ially that portion about the ureteral orifices, and the character of the urine flowing therefrom.

6. Contrary to the opinion expressed in the majority of textbooks, a great majority of the infections both of the bladder and of the kidney are associated with acidity of the urine —that is, are due to microorganisms which do not split up the urea.

7. Probably in the majority if not in all the cases of renal infection due to a urea-decomposing microörganism, after the condition has lasted for a certain length of time, a stone is formed by the decomposition of the precipitated salts about the bacteria as a nucleus.

8. And finally, to be able to thoroughly understand the cases of cystitis, pyelitis and pyelonephritis brought to our notice, to make the proper diagnosis, to inaugurate and carry out a rational line of treatment, to be conversant with the proper means of prophylaxis, and to give a correct prognosis, a careful chemic, microscopic and bacteriologic study of the urine is absolutely essential.

The Complications and Degenerations of Fibroid Tumors of the Uterus as Bearing upon the Treatment of Those Growths. C. P. Noble (Am. Jour. of Obstet., &c., vol. 44, no. 3) in concluding a paper with the above title, says:

It is gratifying to contrast the results which can be secured through the resources of modern gynecology with those which would follow an expectant plan of treatment. The mortality of hysterectomy and myomectomy is variously estimated at from two to ten per cent. In a series of 345 cases published by myself in 1897, the mortality of hysterectomy by supravaginal amputation in the hands of five American gynecologists was 4.9 per cent.; in a series of 100 total hysterectomies the mortality was 10 per cent. In a collection by Olshausen of 806 cases of supravaginal amputation, the mortality was 5.6 per cent., contrasted with a mortality of 9.6 per cent. in a collection of 520 cases of total extirpation. According to Bishop, Mr. Christopher Martin reports 35 cases of total extirpation, with a mortality of 2.8 per cent.; Doyen 60 cases, with a mortality of 2.6 per cent.; A. Martin 81 cases, with a mor

tality of 7.4 per cent. The advocates of vaginal hysterectomy for fibroid tumors report equally as good, if not better, results.

The results of myomectomy indicate that enucleation is a more dangerous operation than hysterectomy, although in the hands of trained men the results are excellent. Kelly reports 97 myomectomies, with 4 deaths. This is to be contrasted with 307 hystero - myomectomies, with 15 deaths, or a mortality of 4.8 per cent. MacMonagle reports 65 cases of myomectomy, with no death.

CLIMATOLOGY AND PHTHISIOLOGY.

UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., Boulder, Col.

Tuberculosis in Animals in Some of Its Relations to Human Tuberculosis.

Salmon (Journal of Amer. Med. Assn., vol. 37, no. 8) gives some telling statistics upon this subject. The slaughterhouse statistics of Prussia give 14.6 per cent. of cattle and 2.14 per cent. of swine to be tuberculous; in Saxony 29.13 per cent. of cattle and 3.1 per cent of the swine. In Belgium 48 per cent. of cattle reacted to tuberculin. Of 25,439 tested in Denmark, 49 per cent. reacted.

In the United States not so great a proportion are tuberculous, but the disease is spreading, and will continue to spread unless vigorous measures are taken to stamp it out. The class of animals most infected are breeding animals and dairy stock. There can be no doubt that tuberculosis in cattle has been increasing in this country during recent years.

The importance of maintaining the source of our food supply free from all disease is recognized by every physician: and when that disease is communicable, fatal to man and surpasses all other diseases in the mortality which it causes the human race, are we likely to urge with too great seriousness its effectual control?

It is acknowledged that there are slight differences in the morphologic and physiologic characters of the bacilli of human and bovine tuberculosis; the bovine bacilli are more virulent for experimented animals, and the human bacilli are inocu

lated with difficulty upon cattle and usually produce a mild and circumscribed disease. From this there has been a tendency to conclude that the two are distinct diseases, and that bovine tuberculosis may be disregarded as a source of the human plague. To me this reasoning appears most unsafe and illogical.

There is probably no pathogenic microbe that undergoes greater modifications in the laboratory under various conditions of environment than the tubercle bacillus, and this is illustrated by the difficulty with which the first cultures from a diseased subject are obtained, and the ease with which it is grown upon a variety of media after it has been gradually accustomed to the changed conditions of existence. If it so readily varies its requirements in the laboratory, is it not reasonable to suppose that it may, in an equally short time, be modified to as great, or to a greater, extent in the bodies of different animals? And if the bovine bacillus is more virulent for cattle, sheep, goats and swine, may it not also be more virulent for man?

That the air of infected cow stables is a bearer of bacilli, is abundantly proved by the spread of the disease among the cattle of such stables, since post-mortem examinations prove the majority of infections among cows are through the respiratory organs. And we need only to state that men are often exposed to the atmosphere of these stables.

The muscular tissues of animals probably do not contain the bacilli in sufficient numbers to be infective, except in cases of generalized tuberculosis, and generalized tuberculosis is rare.

Investigations by different men show that 30 to 40 per cent. of tuberculous cows yield milk with bacilli in it; and the milk of one such cow may be sufficient to infect a whole village. The milk of such animals produces tuberculosis in guinea pigs, swine and calves when fed to them; will it do the same when drank by man? If it is true that bacilli-bearing milk produces tuberculosis in mankind, there should be an increase in the forms of tuberculosis due to infection through the intestinal tract. Sir Richard Thorne-Thorne has made this clear in the Harben lectures for 1898. He shows that in England. and Wales, between the periods 51-60 and 91-95, there has

been a reduction of mortality for all ages of 45.4, while the mortality from all forms of tuberculosis has been distinctly less, viz., 39.1 per cent. Taking that form of the disease registered under the name of tabes mesenterica, the reduction at all ages has been but 8.5 per cent. ; under 5 years the reduction has been but 3 per cent., while under 1 year of age there has been an actual increase of 27.7 per cent. This is the milkdrinking age, and this increase is significant.

The Therapeutic and Diagnostic Value of Tuberculin in Human Tuberculosis.

G. A. Heron (Med. Press & Circ., vol. 73, no. 3251) says that in his hospital experience, Virchow's opinion that tuberculin caused destruction of the tissues around tuberculous centers, and so set free the bacillus to do its work upon healthy tissues, is not supported, for he has not observed any evidence of resulting spread of disease to seemingly healthy organs, or to neighboring tissues. He states that tuberculin has fallen into discredit, in his opinion: 1. By its frequent use in unsuitable cases. 2. By its administration in too large doses. 3. By neglect of the rule that a dose of it should never be given until the patient's temperature has been normal for the previous twenty-four hours at least. 4. By neglect of the rule that the dose of tuberculin should never be increased, but on the contrary should be diminished, when its administration has been followed by a rise in temperature. 5. By the prej udice raised against the remedy, among both doctors and patients, because of the severity of the symptoms which not seldom follow upon its use.

Since the end of 1890, 57 cases have been treated with tuberculin by him at the City of London Hospital for Diseases of the Chest. 51 of these were examples of tuberculosis of the lungs, and 6 of lupus vulgaris. Of these, 5 of the lupus cases and 27 of the others were treated with old tuberculin. 1 case of lupus and 24 cases of tuberculosis of the lung were treated with the new tuberculin. At the end of the year 1900, 17 of the 51 cases of lung disease had been lost sight of, practically from the time they left the hospital. 16 of the remaining 34 were then known to be well and earning their living.

The question is not whether consumptives leave a hospital well or ill, but is, How many of these people are able to work

for their living, and for how long a time did they continue to gain their livelihood? The return to useful life of 16 out of 34 cases of tuberculosis of the lungs is not altogether an unsatisfactory result of treatment, and this result was obtained with the help of tuberculin. 10 of these 16 cases of recovery are known to have remained well and able to work for seven years, 3 for over three years, and 3 for nearly two years. Other patients remained able to work for periods varying from a few months to eighteen months, but as they are known to have broken down in health, they are not included among the sixteen cases of apparent recovery.

32 of these 51 cases left hospital in 1891. Seven years after, June, 1898, the information concerning these cases, obtained for the most part by the assistant medical staff and nurses of the hospital, was as follows: 8 of them were dead, 10 were well, 1 relapsed in 1897, having remained well until autumn of that year, 13 were lost sight of very soon after they had left hospital.

These patients were all treated with the old tuberculin.

In addition to these 32 cases, 5 cases of lupus vulgaris were then treated with the old tuberculin. These cases all did remarkably well up to a certain point, and then, at longer or at shorter intervals, suffered relapse. In 1 of the 5 a relapse did not set in until more than a year after patient left hospital, and she would not return for treatment because she said she could not afford to give the time necessary for this purpose.

Since March, 1897, the author has used only the new tuberculin. During that year 10 cases were so treated in the hospital; 2 of these cases died. The remaining 8 cases were made up of seven examples of tuberculosis of the lungs and 1 of lupus vulgaris. They all did very well, and without exception left hospital, urging as their sole reason for leaving their fitness for work and wish to resume work. In December, 1900, three years after treatment, the following was the result of the use of tuberculin in these 10 cases: 2 were dead, both of them recognized as being hopeless cases from the first; 3 were well and supporting themselves by their work; 3 were lost sight of; 1 remained well until lately, and returned to hospital a few weeks because of a recurrence of the disease.

In 1899, 10 patients, 5 men and 5 women, were treated in the wards with the new tuberculin. Of these 5 women 2 are are known to be still in good health; 1 of the 2 is a domestic servant, the other is a shorthand writer and typist; 2 other women are reported to have broken down in health; the fifth has not been heard from since she left the hospital.