Drug and Alcohol Habitues Treated with Hyoscine.-Riewel, in Monthly Cyclop. and Med. Bull., Oct., 1909, p. 587, states that the hyoscine treatment eliminates the desire for these drugs; the only contraindication to its use is the presence of Bright's disease. The cases should be put to bed and watched by competent nurses day and night during the first week.

Otitis Media Suppurativa; Treatment with Carron Oil.Riggs, in U. S. Naval Medical Bulletin, Oct., 1909, p. 379, reports two cases so treated with prompt recovery.

A Living Double Monster.-In the Bull. Manila Medical Society for June, 1909, is a report, with an illustration, of a double monster, two Filipino infants united by the sacrum; technically, a pygopagus. The children are fifteen months old. Besides the sacral union the only thing in common is a common terminal portion of rectum. The children are well nourished, of the same size, and look alike; temperamentally different, one is irritable and cries on being disturbed, the other takes things easily. The birth was easy and rapid; one presented by the head, the other by the feet.

Congenital Absence of Kidney.-Hagner, in Jour. Amer. Med. Assn., Oct. 30, 1909, p. 1481, reports a case in a woman, age 40, weight 225 pounds, who had pyelitis, for which he incised and drained the kidney. She died nine days after operation; the necroscopy showed a large pyonephrotic kidney on one side but no sign of either kidney or adrenal on the other, and only one ureteral opening in the bladder. The doctor, through cystoscopic and ureteral examinations, had been led to believe that there was only one kidney.

[In the discussion on this case before the Medical Society of the District of Columbia, Dec. 2, 1908, DR. G. BROWN MILLER stated that he had seen the patient with Dr Hagner and had inspected the bladder through the cystoscope, but did not get a good view, and thought that the other ureter might be present. The condition is very rare; Morris says that solitary kidney occurs only once in 3,500 cases; he classes such cases as Dr. Hagner's, not as solitary kidney, but as unilateral, unsymmetrical, congenital absence of kidney, and says it occurs only once in about 7,000 cases. As to the unfortunate result in this case, Dr. Miller suggested that it might possibly have been better to wash out the kidney through a large ureteral catheter.

DR. HAGNER replied that the question of washing the kidney through a catheter had been considered, but that the patient's nervous condition was such that she had to be etherized in order to use the cystoscope, and it was regarded the lesser evil to open and drain the kidney.]

Ethyl Chloride as a General Anesthetic.-Johnson, in the U. S. Naval Medical Bulletin, October, 1909, p. 346, states that ethyl chloride is peculiarly adapted for use in the naval medical service because of the simplicity and ease of administration and safety; the rapidity with which anesthesia is induced and recovery takes place; absence of unpleasant after effects; the lessening of shock; absence of irritation of larynx; cheapness and portability; and, given before ether or chloroform, it lessens time, danger and the unpleasant sensations of the patient.

Rubber Gloves.-R. S. Fowler, in New York State Jour. Med., Sept., 1909, p. 361, concludes from his own experience that the gloves do not reduce the number of post-operative infections; the wound must be made larger than otherwise in order to permit visual direction; the tactile sense is decidedly interfered with; the continued use of the gloves does not educate the tactile sense anywhere near to that of the bare hand; there was no difference in his own case as regards the condition of the skin of his hands; manipulation was slower and in some cases decidedly dangerous; the length of time of operation was decidedly increased, and hence there was added the danger and shock to the patient.

Post-operative Acute Dilatation of Stomach.-H. B. Smith, in Bost. Med. and Surg. Jour., Oct. 14, 1909, P. 529, discusses this subject, and concludes that the condition is of comparatively frequent occurrence after surgical operations done under general anesthesia. The prognosis is good if the condition is recognized early and treated at once; otherwise bad. He recommends evacuation of stomach and bowel contents.

Sarcoma of the Upper Jaw.-Laroque, Old Dominion Jour. of Med. and Surg., reports an interesting case removed under rectal anesthesia. One-fourth grain of morphine was given an hour before operation. Chloroform, by inhalation, was given to the stage of full narcosis, when it was suspended and the anesthesia continued by ether per rectum. Laroque states that the rectal anesthesia was perfectly satisfactory, there being complete absence of coughing and no interference with the operator. transient irritation of the rectum was the only untoward result of the anesthesia.-E. A. B.

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Cancer of Stomach; Use of the X-Ray.-Pfahler, in New York Med. Jour., Aug. 21, 1909, p. 356, believes that a diagnosis can be made by the x-ray sooner than has heretofore been thought possible.

The Proctologist for Sept., 1909, contains the proceedings of the American Proctologic Society for 1909. One is struck by the frequency with which surgical procedures are advocated for con

ditions formerly considered as purely medical. For instance, there are four papers on the treatment of pruritus ani, one of them being by Martin, of this city. He and Krouse recommend radiating incisions for the relief of this condition, while Beach asserts that in nearly every case a small submucous fistula may be found, the slitting up of which will cure the trouble. At the same meeting Gant advocated the treatment of chronic diarrhea by irrigation from above through an opening in the cecum, and described in detail a new cecostomy operation which enables him to insert tubes into both the small and large intestines. The article is fully illustrated.-E. A. B.

Fatty Infiltration of Liver in Infant Three Months Old.— Pratt, in Bost. Med. and Surg. Jour., Sept. 16, 1909, p. 395, reports a case. Discussion on p. 407.

Mortality Statistics for 1908; Bureau of the Census, 1909.— The following extracts are made from the report. The report is for the Registration Area which includes the States of California, Colorado, Connecticut, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, Wisconsin, the District of Columbia and 74 cities in non-registered States. The total population of this registered area is nearly 52 per cent. of the estimated population of continental United States. Total deaths for the year in this area, 691,574. The year 1908 had a remarkably low mortality. Nearly one-fourth of all deaths registered were of persons not born in the United States.

The death rate in 1,000 of population ranged from 10.1 in South Dakota to 18.4 in California. Comparison with deaths. abroad shows that in England and Wales the rate was 14.7; in the city of London, 13.8. The rate for large cities in the United States was from 8.3 for St. Joseph, Mo., to 23.6 for San Francisco.

As to the causes of death, there were 92 from smallpox ; 5 from plague; 2 from yellow fever; 11 from leprosy; 82 from rabies 23 from pellagra (there probably were more, the disease not being recognized); 11,375 from typhoid fever; 4,611 from measles; 4,969 from whooping cough; 10,052 from diphtheria and croup; 78,289 from tuberculosis, all forms; 33.465 from cancer; 60,038 from disease of heart; 61,259 from pneumonia, all forms; 52,213 from diarrhea and enteritis; 39,203 from Bright's disease, the chronic form; 8,332 suicides; 44,089 accidents.

There is much other interesting material in the report.

Tuberculosis.-The following extracts are taken from the published Transactions of the International Congress on Tuberculosis, of September-October, 1908. The volumes cover some 5,000

pages and contain very much of interest and value. Only such things as lent themselves to brief extracting have been taken.

In regard to the viability of the tubercle bacillus Rosenau concludes from a series of experiments that the bacillus can live a long time in dust exposed to the weather, somewhat over seven months; and about 140 days when exposed to the sun. Sputum dried in rooms preserves its virulence till the seventh or ninth month.

"Action of Diffuse Light on the Bacillus Tuberculosis.' Weinzirl, of Seattle, concludes from his experiments that diffuse light acts as a germicide directly, and independently of desiccation. The bacillus can be killed by diffuse light in from one day to a week.

"Inoculation of Tuberculosis Through the Skin."-Courmont and Lesieur, of Lyons, France. The skin, although apparently intact, is not an impassable barrier to the passage of the tubercle bacillus, probably due to the hair. There may not be any trace of such passage.

"Dissemination of the Bacillus by Flies."-André, of Lyons, France. Flies fed on tuberculous sputum evacuate in their excretions considerable quantities of bacilli; this excretion may continue as long as five days, and food a long way off may be contaminated by the fly.

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"Immunization."-Calmette and Guérin, of Lille, France. local suppurative tuberculosis in a consumptive improves the patient's condition and increases his resistance. Some clinicians claim to have obtained improvement in tuberculous patients by subcutaneous inoculation of cultures of virulent bovine bacilli, or dead bacilli, or cultures of human bacilli modified by passage through the body of a cold-blooded animal. Tuberculin is, however, an efficient and less dangerous remedy that secures immunity.

"Action of Soaps on the Vitality and Immunizing Property of the Bacillus."-Noguchi finds that the salts of oleic acid have a marked bactericidal property on various types of tubercle bacilli. "Anatomical Characteristics of Tuberculous Infections.”—Arloing, of Lyons, France, states that the lesions that accompany tuberculous infection do not always present tubercles visible to the naked eye; they are sometimes visible only on histological section. Sometimes we find only bacilli in the tissues, and no tubercular lesion.

"Tuberculosis in Different Organs."-Adami and McCrae, of Montreal, analyzed 1,000 consecutive autopsies and found evidence of tuberculosis in 417, or 41.7 per cent. They consider this proportion as being a little less than the average for Canadian cities, and admit that in some cases the lesions may have escaped notice or, though suspected, could not be proved. The lesions showed healing in 151 cases; were latent in 93; an active early condi

tion in 22; generalized in 43; pulmonary in 85; 13 in bones; 10 in the genito-urinary tract.

"Pleural Adhesions and Tuberculosis."-Landry, of Montreal, analyzed 1,374 consecutive autopsies in a general hospital. 990 cases showed pleural adhesions; 558 cases showed microscopical evidence of tuberculosis in the thorax and 68 of tuberculosis elsewhere. Besides these there was fibrosis of the apex of the lung in 89 cases. Adding up all these it would appear that 715 cases, or 52 per cent., of the autopsies showed signs of tuberculosis. 523 cases showed pleural adhesions, and in 50 per cent. of these there was coincident tuberculosis.

"The Frequency of Healed Tuberculosis in the Mesenteric Glands."-Warthin, of Ann Arbor, concludes that minute hyaline formations, representing healed chronic miliary lesions, are present in the cervical, bronchial and mesenteric glands of all adults. Such lesions are in the great majority, if not in all cases, miliary tubercles.

"Conjunctival Tests."-Baldwin, of Saranac Lake, N. Y., states that as a result of 1,087 tests he finds that the conjunctival tuberculin test with weak solutions and a single instillation has some value in confirming the presence of tuberculosis in the early stages. It has little value when the symptoms of tuberculosis are only suspicious. The conjunctival reaction is unreliable for prognosis. With proper precautions danger to the eye is slight. It should be restricted to adults.

"Mixed Infections in Tuberculosis."-Ravenel and Klebs believe that such infections modify the course of the disease injuriously, are causative factors in some of the grave accidents, and generally tend to shorten life, in many cases appear to be the direct and immediate cause of death.

"Comparative Importance of Treatment in Sanatoriums Near at Hand and an Entire Change of Climate."-Knight, of Boston, believes that the sanatorium treatment of a large proportion of cases of tuberculosis is the best, at least in the beginning. Edson, of Denver, says that an outdoor life is an essential aid to the cure of the disease, and that that climate is most favorable which most readily permits this outdoor life; but if the patient is so circumstanced that he cannot secure in a new climate the food, accommodations, care, medical attention, etc., that he requires, he had better stay at home.

"Fluoroscopy as a Routine Method of Clinical Investigation of Pulmonary Tuberculosis."-Rist, of Paris, states that the x-ray gives us valuable information; adds some precision; corroborates, sometimes corrects, the diagnosis. He thinks that no case is completely examined unless the x-ray is used. Krause, of Jena, says that the x-ray often reveals the infiltrative process, cavities, calcified foci; confirms or completes the clinical findings. "Hemoptysis as a Symptom of Early Pulmonary Disease."