Doctor Makuen in another article, "The Faucial Tonsils and the Teeth" (Journal of the American Medical Association June 19, 1909), says in his

summary:

The faucial tonsils and the teeth are in close approximation and they are alike subject to disease or degeneration.

Diseased tonsils and teeth are locally and systemically unhygienic.

Secretions from the tonsils may infect the teeth, and contrariwise, the tonsils may be infected by the teeth.

Diseased tonsils and teeth cause headache, earache, and facial neuralgia, and they become a direct source of infection to the glands of the neck, and through the efferent lymphatics to the general respiratory and circulatory systems.

Hypertrophied faucial tonsils often become so large as to affect the hearing, the circulation of blood, the nerve supply of the face and head, and the normal development of the alveolar arches.

The teeth serve important purposes, but the exact function of the tonsils has not yet been demonstrated.

The importance of preserving the teeth is fully recognized, but the diseased tonsil is not worth preserving, because it has lost its usefulness and become a menace to the human economy.

The only rational remedy for diseased faucial tonsils is total extirpation.

DERMATOLOGY.

WILLIAM FLEMING BREAKEY, M. D.

CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.

JAMES FLEMING BREAKEY, M. D.

ASSISTANT IN DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.

PELLAGRA.

BONDURANT, of Mobile, Alabama, has an article in the Medical Record, Volume LXXVI, Number VIII, entitled "Pellagra, with Report of Nine Cases."

The article is of interest owing to the recent recognition of the disease. in South Carolina, Illinois and other states.

While the disease is not purely a dermatologic one, still it is accompanied by cutaneous changes, sufficient to demand attention from the dermatologist. "It is a toxemic disease of endemic occurrence, common in Italy and other Mediterranean countries, and has been thought to be caused by eating fermenting and otherwise damaged corn meal. Its development is favored by insufficient and unsuitable food, unhygienic surroundings, and a warm and moist climate.

Clinically the disease presents symptoms of gastrointestinal derangement-salivation, general malnutrition with emaciation, a rough erythematous inflammatory thickening of those parts of the cutaneous surfaces exposed to sunlight, and by serious disturbance of the function of the periph eral nerves, spinal cord, and brain.

In its acute form the disease runs its course in a few weeks to a few months. The mortality is high. Recovery occurs, but relapses are frequent. Many afflicted suffer from associated mental disorders.

Doctor Bondurant gives credit to Doctors Searcy, McCafferty, and Somerville, assistant physicians of the Mount Vernon Hospital (The Alabama State Hospital for Insane Negroes), for the more recent recognition of the conditions in the United States. Since then reports of cases have come from numerous and distant points in the United States showing it to be by no means uncommon. Its recognition was first made in Insane Asylums.

In all the cases reported by Doctor Bondurant, while the nervous symptoms are most characteristic there was a marked thickned erythematous condition of the skin of the wrists and backs of hands, and frequently elsewhere on face, neck, or other parts of body exposed to sunlight.

An editorial in the Medical Record, Volume LXXVI, Number XIV, calls attention to the coming conference on pellagra called by the State Board of Health of South Carolina for November 3 and 4. The editorial intimates that the sudden appearance of the disease in the United States may be a sudden recognition rather than a sudden appearance.

The program is outlined briefly and includes the presentation of clinical cases offering opportunities for intimate observation and study. Doctor Lavinder, of the Public Health and Marine Hospital Service, says that arsenic has given the best results in treatment; such results, however, have not been sufficiently satisfactory, and a further study of the etiology is necessary to any satisfactory method of prophylaxis and treatment. J. F. B.

NEUROLOGY.

DAVID INGLIS, M. D.

PROFESSOR OF MENTAL AND NERVOUS DISEASES IN THE DETROIT COLLEGE OF MEDICINE.

CARL DUDLEY CAMP, M. D.

CLINICAL PROFESSOR OF NEUROLOGY IN THE UNIVERSITY OF MICHIGAN.

TUBERCULOSIS OF THE HYPOPHYSIS.

LUCIEN and PARISOT (Revue Neurologique, Volume XVII, Number IX) report a case of this uncommon disease accompanied by glycosuria.

The patient was sixty-five years old and her family and previous medical history was negative. She was well until November, 1908, when she first noticed frequency of urination, and a month later polydipsia and polyphagia. In March, 1909, the patient remarked a slight edema of the legs and was much emaciated. There was no furunculosis and no pruritus. The urine was clear and abundant-about six litres in twenty-four hours; specific gravity 1022; urea, four grams to the litre; and glucose fortyseven grams. Repeated analysis showed a continued diminution of the urea with the existence of glycosuria which, in spite of treatment, was maintained at between two hundred and three hundred grams per day. Hepatic opotherapy, continued for ten days, made no modification in the

quantity of sugar. The patient suffered from intense thirst but the increase of appetite was not marked and the digestion was good. There was no diar rhea and the feces were normal. The pulse was regular and equal with a blood pressure of one hundred thirty millimeters. The heart was negative. The examination of the lungs showed signs characteristic of phthisis.

The patient was seized suddenly one morning with vertigo and died in a few minutes. Autopsy showed: tuberculosis of the lungs and atheromatous aorta; some hemorrhagic effusion in the gastric contents; and a normal liver, pancreas and kidneys. On opening the head there was found a considerable subarachnoid edema. The hypophysis was macsoscopically normal, but microscopically showed numerous miliary tubercles. A large part of the parenchyma of the organ was conserved normally. As to the relation between the lesions of the hypophysis and the diabetes, it is difficult to affirm with certainty the importance of the role which one organ plays to another. Frequently in people affected with lesions of the hypophysis there is a change in the urinary secretion, usually simply a polyuria or a diabetes insipidus but in other cases glycosuria has been noted. Van Noorden has described such a syndrome under the name of acromegaly diabetes. Hausemann has reported glycosuria as occurring twelve times in ninety-seven cases of acromegaly. It would seem that various lesions of the hypophysis are capable of causing a true diabetic syndrome.

C. D. C.

GASTRIC HEMORRHAGE IN TABES DORSALIS. JENO KOLLARITS (Neurologisches Centralblatt, January 2, 1909) reports a case of vomiting of blood in the gastric crises of tabes dorsalis. Charcot, Vulpian and Neumann have published similar cases. The blood is dark in color and may also be found in the stools. Autopsy in this case showed the lesion of tabes in the spinal cord but no pathologic condition in the stomach. The mucosa was pale and the pylorus somewhat thickened. Neither in the stomach or intestine was the slightest sign of ulceration or any other origin for the hemorrhage. The author regards is as a parenchymatous hemorrhage which was a symptom of the gastric crises. It is very important that these cases should not be mistaken for carcinoma or gastric ulcer.

C. D. C.

EDITORIAL COMMENT.

THE BILL FOR THE STATE REGISTRATION OF NURSES. DURING the closing hours of the last Michigan State Legislature a bill was passed which provides for the state registration of nurses. For the past six years the trained nurses of Michigan, under the authority of the State Nurses' Association, have been endeavoring to secure this legislation and they are to be congratulated upon their successful efforts. The bill provides for a board of registration consisting of three nurses, one registered physician, and the Secretary of the State Board of Health. This would seem a fair

apportionment since it places the responsibility of the regulation of nurses' registration upon those most interested, the nurses themselves, at the same time placing at their disposal the experience and advice of two members of the medical profession. As the Secretary of the Michigan State Board of Registration in Medicine pointed out in a discussion on state registration of nurses in 1906, it is fitting that the nurses should work out their own salvation regarding this question. Obviously this would be impossible unless they control their own board.

The opposition to the bill on the part of some physicians appears to be based upon a complete misunderstanding of what the trained nurses in Michigan are trying to accomplish. It has been stated that the nurses were endeavoring to leave their proper sphere, the nursing of the sick, and had in mind the assumption of the physicians' role in the healing art. Any observing physician would at once scout such an idea. One of the principal criticisms of the trained nurse has been that she is far more likely to fail in initiative and err by not assuming responsibility in time of emergency when the doctor is not present to give instructions. The ideal trained nurse is a true assistant to the physician, not one who doles out so much medicine at stated intervals, or makes routine observations and mechanically records them upon a chart. Loyal to her chief, who is directly responsible for the case, she acts as his representative in his absence, reporting to him at his next visit. There never has been and never can be any real antagonism between a well trained nurse and a broad-minded, competent physician and any endeavor to arouse such antagonism will prove futile. Both the nurse and the doctor are too dependent, one upon the other, to permit of any permanent discord. As a class there is a no more loyal set of women in existence than trained nurses. Disloyalty is a sign of bad training and since this training for the most part in the past has been at the hands of physicians, it merely indicates that the physician has been remiss in his duties.

The different provisions of the bill on the whole are wise and should do much toward elevating the standards of the different training schools within. the state. By the terms of the bill no one is barred from nursing the sick. Very properly, however, it provides who shall be privileged to append the letters "R. N." (registered nurse) after his or her name. This is an eminently fair provision for the nurse who has spent two or three years in preparation for her duties. It does not mean that she is especially well adapted for the work of her profession, any more than does the title "M. D." signify that its bearer is a good practitioner. It simply means that the state, as a protection to the people, has seen fit to designate through its registration board what young women, through their preliminary training are qualified to be professional nurses.

The members of the board will not have before them a light task. Any work, especially when it has to do with regulating the affairs of a class, hitherto not regulated, will arouse opposition and criticism. But other boards have been criticized in the past, yet have survived to accomplish much good. If the Governor in his wisdom will see to it that the board is a good one, representative of the best among the trained nurses in Michigan, no one will have serious doubts of the result of its administration.

ANNOTATIONS.

A STAMPEDE AGAINST THE SPITTING NUISANCE.

PROFESSOR HENRY M. BATES, of the law department of the University. of Michigan, has recently prepared a model antispitting ordinance which the Michigan Association for the Prevention and Relief of Tuberculosis. will endeavor to have enacted in every city and town in this state. Any measure calculated to suppress the disgusting and dangerous habit of spitting is worthy of commendation to municipal governments. The passage of the mandate is not sufficient. Public sentiment should be educated to the degree of enforcement. The spitting habit is charged with being the most prevalent method of spreading tuberculosis, and hence the nuisance should engage the attention of every community. Several Michigan cities already have the matter under consideration and Ionia has taken the initiative in passage.

PROPHYLACTIC RESOURCE AND PECUNIARY REWARD.

MICHIGAN has without doubt the best antituberculosis law of any state in the Union. The State Association for the Prevention and Relief of Tuberculosis was instrumental in having the measure introduced into the legislature by Representative Wood, of Jackson county. The enactment is a modification of the New York law, and the changes have strengthened the statute and likewise improved the text. The law is published in another part of this issue and although strong as a prophylactic resource it evidences weakness as regards the pecuniary reward for medical service calculated to execute its tenets. The obligations imposed upon physicians and health. officers lack the lubricant of adequate compensation. Fifty cents seems a niggardly stipend to offer a physician for reporting tuberculosis cases and cures, yet no provision whatever is made by way of compensating the health officer for the additional labor which this measure entails. However, the service is rendered obligatory by fines ranging from five to fifty dollars. The enforcement of the law devolves upon the health officer and the prosecuting attorney, the salary of the latter in many instances being over three times that of the former. Notwithstanding the fact that one is a city officer and the other a county officer, the remuneration is not commensurate with the nature and amount of service performed. Verily, life does not seem to be reckoned as consequential as law.

THE RED CROSS RELIEF COLUMN.

MISS MABEL T. BOARDMAN, the philanthropic Washingtonian who is identified with the American National Red Cross as a member of the executive committee and the executive officer of the emergency committee, has contributed an article to this issue entitled "The Red Cross Relief