rectly or indirectly to the virus used in vaccinating. The same also holds true of cancer and tuberculosis. Careless vaccinating, dirty hands, dirty instruments, failure to wash the skin upon which vaccination is to be performed, handling of the wound by the patient, such as scratching, etc., are all causes for the occurrence of tetanus in a vaccinated person. The operation of vaccination, while it is a simple one, must nevertheless be carried out with extraordinary care. The instruments should be scrupulously clean and the part upon which vaccination is to be performed should be carefully washed with soap, water and alcohol. It is not wise to use the ordinary antiseptic solutions, as they are liable to destroy the efficacy of the virus. We are certain that the prophylaxis which will effectually prevent the occurrence of tetanus in vaccination is cleanliness.-Editorial, Philadelphia Med. Jour.

TONSILLOTOMY RASH.

WYATT WINGRAVE (Lancet, August 31, p. 591) says: An eruption following operations, often referred to as 'surgical rash," is familiar, but its association with the removal of tonsils and adenoids is perhaps not so widely recognized. The writer's records at the London Central Throat and Ear Hospital and notes of private cases reveal 34 cases in seven years. Although this is but a small percentage he is confident from recent experience that they represent only a portion of those which occur. Of the 34 cases, in 3 (which occurred in in-patients) the condition proved to be scarlet fever, while in one diphtheria developed. The remainder were simple non-specific cases.

The eruption generally appears on the second or third day, and is papular, roseolar, or erythematous. It most frequently affects the neck, chest and abdomen, aud sometimes extends to the face and the limbs. The earliest appearance noted was the day following operation, the latest the sixth day. The duration is generally two or three days, but may extend to five. After reaching a maximum the rash rapidly disappears without desquamation but is sometimes associated with intense itching. As a rule there is but slight constitutional disturbance. The temperature was increased only from 1° to 2° F. The blood during the week following the operation with few exceptions showed an increase in the number of the mononuclear white corpuscles.-Med. Reniew.

THE TREATMENT OF RICKETS WITH SUPRARENAL
GLAND.

HÖNIGSBERGER (Munch. Med, Woch., April 16, p. 627) cannot confirm Stoeltzner's estimate of the utility of suprarenal gland in rickets(Review, vol. iii, p. 230). He began with a daily dose of as many centigrammes as the child weighed in kilogrammes and increased this up to double the amount or more. The substance had no specific effect, though the general health was sometimes improved by its action on the circulation and respiratory center. The same result is obtainable, however, with many much cheaper drugs.-Med. Review.

THE DECREASED BIRTH RATE IN FRANCE.

The gradual but steady and progressive decline in the population of France has long excited feelings of distrust and concern among all thoughtful people. Not only is the birthrate smaller than in any European land, but the infant mortality is also extremely high. This state of affairs has been recently recognized by the government as one to which attention must be paid, and steps be taken to provide if possible remedies to combat the evil. According to the New York Sun, November 24, 1901, a debate took place on the subject in the Senate on November 23d, when the Premier, M. Waldeck-Rousseau, accepted in the name of the government, a proposal for the nomination of an extra parliamentary commission, to seek means of increasing the birthrate and diminishing the mortality.

That France has failed to keep pace in point of population with the other large nations of Europe will be clearly evident when it is stated that at the commencement of the nineteenth century France had 26,000,000 inhabitants, Germany 15,000,000 inhabitants, and England 12,000,000 inhabitants. Now France has 38,000,000 inhabitants, Germany 56,000,000, 'and England 41,000,000.

The remedies recommended by one senator were the adoption of fiscal measures in favor of large families, and, above all, of legislation to check the terrible mortality among infants.

The high deathrate among infants is largely attributed to the pernicious habit of baby farming which prevails among the rich and upper middle classes of France, while probably one of the causes of the low birthrate, is the fact that a large number of the French people are too penurious to desire the expense of raising a large family. France, however, has now come to the conclusion that such a system is in the long run one of false economy.-Editorial, Med. Record.

BARRING OUT CONSUMPTIVE IMMIGRANTS.

The case of the man, Thomas Boden, whom the United States Treasury officials ordered to be taken back to Ireland, because he had tuberculosis, which they held to be a loathsome or dangerous disease," and consequently a bar to admission to this country, was passed upon recently in Brooklyn. Judge Edward B. Thomas decided in favor of the ruling of the Treasury Department, and unless the case is appealed the man will be deported. His wife and child will return with him. He arrived here on November 9, 1901. Physicians examined him on his arrival, and whan they reached the decision that he was suffering from tuberculosis he was sent as a temporary patient to the Long Island College Hospital. The Treasury Department, on special appeal, ordered another examination and the original diagnosis was confirmed. It was then ordered that he be deported, but relatives took the case to the United States Court for decision. Medical Record.

THE INVESTIGATION OF THE TETANUS CASES IN

ST. LOUIS.

A special commission, composed of the mayor of St. Louis; Dr. Max Starkloff, health commissioner of the city; the president of the city council; Dr. Merrel and Dr. Chapman, of the board of health; Police Commissioner Blong and Councilmen Speigelhalter, Hoffmann and Gibson, was convened on the afternoon of December 5, 1901. to investigate the recent deaths from tetanus attributed to the administration of diphtheria antitoxin prepared under the direction of the St. Louis Board of Health, At the first session the commission was organized, the mayor being chosen as presiding officer, and the secretary of the board of health being made secretary of the commission. At the second session of the commission, held on December 10th, Martin Schmidt, assistant city bacteriologist, offered startling testimony. According to the press dispatches, he declared that Dr. Amand Ravold, the city bacteriologist, had directed him on October 3d to prepare for distribution the serum secured from the horse "Jim," which had been shot the day before because it had tetanus. "Dr. Ravold told me," said Schmidt, that the serum could be safely used, as the horse had not been affected with tetanus on September 29th, when the drawing was made. I knew," the witness declared, that the serum was poisonous and unfit for use on human beings, but I felt that I could not question Dr. Ravold's order. So I went ahead and carried out the orders."

The witness repeated his recent assertions before the coroner, that the poisoned serum was sent out to physicians without being first tested on guinea-pigs.

"All

"It was difficult to obtain good guinea-pigs," said Schmidt. the available pigs had been used for tests during the summer, and hence were not in a fit condition for antitoxin tests. I do not know of any tests of the last drawing of antitoxin being made. If such tests had been made I would have known of it."

Schmidt testified further that the serum was kept unlabelled in the ice-box and that the drawings at different dates were identified only in the mind of the colored janitor.-N. Y. Med. Jour. Dec. 14, 1901.

THE REPORT OF THE COMMITTEE ON TETANUS INQUIRY IN ST. LOUIS.

The commission appointed to investigate the cases of tetanus following the use of diphtheria antitoxin made an exhaustive report and one well worthy of the importance of the question under consideration. The committee, composed of Drs. Bolton, Fisch and Walden, all competent bacteriologists, arrived unanimously at the following conclusions.

44

sions:

As the result of our investigations we draw the following conslu

The diphtheria antitoxin prepared by the Health Department of the city of St. Louis, and dated September 30, and some of the serum

dated August 24, was the cause of the recent deaths from tetanus in the cases where this antitoxin was used.

"This antitoxin was sterile, but contained the toxin of the tetanus bacillus in considerable amount.

"There were two different sera issued under the date of August 24th. One portion not containing the tetanus toxin and characterized by other properties, while the other contained the tetanus toxin and was identical with the serum bearing the date of September 30.

"The most important result we have arrived at is the positive demonstration that the toxic serum dated August 24 and that dated September 30 are identical. From this we conclude that the serum of September 30 was issued without having been tested by the proper methods, and that a part of it was filled into bottles bearing the date of August 24, or furnished with labels having previously been stamped with this date. We are justified in drawing this conclusion from two observations: First, that the serum of September 30 was issued before there was time to have performed the simple tests necessary to determine the antitoxic potency of the serum; second, in the same way, serum dated October 23 came into our possession on November 1. This serum has been issucd to physicians by the Health Department, and by them returned to the coroner. It is obvious from this that no animal experiments could have been made with this antitoxin. As this was the case with the serum of October 23, it is the natural inference that the serum of September 30 was issued in the same way.

"We must deny any possibility of latent tetanus having existed in the horse "Jim" from August 24 to September 30 as no well authenticated cases have been reported in which the incubation period extended over seven days, in experiments directed to test this point. The period of incubation cannot be determined from clinical observation, from the nature of the case.

"It therefore follows from this that the serum drawn on August 24 was free from tetanus, but that the serum of September 30 was drawn during the period of incubation, and had it been tested upon animals it must necessarily have revealed its toxic properties.

"Frem the foregoing facts we are forced to cenclude that the diphtheria antitoxin prepared by the city Health Department has been issued before it was possible to have obtained results from the absolutely necessary tests, Had these tests been performed the results upon animals would have been such that the serum would not have been dispensed, and the cases of tetanus forming the basis of this report could not have resulted."-Medical Fortnightly, Dec. 10, 1901.

LUMBAR PUNCTURE IN TUBERCULOUS MENINGITIS.

J. K. FRIEDJUNG (Wiener klinische Wochenschrift) is not inclined to attach too great diagnostic or therapeutic value to this procedure. Headache may sometimes be relieved by it, and possibly may be prolonged slightly, but this is doubtful. As regards diagnosis, a clear fluid obtained

on puncture is an indication of a tuberculous rather than a purulent process; but the converse is not true, and cloudy serum may be obtained in cases that are of tuberculous origin. During the stage of irritation the tubercle bacillus is to be found in smears in 33 per cent., in the stage of pressure in 50 per cent., and in that of paralysis in 75 per cent. of the cases. That is during the earlier periods, when its aid is most needed, the method is least helpful, while at the same time when it is likely to give positive results the clinical picture is usually too clearly cut to require confirmation in this way.-Med. Record.

THE VALUE OF THE WIDAL REACTION IN THE DIAGNOSIS OF TYPHOID FEVER IN CHILDREN.

MILTON GERSHEL (Med. Record, Nov. 23, 1901) says that while the value of the Widal reaction is generally recognized and numerous statistics on cases in adults are available, it would appear that the value of the reaction in children has not been sufficiently emphasize, and that there are lacking statistics based on a large number of cases. It is a matter of common knowledge that typhoid fever in children, and particularly in young children, is apt to be atypical in its course and often difficult of diagnosis. Some of the causes of these difficulties are the following:

The temperature curve in children is apt to be irregular or even intermittent; the date of the onset is very difficult to determine. Furthermore, in a number of cases the spleen is not enlarged, and the intestinal symptoms are mild or lacking.

A further cause of confusion is the frequency of enlargement of the spleen in anemic and rachitic children, and the frequency of enlargement of the spleen due to all varieties of enteric trouble, which condition, if the child suffers from prolonged fever, may give rise to an unwarranted suspicion that typhoid fever is present.

A dilution of 1 to 20 was used in all cases. Where the Widal reaction came as a surprise, or in other words, in cases in which typhoid fever had not been seriously considered, the reaction was repeated in the dilution of 1 to 50. Such reactions were always positive. Dried blood was used for all the tests except in a few cases where the Widal reaction remained negative throughout the course of typical cases of typhoid fever. Serum was then substituted for the dried blood with no different result. Altogether, 670 tests were made in 199 cases. Eighty-four of these cases were instances of typhoid fever and the other 115 were febrile cases of the greatest variety, such as miliary tuberculosis, meningitis, pneumonia, endocarditis, septic conditions, etc.

In a number of these the existence of typhoid fever could not be excluded at the outset. In all cases the Widal reaction was made daily until a positive reaction was obtained, or until the diagnosis had been cleared up by other methods.

In the 84 cases of typhoid fever he obtained positive results in 81. In all, 329 examinations were made. In these cases, repeated tests were necessary before 45 of the cases developed positive reactions, while 36