which was hermetically closed. Inside news by the daily press are not always to the laity alone; they are often reaped by the profession, and in a very valuable form. Take, for example, the history of Koch's tuberculin. After the After the news of its discovery had been flashed all over the world, the members of our profession fairly held their breath with eagerness and anxiety to learn every possible detail concerning it. And rapidly as those details were evolved in the great centers of experiment, just so rap-weighed before and after the experiidly were they known to the profession in every quarter of the globe. And the very rapidity with which the reputation of this discovery was driven through its experimental stages to its death was largely due to the compelling power of the press, which often finds a way of forcing events for which it is waiting. I am aware that I am upon delicate and debatable ground. And, in order that there may be no misapprehension of the statements I have made, let me repeat that, in my view, it is not now, and never will be, proper for a physician to advertise-using the term in its usual sense-and that to give out or to procure the publication of items which are rather vehicles of personal puffery than matters of interest as news, is the worst form of advertising, because it is masked and underhanded. On the other hand, personalities relating to physicians are appearing and will continue to appear in various forms, and, although still under protest, the tendency of professional sentiment is rather toward toleration of them, under certain restrictions, than the opposite. Finally, the publication of proper and reliable medical intelligence by the daily press is rather to be encouraged than condemned. Science and the Eight-Hour ment; the food supplied to him was likewise weighed and analyzed. Very great care was taken to make this glass room absolutely air-tight. No air could get in or out excepting through the air inlet and the air outlet. Thus it was possible to analyze the air as it went in and as it came out. Pettenkofer was therefore able to ascertain that during the nine hours' work the laborer had expended in the form of carbonic acid one hundred and ninety-two grammes of oxygen more than he had been able to inhale during that time. To cover this deficit, it was calculated that the workman must have expended 20 per cent. of the provision of oxygen stored in his system. Of course this deficit was to some extent compensated by the night's repose; but, nevertheless, the balance was not re-established. During the night he naturally absorbed more oxygen than he utilized. But as the respiratory organs work more slowly at night the process of recuperation was not sufficiently prolonged. Both Pettenkofer and Voit came to the conclusion that a night's rest was not sufficient to It re-establish the normal condition after a day of very fatiguing toil. They were of opinion that the deficit might be equal to 10 per cent., and in some cases 20 per cent., of the total stock of energy, and this in spite of the restorative effect of a good night's rest. In view of the recent May Day was the Sunday rest that alone could demonstration in support of "an eight- enable the body to take up the oxygen hour day," it may be interesting, says lost during the week's toil. The exthe Lancet, to recall the experiments periment shows clearly enough the fact by which Pettenkofer and Voit at that manual labor may be too hard and tempted to ascertain what amount of too prolonged. It also shows the need work a healthy laborer could accom- of Sunday rest. But it would be unsafe plish without injury to his health. to compare the steady toil at a wheel They constructed a chamber in glass in a closed glass case with the very leisurely labor of the majority of work- | folded into a compact bundle when not men who work out of doors.-N. Y. in use and slung on the outside of the Med. Record. wagon. As far as possible the contents of the medical chest consist of com New Appliances of the Medical Depart-pressed tablets. The weight of the chest ment of the Army. The medical department of the army is soon to be equipped with ond hundred new ambulances of a different pattern from the ones now in use. The vehicle will be about three hundred pounds lighter than the present one. New medical and surgical boxes have also been designed, and their contents will be condensed as much as possible. These will be placed under the seat of the driver of the ambulance. Two oblong boxes, one on each side of the wagon, will be used for carrying water. The floor of the wagon has grooves, into which the feet of the litters are placed for sliding them into position. Each wagon contains two litters. Leathercovered seats, capable of being folded out of the way, extend along each side of the ambulance. The litters can be is one hundred pounds. The lower half is fitted with small drawers containing bandages, dressings and the like. The surgical chest weighs ninety-six pounds and contains tablets of antiseptic preparations, ether, chloroform and adhesive plaster. The drawers contain instruments and different surgical material. A folding packet, containing the necessary instruments for an ordinary emergency case, may be taken out by the surgeon in case of necessity. One hundred of these cases have already been ' distributed. The medical and surgical cases are so arranged that they may be slung, one on each side of an animal. Cots, chairs and tables, which are capable of being condensed into a very small space, for use in the field, are also provided.-Boston Med. and Surg. Journal. --------------------------------------------------------------------------------------------------------------------------------------------------- Dysmenorrhoea The prominent symptom in all cases of dysmenorrhoea, is the sever pain which demands relief, and which in nearly every instance, is mitigated by the use of whiskey or morphia, both of which are very injurious. A succedaneum for whiskey and morphia is a great desideratum, and this we find in ANTIKAMNIA (opposed to pain.) Samples in powder and tablet form, sent free on application. Address: THE ANTIKAMNIA CHEMICAL COMPANY, In Corresponding with Advertisers, please mention the LANCET-CLINIC. THE the difficulty of the diagnosis between this disease and acute tuberculosis. Dr. Mackenzie saw her on the ninth day, when rose spots were present, though they were not to be seen on the day previous-the eighth. Moderate meteorism, diarrhoea; en A Paper read before the Cincinnati Medical largement of the spleen and moderate Society, April 12, 1892, BY JOHN A. MURPHY, M.D., CINCINNATI. Typhoid fever, like all infectious diseases, is always of commanding interest. Its causation is often difficult to ascertain, its course variable, its complications many. Its treatment is symptomatic. I do not, however, propose to enter into a long description of either the cause, complications, pathological anatomy or treatment of the disease. To the members of this society this would be presumptious and tiresome. It is with those cases which relapse at a shorter or longer time that I propose to engage your attention for a few minutes. delirium were present till the defervescence. The temperature was not high at any time, but very irregular. The treatment was very simple. In three weeks from the time I saw her she was convalescent, which was the last of January. Her convalescence steadily continued until March 10, when she complained of colicky pains and diarrhoea. This continued more or less to March 16, when her temperature at 7 a.m. was found to be 1020. Meteorism, rose spots on the eighth day, enlargement of spleen and diarrhoea accompanied the fever. The fever, like that of the first attack, attained its maximum before 12 m. It continued until March 26-sixteen days. The treatment consisted of milk and whisky. The delirium was not so marked as that of the first attack. She is now in full convalescence. To the better understanding of the subject I may briefly relate the history of the case, as also that of the relapse. On January 11, '92, I was called to see It may be well to say that the saniMiss C., aged twenty-five, a stenog-tary conditions inside and outside of the rapher by profession. She had fever, 103°. She stated that she had been ailing for a week with malaria, loss of appetite, and increasing debility. Gastric irritation and vomiting, with slight cough, were prominent symptoms. The temperature line was irregular, being at its highest in the morning, before 10 o'clock. As she is of a scrofulous constitution, and the fever being so irregular, I had Dr. Mackenzie see her in consultation, fearing acute tuberculosis of the lungs. Every one who has had much clinical observation is aware of house in which she was sick are good. One water closet was not in the best condition, so that I had it refitted with a tank. Still further, the case may be better understood if I state that I had treated her sister, a school girl of fourteen, six weeks previously, for a mild attack ending in femoral phlebitis of the left thigh. During the illness of the young girl, an older sister married and in her twenty-third year of age was seriously ill with the disease. She was under the treatment of my friend Dr. I. D. Jones. He asked me to see her in consultation, when she was almost collapsed from a large intestinal hemorrhage, from which, however, she happily recovered. There are three young sons under age in the family who have not had the disease. Why they should have escaped, if the cause of the disease was in the water (which is from the river) or in milk, it is difficult to say. It may be that each case received the poison in some other place, or in the air outside of the house. First, then, we had a very mild case; second, a severe ataxic case; third, an adynamic case lasting three weeks and convalescing almost five weeks and then relapsing, the fever continuing for sixteen days. What is the cause of the relapse? Before any attempt at answering this question, I may say, that some twelve years ago I discharged a man from my ward in the Cincinnati Hospital who had passed through a severe ataxic form of the disease of four weeks' duration. He had remained in the convalescent ward four weeks, so that to all appearance he seemed thoroughly reëstablished in physical force. On the third day he was brought back to the Hospital in a dying condition from peritonitis resulting from a perforation of an ulcer of Peyer's glands. As great interest was manifested in the case, a most careful section was made. In addition to the unhealed ulcers, of which there were three, with the perforation of one, there was also a fresh enlargement of additional glands of Peyer which were about to enter into the sloughing condition. My theory at the time, and now, is that the man had a reinfection from ulcers not healed, and that he would have passed through a relapse of fever if he had not been carried off by the traumatic peritonitis resulting from the perforation. Is it not possible that there was another infection of the agminated glands and those of Peyer from the unhealed ulcers? Is it possible that Miss C. took in water or milk an additional infection to cause the relapse? Is it possible that the soiled clothes of her sisters may have been the cause of the disease in Miss C.? The relapses vary, according to different observers, from 3 to 18 per cent. Certainly, in my experience relapse has not been observed oftener than three times. It One fact I have omitted, that during her convalescence from the first attack her pulse increased steadily from 115 to 125. In her convalescence from the relapse the pulse has been steady at 110° to 1150. The cause is inexplicable. The heart does not give any sounds indicating valvular disease. may be, as it is supposed in all cases, that the muscular fibre of the heart was more or less damaged, and the frequency of pulse is due to this cause, producing impaired dynamic force and consequent feebleness and irritability. This, however, is only speculative. PRACTICAL CONCLUSIONS. 1. No immunity to typhoid fever is given by one attack. Formerly it was held by some that the infiltration of the agminated glands, the solitary ones and those of Peyer, were destroyed by the necrosis and sloughing, thus creating an immunity to further inroad of the virus, or what is now called by many the bacillus of Ebarth. This, however, is only theoretical. 2. The cause of the fever is by no means settled or ascertained. 3. While in this city its prevalence is greater in autumn, yet it is seen and treated more or less during every month of the year. 4. If the cause resides in the water, we should, according to our bacteriological friends, have the disease endemic in this city every month of the year. 5. Our friends who hold to the microbe theory of the disease may tell us, that while all those liable or predisposed to the disease—the young under thirty-may receive the microbe or bacillus in the polluted water or milk, yet that the great majority have so many phagocytes destructive to the typhoid bacilli, that they in this way escape the disease. 6. It is by no means demonstrated that typhoid fever is not produced by animal or organic decomposition. Time forbids me to dwell on this point, 7. The attempt to manage or cure the disease by remedies destructive of the bacilli is futile. S. Active medication is forbidden by men of much clinical observation. 9. The main points in the therapy are to lessen the fever by the application of water to the surface, and cold water by enema, and to support the The failing heart by stimulants, alcoholic in character, and by liquid food. At what temperature the water shall be applied, either by sponging, the pack, or the bath, is a matter of great judgment. 10. The coal tar antipyretics, antipyrin, antifebrine, and phenacetin, are depressants to the heart and should rarely be used. 11. Since the clinical thermometer has come into general use, and the danger of high temperature has been so strongly insisted on, there is reason to think that the use of antifebrifuges and antipyretics have done much harm, even to the production of death in cases otherwise mild, and which might have gotten well by the efforts of nature and abundance of liquid food. Certainly the large doses of quinine so much in vogue a few years ago did great harm. 12. Finally, in view of the possibility of a reinfection of additional glands taking place from ulcers slow in healing and open at the end of four weeks from the beginning of convalescence, it is well to insist on quietude and liquid diet for that time. [FOR DISCUSSION SEE P. 42.] Resorein Plaster in Rodent Ulcer. Dr. C. Boeck (Monatshefte für Praktische Dermatologie, No. 4, 1892) has healed two cases of rodent ulcer in two old men, both over seventy years of age, by means of applications of a plaster of resorcin. In one case the ulcer had been present for ten years, with a consecutive ectropion; in the other the ulcer occupied the right temple, and was one centimetre in diameter. It had been present for six months. The plaster was changed every day. An improvement set in very soon, and after two months and six weeks respectively they had healed over.-[Pritchard. Society Reports. ACADEMY OF MEDICINE. OFFICIAL REPORT. Meeting of May 20, 1892. President, G. A. FACKLER, M.D., in the Chair. T. V. FITZPATRICK, M.D., Secretary. DR. B. K. RACHFORD read a paper on The Anemia of Tuberculosis. He introduced his subject with the report of a case. A young girl, with a strong tuberculous family history, who had been constantly exposed to tuberculous contagion for years, presented herself with dyspnoea, pain in side, loss of appetite, sick stomach, great weakness and nervousness; there was fever, no cough, and no physical evidences of either lymphatic or pulmonary tuberculosis. Two years previously, however, she had some "kernels" in her neck. The most striking symptom was the extreme anæmia. no The blood was found to contain only 25 per cent. of the normal proportion of hemoglobin and 1,680,000 red corpuscles to the cubic millimetre. After three months of treatment with iron and arsenic the patient was discharged, feeling better than she had for years. At this time the hemoglobin had a valuation of 90 per cent., and there were 4,000,000 red corpuscles to the cubic millimetre. Seven weeks later, although the patient said that she was well, an examination of the blood found only 65 per cent. of hemoglobin and 3,200,000 red corpuscles to the cubic millimetre. Two weeks of treatment again brought the hemoglobin to 90 per cent. In this history special attention was called to: (1) The strong tuberculous family history; (2) the constant exposure to the contagion; (3) the "kernels" in the neck two years before the case came under observation; (4) the absence of immediate evidence of glandular or pulmonary tuberculosis; (5) the state of the blood; (6) the improvement of the blood-state after treat |