Notes and Queries.

THE STATIStics of the Serum Treatment of DIPHTHERIA.—Photiades (Arch. Generales de Med., January, 1898,) shows that recently endless confusion has arisen in the study of diphtheria. In place of Trousseau's clinical classification of sore throats into true diphtheritic angina as opposed to toxic, infective, and malignant angina, the presence of Loeffler's bacillus is now sufficient to fix the diagnosis of diphtheria. To adapt the new facts of bacteriology to one's clinical knowledge becomes more and more difficult. For instance, Gouguenheim finds diphtheria to be much more common in adults than is usually supposed; besides, in its membranous form it occurs commonly as lacunar tonsillitis. He says every acute case of sore throat should be examined bacteriologically for fear of missing diphtheria. A harmless catarrhal angina may reveal Loeffler's bacillus (Gahli and Deucher). There are typical and atypical Loeffler's bacilli; typical but not virulent pseudo-diphtheritic bacilli (Park). Virulent Loeffler's bacilli may cause a local non-contagious disease, fibrinous rhinitis (Scheinmann). The pseudomembrane, formerly the clinical and pathological criterion of diphtheria, is not a product of a specific bacillus, but may be produced by streptococci, staphylococci, or the bacterium coli. The B. diphtheriæ is hardly ever present alone (Danelo and Ruault). Severe septic diphtheria is not caused necessarily by an associated infection, for in some cases streptococci can not be found in the internal organs, and when they are, the symptoms during life may not have pointed to septic diphtheria at all (Kuttner and others). After all this it is not surprising that statistics have been made to prove (1) that the serum treatment has almost suppressed mortality, (2) that since this treatment was begun the mortality is as high as ever. Thus, without considering the conflicting statistics of individuals, it has been shown that the serum has increased the mortality at Trieste, St. Petersburg, and Moscow, has diminished it enormously at Paris, Berlin, Vienna, and Buda-Pesth, and has had no influence on it at Leipzig, Milan, and London. In America, Coakney has shown for Boston, New York, and Brooklyn (1) that the declared cases of diphtheria have increased enormously; (2) that though the relative mortality (percentage of declared cases) has diminished since the serum treatment, the absolute mortality calculated on the total population is as high as in the worst years since 1882. Though the public demand that every clinician should have an opinion as to the value of serum, either for or against, statistics are perfectly useless up to now in helping him to form one. He must therefore fall back on his own resources, which are those of clinical empiricism. It is enough for him that the serum acts, and that chance has been excluded from the cases where it

succeeds, that is, he must consider the individual, not masses of statistics. No one who has seen the membrane clear up, the natural voice return if the nares are involved, and convalescence begin within forty-eight hours in a case which experience shows to be very severe, can doubt the good done by the serum. Its failure in certain cases is no reason for doubting its use. Every thing points to the fact that diphtheria toxins vary greatly in virulence. and it is possible that bacteriology may prove eventually that some diseases considered absolutely specific are not so. For this, theories of bacterial symbiosis have prepared us, and Windrath has shown that there is nothing specific in the toxins of specific bacteria. It accords with this, that the author has often used the serum in cases which were clinically severe diphtheria, but where bacteriology showed streptococci to be in the majority, with as much success as in those caused by Loeffler's bacillus alone.-British Medical Journal.

ALMSHOUSES IN MASSACHUSETTS.-The report of the Board of Lunacy and Charity of Massachusetts lays bare a startling state of affairs, and one that it is difficult to credit in our advanced stage of civilization. Over two hundred towns and counties maintain almshouses, the best managed of which makes no provision for the separation of the sane and the insane. This is bad enough, but the report goes on to state that in some of the almshouses it was found that there was not only no provision for the separation of the sane from the insane, but the sexes even were not separated by day or night, and the children were allowed to mingle at will with the adults. In those almshouses where the pretense was so palpable as to render it immoral in itself. Various effort have been made at different times to induce the legislature to introduce the necessary reforms, but, owing to the action of an interested opposition, have up to the present effected no satisfactory result. This report should open the eyes of the public to so scandalous a condition of things, and should tend to bring about the much needed alterations in the rules now controlling these institutions. A State that has been one of the foremost in inaugurating reforms should surely relinquish the old-time method of classing pauperism and crime in the same category, and compelling those whose only sin is to be old or crippled to herd with the scum of the earth.-Medical Record.

THE SERUM DIAGNOSIS OF ENTERIC FEVER.-Levy and Gissler (Münch. med. Woch., December 14, 1897,) describe their method of carrying out Widal's test. The typhoid bouillon culture should not be older than ten to twelve hours; otherwise there is danger of a pseudo-agglutination. The authors maintain that finid serum should be used in preference to dry blood. An observation period of two hours is sufficient. In a typhoid epidemic the serum reaction gave a positive result in one hundred and five out of one hundred and fifteen cases. The authors investigated these cases in such a way that one of them made the bacteriological examination and

the other the clinical, and then they compared notes. All the one hundred and five cases showed the clinical characteristics of enteric fever, whereas the remaining ten did not. When it is considered how difficult it is to exclude errors of diagnosis in an epidemic, the value of the test becomes obvious. Two cases were particularly instructive. The diagnosis lay between enteric and puerperal fevers. In the one case the patient was admitted after fourteen days' illness, and Widal's test was positive. Besides a puerperal endometritis, the characteristic lesions of enteric fever were found after death. In the other case the patient was sent in with the diagnosis of enteric fever, but the reaction was negative. At the necropsy a puerperal endometritis was found, but no lesions of enteric fever. A table is appended showing the details of the various cases. In none of the genuine cases did the reaction fail. The serum reaction enabled them to distinguish between diseases with symptoms resembling enteric fever and the abortive forms of the disease itself. In ten of the eighteen cases it made the diagnosis possible in the first week; of the remaining eight, five were not enteric fever, and three gave the reaction later. Of twenty-six examined in the second week of the illness, the reaction was positive in twenty-two, and the remaining four proved not to be typhoid. Of twentysix in the third week, twenty-four were positive, and the remaining two turned out not to be typhoid fever; sixteen examined in the fourth week, thirteen in the fifth, seven in the sixth, ten in the seventh, and five in the eighth, all gave positive results, and the disease presented the characteristics of enteric fever.-British Medical Journal.

A CASE OF ERYTHROMELALGIA (Weir Mitchell's Disease).-Dr. Rost, Prof. Oswald's assistant at the Augusta Hospital, Berlin, recently presented a case of this rare disease at the Verein fur Innere Medicin. As he has been able to find only some forty cases of it altogether in the literature, each case is of special interest. It aroused a good deal of attention and was carefully observed by most of those present. The opinion expressed by Dr. Rost, which seems to be that generally held here by the internists, is that of Dehio: He considers it an independent disease and due to a state of irritation of the cells of the anterior horns at certain levels in the cord. Some time ago a series of articles from Vienna claimed that it was a symptom-complex with intimate relations with such other affections as Raynaud's disease and the neurotic edemas. This view does not seem to meet with much favor in Germany, and its independent character as a disease with probably a special functional disturbance at least of definite anatomical elements is conceded.--Philadelphia Medical Journal.

HEREDITARY LOCOMOTOR ATAXY.-Kalischer, at the Berliner Gesellschaft fur Psychiatrie (Neurol. Centralblatt., December, 1897,) showed a mother and son, aged fifty-one and twenty-seven years respectively, both suffering from typical locomotor ataxy. There was nothing whatever to

suggest syphilis either in the history or in the patients. In the mother the disease began at thirty-one years; in the son at twenty-six years of age. Other cases have been recorded in which the children of parents who had locomotor ataxy showed symptoms of the disease much earlier than in Kalischer's case, but it is pointed out that in children the diagnosis must be made with caution, as Friedreich's disease is easily mistaken for locomotor ataxy. The writer has been able to find two such cases where the diagnosis and hereditary locomotor ataxy in children seemed certain, and other doubtful cases are mentioned.—British Medical Journal.

INFLAMMABLE COMBS.-The Lancet of March 5th warns the public against the dangers of celluloid combs, citing one case in which severe burns were caused by the comb which was ignited by curling tongs. Experiments showed that these combs readily ignite by the degree of heat usually given the curling irons in use by ladies.

THE BORELLI INSTITUTO IATROMECCANICO, named in honor of the anatomist and physiologist Alfonso Borelli, of Naples (1608–1679), and designed for the practice of muscular therapeutics and the prosecution of physical education on a scientific basis, was recently opened in Rome.

THE ROENTGEN RAYS IN COURT.-A judge of the Superior Court of Connecticut recently refused to make a ruling in a damage suit to compel the application of the X-rays to test the question of injury to a bone. Expert testimony had been introduced to show the value of the rays in such

cases.

AMERICAN MEDICAL ASSOCIATION.-Dr. C. C. Fite, New York, N. Y., has resigned as Secretary of the Section on Materia Medica, Pharmacy, and Therapeutics of the American Medical Association, and Dr. Leon L. Solomon has been elected to fill the unexpired time.

THE OHIO STATE MEDICAL SOCIETY will hold its annual meeting at Columbus on May 4, 5, and 6, 1898, under the presidency of Dr. William H. Humiston, of Cleveland. Addresses will be delivered by Drs. Senn, of Chicago, and Hare, of Philadelphia.

ARTIFICIAL IMPREGNATION.-The Catholic authorities at Rome have rendered a descision forbidding the practice of artificial impregnation, devised by Sims. The reasons for this prohibition are not stated in the decree.

DEATH OF PROFESSOR STRICKER.-The cable reports the death of Prof. S. Stricker, professor of General and Experimental Pathology and Therapeutics in the University of Vienna. He was born in 1834.

ASSOCIATION OF AMERICAN PHYSICIANS.-The thirteenth annual meeting of this association will be held in Washington, on May 3, 4, and 5, 1898.

Special Notices.

ARISTOL INSTEAD OF IODOFORM.-Dr. Geo. L. Servoss, of Indianapolis, contributes the following interesting report from his practice: "In several cases of traumatism coming under my observation it has been my misfortune, when using iodoform, to see marked symptoms of iodoform poisoning, which disappeared when this drug was discontinued and replaced by aristol. Two cases in particular are worthy of note. J. R., a man of about forty years, was thrown from a carriage, receiving a scalp wound. After washing the wound carefully with bichloride solution 1-2,000 and shaving the adjacent parts, I inserted three or four stitches and applied a dressing of iodoform and iodoform gauze. In twenty-four hours the wound appeared inflamed and irritable. Thinking that it was possibly due to iodoform irritation, I used aristol instead, and encountered no further trouble, the irritation subsided and the wound healed rapidly. The second case was that of a young man, eighteen years old, who had scratched his finger on the tin binder of a butter tub cover, the wound receiving only passing attention at the time. In the course of four or five days, however, the finger began to swell, and when he came under my observation there were symptoms of purulent infection, which necessitated opening at several points, washing out with hydrogen peroxide and other antiseptic solutions before suppuration ceased. When the wound became healthy I used an iodoform dressing, which was followed by an erythema that persisted until aristol was substituted, after which I experienced no further trouble, all irritation disappearing." In conclusion Dr. Servoss says: “This being my experience in these and many other cases, I have almost abandoned iodoform and am using aristol almost exclusively. I have yet to see a case in which the least irritation has followed its use."

PETROLEUM EMULSION.—Although the medical properties of petroleum have been known since a very early date, yet it is only within a few years that the remedy has been prominently brought to the attention of the profession. There can be no question whatever but that petroleum is an oil which is digested and absorbed like any of the fatty foods. The oil is emulsified by the pancreatic juices and absorbed by the lacteals. The Angier Chemical Co. put petroleum on the market in the form of an emulsion because they believe that as the process of emulsifying thoroughly breaks up the oil into minute particles, it thus predigests it and puts it in a condition so that it can be absorbed at once. The Angier emulsion has combined with it the well-known hypophosphites. Each ounce of the emulsion contains 33% per cent of purified petroleum and twelve grains of the combined salts of lime and soda. In consumption, bronchitis, and in all the various diseases of the pulmonary tract, experience shows this preparation to be of great use.

NEURECTOMY FOR TIC-DOULOUREUX.-Bernay's "Report of a Surgical Clinic," complimentary to the Members of the Mississippi Valley Medical Association, contains the following in reference to his patient's condition and treatment before neurectomy for tic-douloureux was decided upon:

"Case 5. The patient, aged fifty, white, female. Family history: Has one sister who suffered from emotional insanity; otherwise the family history is good. Previous health excellent. The present trouble began with a severe neuralgic toothache, localized in the right lower molars. Paroxysms of pain were of daily occurrence, and most severe in the mornings about breakfast time. The pain subsided temporarily