DR. BILLINGS TO BE RETIRED.

The New York Medical Journal thus refers to the retirement of Dr. Billings from the public service:

"We learn that Deputy SurgeonGeneral John S. Billings, of the army, has requested that his name be placed on the retired list, and that in October that distinguished officer will leave the Army Medical Museum, of which he is curator, and the Library of the Surgeon-General's Office, of which he is librarian, and these magnificent institutions, that have been made what they are largely by his ability and zeal, will know him no longer. Thus goes the last of the trio-Woodward, Otis and Billings, that gave the army medical corps world-wide reputation.

"Before the date he has selected for his retirement he hopes to complete his work on the final volume of the Index

Catalogue, a work that has made the medical profession of the world debtors to the United States Government, to the Army Medical Department, and, last, and by no means least, to John Shaw Billings. In the British Medical Journal for April 20th, Mr. Jas. Blake Bailey, the librarian of the Royal College of Surgeons of England, pays tribute to Dr. Billings by advising librarians and authors to adopt as standard abbreviations those used by Dr. Billings in the Index-Catalogue of the Surgeon-General's Library. The system, he says, was well thought out and has thoroughly stood the test of use." A catalogue of the museum also has been completed under Dr. Billing's direction, and we hope it may soon be published.

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"In seeking official retirement Dr. Billings does not propose to give up work, as he has accepted the chair of hygiene in the University of Pennsyl

vania, and his energy will be likely to find congenial employment in the duties connected with it."

The immense volumes of the IndexCatalogue which have, from time to time, been noticed in these pages, will stand as lasting memorials to the untiring energy and great ability of Dr. Billings. We heartily congratulate the Institution that has succeeded in getting him upon its staff of instructors.

DEATH AFTER ANTITOXIN.

A death has been reported from Brooklyn after an injection of antitoxine. Whether the death is a case of post hoc or propter hoc has not been satisfactorily determined. The preparation used was from an acknowledged authority in Germany and was furnished by one of the most reputable drug houses of this country. The physician, Dr. Kortright, in whose practice the case occurred, is well known among his confrères as a painstaking and conscientious physician. Whatever the cause of death in Bertha Valentine's case, it cannot check the enthusiasm that the cold statistics of reliable observers have created. Even should the remedy be proven to be dangerous in some cases, that would not be sufficient cause for its discontinuance. Anæsthetics cause a death occasionally and always jeopardize the life of the patient, but the danger from the disease is so much greater, that we do not hesitate to place the patient in that condition between life and death and hold him there for hours. The evidence of the curing property of antitoxine is accumulating so rapidly and from such varied sources that it will require more adverse crit

icism and unfortunate incidents than have yet occurred to destroy the faith of the profession.

EFFECTS OF OPIUM EATING.

The trade in opium in India is a source of much revenue to Great Britain, but whether that fact influenced the report made by the Royal commission we are not able to say. There were more than 470 witnesses examined, of whom 152 were called, it is claimed, at the desire of the AntiOpium Society. The report was practically unanimous and stated that "the temperate use of opium in India should be viewed in the same light as the temperate use of alcohol in England. Opium is harmful, harmless, or even beneficial, according to the measure and discretion with which it is used." The question arises, Can a man be temperate in the use of opium? The tendency is to increase the dose day by day, the tolerance of the system to the drug requiring larger and larger doses. Then this report is directly contrary to the assertions of medical missionaries in opium-eating countries, who are in daily contact with opiumeaters for years, and have excellent opportunity for studying its effects.

AMERICAN MEDICAL ASSOCIATION. The forty-sixth annual meeting of the American Medical Association, held in Baltimore May 7th to 10th, was probably the most satisfactory ever held. The attendance was very large, but hospitable Baltimore found room and entertainment for all. We will give our readers the benefit of abstracts of the more interesting papers (and there were many of them) from time to time.

Diseases of the Ear. A Text-Book for Practitioners and Students of Medicine. By Edward Bradford Dench, Ph. B., M.D., Professor of Diseases of the Ear in Bellevue

Hospital Medical College, etc. With eight colored plates and one hundred and fifty-two illustrations in the text, Octavo; 645 pages. D. Appleton & Co., New York; 1894.

In the preparation of this volume. the author has had regard both for the general practitioner and the special surgeon. After a chapter devoted to the anatomy and another to the physiology of the ear, a chapter is devoted to physical examination. As the volume is intended, in a large degree, for the use of the general practitioner, who is not familiar with examinations of the ear, the author has preferred to err on the side of prolixity rather than conciseness. It is a fault with many works by specialists upon special subjects that the reader is given credit for more information on the subject than can be expected of the majority of general practitioners. The author goes into the subject with thoroughness and clearness. The technique of examination is fully considered and full instruction given in the use of the various instruments used in making an

examination.

In contrast with most works upon otology the author emphasizes the importance of a thorough functional examination and has devoted an entire chapter to this subject. This chapter completes Section I.

Section II. is divided into four parts, which treat respectively of diseases of the auricle, of the external auditory meatus, of the middle ear and of the

mastoid process, comprising the conducting apparatus.

Section III. devoted to the Surgery of the Conducting Apparatus, is divided into three chapters-Middle-Ear Operations; The Mastoid Operation, and The Surgical Treatment of the Intra-cranial Complications of Aural Suppuration. This Section is based upon the author's personal experience, and is mainly intended, doubtless, for the specialist.

Section IV. treats of diseases of the perceptive mechanism, and will prove more interesting to the specialist than to the general practitioner, while Section V. discusses Complicating Aural Affections, such as those complicating the acute infectious diseases, those dependent upon functional nervous disorders, and chronic visceral con ditions.

Taken all in all, the work strikes us as the most useful upon this branch for the general practitioner that has come to our notice.

Cod-Liver Oil and Chemistry. By F. Peckel Moller, Ph. D. Peter Moller, London. And can be had from W. H. Schieffelin & Co., New York.

A large quarto volume of about 500 pages, beautifully printed and bound. The Introduction describes the country and the people of Norway, the various points in cod fishing, etc. Part I. treats of Hydrocarbons; Part II. of the Derivatives of Hydrocarbous Hydrogen Compounds, Alcohols and Phenols; Part III., Oxygen Compounds-Ethers; Part IV., Aldehydes and Ketones; Part V., Carbohydrates

and Glucocydes; Part VI., Oxides; Part VII., Mutual Combinations of Hydrocarbons, Alcohols, Phenols, etc.; Part VIII., Hologen Compounds; Part

IX., Sulphur Compounds; Part X., Nitrogen Compounds; Part XI., Proteids, Ptomaines, Leucomaines and Ferments; Part XII., Atoms.

THE SERUM TREATMENT OF DIPHTHERIA.-Mya (Lo Sperimentale, February 21, 1895) discusses some of the drawbacks to the serum treatment. Cutaneous manifestations have been unanimously attributed to the treatment; they have rarely been hemorrhagic, and occasionally with general disturbance. A very few cases of articular complications have been noted, which pursued a rapid course, but were not serious. Some have attributed with apparently insufficient reason, renal, cardiac and nervous complications to the serum. The author's observations extend to over 50 cases, and the inconveniences caused by the treatment have been insignificant. In four cases there was a scarlatiniform eruption. The resemblance in one case to scarlet fever led to the isolation of the patient, but the subsequent course showed the true nature of the case. A rapid and evanescent urticaria was seen in two cases. Sometimes the temperature was raised and a general disturbance was noted. This, of course, is no contraindication to the treatment. Most authors have attributed the eruptions to the horse serum. The serum does not possess any demonstrable action upon the red blood cells. The author would attribute the cutaneous manifestations to a vasomo

tor change or to an alteration in the lymphatic circulation. Fever must be due to exaggerated personal susceptibility. Dose has no effect in producing

cutaneous complications. The author does not think it possible to attribute either albuminuria or the myocardial and nervous manifestations to the serum. Among the 50 cases there was diphtheritic paralysis in four of five cases, and in one sudden death from cardiac complications; but in days before the serum treatment the author saw more cases of this kind. He concludes that the serum should be. used early and abun antly in severe cases. It must be recognized that since the introduction of the serum treatment cases hitherto looked upon as beyond help have recovered, and especially in infants.-Santucci and Mucci (Lo Sperimentale, February 11, 1895,) first remark upon the technique of tracheotomy. They have treated 13 cases with serum supplied by Roux and Behring. The diagnosis was confirmed bacteriologically in six cases. The cases were all injected except one, immediately after admission. In only two cases was urticaria noted. Among 13 cases three died, representing a mortality of 23 per cent., whereas in seven cases otherwise treated during the same period four died. The authors

think that the results speak in favor of the serum treatment. They also are of opinion that tracheotomy increases. the gravity of the case by opening the way to the absorption of infective products, but intubation is only practised in Mya's clinic in infants under one year of age, in whom recovery after tracheotomy has not been noted.Silva (Gaz. d. Osped., March 2, 1895,) has treated 17 cases with Behring's serum, details of which are given. The youngest patient was ten months, the eldest 15 years old. Bacteriological examination was made in 15 cases, and in 14 Löeffler's bacillus was found. Of the 17 cases three died, but one of these was obviously not diphtheria, and perhaps another should also be excluded; the mortality would then be 7.14 per cent. Among the recoveries were some very severe cases with complications. In six cases there were symptoms of laryngeal stenosis. Sometimes the serum was injected into the veins, and then half the quantity only was used. No signs of local irritation were produced. Enlargement of the submaxillary glands was noted, and the membrane began to detach itself spontaneously. Where albuminuria or nephritis was present the serum did not aggravate it. The general condition of the patient was improved. Recovery soon took place after the injection-in from five to eleven days. Paralysis was twice seen. There was a suppurative parotitis in one case. The author concludes that the results of the treatment were satisfactory.— Times and Register.

CERTAIN PELVIC ABSCESSES, WITH A NEW APPARATUS FOR THEIR SUCCESSFUL DRAINAGE AND CURE.-(Schuyler

Α

C. Graves, M.D., Medical News.) short time ago every collection of pus in the female pelvic cavity, excluding such as might be associated with disease of the bony structures, was supposed to be caused by pelvic cellulitis, or pelvic peritonits; so-called perimetritis, or parametritis. The discovery of the pus-tube came, and to-day there are many who believe that every form of pelvic suppuration in women, with the exception noted, is tubal, ovarian or tubo-ovarian. Time has proved

that the former classification was wrong; but it does not take time to prove that the latter, also, is wrong.

The fact nevertheless remains that parametric abscesses without tubal connection do exist, and present indications for treatment radically differing from those of a purely tubal or ovarian origin.

The differential diagnosis, I admit, is difficult, and, at times, impossible. The history of the case, gonorrhoeal or puerperal, together with the tactus eruditus of an experienced observer, often throws light upon the subject. The most reliable, though by no means pathognomonic, indication of a pelvic abscess that is neither tubal nor ovarian in character is the crowding of the uterus laterally, or particularly, upward and forward against the symphysis.

There is a principle in the practice of pelvic surgery bearing upon the treatment of circumscribed collections of pus that ought never to be ignored; it is this: Any inflammatory mass susceptible of enucleation should be approached through the abdominal cavity, and any inflammatory mass not susceptible of euucleation should not be approached through the abdominal