and legs were edematous. The child, then two and a half years old, had been brought up from birth on "maternized" milk. After this diet had been exchanged for one of ordinary boiled milk, with potato, lime-juice, and even a little raw meat the scurvy disappeared and a general improvement in health supervened. The other paper was communicated by M. Miele to the Flemish Medical Congress held at Antwerp in September. In it the writer discussed the etiology of rickets. He referred to the connection commonly observed to exist between this disease and artificial feeding in infancy. He noticed also the toxicity exhibited by the urine in many cases of dyspepsia, and he based on these facts a belief that the dyspeptic basis which underlies the rachitic state really implies a toxic absorption. The result of this is a blood-dyscrasia, and this again gives rise to malnutrition of tissue cells in the bones and viscera and to all the rachitic phenomena. He quoted two cases of myxedema in children, both attributable apparently to a rachitic perversion of growth in the thyroid gland. This hypothesis, whether we accept it in all its details or not, is by no means an unreasonable explanation of the undoubted association of rickets with an improper dietary. It is notorious that a system of artificial feeding during infancy is becoming very general in this country, and that it even amounts in some cases to the virtual exclusion of natural milk from the daily diet. This practice implies a departure from the normal method which can not but be viewed with grave anxiety. There may be cases in which it may answer for a time as a temporary expedient in the case of delicate children, but it is always needful to remember that such methods at best are unnatural, and, if employed, must be closely watched and discontinued in favor of a natural milk diet as soon as this can be borne. Otherwise we shall in time come to see more of the still uncommon disease known as scurvy rickets.-The Lancet.

PREPARATIONS MADE FROM BLOOD.-The idea of making use of blood or some element of the vital fluid as a reconstituent medicine commends itself naturally, as is shown by the old practice of drinking bullock's blood, but Dr. W. Rosenstein (Deutsche medicinische Wochenschrift, 1899, No. 17; Centralblatt für innere Medicin, October 14th) thinks that it rests on a false assumption, for it has not been shown that the iron of blood is absorbed from the stomach. Blood preparations can prove effective, he says, only when given by intravenous or subcutaneous injection, and neither of those methods of administration is suitable for general use.-New York Medical Journal.

SHORTENING THE ACADEMIC AND Professional CoURSES.-In view of the present agitation of the question of students studying for the degree of Bachelor of Arts being allowed to substitute work in the professional schools of law and medicine for the regular college studies during their junior and senior years, the Council of the University of the City of

New York, at a meeting held November 6th, resolved to make a request to the State Board of Regents to take action in the matter and determine how far this should be permitted. Chancellor MacCracken expressed the opinion that the adoption of such a plan would not affect institutions which, like the University, were provided with professional schools, but might be disastrous for the smaller colleges without such departments.Boston Medical and Surgical Journal.

DEATHS AFTER COMPULSORY VACCINATION.-Two deaths, one at Geneva and the other at Brewsters, which have lately been paraded in the newspapers as the result of "compulsory vaccination," have been investigated by the State Board of Health and found to have been due to neglect, ignorance, and filthy habits of the parents of the children, who entirely failed to carry out the instructions of the physicians performing the vaccinations. One of the children died of tetanus and the other of septicemia. Ibid.

THE PLAGUE.-There are apparently no cases of plague now in all Egypt, and there is no reason why Europe should not relax all quarantine measures, but no one must stop careful inspection both here and at all European ports. The study of the Alexandria cases confirms the belief that plague is a place disease, probably connected with the soil. Also it looks. as if man himself was not the chief agent in the propagation of the disease, though this does not necessarily apply to his clothing, bedding, and carpets. The Lancet.

FOOD ADULTERATION.-The United States Senate Committee on Manufactures, consisting of Senators Mason, of Illinois, Wetmore, of Rhode Island, and Harris, of Kansas, which is conducting an investigation into the matter of food adulteration, and which has previously held sessions in Washington and Chicago, began to sit for the taking of testimony in New York on November 11th. The committee is assisted by Dr. Wiley, the chief chemist of the Government.-Boston Medical and Surgical Journal.

DEATHS OF EMINENT FOREIGN MEDICAL MEN.-The deaths of the following eminent foreign medical men are announced: Dr. Borysiekiewicz, Director of the Ophthalmic Clinic and Professor of Ophthalmology in the University of Gratz, at the age of 50 years; Dr. Berti, Assistant Professor of Surgery in the Modena Medical School; Dr. Jules Simon, of Paris; Dr. Taulier, of Avignon, Senator for Vaucluse.-The Lancet.

TWO PHYSICIANS in Frankfort, Ind., have been prosecuted for failure to file birth returns in accordance with the vital-statistics law. One was fined $18.80, and the other was discharged on his oath that he had filed the required report, and had sent it in by mail.-Jour. A. M. A.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

THE ETIOLOGY OF ACUTE DIFFUSE PNEUMONIA.*

BY WILLIAM N. BEGGS, A. B., M. D.

Professor of Clinical Diseases of the Chest and of Pathology in Gross Medical College, Denver, Col. Inasmuch as the consideration of the etiology of pneumonia is inseparably connected with its pathology, I shall first present the pathological classification which to me appears the most rational at the present time. We are, of course, familiar with the general classification of acute pneumonias into lobar and lobular, or croupous and catarrhal, and I need not give their anatomical characteristics. We are also well aware that the terms lobar and croupous and lobular and catarrhal are not absolutely synonymous. While we have understood that as a general rule croupous pneumonia is lobar and lobar pneumonia croupous, and that catarrhal pneumonia is lobular and lobular pueumonia catarrhal, we have also, of course, known that this is not a rule without exceptions. Catarrhal pneumonia may involve an entire lobe, croupous pneumonia may involve less than a lobe, or even have a lobular distribution.

and

Recently attempts have been made to attain a more exact classification of the pneumonias, and some confusion has arisen as to the exact characterization of some of the members of this group. Thus Aufrecht, in Volume XIV of Nothnagel's Specielle Pathologie and Therapie (just

*Read in symposium on Pneumonia at Colorado State Medical Society, June 22, 1899.

appeared), gives the following classification of the acute diffuse affections of the lungs :

(a) Croupous pneumonia.

(b) Catarrhal pneumonia (hitherto also called lobular pneumonia). (c) Atypical pneumonia (hitherto called infectious, bilious, or asthenic pneumonia, or pneumo-typhus).

(d) Hypostatic pneumonia.

(e) Aspiration pneumonia.

(ƒ) Desquamative pneumonia. (g) Syphilitic pneumonia.

Disregarding the syphilitic affection, we see that he separates the atypical pneumonias from the croupous, and the hypostatic, aspiration,' and desquamative from the catarrhal, with which they have generally been classed. Now they certainly do present some different characteristics from the typical paradigms of croupous and catarrhal pneumonias; there are a number of different bacteria forming the etiological factors; but it is just to question whether they are anatomically essentially different or not. If they are, this classification is correct; if they are not, it is unjustifiable.

Some difficulty in arriving at a generally accepted classification seems to be due to the tendency on the part of some to exact a sharp differentiation between the different types of inflammation. That is, however, not always possible. Pathological processes overlap each other just as normal animal and vegetable varieties do. Therefore, in deciding upon a nomenclature it is necessary to make use of the rule "de potiori denominatio fit"-the nomenclature is determined by the chief characteristics. For example, in an inflammation "escape of fluid on the surface of a mucous or serous membrane gives the picture of a serous catarrh. If the fluid is associated with marked mucoid change of the superficial epithelium and of the mucous glands, there is a mucous catarrh. If a marked desquamation of the epithelium with or without mucoid change occurs, there is a desquamative catarrh, and it may occur not only in mucous membranes, but also in the respiratory parenchyma of the lungs, on serous surfaces, in the kidney tubules. If the deposition of fibrin or coagulation occurs in a liquid exudate, there are formed fibrinous or sero-fibrinous exudates, which are also called croupous. They occur chiefly on the surface of serous or mucous membranes and in the lungs." (Ziegler.) Now these seem to be easily enough distinguishable one from the other, and they are as

a rule. However, we sometimes find more than one of these characteristics associated, and we may experience some difficulty in the classification. Thus we know that the coagulating exudate is, par excellence, the characteristic of the so-called croupous pneumonia, and the non-coagulating exudate that of the catarrhal pneumonia in its various forms. Nevertheless we may find exquisite examples of coagulative exudate in pneumonias which we could not possibly designate as croupous, and which, on account of the preponderating characteristics, we must call catarrhal. (Orth.)

Fibrinous pneumonia is not always spread over large portions of the lung, but there are also very circumscribed, even lobular fibrino-pneumonic foci; these may also be multiple, as occurs in the so-called wandering pneumonia. Stengel says "there are wide variations, however, for, on the one hand, typical fibrinous pneumonia may occasionally appear as a more or less lobular disease (particularly in influenza), and, on the other hand, the process may spread from one part of the lung to another (pneumonia migrans)." Ritter, in the report of a small epidemic of pneumonia, seven cases affected, three fatally, gives (according to Aufrecht) the following as the pathological conditions in the fatal cases: "There was in one case grayish red lobular hepatization of the lungs; in the second, grayish red croupous hepatization of the lungs. In many places the macroscopical appearances corresponded rather with those of a catarrhal pneumonia, but nevertheless the microscopical examination showed, as in both the other cases, that it was a case of flaccid croupous pneumonia." According to Leichtenstern, "all these atypical pneumonias are only varieties of the endemic-epidemic croupous pneumonia." In prebacterial times, however, he regarded them as decidedly different and separate diseases.

In a similar manner Aufrecht, not finding in aspiration pneumonia, hyostatic pneumonia, and desquamative pneumonia certain of the anatomical characteristics, especially one which he finds in the typical catarrhal pneumonia of early life, excludes them entirely from the class of catarrhal pneumonias; this, too, notwithstanding the fact that one of them especially (the aspiration pneumonia) has been almost universally regarded as a typical form of catarrhal inflammation. He says that the "gross anatomical characteristics must be regarded as the sole cause for the identification of these two processes. In this, however, the differences in the etiological factors and what is dependent thereon, the different classes of the individuals affected-catarrhal pneumonia gen