicine,' i. e., Dr. med. in front of their names?-a compulsion that should show no laxity, since its object is not only to instruct the people at large, but prevent the osteopath, the optician and others too numerous to mention, from arrogating to themselves an honor that, on account of its bastardy, is today an exceedingly commonplace designation. Now this may sound Utopian, but it is done in

other countries-namely, in the German speaking ones, where systematization is a cult that it would be well for us to follow. Of course, there is no denying that this would be a slavish imitation of something that is foreign-hence, despicable; but despite this apparently insuperable drawback, and not overlooking the awkwardness of the more elaborate designation, would not the results counteract these and other objections? We think they would, for the reason that almost immediately the line of demarcation would plainly show who is the doctor of medicine and who is the doctor masquerading in soiled and tattered garments that must be cautiously arranged to hide his ignorance."

"ON THE BOOKS."

Missoula, Mont. [To the Editor]-What would you do? The situation is this: Sixty years and seven months old. Have practiced medicine and surgery forty years. Have hung our shingle to the cold and bleak blizzards of the far north, to the gentle, balmy zephyrs of the Southland, from the "Rio Grande to the Passamaquoddy Bay" and from the Atlantic to the Pacific, and "then some." Somewhat unlike the proverbial rolling stone, we gathered moss-lots of it—but it didn't stick. Always had a good practice but (and a great big But, too) we had no financial sense nor much of any other kind of sense, candidly! There are at least $35,000 of uncollected accounts on my books. Directly and overwhelmingly to the contrary of what many believe, your patients will think more of you when you make them "come to the scratch."

Every medical college should have a competent man to give the boys some plain talk on the business end of the profession at least once a week. It should be a most valuable innovation. Boost it! As a rule physicians are poor financiers and life is a struggle. They generally "keep the wolf from the door," but, in many instances, it would have to be an old, weak and toothless wolf.

We believe we are more competent to practice than ever, but not to undergo the hardships and exposure incident thereto. Why can't some one find a trump for that half-way-true and old saying, "The older the fool, the bigger the fool." We mean on this order: "In the middle of life we are in debt," and "Don't grieve over spilt milk, but fill your can with water and proceed." We must do something. "An idle brain is the devil's workshop." Can't possibly lead a life of "masterly inactivity." We are tired of the practice. Your advice, Doctor. R. O. G.

[$35,000 in the books" is indeed a goodly sum, and evidently, according to "R. O. G.,"

covereth a multitude of business sins. Gentle reader, how do you translate dollars from books to bank? We'd like to know.-Ed.]

Local Tuberculin Reactions.-Sachs, in the Journal of the A. M. A., concludes that a large clinical experience substantiated by necropsies in a proportion of cases, points strongly to the efficiency of the local tuberculin reactions. The verdiet today is that a positive reaction following local application of tuberculin (conjunctival or cutaneous) signifies the existence of a tuberculous focus in the organism without giving a definite idea as to its active or latent character. Reactions vary according to the site of the inoculations, and a clear description in each individual case should be given as to the locality used. This is necessary for the comparative study of the work of different observers. Tests of various dilutions of tuberculin contribute to the belief that the actual amount of absorbed tuberculin is an important factor in determining the degree of the reaction. The claim that a positive conjunctival reaction signifies active tuberculosis is not substantiated. It is possible, however, that the activity of a tuberculous process may, under certain conditions, be a factor in causing a positive local reaction with a minimal dose of tuberculin and further experience with the test, and various dilutions applied to various groups of cases with a perfected technique, assuring absorption of definite quantity, may possibly lead to some method of differentiation of active and latent cases. Patients with suspected tuberculosis with a rapidly developing and marked cutaneous reaction, generally respond readily to the subcutaneous injections of minimal doses of tuberculin. Hence the relative value of such cutaneous tests in cases in which the employment of the subcutaneous test is contraindicated. The subcutaneous test remains the decisive diagnostic procedure in doubtful cases of tuberculosis, particularly if a local reaction is desired. The possible unfavorable effects of this test in some cases may be avoided by the use of small doses of tuberculin (initial 1/5 or even 1/10 mg.), according to the age and condition of the patient. The use of these tests opens a new field for further clinical and laboratory research which may provide a safe, reliable method of diagnosing obscure and early cases of tuberculosis.

Principles of Public Health. A Simple TextBook on Hygiene, Presenting the Principles Fundamental to the Conservation of Individual and Community Health. By Thos. D. Tuttle, B. S., M. D., Secretary and Executive Officer of the State Board of Health of Montana. World Book Company, Yonkers-onHudson, N. Y. 1910. Price, 50c.

There have been various text-books of more or less extensiveness, brought out from time to time by various authors upon the popular aspects of public hygiene, but somehow or other, to our mind, they have none of them measured up to our idea of what such a book ought to be. We are more than pleased to be able at last to record our conviction that the right book has been written. This of Dr. Tuttle's is by far the most sensible and altogether excellent that we have ever seen. It avoids all the extravagances and extremisms which characterize so many of the writings on the subject, and its style is delightfully breezy and readable. Above all it is what very few books or articles on public hygiene are really practical. It is evidently put out with the prime idea of using it in the public schools; and we predict that in those schools that are fortunate enough to adopt it the teaching of public hygiene will be a pleasure to both teacher and scholars. But we trust, also, that its use will not be restricted to the schools, but that it will find its way into the homes of the people, from Maine to California. We invite our readers to do their part toward bringing about such a circulation for the bookfor it deserves it.

A Text-Book of General Bacteriology. By Edwin O. Jordan, Ph. D., Professor of Bacteriology in the University of Chicago and in Rush Medical College. Fully Illustrated. Second Edition. Thoroughly Revised. Philadelphia and London: W. B. Saunders Company. 1910.

Jordan's second edition of his standard work on bacteriology has been brought strictly up to date. He has given to the profession, in this work, a carefully written and instructive treatise on the subject. He has not sacrificed the theoretical to the practical-a fault too commonly found in books on bacteriology. The descriptions of technique are excellent, and are well

supplemented with drawings and photographs. All the newer work on parasitology, as it pertains to the practice of medicine, is incorporated in this second edition. A good description of the spirochetal organisms, particularly the trepanoma pallida, is given, with Levaditi's method of staining the same, in chancrous and other syphilitic lesions. Due attention is given to the Wasserman reaction, although Jordan does not describe the technique of the method of application of this test. We do not know of a more readable or valuable text-book on bacteriology. 慌慌慌

Compend of Gynecology. By William Hughes Wells, M. D., Associate in Obstetrics in the Jefferson Medical College; Assistant Obstetrician in the Jefferson Medical College Hospital; Fellow of the College of Physicians of Philadelphia. Fourth Edition. Revised and Enlarged, with 153 Illustrations. Philadelphia: P. Blakiston's Sons and Company. 1911. Price, $1.00.

This little book is one of a series of quizcompends that Messrs. Blakiston have been putting out for several years, and represents the fourth revision of this particular compend. The primary use of these compends is to enable the student by the shortest method to refresh his memory on the subjects treated of for the purpose of passing State board and similar examinations; and for this purpose they are admirably adapted. The book under review has evidently been thoroughly brought up to date, and presents the modern status of gynecology. No doubt the series have a much broader utility than the one to which we have referred. It is more than likely that the practitioner finds in these little books a sort of ready reference index, which serves as a guide to the larger and more exhaustive text-books. However and wherever they are used, their popularity has fully justified their publication.

that he should have a working knowledge of the major principles of pharmacy. He ought, at any rate, to possess a sufficient acquaintance with the subject so that he may know how to intelligently employ the products of modern pharmacy and to apply therepeutic knowledge with the maximum degree of practical efficiency. This is the expressed purpose of this manual, and the author is careful to explain in his preface that the book presents only those facts of pharmacy which have an interest for the medical man; no working formulae or quiz-compend attributes have been attempted. It contains all the essential groundwork of pharmacy and pharmacology, such as is necessary to both intelligent prescribing and intelligent dispensing, and should be a valuable adjunct to the doctor's working library. The section devoted to a discussion of proprietary remedies is exceedingly sane and fairminded.

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A Manual of Physiology. With Practical Exercises. By G. N. Stewart, M. D., Professor of Experimental Medicine in Western Reserve University, Cleveland, Ohio. Sixth Edition. 1064 Pages and 450 Illustrations. New York: William Wood and Company. 1910. Price, $5.00.

Stewart's Physiology continues to march in the front rank of American text-books on this subject. Indeed, we know of no reason for limiting the statement to any geographical bounds. It is second to none in the world, at least as a medical physiology, and there are exceedingly few that rank as its equal. The author has the rare characteristic that he is greater than his subject. He is not only a physiologist, but a philosopher, and knows how to give to his facts. that broad interpretation that marks the great teacher. Even his literary style is all his own, and he has an original forceful way of illustrating and driving home mechanical and biological principles that is not only effective but altogether fascinating. Impartiality and discrimination characterize the treatment of debatable topies, and the practical note is everywhere blended with the theoretical. We are, for our part, gratified to note that he ranges himself on the side of the neurogenic theory of the heartbeat, although he is, of course, restrained for the present from asserting his position by lack of evidence.

Pleuritic Effusions in Infancy.-Miller, in Archives of Pediatrics, gives the following points:

Percussion. Decided flatness or dullness in infants, as in adults, is next to exploratory puncture,

the most reliable sign of fluid that we possess. With the flatness there is an increased sense of resistance to the percussing finger which is highly characteristic. Usually, if the effusion is large, there is, above this dull area at the apex, tympanic or Skodaic resonance; but this does not obtain if the amount of fluid is very great or extremely small. J. L. Morse has called attention to tmypany at the base of the lung, above the site of the diaphragm, while there is flatness above. This note, which is transmitted from the abdomen, the author has also observed. The possibility of its occurrence should be borne in mind. Small and commencing effusions follow the laws governing similar conditions in adults; but even moderate effusions are apt to assume a more horizontal upper line of dullness than in adults, impaired resonance being noted both in front and behinda most valuable sign in differentiating from pneumonia. Unless there is air in the pleural cavity the dullness is rarely movable. In eliciting dullness in infants percussion must be light, else the pulmonary resonance beneath will completely mask the diminution of resonance produced by the fluid.

Vaccine Treatment of Cholecystitis.-Wright and Reid, in the Lancet, report two cases of cholecystitis treated with vaccines, both of which were cured. One case was that of obstructed jaundice, which was not relieved by operation, and the bile was discharged through a sinus. Bacillus coli was isolated from the bile, a vaccine prepared, and after three injections the sinus closed and the jaundice cleared up, resulting in a complete cure. The second case was one in which fourteen stones had been removed from the gall-bladder two months previously; the sinus remained open and the patient did not improve. Under vaccine treatment the sinus closed and the patient made a somewhat slow but complete recov

ery.

In a case reported by Turton and Parkin, the patient had been ill three weeks with gradual loss of flesh, abdominal pain, rigors, and at intervals swelling of the epigastrium. He was operated on for pancreatic disease, but the pancreas was found to be normal and a large stone was removed from the gall-bladder. The rigors continued, and the patient was sent home to die. Examination of the gall-bladder secretions gave a pure culture of Bacillus coli. A vaccine was made and 500,000,000 inoculated. This was followed by one rigor three days after the inoculation. Two more injections were given, and the patient made a rapid and complete recovery.