Syphilis in the Innocent. (Syphilis Insontium). Clinically and Historically Considered with a Plan for the Legal Control of the Disease. By L. Duncan Bulkley, A.M., M.D., Professor of Dermatology, New York Post Graduate Medical College; Physician to the New York Skin and Cancer Hospital, etc. 8vo, about 350 pages. [New York: Bailey & Fair child.

The attention of the profession is called to this forth. coming work to which was awarded the Alverenga Prize of the College of Physicians.

This work of 802 pages is a most excellent treatise on dermatology; it includes everything essential up to date and is written in clear and comprehensive lan guage. Thirty-five new diseases have been added in this edition. The chapter on Tuberculosis has been re written and considerably enlarged, so as to bring it in harmony with modern bacteriology and histology. Among the important chapters added are Pityriasis Rubra Pilaris, Keratosis Follicularis, Actinomycosis, It contains a complete presentation of the subject of Eeucokeratosis Buccalis, Xanthoma Diabeticorum. the innocent acquiring of Syphilis in social and indus. Among the chapters of minor importance are Savill's trial life, and also professionally, with histories of over Disease, Scarlatiniform Erythema, Acauthosis Nigricans, Angioneurotic Edema, Acromegalia, Alopecia Follicularis, Parasitic Forms of Eczema, Several Varie ties of Gangrene of the Skin. The original illustrations added in this edition consist of five plates and twentytwo woodcuts. The illustrations, some of them black and some colored, are very good and plain. The type is large and clear. It is a work which we can conscien tiously recommend to every practitioner and student.

Lessons in Physical Diagnosis. By Alfred L.
Loomis M.D., LL.D., Professor of Practice of Pa-
thology in the University of the City of New York.
Tenth Edition. Revised and Enlarged. [New York:
William Wood & Co.

one hundred personal cases of extra-genital chancre.

Tables are given of all the Epidemics of Syphilis, and also one including over 9,000 cases of extra-genital infection, of which the data are found in the Analytical Bibliography. This latter covers over 150 pages, with references to cases reported by several thousand writers, and in the Synopsis of Facts and Literature these are all analyzed.

It is not too much to say that this is one of the most exhaustive works which has ever been made of any one medical subject; but it is also intensely practical, and places the matter of the legal control of Syphilis upon a different basis from that commonly recognized.

The Ambulance Street Car.-The application of the modern system of ambulances to electric street This comprehensive work contains twenty lessons, railways has been attempted in St. Louis (N. Y. Med. 278 pages, on the essentials of physical diagnosis, and Jour.). It results in the establishment of an emergency is an excellent guide to the student of this branch of ward on car-wheels. The springs of the car are so medicine. The section on the "Physiological Action of made as to reduce to a minimum all the jar and shock the Heart" and the lesson on the "Examination of that are apt to occur to the patient during transit. As Urine" have been entirely re-written and a new lesson three large hospitals and the chief dispensary of the on "Clinical Microscopy" has been added in this edition. city are located along the line of the electric roads, it The name of the author alone is sufficient to recommend will be convenient to convey the sick and injured from the book to every student in the land. central districts, as well as outlying ones, by means of the electric car ambulance. The ordinary city ambu. lances, moved by horse power, will still be required to supplement the work of the car ambulance. Every electric car company in our cities should include an ambulance as a part of the original plant for this reason, if for none other, that a large casualty list is apt to accompany the establishment of electrical rapid transit in any crowded district. The companies should be prepared to help in the relief of those unfortunate citizens who suffer at the hands of inexperienced motormen and deranged machinery.

Essentials of Minor Surgery, Bandaging and Venereal Diseases. By Edward Martin, A.M., M.D., Philadelphia. Pp. 166. 1893. [W. B. Saunders. St. Louis: J. H. Chambers & Co. Price, cloth, $1.00.

of

This is the revised and enlarged second edition No. 12 of Saunder's Question Compends. It contains a good resume of those subjects which were formerly unfortunately learned after the student had entered upon

MEDICAL SOCIETIES

Tri-State Medical Society of Alabama,
Georgia and Tennessee.

uterus, generally endometritis. The treatment of this condition was given: 1. By local treatment. 2. Amputation of the cervix. In all diseases of the uterine adnexa, rest and abstinence from sexual intercourse necessary. The three principal points of diagnosis in disease of the uterine adnexæ are: 1. Repeated attacks of peritonitis. 2. Repeated hemorrhages. 3. Pain. Indications for operation: 1. Those attending pelvic peritonitis, accompanied by tortuous and distended MORNING tubes, which may usually be felt in Douglas' pouch, behind the uterus. This condition may be preceded by the history and symptoms of an abortion, a gonorrhea, or a tubal pregnancy. 2. The physical signs of enlarged and tender ovaries due to chronic abscess

The fifth annual meeting was held in the Unitarian Church, Chattanooga, Tennessee, October 17, 18, and

19, 1893.

FIRST DAY-TUESDAY, OCTOBER 17, 1893.
SESSION.

Meeting called to order by President, Richard
Douglas.

Prayer by Rev. John A. Stevens.

3.

A new constitution was read by the Secretary and The physicsl signs of prolapsed and tender ovaries, ac

made a special order for Thursday morning.

A paper by J. W. Russey, of Chattanooga, was read, entitled:

TREATMENT of PuerperaL MASTITIS.

companied by irregular hemorrhages and incapacitating pains. 4. Some few cases of dysmenorrhea as the principal symptom, with a possibility of its being kept up by chronic disease of the ovaries and tubes. 5. Where hemorrhage is the principal symptom, accompanied by Compression of more general utility than any simple the ordinary signs of grave pelvic disease. 6. In a few measure, both prophylactic and curative, To be efficient cases of general peritonitis, preceded by the symptoms for former purpose, must be used early after labor. of rupture of a pre existing pelvic abscess, ovarian The chest binder of Dr. Guiterras a most satisfactory abscess, pyo-salpinx, or abscess in the appendages demeans of applying pressure. If abscess forms, pus veloped during the progress of puerperal septicemia should be evacuated early and perfectly. Washing the and just so long as endometritis existed, there could be abscess cavity preferable to drainage tubes. If drainage no tendency on the part of the ovaries and tubes to reis necessary, horse hair to be preferred to rubber tubing Cover. He distinguished endometritis clinically as simGreat care should be taken in selecting point for in-ple gonorrheal and septic. Treatment given was concision, if circumstances admit, on account of scar in stitutional, generally followed by local treatment, and cosmetic point of view. especially tampons of 10 per cent sol. ichthyol in boroW. G. Bogart said that mastitis could be prevented glycerine, either with or without previous dilatation. by proper prophylaxis. The breast is liable to injury Said that this plan of treatment deserved serious conby manipulation. He had found only one pump satis-sideration before such patients were subjected to the factory by which the breast is steamed at the same time dangers of laparotomy. that the milk is drawn out. In the early stage, try abortive treatment; if abscess threatens, poultice, later, incision, cleansing with peroxide of hydrogen and pack with iodoform gauze.

G. A. Baxter-The chief point is the free exit of milk; preceding this, the excessive secretion of milk. produced by improper diet. The ordinary diet should be used a liquid diet is especially improper. As soon as there is any hardness of breasts, annoint them with

warm castor oil.

G. W. Drake believes in medical treatment, the internal administration of bichloride of mercury for the revulsive effect.

Richard Douglas indorsed the position of the author be decided on its own merits. Removal of appendages as to the indications for operation, but each case must will not cure hemorrhage from the uterus, the proper treatment of which is divulsion of the cervix.

P. L. Brouillette was surprised that in the discussion of the subject, electricity had not been mentioned. In his experience many of these cases had been cured by the use of this agent without curetting or removing the ovaries.

H. Berlin thought it a mistake to remove the uterine appendages for hemorrhage. Electricity applied with positive pole inside the womb will control hemorrhage by destroying the mucosa if a strong current is used. It would be impossible for the woman to conceive after

Richard Douglas called attention to the anatomy of
the gland. Prof Dugas is entitled to the credit of orig.
inating the only rational treatment-that by pressure.
The cause is due to the presence of micrococci. The this.
milk forms a favorable nidus for their development.
J. A. Goggans, Alexander City, Ala., read a paper
entitled:

TREATMENT OF THE DISEASES OF THE UTERINE
APPENDAGES,

and presented specimen of ovaries.

Dr. Brouillette objected that the Farradic current could stop the hemorrhage.

Dr. Berlin said that his experience was only with the galvinic current which was generally used.

G. W. Drake said that most physicians, had not been educated so as to use electricity intelligently. It

These cases all come from pre-existing disease of the might relieve hemorrhage by reflex action.

Frank Trester Smith thought the operation of little danger. In the statistics, death is ascribed to the operation instead of the cause for which it was performed. Where tracheotomy was performed for foreign bodies, the statistics are good. The operation adds but little to the danger of the patient.

H. Berlin said that experiments on dogs in which croup had been artificially produced, showed that the effects of early operation were good. There was little

R. M. Harbin presented a case on which he had per danger from the operation itself. formed tracheotomy for membranous croup.

W. F. Westmoreland thought the paper valuable, as it called attention to the value of surgical interference. SERIOUS AND WATERY DISCHARGES DURING GESTATION, The surgeon was generally called too late. Tracheotomy, in itself, is not a dangerous operation. He had used cords, fastened in the edges of the wound and tied behind the neck, and thought this practice resulted more favorably than with the use of the tube.

interesting, but not satisfactory. In one case in his ex perience he thought the discharge from a case of hydro salpinx. There had been an occasional gush of water after the pregnancy.

a pint of sterilized water. This he believes will prevent antimortem clots, and is a remedy for shock. Specimen of antimortem clots were presented. He concluded strychnine was the best stimulant; baths the best antiRichard Douglas said that hydrorrhea is frequently pyretic. Quinine and antipyrine have no place in the met with in women who have had syphilis or gonorrhea. treatment of the disease. When the amniotic sac is opened, it is followed sooner or later by expulsion of its contents. If the fluid is amniotic, it will contain urine; otherwise not.

G. A. Baxter related a case in which there was a large flow of amniotic fluid following a fall. He had delivered the woman of a dead child, five months later. A partial rupture is not always followed by expulsion of the fetus. He thought a chemical analysis would determine whether the fluid was amniotic.

Geo. R. West stated that a serous discharge from the cervix might be from a cancerous condition.

J. R. Rathmell, in closing the discussion, thought that it might be possible in the early months of preg nancy that the discharge might come from the tubes. None of his cases ever suffered from gonorrhea.

NIGHT SESSION.

A paper was read by R. M. Cunningham, Birming ham, Ala., entitled:

RECENT OBSERVATIONS OF CROUPOUS PNEUMONIA, WITH
SPECIAL REFERENCE TO PROPHYLAXIS AND
TREATMENT.

This paper was largely statistical, based on an epi. demic among the convics at Pratt Mines, concluding as follows:

1. An unusually severe, general and fatal endemic of croupous pneumonia at this prison, coming on without apparent cause and ending, practically, abruptly.

W. L. Nolan could not see wherein filling up the system with a saline solution would benefit the patient. The statistics show the death rate to be about the same under different lines of treatment.

G. A. Baxter believed the remedies of the past of little value and Dr. Cunningham has made a discovery of value to the world. It was the chloride of a sodium which affected the condition of the shock, and the filling the tissues with the solution.

P. L. Brouillette wanted to defend his favorite treatment, with carbonate of ammonia, which had been his sheet anchor. In thirteen years, treating perhaps fifty cases a year, he had never lost a case; and regarded the disease as a mild disorder.

Willis F. Westmoreland thought that the paper showed that the use of the saline solution not only buoyed the patient temporarily, but was of permanent value. It probably has some effect on the blood result.

H. Berlin thought perhaps Dr. Cunningham's cases were not simply croupous pneumonia, but that other micro-organisms might be present. Ordinarily, saline solutions are used to fill up the vessels when they are empty from loss of blood.

Dr. Cunningham thought that the chloride solution would supply something to the blood in which it was deficient. Statistics show that the mortality in this disease was enormous.

A paper was read entitled:

SOME OF THE DISEASES OF THE FEMALE URETHA,

2. That more than double the percentage of negroes by J. C. LeGrand, of Anniston, Ala. The paper related was attacked when compared with the whites.

3. That it affected alike all ages.

4. That it attacked the robust and strong the same as

those in more or less bad physical condition.

5. That it affected those who worked outside the same as those that worked inside the mines.

cases in which relief had been experienced from treatment, and others in which no treatment was of any avail.

J. A. Goggans could not add anything to the treatment. He had used an infusion of pterus aquilina (brake fern) with good effect. We should look for

6. That an unusually large number was suddenly and disease of neighboring fistula. violently attacked.

7. The pulmonary tissue involved.

8. The unusually high temperature, fast pulse, and respiration.

H. Berlin had tried every remedy. The only remedy in some of these cases is to produre a vesico vaginal fistula.

Richard Douglas said that in the diagnosis between 9. The low mortality considering extraordinary se- organic and functional diseases inspection was neces verity of the endemic, and the character of the patients. sary. Urinary disorders may be produced by abnormal For prophylaxis, disinfection was tried by washing conditions of the surrounding structures. The treatthe cells with a solution of bichloride and steaming the ment suggested by Dr. Berlin is the only rational methbedding. The epidemic abruptly terminated and there od. The relief is complete and instantaneous. These have been no cases since, the author believes as a result cases can retain the urine partially. The opening is of the disinfection. Treatment consisted in the admin not closed for six months or a year. istration of stimulants and antipyretics in a majority of For shock, a solution of common salt was injected hypodermically (hypodermoclysis), one dram to

cases.

J. B. S. Holmes related a case in which the operation

was a success.

[TO BE CONTINUED.]

NOTES: AND ITEMS

endurance of a physical kind. Several striking exam. ples were supplied in which mental endurance carried the day, and it was shown that pure physical accom

The Athletic Life.-Sir Benjamin W. Richard-plishment, great as it might be, was of little avail when son in a lecture before the Athletic Association of Bir- not backed up by the strength of the natural and comminghom (Lancet), limited the period of the athletic manding mind. In other words, mere strong savagery career to a shorter course than is generally accepted could not make either a nation or a man physically namely, from the eighteenth to the thirty-sixth year; but it should be understood that he meant by this the true athletic existence, in which really active contests can be carried on. Contests of a serious kind should not be attempted until the body approaches maturity

which, though not measurable, nor to be weighed, nor great; there must be that inborn faculty or quality in substance visible, becomes in action the essential virtue, the power that wins-the same virtue that sus tains the orator, the writer, and the discoverer, and that belongs in the highest degree to the highest civili

zation.

The Lesson to Physicians from the Infectiousness of Tuberculosis.-The Section of Hygiene of the late Pan-American Medical Congress adopted the following resolution unanimously (American Lancet):

Resolved, That tuberculosis causes more deaths than any other disease; that it is known to be communicable, especially to persons living in houses and shops with consumptives. Therefore the attention of national, State, and municipal authorities should be directed to the necessity for controlling the dissemination of the disease: 1st, by notification by physicians and householders; 2d, the regulation of the residences of the tubercularized; 3rd, by controlling their movements so far as possible; and 4th, by the establishment of the hospitals and homes for the infected poor.

If physicians believe the sputa of the tuberculous jeopardizes the healthy, they should publish this knowl edge to the public, and do it with such persistence and force that all may be compelled to listen and heed. They should also point out the methods by which such dangerous sputa may be rendered perfectly harmless. Nor.should they rest until means have been provided for the education of succeeding generations to this important knowledge.

and should not be continued after the time when the body comes near to middle age. A point was raised whether every person can be transformed under any trainer or under any system of training into a veritable athlete that is to say, into one who can properly enter into a contest. It was admitted at the end of the discourse that a physically uncultivated nation might have its strength easily doubled by the introduction of a sound system of athletisism; but it was contended that among the members of communities there were always a number who, although benefitted by physical exer cises, could never become athletes and who ought never to attempt to reach the position. A distinction was thus raised as between common physical exercise and the trained exercise intended for the purposes of com petition. A speaker, Mr. Mathews, in moving a vote of thanks to the lecturer, explained that he, a Swiss mountain climber, kept up his climbing feats although he was sixty years of age-viz, twenty-four years of age beyond the period that had been specified. But that is not athleticism, was the reply; it is common exercise that requires no trainer, and, although it is risky, it does not come into the sphere of the athletic life. Here is a question that opens up a wide field of controversy among those who have made athletic pursuits a part of their practical studies. Is there a line of demarcation between athletic exercise and systematic common exercise? The answer, we presume, will be that there is such a line of demarcation, and that the term 'athleticism' is only applicable to pursuits where competition comes into play and where perhaps a course of training is required for success. This evidently was Sir Benjamin Richardson's view, and he mentioned, as the qualities to be developed by such training, precision, decision, presence of mind, and endurance. These qualities are of a mixed sort, being partly physical and partly mental, but their interrelation is very intimate, and it is easy to see that their joint employment must result in the perfection of athletic prowess, in whatever department of athleticism they are displayed. At the same time the four qualities had not, in the lecturer's eye, an equal value; mental endurance, the other qualifications being in fair condition, stood first. A com paratively feeble development of body could be made All physicians know that but few once infected with effective by mental endurance, and some most im phthisis ever recover, hence the importance of preventportant physical difficulties could be overcome by ing the infection if possible. From this standpoint it strength and endurance of will aiding and sustaining would seem the clear duty of every lover of his race to

Do physicians believe that the meat and milk of tuber culous animals often contain the infectious substance and produce the disease in such as consume the same? Then should they unite and demand that the meat and milk be regularly inspected, and the affected animals destroyed.

If we grant that tuberculous sputa may infect a habitation, then we should insist upon the immediate destruction of such sputa and the thorough disinfection of the house.

Do physicians believe that an injured lung or other exposed organ is liable to be infected with tuberculosis by exposure? Then they should insist on removal of the tuberculous from the wards of the general hospital.

Do physicians believe that a tuberculous patient is the center of infection? Then should they advocate the establishment of special consumption hospitals.