cially after impaction of the presenting part, still the criticisms made by Drs. Anderson and Gilbert are just, which I will probably remember in future cases of this kind.

JOHN MASON WILLIAMS, M. D., Secretary.

Abstracts and Selections.

INDUSTRIAL OCCUPATION OF WOMEN AND INFANT MORTALITY.—At a meeting of the Royal Statistical Society, March 15, 1898, under the presidency of the Right Hon. Leonard Courtney, M. P., a very valuable paper was read by Miss Clara Collet, M. A., on the "Extent and Effect of the Industrial Employment of Women." The paper was based upon a careful analysis of the statistics of the occupation of females in England and Wales enumerated and tabulated at the five censuses in 1851-91. Contrary probably to general impressions Miss Collet shows that the proportion of females returned as following definite occupations was lower in 1881 and 1891 than in the three previous census years. The most remarkable change shown in these census returns is the decline in the proportion of women employed in agricultural and farm service, which was in 1891 only one-tenth of that recorded in 1851; marked decline was also shown in the proportion of women employed in silk, worsted, and woolen manufactures, and also in the proportion of seamstresses, owing mainly to the introduction of sewingmachines. On the other hand, an enormous increase has occurred in the proportion of women engaged in the teaching service, and the proportion of those returned as tailoresses, mostly sewing-machinists, also shows a large increase. The paper gives special attention to the evidence afforded by available statistics as to the effect of the industrial occupation of women upon infant mortality. Miss Collet, while admitting that the industrial employment of married women with young children is an obvious evil, after an elaborate and careful investigation which we cordially recommend to the special attention of medical officers of health for industrial populations, corroborates the conclusion expressed some time since by Mr. Noel Humphreys, at a discussion on the subject, that the factory employment of women is not the main cause of the high rate of infant mortality in Lancashire and other industrial localities. Some very interesting tables are given in the paper showing that there is much more constant relation between infant mortality and the social condition of different town populations, measured by the proportion of domestic servants employed, than there is between the proportion of industrial occupations among women and infant mortality. The census returns do not, unfortunately, show separately the occupations of married and single women, which information is to a large

extent necessary to the satisfactory elucidation of the problem dealt with in Miss Collet's paper; by an ingenious method, however, she is able to ascertain the minimum number of industrially employed women in each of the manufacturing populations to which her investigations are principally devoted. The result of these investigations has been to show that no constant relation exists even between infant mortality and the proportional employment of married women in industrial occupations. The effect of industrial employment of women, and even of married women, depends in great measure upon the conditions under which such labor is conducted, and it is not difficult to imagine conditions under which its influence upon infant mortality might be even beneficial, inasmuch as it would make possible better housing, a higher standard of home comfort, and generally more healthy surroundings. There are doubtlessly careful and careless mothers in all classes; but given this admission infant mortality appears to be mainly a class question and bears a far more constant relation to the wages or earnings of the parents than to the proportion of mothers engaged in industrial occupations, which is but one of the many factors which influence this complex question.—Lancet.

INDICATIONS FOR THE OPERATIVE TREATMENT OF HEPATIC TUMORS. Terrier and Auvray (Rev. de Chir., May, 1898,) in considering the indications for operative interference in cases of tumor of the liver, point out that the opportunities afforded to the surgeon of intervening in such instances must be regarded as very rare. In most cases of hepatic tumor the growth is secondary, and an index of generalization of disease, starting in some organ more or less remote from the liver. This conclusion applies not only to malignant disease-such as carcinoma and sarcoma-but also to lymphadenoma, which ought to be considered in a large majority of cases as the local manifestation of a general malady needing an exclusively medical treatment. In most cases of primary cancer of the liver there is a local multiplicity that is to say that, though the liver is the only organ affected, the growths are multiple and disseminated throughout the parenchyma of the gland. It is a necessary condition of success for the removal of any hepatic tumor that the growth be a single one, and also that it be situated at a part of the liver that is readily accessible. It would not be justifiable to attack any tumor deeply situated in either of the two large lobes of the liver. A condition favoring extirpation would be the presence of a pedicle. With regard to therapeutical indications, therefore, the seat of the disease in the liver, the absence or presence of a pedicle, and the existence of one or several growths would be facts of the first importance. The removal of a tumor presenting the above-mentioned favorable conditions for operative interference would still be contra-indicated if such tumor has contracted close adhesions with the abdominal wall or the surrounding abdominal viscera. The authors conclude that a hepatic tumor, whether benign or malignant, may justifiably be removed if it be single, readily accessible,

possessed of a pedicle, and free from adhesions to surrounding structures. The prospects of success are least favorable in cases of cancer, on account of the probability of relapse. In the liver, however, as in other organs, a center of infection constituted by a malignant growth ought to be suppressed, and even in cases in which extirpation would be impossible a palliative operation-cholecystostomy, for example—would be indicated, with the object of relieving functional disturbances, and so of prolonging the life of the patient.-British Medical Journal.

THE PRESENCE IN THE BLOOD OF FREE GRANULes Derived FROM LEUCOCYTES.-M. F. Muller, an assistant in Nothnagel's clinic in Vienna, in 1896 described certain "small, generally round, colorless granules" which he found constantly present in the freshly drawn blood from healthy and diseased persons. These granules are readily distinguishable from blood plates. Dr. William Royal Stokes and Dr. A. Wegefarth conducted a series of observations in the bacteriological laboratory of the Health Department of Baltimore, and their results were published in the Johns Hopkins Hospital Bulletin, No. 81, December, 1897. The paper is now reprinted in pamphlet form. After detailing their experiments the writers sum up as follows: "In the blood plasma and serum of man and many of the lower animals there are present varying numbers of granules which resemble the granules of the eosinophilic and neutrophilic leucocytes in size and appearance. After addition of dilute acids, dilute alcohol, etc., and subjection to body temperature, the granules of the leucocyte assume marked activity, and such treatment increases the number of granules present in these fluids. These free granules are almost certainly derived from the granular leucocytes. The filtration of the serum of the dog and rabbit through new Müncke porcelain cylinders remove its normal property of causing the agglutination and cessation of motility of many motile pathogenic bacteria and of destroying large numbers of these organisms. This property can be partially restored by adding a sediment consisting of leucocytes, free granules, and red blood-corpuscles. Since the red bloodcorpuscles are not germicidal (Buchner) it follows that the restoration of the bactericidal property is due to the addition of the leucocytes and free granules, and that these cells can furnish a germicidal material." From these facts Dr. Stokes and Dr. Wegefarth evolve a theory of immunity, but admit that the proof is extremely difficult to furnish, since filtration of a sediment even through double filter-paper will allow leucocytes as well as granules to pass. They suggest that the bactericidal power of the leucocyte of the blood and of the serum of man and many animals is due to the presence of specific granules, especially the eosinophilic and neutrophilic. These observers think that the granular leucocytes when called upon to resist the action of invading bacteria may give up their granules to the surrounding fluids or tissues. They consider that this theory explains how apparently cell-free fluids can destroy bacteria.-Lancet.

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THE INFLUENCE OF ALTITUDE ON TUBERCULOSIS.

At the June meeting of the American Medical Association Drs. William C. Mitchell and H. C. Crouch presented a paper on "the influence of sunlight on tuberculous sputum in Denver; a study as to the cause of the great degree of immunity against tuberculosis enjoyed by those living in high altitudes."

The chief factors in the benefits received by consumptive healthseekers in the Rocky Mountains are according to these observers: first, dry air; second, diminished atmospheric pressure; third, "the powerful influence of the solar rays." In short, high altitudes present meteorological conditions which inhibit the proliferation of the tubercle bacillus in the body, while at the same time the system is stimulated to increased resistance, and fortifies itself against the invader. Moreover, in the opinion of some the fierceness of the sunbeam in the dry and rarified air is destructive to the germ of phthisis.

Upon the first point the authors say:

Both the absolute and the relative moisture is low in high altitudes, and this together with the lessened atmospheric pressure and almost constant winds greatly facilitates evaporation. Extremely favorable conditions are thus created for the abstraction of moisture by the atmosphere from whatever substances it comes in contact with. The moist surface of the lungs must suffer considerable loss of moisture; and it is this battle for moisture

compensation that we believe to be one of the factors by no means the least important in granting such a large measure of immunity against tuberculosis here, or in arresting or retarding such processes in their incipiency. The tubercle bacilli grow but poorly, if at all, on media deficient in moisture; and while it scarcely seems possible that enough moisture could be abstracted to leave the alveolar linings too dry to offer a suitable nidus for the bacilli, yet it is not improbable that this constant and rapid pulmonary evaporation creates conditions extremely unfavorable to their development.

It is doubtful if there be any scientific force in this statement. The expired air is always saturated with aqueous vapor, whether the surrounding atmosphere be moist or dry, and it is simply ridiculous to talk of a dry pulmonary mucous membrane when the same is reflected over the pulmonary capillaries which are always full of blood. However, the constant draught of moisture from the lungs occasioned by the wind and dry atmosphere exert a beneficial effect by a quickening of all the pulmonary processes, circulation, oxidation, the elimination of aqueous vapor, carbonic acid, etc. The opinion as to the second is as follows:

Increased atmospheric pressure causes the blood to recede from the capillaries of the skin and mucous membranes, thus producing anemia of these parts. The diminished pressure of high altitudes causes greater dilatation of the capillaries, with a resulting mechanical hyperemia. The mucous membranes are often ruptured, and we may have hemorrhages from the nose, mouth, or lungs. The tympanum is bulged outward, the respiratory and cardiac movements are quickened, and muscular movements are facilitated. In short, we have the condition described by adventurous mountain climbers as mal de montagne.

These factors are physiological and acknowledged by all climatologists to contribute forcibly to the resistance of the system to bacterial invasion; but why leave out the most important factor of all, viz., the enormous increase of red blood-corpuscles which physiologically results from the breathing of rarified air, and the demand of the system for more oxygen carriers, and consequent more rapid delivery of oxygen to the tissues?

In the following paragraph the third point is perhaps justly set aside, while the first and second are allowed their merited value:

There are two conditions which militate against the spread of tuberculosis in high altitudes: (1) The powerful influence of the solar rays acting through a thin atmosphere rapidly destroys the virulence of exposed tuberculous matter. (2) The vital functions are so operated upon by the various