more accurate than elsewhere.

It must be remembered, however, that both Carinan and Case are working for institutions whose financial resources are unlimited.

Skinner of Kansas City has not this advantage, but notwithstanding this fact he is doing most excellent work, and has developed a technique of great value which has the advantage that it can be carried out at a comparatively moderate cost.

The Roentgen ray also plays an important part in the diagnosis of mediastinal tumors, tumors of the chest, pleural effusions, empyemas, aneurism, etc.

Roentgenology has taken its place as an indispensable aid to the practice of both medicine and surgery, but in order to get the best results a considerable armamentarium and a high degree of technical skill is necessary. It is hence justly to be considered as a specialty and in this age of specialization the Roentgenologist must play his part, and this is by no means a small one. 815-816 Brockman Bldg., Los Angeles, Cal.

ABSTRACT OF PAPER READ BE-
FORE OREGON STATE MED-
ICAL ASSOCIATION.
Medford, Oregon, Sept., 1913.

By E. B. Pickel, M.D., of Medford. After hurriedly passing over the various classifications of nephritis from the exudative forms of Bright, through the clinical classification of Rayer, the pathogenic of Rokitansky, and others, the author concludes the question to be unsolved, and that any attempt to change the old nomenclature as adopted by Senator, Bradford and Herrick, is a task of Herculean proportions.

The etiology is held to be an unsettled question, with the toxin of some micro-organism in the ascendancy, while a gastro-intestinal toxaemia is an im

portant factor and heredity a predisposing cause in many cases.

The desquamative stage of scarlatina is in a class by itself as a cause of an acute diffuse type of Bright's disease.

In the symptomatology and diagnosis, the author holds albuminuria to be the cardinal symptom, and lays especial emphasis on the importance of differentiating between the albumen due to contamination of the urine after leaving the kidneys and that of true renal origin. High blood pressure is spoken of as a symptom common to all forms of the disease, but caution is given that other diseased conditions may also show a high record.

The different eliminative tests for the diagnosis are mentioned, but their infallibility is questioned; yet, the phthalein test of Roundtree and Geraghty is considered worthy of use.

In the treatment of all forms elimination is the watchword, with a restricted salt diet in the exudative forms. Care for the heart and vascular system and improve metabolism.

A RECONSTRUCTIVE AFTER WINTER DISEASES.

The unanimity of opinion among medical men in choosing cod liver oil as the reconstructive par excellence after diseases of the respiratory tract proves beyond doubt its value.

The only question which can arise in connection with cod liver oil's employment is the form in which to give it, and this question has been settled in the minds of those physicians who prescribe Cord. Ext. Ol. Morrhae Comp. (Hagee). With this product the patient enjoys every advantage of the raw oil, but is spared its nauseating effects.

Mrs. Wm. B. Middleton and Miss Alice A. Middleton will conduct a general Nurses' Registry, at 1103 West Eighth street.

Board, has had with a co-ordinate branch of the State government are the only basis of dissatisfaction on the part of the Board, and

"WHEREAS, Such an implication is absolutely foreign to the facts of the case;

"RESOLVED, That the formal communication signed by all the members of the Board and ordered transmitted to the Governor at the regular meeting of November 1st, 1913, be furnished to the public press.'

For some time the Board of Control seems to have used its supervision of finances as a sort of club to direct even in minute details the activities of the State Board of Health. This is in contravention of the former plan of permitting the State Board of Health to direct its own affairs so long as it kept within its legislative appropriation. The trip of Dr. Snow to Washington, which later led to his resignation, was made in obedience to resolutions passed by the State Board of Health August 20, 1913. The purpose of the trip was to obtain an increase in the federal appropriation in connection with plague work and the estimate for the expenses of the trip, $257.50, was submitted to the Board of Control and returned with the following statement:

"As the policy of this Board has been to discourage all trips of State officers during the first six months of the Biennial Period and as this policy is consistent with all our rulings previously made in this regard, we are returning the estimates without our approval."

It would seem that the Board of Control could not recognize the urgency of the plague situation nor the necessity for the increased appropriation by the national government except during certain "biennial periods," a policy that approaches the height of the ridiculous.

August 20, 1913, the State Board of Health arranged to send Dr. W. A. Sawyer, Director of the Hygienic Lab

oratory, as its representative to the annual meeting of the American Public Health Association at Colorado Springs. The estimate of the expenses of the trip, $110.00, was rejected by the Board of Control under its "biennial periods" ruling. It is unfortunate that the American Public Health Association cannot faithfully observe this State's "biennial periods" when arranging for its meetings. Dr. Sawyer had been invited to read a paper on "The Prevention of Carriers," a subject with which he has gained national repute through his excellent work in connection with the "typhoid carrier'' Olsen.

December 6, 1913, our State Board of Health resolved to send Prof. Jaffa, Director of the Food Laboratory, to Washington as its representative at the meeting of the National Committee on Cooperation between the state and federal government. The Secretary of the Department of Agriculture had especially requested that Prof. Jaffa be sent to this meeting, since he was one of the three state representatives on the National Committee of five. The estimated expense of the trip, $280.00, was rejected by the Board of Control under its "biennial periods" rule. Ridiculous.

In June, 1913, the State Board of Health filed estimates for printing new editions of the Food and Drug Laws, of a pamphlet on rabies and of one on water supply and sewerage disposal. These were held until after the fifteenth of the month in order to include the new acts approved by the Governor. The estimates were then sent to the Board of Control, by whom they were approved upon condition that the cost be charged to the succeeding "biennial period.'' This meant the transference of $1628.30 from the funds provided by the Legislature for the maintenance of the State Board of Health to the general fund of the State, really a miscarriage of funds on an erroneous basis that may well convey a false impression.

The interference of the Board of Control has extended to many of the minor activities of the Board of Health, thus tending to hamper its work. In March, 1913, a page of copy from the monthly bulletin was returned with the statement: "We have cut out the enclosed report of the Executive Division, copy No. 15, as we do not believe matter of this kind should be inserted in your monthly bulletin." A re-submission of this copy with an explanation of its purpose, and the fact that it has been regularly published for more than a year, met with the same reply. The cost of publishing the page amounted to $2.00.

From this it would appear that the Board of Control assumed the position of editing the State Board of Health's bulletin.

August 23, 1913, the State Board of Health submitted an estimate which included the item: "inspecting and oiling adding machine, $2.50." This was returned with a lucid explanation: "You I will note that we have stricken out the items of expense inspecting and oiling adding machine, $2.50." The following month this item was re-submitted with the explanation that the accuracy of adding machines is not guaranteed unless the manufacturer cleans and oils them, and it was then allowed without comment.

The following is from the communication to the Governor by the Board of Control one year ago, January 6, 1913:

"An audit of the accounts of the State Board of Health for the period beginning July 1, 1909, and ending June 30, 1912, has disclosed certain discrepancies and methods of doing business which it is deemed proper to call to your attention. As a net result of the audit, Dr. W. F. Snow, Secretary of the Board, has been required to return to the funds of the State Board of Health a total of $705.47 to cover discrepancies. At the outset it is the duty

of this Board to make plain to you that although the Secretary had to return this amount, there is no suggestion of any criminal action on his part. The returning of this money by Dr. Snow is the direct result of the vicious system of transacting State business which had grown up in so many departments and institutions.

"Some idea of the inefficiency of the old methods and the confusion arising therefrom can be had from a knowledge of the fact that it took expert accountants the greater part of three months to reconstruct the records of the State Board of Health for the period of audit. In many instances the records were absolutely worthless, admitting of no check or countercheck and presupposing as a part of the system an accurate memory on the part of the person in charge.

"The discrepancies making up the total of $705.47 cover the entire period of audit. There are so many and they are of such a variety that a recitation of them would be in effect a duplicate of the report of the audit by the accountants. Therefore, a copy of the report is hereto attached and made a part of this special report. Steps have been taken to properly formulate the business methods of the State Board of Health and to prevent recurrence of the discrepancies and confusion which have arisen under the old system. Of the amount returned by Dr. Snow, $329.14 has already been deposited to the account of the State Board of Health in the California National Bank. Herewith transmitted to you are a certified check for $350.00 and a check on the bank of Palo Alto for $26.33 to cover the balance of the discrepancies."

The above communication is most decidedly deceptive, to use extremely mild language, and is not especially complimentary to our State Board of Health and its former Secretary. As a matter of fact if no audit had been made, this State would have been ahead over

$100.00 which Dr. Snow would have been out of pocket. It is interesting to note that the basis for this letter is stated by the Board of Control to have required the work of an expert for three months at a cost of $700.00. It is unfortunate that there should be friction between the State Board of Control and the State Board of Health. The members of the State Board of Health serve without compensation, giving freely of their time and experience and guarding the public health of California, and deserve at least fair treatment at the hands of the politicians.

TUBERCULOSIS NURSES.

The free use of tuberculosis nurses during the past few years has proven the most effectual means of reducing the mortality and morbidity from that disease. Employing 165 tuberculosis nurses, New York City reduced the number of cases of tuberculosis from 32,065 in 1910 to 22,752 in 1912. The death rate from pulmonary tuberculosis in Manhattan and the Bronx fell steadily from 427 per hundred thousand of population in 1881 to 190 per hundred thousand in 1912, a reduction of fiftyfive per cent. In a personal communication Dr. Hermann M. Biggs, the General Medical Officer of the City of New York, states that "one of the most important features of the administrative control of tuberculosis consists in the continued supervision of the cases by nurses. In this city, we thus supervise all such cases under the care of private physicians and these we keep track of by writing to the physicians several times a year asking whether the patient is still under his care and, if not, whether he has any objection to our attempting to trace the whereabouts of the patients.

"The ends sought to be accomplished by having a nurse visit the patients in their homes, are several. In the first place, accurate information is required

concerning the home conditions, that is, the number of rooms, sanitary condition, income of the family, etc.

"In the second place, we attempt in this way to secure knowledge of other cases.. The nurse makes careful inquiries concerning the other members of the family and urges that all of the members of the family visit the tuberculosis clinic of his district in order to ascertain whether or not they are infected. In this way, early cases are often brought to light and these, of course, are then offered sanatorium

care.

"Still another end in view, is to trace, if possible, the source of the infection and to discover whether the patient originally reported is a primary or secondary case.

"The work of our tuberculosis nurses has been so eminently successful that we do not see how any effective tuberculosis work can be carried on without them."

Following this lead, a number of eastern cities, notably Buffalo, Cleveland, Boston and Baltimore, have markedly increased their number of tuberculosis nurses. After studying the local condition, in Los Angeles, it would seem that we ought to have about the same number as Buffalo, seventeen (a head nurse and sixteen nurses). At present Los Angeles has only one tuberculosis

nurse.

In 1911 Buffalo had a population of 435,315 and the deaths from pulmonary tuberculosis numbered 500. Buffalo at that time had the corps of tuberculosis nurses, for which Los Angeles is now pleading and was seeking better hospital facilities for the few remaining cases. Under the circumstances it is interesting to note the following from Health Commissioner Fronczak's annual report:

"Can we continue to lose 500 people annually-men and women who otherwise ought to be the very flower of humanity, because the tax rate is liable