the best water in the lakes of more than twenty-five feet in depth cannot, throughout the year, be obtained from any fixed depth, and that the depth at which the water should be taken should vary with the seasons, to avoid as much as possible the influence of these seasonal overturnings and disturbances of the layers of water from the surface of the lake downward.

It has been the custom heretofore to fix the depth of intake near the bottom of such lakes, and where the water is pumped from the lake to filters, as at Zurich, Switzerland, it is immaterial where this depth is taken, provided the intake is not so near the top as to take in water subject to the direct influence of the sun's rays in summer, nor so near the bottom as to stir up the precipitated organic matter by the currents of inflow to the pumps; but in cases where filtration is absent, the depths should be variable and adapted to take the best water surrounding the point of intake.

In conclusion, I wish to call attention to an error which often finds its way into papers and discussions on the cause of typhoid fever. Many writers, including some learned physicians, are prone to the theory that typhoid fever can be traced to sewer gases, holding them as causes, when they are not and cannot, in the light of present knowledge, be considered as causes.

Sewer gases and atmospheres containing the gases from putrefying organic matter are deficient in oxygen, and may be regarded as having a strong influence on the susceptibility of persons to typhoid fever, but are entirely distinct from and independent of the cause of this disease.

Thus with a perfect system of sewerage, drainage and ventilation, but with a sewage-polluted water supply, typhoid fever will still exist, although with rates reduced in some proportion to the improvement of the quality of atmosphere inspired.

But with a perfect water supply and bad drainage, sewerage and ventilation, while the vitality of persons exposed will be lowered, there will be no danger from typhoid infection, since the cause of typhoid cannot exist in a pure water.

In this case I do not consider the possibility of infection by other articles of diet than water, because it has been shown in the reports of the Massachusetts State Board of Health that quite 99 per cent. of all typhoid is traceable to polluted or typhoid tainted water supplies (Sedgwick).

Therefore, typhoid infection from other causes or carriers than water may be regarded as in the nature of accidents, to which we are all exposed, and from which few suffer.

MEDICAL EXCERPT.

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

ACUTE OEDEMA OF THE LUNGS.-M. Huchard, Gazette Hebdomadaire, 2d May, 1897, has presented a most interesting communication to the Académie de Médecine, on "Acute Oedema of the Lungs;" he attributes this oedema, which is sometimes alarming, to inflammation of the aorta or to a peri-aortisis with an inflammatory or reflex action on the cardio-pulmonary branch of the nervous plexus; this occurs usually in arterio-sclerotitis.

While this oedema takes place most frequently in sclerotic conditions of the aorta, it is often preceded by a very great diminution of the aortic tension, and by a rapid and enormous increase in the pulmonary tension. The right ventricle resists this, and becomes hypertrophied; and, so long as it is able to resist, the oedematous condition of the lung is prevented; but if the power to resist gives way suddenly, for any cause, the acute oedma speedily takes place. The defect then is not in a defect of the left, but in that of the right. The pathogenic relation, then, is this, disturbance of the cardio-pulmonary innervation by the peri-aortisis; great increase of the vascular tension in the lesser circulation; acute or rapid insufficiency of the right ventricle.

The therapeutic indications that follow from this pathogenic theory may be summed as follows:

The heart is strengthened by diminishing its work; in order to meet this indication a copious bleeding, equal to 300 or 400 grams is directed, besides local extraction of blood by wet cups over the thoracic cavity and over the liver and by a repeated application of dry cups over the thorax, the trunk and the limbs.

A tendency to collapse of the heart is met with injections of caffeine and camphorated oil.

To ward off disturbance of the cardiac-pulmonary innervation, and especially paresis of the bronchial tubes and of the diaphragm, recourse must be had to the preparations of strychnine, especially in the form of injection; the return of similar attacks must be met by cauterization over the sternal region or by the application of cauterization or of wet cups in the same locality.

In regard to morphine or atropine, so much praised by some authors in similar conditions, they are admissible when they do not

interfere with the action of the urinary organs. The same rule will apply to blisters and to the use of iodide of potassium; this latter remedy being of itself capable of causing an acute or a subacute attack of the oedema of the lungs.

Finally it is necessary to keep up a very free action of the urinary organs. This may be accomplished by exclusive use of a milk diet and of theobromine, to the extent of 1 grams to (3) three grams a day.

The rhenal changes observed in such patients are due to the disturbed condition of the aorta.

RICKETS IN PARIS.-Dr. Beluge made the following statement to the Congrés des Sociétés Savantes, Progres Medicals, 1st May: Rickets are very common among the working classes. Of the cases observed 33.75 per cent. occur under 3 years. 2d. Children fed on the breast, 28.59 per cent.; on the bottle, 45.36 per cent. 3d. Rickets are comparatively rare during the first six months, only 6.59 per cent.; from six months to a year, 33.33 per cent.; from one year to 18 months, 58.28 per cent. 4th. The time at which it appears generally is when the child is weaned, and it becomes necessary therefore to carefully observe this period of infantile life, both as to the nourishment as to the attempts to walk and to general hygiene.

FIRST SOUND OF THE HEART.-The Gazette Médicale, gives the remarks of M. Mongour on four new cases of the disappearance of the first sound of the heart in typhoid fever, a phenomenon which was first observed by Picot, and by Stakes.

The subject was discussed in a memoir to the Congré de Médecine in 1895. He now gives the following, in the Presse Medicale, of the 2d of April.

Ist. The disappearance of the first sound of the heart, whether at the apex, at the base, or in both situations at the same time, generally comes on during the period of oscillation in typhoid fever.

2d. The systolic sound reappears during the last oscillations, before the beginning of the hypothermic period.

3. When observed as an isolated cardiac symptom, the disappearance of the systolic sound is not accompanied with grave functional disturbance.

4th. This symptom may occur during the period of a relapse, having been observed in the first period also.

5th. The prognosis regarding this complication, is intimately associated with the frequency of the pulsations; below 110, it is without danger; if it reaches 120, there is great danger; above 120, death may be looked upon as certain. The dicratic action of the pulse does not form a specially grave element in the course of the disease.

6th. While keeping in view the transitory nature of this symptom, and of the fact that the first sound reappears with its rythm and normal intensity, it may be asked if this disappearance of the systolic sound is not intimately associated with a disturbance of the nervous system rather than with a lesion of the cardiac fiber?

MICROBES OF THE GLANDS OF THE EAR.-In a report to the Sociéte de Médecine de Berlin, a microbe of the ear has been described. It has been found in Steno's duct, in patients in the service of Leyden.

It is a sort of diplococus forming links which have a slight movement. Found in the cells, it resembles the gonococus or the menongococus, but it is much less in size. Cultures formed with it resemble those of the streptococus.

SUBNITRATE OF BISMUTH-POISONOUS?—A communication of M. A. Dubreuilh, was presented to the Société de Therapeutique, Gazette Hebdomadaire, 25th April, as follows: A man, thirty years of age, took a dose of 3 grams of subnitrate of bismuth to check a diarrhoea from which he had suffered for several days previous, and was covered with an intense eruption, resembling scarlatina. This erythema lasted four or five days, and ended in a desquamation in scales, most abundant on the feet and hands.

The patient was attacked for the third time with the same erythema, and always after the use of the subnitrate of bismuth; he had several other attacks of diarrhoea without any symptoms of erythema or other form of skin trouble. This is a fact that it is necessary to emphasize, since the frequent occurrence of infectious desquamative erythema is well known to take place in cases of disease, as for instance in entero-colitis.

The clinical and experimental proofs of the toxic effects of the subnitrate of bismuth, when employed externally, has been known for several years, but the author says this is, in his experience, the only instance of its poisonous effects when given internally.

HAEMOKONIA.-Dr. Muller of Vienna has described certain particles found in the blood under the name of haemokonia (blooddust). They resemble fat-globules, and the largest are 1-25000 of an inch in diameter. They are motile and are unaffected by osmic acid.

EDITOR'S TABLE.

SANITARIAN, JUNE NUMBER, 1897.

ALL Correspondence and exchanges and all publications for review should be addresed to the Editor, DR. A. N. BELL, Brooklyn, N. Y.

THE CENTENNIAL CITY.

The managers of the great industrial exposition which illustrates the Tennessee Centennial were compelled to have the limits within which it will be held incorporated with all the powers incidental to municipalities, since otherwise there would have been no police protection. Consequently, all sanitary matters within the said bounds will be under the jurisdiction of the said authorities. It is understood that in all respects the sanitation will be a model. Neither expense nor care will be spared to gain this end.-Bulletin Tennessee State Board of Health, April 20, 1897.

Editor SANITARIAN:

NASHVILLE, Tenn., May 11, 1897.

Permit me to call your attention to an article in your May number, quoted from a recent issue of the Memphis Commercial Appeal, which is unjust and misleading. We are willing to stand on facts, and with facts comparisons can be made; and I would ask that you kindly publish the statistics, from the State Board of Health Bulletin of December, 1896, taken from the official reports of the respective Health Officers of Memphis and Nashville.

Memphis, with a white population of 28,561; colored, 27,573, total 56,134, reports total number of deaths for the year 1896, 1,348-whites, 625; colored, 723. Annual death rate for whites, 21.88; colored, 26.22; total, 24.01.

Nashville, white population, 54,595; colored, 33,159, total 87,754, reports total number of deaths for the same period, 1,809— whites, 838; colored, 916. Annual death rate for whites, 16.35; colored, 27.62; total, 20.61.

Under the heading of "Constitutional Diseases," the Memphis Commercial Appeal places particular stress on Nashville's loss by consumption. Memphis lost last year, from constitutional diseases, 432, while Nashville, with more than one-third larger popu