able to protect itself in some degree. That many things have been demonstrated by vivisection goes without saying, and, in this connection, is it not better to inject a guinea-pig or a dog with serum and thus test its efficacy, than it is to inject the serum into an innocent child and produce tetanus?

THE IMPORTANCE OF ORGANIZING COUNTY MEDICAL SOCIETIES.

The recent action of the American Medical Association, in which its constitution was so changed as to make alliances between the State and County Medical Societies of this country, makes it necessary that every county wishing a representative in the National Association must have a County Society in order that it may have a representative in the State Society, and from the State Society to the National Association, thus making a grand alliance between all of the societies in the United States. It is to be hoped that every member of the profession in this State will, at his earliest convenience, become a member of his County Society. Further, "what is everybody's business is nobody's business," but in this instance it should be everybody's business to organize a County Medical Society, and to that end some physician or a number of physicians should issue a call to every practitioner, and when they are together agree upon the name of the society, and the present manner of naming the society is to call it by the name of the county in which it is organized. The organization is effected by the election of a President, Vice-President, Secretary, and Treasurer, and by agreeing to adopt the constitution of the American Medical Association and the Code of Ethics, and any regulation that you may wish to make concerning the individual society. Having thus completed the organization you will, of course, have meetings at stated times-once in three

months or once each month.

Current Surgical and Medical Selections.

ACUTE LEUKEMIA IN CHILDHOOD.-Dr. Macrae records (Johns Hopkins Hosp. Bull., Baltimore, May, 1900) a case of acute leukemia, of about a month's duration, in a little boy aged three, characterized by anemia, fever, purpuric rash, blood picture of leukemia, hemorrhages, and convulsions, and terminating by death. He draws the following conclusions from a careful analysis of other thirteen recorded cases:

Leukemia is a relatively rare disease in the first decade, only two cases of that condition having occurred in 3,000 autopsies performed by Friedrichshain. As is the case in leukemia at all ages, a large proportion of the patients were males. There was nothing conclusive in the family history of the thirteen cases investigated, as in only one instance was there any evidence of leukemia in the family. The previous history of the children revealed nothing of importance, if we except affections of the tonsils, which were present in several of the cases, and which may possibly suggest something of a causal relationship. In the Lançet, London, for 1900, vol. i, p. 227, Hunter has referred to the probable association between foci of infection in the mouth, such as carious teeth, and pernicious anemia, considered as a chronic infective disease.

A possible association with the "lymphatic constitution" must also be considered, although Ewing, who discusses this matter (N. Y. Med. Journ., 1897, vol. ii, p. 37), can trace no direct connection between the two conditions.

The onset is usually sudden, and is accompanied by fever in the majority of cases; but, as a rule, the temperature does not rise very high. Hemorrhage from the nose, mouth, stomach, bowels, and kidneys occurred in the majority of the cases, and was accompanied by a purpuric rash. Enlargement of the cervical glands, associated with affections of the mouth and tonsils, occurred in half the cases, while general glandular enlargement was present in a smaller proportion. The spleen was enlarged in every case, and the liver also in more than half the series. Miscellaneous symptoms complained of consisted of pains in joints and bones, hemiplegia and priapism.

Marked anemia was always present. The highest count of corpuscles showed 2,350,000, and the lowest 1,000,000. The percentage of hemoglobin varied from 40 to 18. The degree of anemia in those acute cases is striking, and suggests the possibility of the development of the disease in children already anemic. The red blood corpuscles did not show any rapid fall while the cases were under observation, the possible explanation being that these children had been suffering for some time from leukemia in a chronic form, and that what was regarded as the whole course was merely an exacerbation at the end. The duration of the cases varied from four to

nine weeks. The diagnosis can only be made with certainty through an examination of the blood. The conditions with which it is most apt to be confounded are: (1) An acute infection, with specially marked throat symptoms; and, (2) a hemorrhagic purpura. In none of the cases did treatment appear to be of any service.- The Edinburgh Med. Journal.

SKIAGRAPHY IN THE STUDY OF FRACTURES AND DISLOCATIONS.-M. Manoury, of Chartres, maintains that the mistakes ascribed to the X-rays are the result of erroneous interpretation of the information conveyed, and he advocates greater precision in radiograph examinations. While the clinical diagnosis of fractures has maintained its value, skiagraphy renders it more certain and more precise, especially in complicated cases, and where the swelling of the soft parts interferes with other methods of examination. The fractures in which radiography is specially useful are the following: Those of the upper end of the humerus, which may be the cause of the stiffness and disability frequently ascribed to a bruise of the soft parts; fractures of the lower end of the radius, of the lower end of the bones of the leg, of the astragalus (which were formerly regarded as a very rare injury), and of the metatarsals.

The progressive formation of callus can be readily studied by radiography; it has been observed that, in children, the reparative process in fracture is not limited as in the adult to the immediate vicinity of the fragments, but extends for some distance along the shaft.

With regard to treatment, radiography is valuable in affording information as to the necessity of operative interference in fractures, and especially those in the region of the elbow and ankle.

Von Bergmann, of Berlin, who also submitted a report on this subject, insisted on the value of radiography in fractures of the patella, of the lower end of the radius, and of the metatarsal bones. In referring to the interposition between the fragments of a portion of muscle, as a cause of ununited fracture, he pointed out that although it might be impossible to demonstrate this with certainty by means of the X-rays, such a condition might be inferred when the image projected in the fluorescent screen showed the fragments to be separated by an interval which remained the same, whatever position the fractured limb was made to occupy.-The Edinburgh Med. Journal.

TREATMENT OF SCARLATINAL NEPHRITIS.-Dr. Robert Coleman Kemp recommends amyl nitrite by inhalation for uremic convulsions. As regards the use of oxygen in pulmonary conditions due to nephritis may be cited pulmonary edema, pulmonary congestion, or pleurisy with effusion due to oliguria, as sufficient examples. The early use of this agent is the keynote of success, for it will dilate the bronchioles, improve the respiratory functions, and also the pulmonary and general circulation. Such results must diminish the chances of further extension of the morbid proc

esses, and aid the absorption of those products if already present. As an aid to the elimination of toxins, it improves the condition of the red blood cells and the secretory functions. One of the most valuable agents is normal saline solution. Enteroclysis at 110° to 120° F. with this solution for fifteen minutes to an hour continuously, depending upon indications, and as frequently as three or four times daily in oliguria, uremic convulsions, uremic coma, dropsy, suppression of urine, pulmonary edema, pleurisy with effusion, gives satisfactory results.—Pediatrics.

KOERNIG'S SIGN IN MENINGITIS.-By Dr. P. Roglet (Gaz. Heb. de Med. et de Chir.). Koernig's sign is produced by irritation of the meninges of the lower portion of the spinal cord and of the nerve-roots that constitute the corda equina. In the healthy subject, placed in the sitting posture, with the thighs flexed at right angles to the trunks and the legs completely extended, the fibers of the flexor muscles of the knee-joint are extended to their extreme limit, and their elasticity is almost completely exhausted. In patients suffering from meningitis complete extension of the legs is impossible, due to the contracture of the flexor muscles of the leg. This phenomenon is usually bilateral, although at times it is found on one side only; it disappears when the patient assumes the dorsal decubitus. The time of its appearance or disappearance varies greatly; the same may also be said of the intensity of the phenomenon. When it is present it is valuable as a differential sign from influenza, typhoid fever, infantile paralysis, tetanus, and meningismus; its absence does not, however, exclude the diagnosis of meningitis or irritation of the meninges.-The Post-Graduate.

MANAGEMENT OF FACE PRESENTATIONS.-Malcolm McLean (Medical News) has accomplished safe delivery in this condition by a method which has been suggested, but results not reported, by other obstetricians. With the use of Schatz' method, that of converting a face presentation into one of the vertex, correction must be early while the head is above, or at the superior strait, and the waters of the sac undischarged. It is difficult in this procedure to make a diagnosis of face presentation early enough, and it is not easy to so secure the corrected position that relapse into the extended pose may not occur. He thinks that in the majority of cases the faulty position of the head is itself produced as the head attempts to settle into the pelvic canal. The general teaching that the mento-posterior position of the face will be self-corrected as soon as the chin reaches the floor of the pelvis, he considers delusive. This has occurred in but one instance in all of his

experience.

He terms his method of dealing with this condition "version by vertex within the pelvis." The patient is put under full chloroform anesthesia ; the surgeon's hand is passed carefully into the vulva while the outside hand seizes the body of the child. If there is no uterine contraction the chest is pushed obliquely from behind forward, as much as possible away from the

point toward which the chin is pointing, in the direction of the occiput. The hand within the vagina is at the same time pushed up beside the head in one or other of the oblique diameters of the pelvis so that the fingers can reach the suboccipital portion of the head, while the thumb is used to steady the brow, and with a slight lifting motion imparted to the whole head it is caused to rotate on its axis, the chin passing upward above the sacro-ischiatic notch, as the occiput is drawn down below the pubis. Flexion may be hastened by pressing down the occiput with the outside hand as soon as the face is dislodged from its wrong position.

The writer reports two successful cases where this method was employed, in one of which the chances of its proving successful seemed very doubtful. The Chicago Clinic.

VACCINAL IMMUNITY IN THE NEWBORN AND ITS INTRA-UTerine TRANSMISSION.-Some interesting facts bearing upon this question are presented in an experimental study by Piéry (Lyon Medical), in which are recorded observations upon fifty-nine cases of vaccination practiced concurrently upon the mother and her infant. The mothers were vaccinated once, and upon the infants the operation, if successful at first, was practiced a second time.

Of fifty-nine infants, thirty-six were refractory to vaccination, while twenty-three were vaccinated with success. Of the thirty-six mothers whose infants were thus immune, thirty-two showed themselves refractory to vaccination, and thus proved themselves possessed of the same immunity. Only four infants whose mothers had been vaccinated with success after parturition, and were therefore in a state of receptivity at the time of the infant's birth, manifested immunity when subjected to the test. This conclusion strongly confirms the observation of Beclere, Chambon, Ménard, and Coulon, who found in a series of sixty-five mothers and infants that immunity in the infant was manifested exclusively by those whose mothers showed the same insusceptibility. The author believes that his four exceptions to the rule stated by these observers are scarcely numerous enough to invalidate its truth.

If, however, in intra-uterine transmission of immunity in the mother accounts for the immunity of the child, it does not follow that all mothers thus protected are able to transmit a like immunity to their offspring. In the author's statistics it was noted that while thirty-two mothers transmitted immunity to their offspring, seventeen others bore children who were susceptible to vaccinal inoculation. An interesting observation not included in the series concerned a woman vaccinated without success after a twin birth, who transmitted her immunity to only one of her infants, the other presenting a normal pustule after vaccination.

Combining his results with those of previous observers, Piéry finds that transmission of immunity may be observed in 58 per cent of the cases.

The reason of the inconstance of transmission of immunity is attributed