hat must allow a considerable quantity of air to become heated above the temperature of the body, and this also must have a bad effect on the nutrition of the hair.

Tuberculin in Tuberculous Joints.-Packard, at the American Orthopedic Association, said that in many cases in which there had been discharging sinuses for a long time and in which, from the clinical symptoms, it was evident that there was mixed infection the results were excellent from the use of tuberculin without an autogenous vaccine. Though cultures were not made, it was probable that in these cases the active organism was the staphylococcus. If there was the slightest question as to the diagnosis the Moro or the v. Pirquet test was made, and always found positive. X-ray pictures and miscroscopic examination of material obtained by curettage confirmed the diagnosis also in a case in which the secondary infection was severe and the reaction marked from tuberculin alone, without an autogenous vaccine. He would not use tuberculin as a routine treatment in all cases of joint tuberculosis. When either children or adults were doing well and there was no evidence of the disease being active or progressive, and when the general condition was satisfactory he would not use it, but when the disease was progressive and painful, in spite of protection and other general measures, he considered tuberculin to be a valuable adjunct to the treatment.

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Pseudo-Trachoma in the Newborn.-Wolfrum, in Muenchner Med. Wochenscrift, says that in Leipzig sporadic trachoma is by no means a rarity, and it develops in subjects who have. neither been abroad nor been in contact with suspects. These trachoma subjects may all have had some disease of the sexual organs. In one instance a servant girl had marked trachoma, and she had been taking care of a nursling who had an affection of the eye. Now that attention is directed to such associations we should make some progress. One such case means much. Unfortunately, it was impossible to fill out the details of the case. It is, of course, unknown whether she had the so-called inclusion catarrh of the conjunctiva which is believed to stand in some definite relationship with the gonococcus or a frank blenorrhea neonatorum. It may be imagined that a subject with so-called inclusion catarrh of the urethra simulating gonorrhea affects his own conjunctiva and in time develops a true trachoma. Or a pregnant woman with inclusion catarrh of the vagina infects her newly born child with blenorrhea neonatorum. There is no longer

doubt that the latter condition may occur with nothing but inclusions in the pus, just as it occurs with both inclusions and gonococci. It is anatomically impossible for an infant to exhibit a condition like true trachoma in the adult, and the rapidly destructive consequences in the child would also give trachoma no opportunity to develop.

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Treatment of Acne Vulgaris.-Burke, in the Pennsylvania Medical Journal, notes that with stock vaccines he has not noticed any benefit in the treatment of acne vulgaris. After briefly alluding to the favoring conditions produced by constipation, anemia, and sluggish circulation, he advises puncturing and evacuation of all pustules by means of a comedone extractor, the latter instrument being employed for all comedones large enough to be seen. The face is scrubbed vigorously every night before retiring, with green soap and hot water; thereafter rinsed with cold water and greased with an ointment made up of: R Beta-Naphthol..

Sulphuris prec.
Sapo viridis..
Adeps lanæ...

M. ft. ung.

5 per cent

.25 per cent

.35 per cent

.35 per cent

Goodall and

The Thyroid and Female Genitals. Conn, in Surgery, Gynecology and Obstetrics, conclude a study on this subject as follows:

1-The relation between the female genitals and the thyroid is very intimate.

2-The generative organs which stand in such close relation with the thyroid are the ovaries. 3-The uterus is devoid of any influence upon thyroid activity, except in that its function may affect the ovarian function, and through this the thyroid.

4-Thyroid activity is in a measure under the governance of ovarian activity.

5 Ovarian hyperactivity is a frequent cause of the development of exophthalmic goitre.

6-Diminished or absent ovarian activity usually coincides with myxedema.

7-Puberty, menstruation, pregnancy, lactation, and menopause exercise a profound influence upon the thyroid secretion.

8-Thyroid secretion and ovarian secretion do not supplement each other; they neutralize each other.

9-The ovary has two secreting structures, the corpora lutea and the intestinal cells.

10-It is the secretions from the latter which

seem to bring the ovary and thyroid into such close relation.

Contraindications for Lavage.-Hammer, in the Virginia Medical Semi-Monthly, says that lavage and introduction of the tube are contraindicated: 1-In all constitutional and local conditions which may be aggravated or life endangered by the irritation and exertion of lavage: (a) Pregnancy: (b) heart disease with a state of defective compensation-heart neuroses, angina pectoris, myocarditis, and fatty heart in an advanced stage; (c) aneurism of the large arteries; (d) recent hemorrhages of all kinds, including apoplexies, pulmonary, renal, vesical, gastric, rectal, and hemorrhagic infarctions; (e) advanced pulmonary tuberculosis; (f) advanced pulmonary emphysema with bronchitis; (g) cerebral hemorrhage; (h) advanced cachexia; (i) presence of continued or remittent fever.

2-The stomach and intestinal diseases which are contraindications for the use of the tube are: (a) Ulcer, with recurrent hematemesis and evidence of blood in the stools; (b) palpable carcinoma of the pylorus, with vomiting coffee-ground material, and the classical symptoms of cancer; (c) stomach and intestinal troubles with acute fever; (d) hypersensitive gastric mucosa easily started to bleeding; (e) secondary gastric affections whose dependence upon a distinct and more important primary disease is evident.

慌慌慌

Improvement in Cesarean Technique.-Veit, in Zentralblatt für Gynekologie, describes a new method of performing Cesarean section, and believes it to be an improvement. The incision is made in the linea alba, opening the abdomen at such a point that the umbilicus is in the middle of the incision. The abdominal wall is covered with aseptic material, and the uterus carefully delivered through the incision, with the patient in the Trendelenburg posture, the fundus lying upon the epigastrium. Moist sterile towels are then carefully packed behind the uterus and above it so that the abdominal cavity is completely shut off. The uterus is opened by a transverse incision, and the position of the patient makes the delivery of the child a very easy one. The afterbirth is readily delivered. The contents of the uterus escape toward the chest of the patient and do not go into the abdomen, and the uterus is immediately closed by suture. The uterine surface is very thoroughly and carefully cleansed and the uterus replaced in the abdomen. Especial care is then taken to disinfect the abdominal walls and the abdominal wound is then closed. If the operator prefers to have the patient in the horizontal posture, the uterus is brought out to one

side with the fundus over the patient's thigh. The point made by Veit consists in the care exercised to prevent the uterine contents from escaping into the abdominal cavity, and in his revival of the transverse incision across the fundus, which has been abandoned by many operators.

The Third Heart Sound and the "B" Wave in Slow Heart Action.-Windle, in the Quarterly Journal of Medicine, in a study of the third heard sound and the "B" or "L" wave arrives at the following conclusions: (1) A third heart sound with an associated "B" wave was present in two out of 193 observations on normal individuals. The pulse rate was abnormally slow and sinus irregularity present in both eases. (2) In 13 instances of the number of persons examined, a decided "B" wave was present in the venous tracing, in none of which was a third sound heard. Marked sinus irregularity was present in 9 of the records. The pulse rate in these cases varied from 50 to 60 per cent. (3) When the pulse rate was quickened in cases in which the "B" wave was persistently present under normal conditions, it did not show in the tracing when the pulse rate exceeded 80 per minute. When associated with sinus arrhythmia it was absent from the venous curve when the arrhythmic beats approached this rate. (4) The "B" wave may first appear in the venous tracing coincidently with regular slowing of the heart to a rate of from 50 to 70 per minute under digitalis. This may be brought about in the normal heart. In no case observed was there a third sound present. In slowing resulting from partial heartblock due to squill, an extra wave succeeding blocked auricular waves is shown to occur coincidently with the establishment of heartblock; in this case a clearly marked third sound was present. (5) Venous curves showing the "B" wave may present a close resemblance at times to those resulting from extrasystoles or cases of heartblock. (6) With a certain rate of pulse the "B" and "A" waves may fall together and give an appearance to the curve closely simulating an increased "a-c" interval.

She (complainingly): "You promised faithfully that you wouldn't smoke any more after January 1."

He: "I'm not. I am simply keeping up the usual amount.

Customer: "Are you sure you'll have my taxi at the house on time?"

Garage Owner: "Certainly. Don't you know there's nothing surer than death and taxis?"

An Introduction to Therapeutic Inoculation. By D. W. Carmalt Jones, M. A., M. D. (Oxon.), M. R. C. P. (Lond.), Assistant Physician and Director of the Department of Bacterio-Therapeutics, Westminster Hospital, London, England. London: MacMillan & Co., Ltd., 1911.

This book is divided into two parts, under the heading of Principles and Practice. The first part is an attempt to state in the simplest possible terms the common-sense therapeutic inoculation, the object of which is to induce immunity to bacterial infection. The main principles of immunity are quite simple, and only such experiments as illustrate these principles have been cited in the book. The second part of the book deals with the application of these principles, and some technical details which are described in the first part of the book are, for the sake of completeness and to avoid cross reference, repeated in the second part. This second part deals with the treatment of certain infections by means of therapeutic inoculation. Only those infections in which there has been wide experience are considered, and exceptional cases are rarely mentioned. The technique described is substantially that of the laboratory of St. Mary's Hospital, London, which is admittedly the headquarters of this kind of therapy. The book commands unqualified endorsement, and we heartily commend it to our readers.

Hughes' Practice of Medicine. Including a Section on Mental Diseases and one on Diseases of the Skin. Tenth edition, revised and enlarged. By R. J. E. Scott, M. A., B. C. L., M. D., attending physician of the Demilt Dispensary; formerly attending physician to the Bellevue Dispensary, New York. With 63 illustrations. Philadelphia: P. Blakiston's Sons & Co., 1911.

This time-honored book appears to lose nothing of its popularity, or, for that matter, of the elements which have gone to make it popular. It remains, so far as we can see, the standard of this type of work. The inclusion of the sections on psychiatry and dermatology make it more complete than most books of its class, and its entire arrangement is a model of conciseness and comprehensiveness. Many changes appear in this tenth edition, indicative of the march of science since the appearance of the previous issue. Pneumonia has taken its place, very properly, among the infectious diseases instead of among the dis

eases of the lungs, and herpes zoster among diseases of the nervous system instead of diseases of the skin. Several new sections have been added, such as Pellagra, Glandular Fever, Cammidges Reaction, etc., made necessary by investigations in these subjects. Special attention is paid throughout to diagnosis and treatment, as being the cardinal points of a practical work. Numerous tables of differential diagnosis have been added, and the number of illustrations increased from twenty-seven to sixty-three. 惺惺惺

Vaccine Therapy in General Practice. By George H. Sherman, M. D. Published by the author. Detroit, Mich., 1911.

There is no doubt whatever that the majority of the profession is passing up a good thing in therapeutics when they fail to use the vaccines as a routine of treatment. For this they are not themselves altogether to blame. There are many important features of bacterial therapy which have been brought to light by recent investigators and mentioned in literature which, so far as the great rank and file of the profession is concerned, are buried forever. In this book a number of them have been gathered together and, savored with the personal experience of the writer, will serve as a perpetual contribution to the practical end of this growing branch of therapeutics. The distribution of Dr. Sherman's little book will do much to stimulate an interest in this field, and while it may frankly be admitted that it is partly intended to increase the author's business, it will only do so by correspondingly increasing the business and the success of those who avail themselves of it.

Health Hints and Health Talks. By E. R. Pritchard, Secretary of the Chicago Department of Health. Chicago: The Reilly & Britton Co., 1911.

These Hints and Talks were originally published in newspaper form as a part of the educational and publicity work of the Chicago Department of Health, and it is universally conceded that they accomplished a great deal of good in helping people to more light on the all-important matter of health and sanitation. The author and publishers now offer them to a wider circle of readers in the hope that they will be of still fur

ther aid in spreading the gospel of health and the abolition of needless sickness and death. From our own rather cursory examination of the book we should be disposed to think it will be much better adapted to the physician than to the public; but even so, it will serve the purpose of a firstrate instructor for the practitioner in his public and family relationships. It will teach him how to teach his clientele.

* * * Gonorrhea in the Male. A Practical Guide to Its Treatment. By A. L. Wolbarst, M. D., Consulting Genito-Urinary Surgeon, Central Islip State Hospital; Visiting Genito-Urinary Surgeon, People's Hospital, West Side German Hospital and Beth Israel Hospital Dispensary; Professor of Genito-Urinary Disease, New York School of Clinical Medicine, etc. New York: International Journal of Surgery Co., 1911.

One might be disposed to think at first blush that the subject of the treatment of gonorrhea has been worn so threadbare that a book of this character would seem to be superfluous. But those who are in a position to know will bear witness with practical unanimity that, in spite of the wide discussion of the matter and the commonness of the disease, the general practitioner is still very much at sea as to the modern scientific treatment of gonorrhea. Hence we are compelled to conclude that there is a real need of such a manual as this of Dr. Wolbarst's. It is certainly worthy of perusal and adoption. We especially commend its practicality and its conservatism. We heartily agree with the author that much damage is done by the prevalent methods of treating gonorrhea, particularly in respect of our remedies being too strong and used with a vigor far too heroic for the delicate and inflamed tissues to bear with impunity; and his work is a plea for greater gentleness and conservatism in the drugs and instrumentation employed.

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What to Eat and Why. By G. Carroll Smith, M. D., of Boston, Mass. Octavo of 310 pages. Philadelphia and London: W. B. Saunders Co., 1911. Cloth $2.50 net.

The author of this book disclaims any intention of covering the whole subject of dietetics, or of discussing all the affections in which a regulation of diet is a benefit. He further admits that very little is said about the chemistry of foods. His aim has been to place before the medical student and practitioner the fundamental elements of food and the principles underlying its use, the essential reasons why we find a change of diet desirable in certain diseases, and how this change may be made with the most practical and timesaving efficiency. A careful study has been made of the rational history of the cases considered, especially with reference to the kind of food taken

Spirochetes.-A Review of Recent Works, with some Original Observations. By W. Cecil Bosanquet, M.A., M.D., Fellow of the Royal College of Physicians, England; Formerly Fellow of New College, Oxford. Illustrated. Philadelphia: W. B. Saunders Company. 1911.

Here is something that is entirely new, so far as special medical literature is concerned. The Spirochestes have been playing a very important part in pathology for the past decade, yet so little is known of their character and habitus, that we do not yet know their correct place among living things. It is understood that they stand somewhere between bacteria and the protozoa. with a little leaning toward the former. This book represents an attempt to set forth the statement of different investigators upon the character and behavior of these organisms, with a view of establishing if possible the characteristic features of the genus. The author recognizes that hi work is anything but exhaustive, but it is at all events a worthy effort to start the ball a-rolling, and will doubtlessly lead to a more systematic and comprehensive literature on this branch of pathogeny than we have yet had.

Practical Cystoscopy and Diagnosis of Surigcal. Diseases of the Kidney and Urinary Bladder. By Paul M. Pilcher, A.M., M.D., Consulting Surgeon to the Eastern Long Island Hospital; Late Surgeon to the German Seney and Samaritan Hospitals of Brooklyn; Associate Surgeon to St. John's Hospital of Brooklyn; Cystoscopist to the Jewish Hospital of Brooklyn. With 233 Illustrations, 29 of them being in Colors. Philadelphia: W. B. Saunders Company. 1911. Only last month we were receiving a manual by Dr. Squier on the technique of cystoscopy, and at that time we commented upon the growing importance of the cystoscope, which has revolutionized this class of work, revealing the living pathology of the urinary tract and making clear many conditions which were formerly obscure. Now comes Dr. Pitcher with a still more pretentious and detailed work on the subject including not only a presentation of the visual diasnostics but an interpretation of the findings obtained under the process. The illustrations of the book are in Messrs. Saunders best style. We could say no more. The text is clear, concise and well arranged, and we assume is trustworthy.