H. A. COTTELL, M. D., M. F. COOMÈS, A. M., M. D., Editors.

No. 10.

ERNEST G. MARK, A. B., M. D., and JOHN R. WATHEN, A. B., M. D., Assistant Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid.

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TETANUS RESULTING FROM VACCINATION.

We had scarcely recovered from the surprise of tetanus following the injection of anti-diphtheritic serum in St. Louis, when it was announced that tetanus had followed vaccination in New Jersey. Both of these accidents are to be deplored, and especially the latter, because of the comparative harmlessness of vaccination and its prevention of so loathsome a disease as smallpox, which at present is epidemic in many parts of the country. Further, we have to contend with the anti-vaccination sect, which I regret to say is made up in part of members of the medical profession. It seems to be questionable as to whether the tetanic germs were in the vaccine virus or whether they found their way into the wounds from other sources, as from the clothing and the want of proper cleanliness at the time of vaccination. It is certainly a great calamity that tetanus should follow vaccination, for there is nothing more certain in the whole history of medicine than that proper vaccination is a preventive of smallpox, and this accident will place many barriers in the way of preventing and stamping out this loathsome disease. However, if it can be ascertained that the tetanic germ was not in the virus and that it did find its way into the wound through some other source, then the normal equilibrium of public sentiment concerning vaccination may be regained, otherwise it will be a long time before the timidity of the people will allow them to consent to be vaccinated. Of course the anti-vaccination set will double their energies and make a desperate effort to prevent anybody from being vaccinated, and will doubtless find many adherents.

KENTUCKY SCHOOL OF MEDICINE.

The next annual session of the Kentucky School of Medicine will begin on January 2d, under the most favorable auspices in the history of this grand old institution. While the school has always been renowned for its thorough equipment, excellent teachers, and the character of work done, it is now in a far better condition for the best quality of modern scientific work than at any time in its history. With the large hospital adjoining the college, where the latest modern methods in clinical work are demonstrated before the class, with the perfectly equipped laboratories and many other facilities, the student who graduates from this school should be thoroughly prepared to practice his profession.

Current Surgical and Medical Selections.

METHYLENE-BLUE IN URETHRITIS.-It is best given in gelatine capsules in one-grain doses three or four times a day. After the fourth day the dose may be reduced to twice a day. Given alone it sometimes causes irritation of the neck of the bladder, but when combined with oil of nutmeg there is no trouble of this kind. Oil of sandalwood is a desirable adjuvant because of its diuretic action and also on account of its sedative effect upon inflamed mucous membrane. Recent observations show that, when given internally, methylene-blue reappears unchanged in the urine within two hours. By giving four one-grain doses of methylene-blue daily there is always enough of it in the urine to kill all the germs it comes in contact with. This is irrigation "from above," irrigation, not of the urethra alone, but of the entire urinary tract. By this method of irrigation there is no danger of forcing the infection into remote recesses of the genitourinary organs.

Troublesome gastric symptoms sometimes follow the administration of the methylene-blue of the shops, but, with the following formula put up in elastic capsules, uniformly satisfactory results have been personally obtained:

The above formula should not be used for more than ten days without intermission, and while giving it the patient should be instructed to drink freely of water.-The Medical Times.

STRICTURE OF THE ESOPHAGUS.-While the diagnosis of this condition is usually to be easily and satisfactorily made by means of the esophageal bougie, the use of this instrument is sometimes inadmissible, owing to suspected aneurism of the aorta, hematemesis, the weakness or disinclination of the patient, etc. Under such conditions a method described by Holzknecht (Deutsch. med. Woch., September 6, 1900) is likely to be of great value, as it gives accurate information regarding the presence, locality, caliber, and length of a possible stricture in a simple and painless way that is free from all risk. On illumination of the chest by means of an X-ray tube placed below the right shoulder and with the fluorescent screen arranged so that the line of sight runs from the left behind, forward and to the right the esophagus is visible as a light streak occupying the position between the dark masses of the heart and the vertebral column. On giving the patient a small quantity of water holding in suspension 15-30 grs. of subnitrate of bismuth, if a stricture be present, the fluid will be arrested at this point and a precipitation of the metallic powder takes place, which will throw an appreciable shadow on the screen. This test is mainly useful in stenoses of small caliber, and if it prove negative, the bismuth should be enclosed in a capsule, and the process of deglutition observed as before. If this, too, fails, it may be well to repeat the experiment, having preceded the administration of the capsule by the giving of a small morsel of bread, which is sure to be arrested and so impede the progress of the test object. Medical News.

PROLAPSUS OF THE RECTUM IN CHILDREN.-Custom says (Annals of Surgery) that all cases of true prolapse of the rectum will show a tumor projecting out of the anus. At the base of the tumor will usually be found a sulcus between the mucous membrane of the prolapsed gut and the skin of the anal orifice. In almost all cases the lumen of the gut may be seen in the center of the tumor. There may be inclusion of the peritoneum in cases of prolapsus, but this occurrence is fortunately rarely met with. One of the most important causes of prolapse is infection, whether produced by a retention of the feces or by diarrhea. This applies, of course, to young children. In older children and adults the prolapsus is often due to the presence of a polypus, an ulcer, hemorrhoids, or some other lesion of the rectum. The judicious use of a rubber rectal plug to keep the prolapse reduced, cleanliness, and tonic treatment with the use of strychnin, will probably give the best of results. Polypi, hemorrhoids, or other local lesions will require a surgeon's care; irreducible or constricted prolapsus will have to be resected. Mikulicz first cuts through the outer intestinal tube in its anterior circumference, catching up each bleeding vessel as it appears and ligating it with fine catgut. As soon as the peritoneal pouch has been opened its interior is examined for the presence of small intestine. The peritoneal cavity is then closed by a running suture. The anterior aspect of the internal intestinal tube is cut through little by little until it is opened, and then both intestinal

tubes are united by deep silk sutures to the entire line of the incision. The posterior surface of the prolapsus is treated in absolutely the same way, both intestinal ends being united by means of silk sutures. He simply covers the line of sutures with iodoform, places a strip of iodoform gauze over this, and then a wood wool cushion. Daily irrigation with a mild antiseptic solution should be used, opium given internally for a week, and the patient kept upon a diet leaving little intestinal residue. The results of operation are usually excellent.- The American Journal of Obstetrics.

SURGERY IN The Presence OF SUGAR IN The Urine.-Fisk (Annals of Surgery) reports a number of cases in which he operated successfully in the presence of sugar in the urine. He reviews the literature of the subject and draws the following conclusions: The presence of glycosuria in those individuals who may have surgical diseases does not in itself constitute an absolute contraindication to any and all surgical relief. Very great judgment must be exercised in the selection of cases, in the determination of the kind and extent of the operation to be performed, and the strictest surgical asepsis must be rigidly enforced throughout. Infection, when it occurs, is from without, and is the result of an error in technique; it thus happens the constitutional symptoms become more serious and out of all proportion to the local, generally ending in death. When infection does not occur the operative wounds heal kindly, but slowly, especially granulating wounds. The vascularity of the tissues must be interfered with as little as possible, so that every operation should be planned with this object in mind. This is particularly so in gangrene of the extremities, in which the statistics of Heidenheim, Kuster, and Smith and Durham show most conclusively the necessity of high amputations in these conditions. He is of the opinion that it is better to cut down upon and ligate the artery in gangrene of the extremities rather than to attempt the bloodless amputation by means of the Esmarch band, because of the possible harm to the tissues, especially the blood-vessels, whose vitality is not the best.-American Journal Medical Sciences.

MEASLES AND ITS TREATMENT.-M. P. Hatfield. (The Medical Standard.) In an article on the general subject are the following directions for quarantine and treatment: The disease is highly contagious from its very onset. The contagion does not appear to possess the vitality of scarlet fever, for its potency is short-lived, and does not persist in infected clothing, books, and rooms as do the germs of scarlet fever; but, on the other hand, fewer children escape than in the case of scarlet fever. The entire course of an uncomplicated case of measles from exposure to recovery ought not to exceed three weeks, though it is safer to allow four weeks for quarantine. When there is persistent bronchitis, pharyngitis or discharge from the ear or nose, the quarantine should be continued until the complication ceases. It should be remembered that measles is highly contagious from the very

beginning of its catarrhal symptoms, and its contagiousness seems to be in direct proportion to the severity of the catarrh and its persistence. Quarantine is not usually long enough.

The chief duty is to keep patients warm in bed and watch for threatened complications. There is a great dread of cool drinks during the feverish stage, but the author has never seen any ill-effects from allowing cool-not iced lemonade or flaxseed tea with lemon. A temperature of 103° to 104°, with accompanying headache, can be greatly alleviated by two- or threegrain doses of phenactin or lactophenin.

If necessary, minute doses of codein may be given to relieve the harassing cough. Cod-liver oil with syrup of iodid of iron should be used wherever enlarged bronchial lymph nodes are suspected, and persisted in until the tendency to recurrent colds is overcome.—Archives of Pediatrics.

THE PATHOLOGY OF TUBAL PREGNANCY.-Max. Herzog, Chicago (in American Journal of Obstetrics), says: As to the cause of tubal pregnancy, inflammatory diseases of the tubes and uterus must be entirely discarded; nor is the etiology uniform for all cases. Congenital anomalies of the tubes, due to a faulty development of the Mullerian ducts, are responsible for a certain proportion, and likewise as important a cause is the unduly marked participation of the tubal mucosa in menstruation. This menstrual condition of the tube may be so intense as to cause a hematosalpinx, and the menstrual change offers just the soil for the lodgment of the ovum. The histology of the early placenta fetalis is the same as in uterine gestation. The amnion is considered a serous membrane, with an endothelial instead of an epithelial lining. The chorion and villi are covered by the layer of Langhams and the syncytium, the latter being considered of fetal origin. The chorion and villi contain blood-vessels filled with fetal nucleated red blood cells, while the intervillous space is filled with maternal blood. Issue is taken with Kuehne, who claims that there is no formation of decidua cerotina in tubal pregnancy, but only a pseudo-decidua from the layer of Langhans, Herzog claiming that there is a decidua formation from the connective tissue of the tubal mucosa, and while a reflex is formed it degenerates very early. The wall of the tube becomes extensively edematous, and consequently offers slight resistance to the rapid proliferation of the villi and their coverings in their attempt to gain a firm attachment for the ovum, and accordingly we see frequently an epithelial proliferation that reminds one of syncytioma malignum of the uterus. This proliferation leads later to extensive hemorrhages in the intervillous space, with the subsequent death of the fetus. In the forty cases from which the author gains his data he was struck by the great changes in the placenta and the frequency of the intervillous hemorrhages, which, in many instances, must have considerably antedated the rupture of the gestation sac. Uterine decidua was found in most of the cases examined.-St. Louis Medical Review.