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plain duty to do all in our power to prevent the spread of typhoid fever by the urine. Much may be done by the systematic use of reliable urinary disinfectants, such as urotropin, which should be administered for a reasonable time to every typhoid convalescent. Patients should be informed of the fact that their urine may be dangerous. No doubt some of them would feel the responsibility thus placed on them and exercise a certain degree of care.

This is another striking example of the direct and real value of bacteriological laboratory methods applied to practical medicine. As the matter now stands it is quite clear that practitioners of medicine, in order to do their full duty in this matter of typhoid fever, must possess or control sufficient bacteriologic skill and apparatus to determine whether or not the urine of their typhoid patients is free from typhoid bacilli before returning to their usual modes of life. "Journal American Medical Association."

MEDICAL EXCERPT.

By T. P. CORBALLY, A. M., M. D.,

THE DANGERS OF POPULAR SPORT.

The serious and sometimes fatal accidents that occur in popular games are eminently suggestive of greater care by enthusiasts who thus expose themselves to dangerous or fatal injuries.

Lawn-tennis is not a very dangerous game, but accidents do occur more frequently, perhaps, as played in Europe than in this country.

These accidents have never been described until very recently; they have been brought to the attention of the medical profession by Dr. Clado, whose history has been published in extenso in "Le Progrès Médical," of November 1, 1902, in its "Clinique Chirurgicale."

Tennis-arm. The players of lawn-tennis have given this name to an injury of the arm which occurs under two different forms; the first as a fatigue, an exhaustion of the muscles of the arm; the second as a material lesion, located in the neighborhood of the elbow of the right arm. The first form is found in players who force the muscles of the arm and shoulder excessively; the second is found more rarely and in conditions extremely well -defined.

Through the kindness of one of the ablest players in France, the

doctor says: "I have been able to collect twelve cases that have enabled me to describe this form of disease."

The affection is characterized by a sudden pain, located at the external part of the elbow, and above the line of articulation, producing a functional loss of power of the superior part of the right arm, at least for all movements that require a certain amount of muscular strength.

The etiological conditions that give rise to tennis-arm may be easily determined. It is the result of quick and violent movements, causing functional loss of power at the same time or as some extraordinary effort is made in order to gain a definite point. In either of these efforts the violence of the muscular contraction appears to be the immediate cause of the injury.

Players having well-developed muscles are more disposed to an attack of this kind than those of more feeble development. Another important fact to be noted is that strong and well-trained players are more susceptible to an attack than poor players or beginners. Besides, female players are entirely exempt, at least I do not know of a single case. The etiology of tennis-arm may be stated in a few words; it is confined almost exclusively to men, at least I do not know of a single female player who has suffered from it. It always attacks the strong and practiced players, and begins with a violent contraction of the arm.

Three symptoms mark the existence of tennis-arm: First, pain; second, want of power in the arm; third, swelling. The first two of these are always present; the third not very frequently. Pain is the invariable and characteristic symptom of the disease. It comes on suddenly and in consequence of a violent movement of the muscles of the arm. It is characterized by a sensation as of a sudden rupture, which the player compares with that of a violent tearing at the external part of the elbow. The arm falls as if paralyzed. The injury is found to be located along the external lateral ligament of the elbow, not far from the insertion of the supinator brevis muscle.

Swelling is not constant; I have found it in ten cases, present in four; it disappears in from three to eight days. Functional loss of power is a constant symptom. In about half the cases the arm falls as if paralyzed.

The Diagnosis of tennis-arm rests on the presence of three indications. The first indication that offers-and it forms the diagnosis in the greater number of the players who have suffered

is an almost complete loss of power of the muscles of the forearm. The duration of the paralysis varies from two to eight days, and at the end the player may generally resume his practice. In four cases, however, it lasted six months, and in one case a year. In general, active play should not be resumed before the lapse of some months.

Pathogenic Conditions.-There are two ways of returning the ball to the adversary; first, in meeting the ball from above, raquette haute; second, in meeting it from below, raquette basse. The first never causes tennis-arm. This method constitutes a bad or indifferent player. Ladies employ it almost exclusively. The hand holding the raquette is raised as high as the head, the raquette inclined backwards strikes the ball and returns it in a curved line; the muscular effort is moderate, the only strain is on the shoulder. In the second the raquette receives the ball in its course or after it has rebounded, striking it from under and returning it with great violence immediately above the filet, giving it a course as direct as possible, intending that on the side of the opponent it does not rebound from the ground.

(The movements necessary for the skillful returning of the ball are described in detail; they are quite complicated.)

ITS COURSE depends on the prudence of the player; if he stops play immediately and takes necessary rest, recovery may be complete within a month. Relapses are frequent.

PROGNOSIS is generally favorable. As all movements are possible, except that which caused the injury, the only permanent result is the necessity of abandoning lawn-tennis.

TREATMENT consists in necessary rest; massage, occasionally the application of a bandage from the wrist to the elbow. None of the severer applications used in surgery are necessary.

FOOTBALL. A Kentucky clergyman declares that football is worse than prize-fighting, because more men have been killed on the football field in this single season than have died as a result of injuries received in the prize-ring in all the years since such fighting began in this country. Another clergyman, out in Chicago, says that the spectators who thrill with joyful excitement as they watch the gridiron battles are little less bloodthirsty than the wicked Romans who crowded the gladiatorial shows, and with their cruel thumbs signaled death for the vanquished. That football has come to be a disquietingly strenuous game is beyond ques

tion, and yet these criticisms of it are obviously absurd, for they ignore the very essential element of motive. The injury of the players is not an object, but an incident of football. Railroads are not condemned because they have in the past exacted a dreadful tribute of human lives, and even with the better methods of to-day continue to claim in every twenty-four hours more victims than fell in many a world-famous battle. Our subway, too, has already resulted in not a few deaths, and, though we mourn them, the work goes steadily on, with no protests from Louisville or Chicago. As for the spectators at football, not one in a hundred. ever saw a player killed or even seriously injured, and not one in a thousand is ever likely to do so. A vast majority of the hurts received are trivial, and the onlookers are hardly to be blamed if they suffer from them as little as do the boys upon whom they are inflicted. The question whether the game as played is a profitable one is certainly debatable, but it ought to be debated reasonably, and the fact that it is commended by multitudes of people whom it is grotesque to describe as bloodthirsty should have its effect on the judgment of those whom its casualties disturb, particularly when they are clergymen whose only knowledge of the sport is derived from the reading of statistics, collected from all over the country, of deaths and injuries from it. There are no balancing figures to show the other side-its development of strength, courage and character.

EQUABLE DISTRIBUTION OF DIPHTHERIA.-Passaic's Board of Health, while searching for the origin of many cases of diphtheria that exist among the school children of the town, has discovered that the spread of the disease has been due, in large part, at least, to an invention of-the Board of Education. It seems that it is the custom in the Passaic public schools to give each pupil a lead pencil every morning, and to collect the pencils every night for another distribution next day! This plan has the obvious advantage of being economical, and it is also extremely fair. Using pencils as children always do, with frequent applications of the point to their tongues, each pupil in each school had an equal opportunity to acquire such contagious maladies as might be going around, and an equitable distribution of diphtheria was rendered almost certain. The Passaic health authorities have decided, however, that this method of supplying pencils is not, on the whole, to be commended, and they have, with some vehemence, directed

the school people to think up another scheme. It would be interesting to know in how many other towns the same and similar exhibitions of official ignorance are in progress, and especially if there is anything like it in New York. It is rumored that not quite all of our devices for supplying our public school children with text books and the other implements of their work are beyond the criticism of sanitarians, and, with such a Health Board as we now haye, these rumors ought to be quickly ended, either by authoritative denial or by the removal of the abuses underlying them.

TREATMENT OF DIPHTHERIA.-Dr. J. W. Pearce ("American Practitioner and News," July 15, 1902) says that he has never lost a case, and attributes his success to the use of ecthol. “If I can get perfectly fresh antitoxine I give it, but if it cannot be had perfectly fresh I do not. Whether antitoxine is given or not, I give ecthol in full doses, appropriate for the age of the patient, every three hours, administered by the mouth. The entire fauces, larynx and pharynx are sprayed with a mixture of ecthol and peroxide of hydrogen, three parts of the former to one of the latter, every fifteen to thirty minutes. Calomel in small doses is administered every hour until the bowels are thoroughly moved. Nourishing and supportive diet is given at short, regular intervals, and everything done to make the patient comfortable in the way of supplying fresh air, etc. I have been using this plan, modifying it to suit the needs of each individual case, for several years, knowing that it will give good results and entire satisfaction if it is carefully and effectively administered and carried out. Nothing can save a patient in articulo mortis, and it is needless to try this in such cases, hoping to do something."

A MAN'S NOSE BURSTS INTO FLAMES.-A man was walking along the Boulevard Saint-Michel, Paris, one day recently, and stopped to light a cigarette. Suddenly his nose burst into flames, which spread to his beard. A crowd assembled, while the unfortunate man danced with pain until a policeman took him to a pharmacist's shop, where his burns were treated. An examination of the nose showed that it was made of celluloid, the lous dealer who sold it having foisted it on his client instead of the horn nose, which had been prescribed.

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