more protected location of the ganglionic matter in the cord; but occasionally the morbid process is much more intense in the spinal membranes, and complete paraplegia may ensue, usually with abolished reflexes, while, as a rule, in the later stages of the disease following the ordinary type, the reflexes are diminished. The writer has seen one case, in consultation with Dr. R. Brent Murphy, in which a child, six months old, developed very exaggerated reflexes with marked ankle clonus in the third week of the disease. This is probably very unusual. Throughout the disease, the pulse is usually frequent, and often irregular. Respiration is often jerky and irregular, and a diagnostic point of some value is that the irregularity of the pulse often does not occur at the same time as irregularity of respiration.

The

Where recovery takes place, it is usually a slow process. Headache persists for a long time, and a lasting liability to headache may supervene. Where much involvement of the inner ear was present, some permanent deafness is liable to supervene. Many symptoms found in this disease were not mentioned. Time does not permit me to speak as fully on some of the important ones as their value deserves. symptomatology of cerebro-spinal fever is almost kaleidoscopic in its variety, and there is no symptom here mentioned which may not occasionally be abThe principal ones, however, were considered; and if we try to regard them as the visible garment of the disease, enough has been said about them to be of some aid, perhaps, in the management of that very grave disease.

DIAGNOSIS OF CEREBRO-SPINAL FEVER.* BY ELSWORTH SMITH, Jr., A.M., M.D., St. Louis.

S the symptoms upon which, of course, the diagnosis of cerebro-spinal fever must ever be based have been so graphically and exhaustively portrayed by the last speaker, little remains except perhaps to estimate their respective value from a diagnostic standpoint; and in order to further elucidate this phase of the subject, I have collected the following observations, based on a report by Dr. J. W. Class, Medical Inspector of the Health Department of Chicago, of 38 cases occurring in the practice of skilled diagnosticians, from which all doubtful cases were eliminated, and also upon the history of 12 cases treated at our City Hospital since January 1st, 1899, and kindly placed at my disposal by Dr. H. L. Nietert, superintendent and surgeon in charge, in all of which the diagnosis was verified by autopsies. Tabulated, these observations are as follows:

*Read before the St. Louis Medical Society, April 15, 1899.

A perusal of the above table shows how numerous and varied may be the symptoms of the disease in different cases, but the following are probably those most constantly present, namely: initial chill with vomiting, followed by irregular temperature; severe pain in back of neck and head; delirium, passing often into coma; rigidity and retraction of head; congestion of conjunctiva; strabismus. When to the above enumerated symptoms we add a sudden onset of the disease with rapid advance and early marked prostration, we have a picture that is as a rule easy of recognition. Difficulty in diagnosis of this affection comes when we have to do with the mild cases, in which the symptoms may be few and ill-developed, especially in sporadic cases. Recourse should be had in all obscure cases, where possible, to the examination through lumbar puncture of the cerebro-spinal fluid, for the diplococcus intracellularis of Weichsel

sions and stupor. Generally, however, early redness of the fauces will be present, and if the patient survives long enough, the characteristic eruption will settle the difficulty.

VII. In small-pox, sometimes begins with severe pain in back and head and vomiting, then appears a purpuric rash. Reliance in such must then be had to the papular character of eruption and the course of the disease.

In forms of meningitis secondary to acute diseases, as pneumonia, the stiffness of the muscles of the neck and back and hyperesthesia are not generally so marked, but in many of these cases the solution of the problem is most difficult.

THE TREATMENT OF WHOOPING COUGH.

BY MILTON P. CREEL, M.D., Central City, Ky. Surgeon Q. C. Railway, Surgeon L. & N. Railway, Secretary Muhlenberg County Board of Health, Referee for Muhlenberg County for Kentucky State Board of Health, President Muhlenberg County Medical Society, Member U. S. Board Pension Examiners, Member American Medical Association, Member Kentucky State Medical Society, etc., etc.

NVESTIGATION of a subject often leads to the bringing out of truths we never before considered in connection with a subject. Whooping cough is a disease which is very common, and although the medical annuals each year contain a number of drugs which have been brought out as specifics, yet we find that nearly all the writers on the diseases of children still regard whooping cough as a self-limited affection. Several years ago I took occasion to make a study of the literature of whooping cough with a view of ascertaining the status of opinion among the ablest observers regarding the self-limited character of the disease and of the preference regarding the remedial agents employed.

I shall let it suffice to say that the drugs which have been employed embrace all of the anodynes, antispasmodics and agents of that character, as well as nearly every other kind of drug which can be conceived of.

The

Belladonna I have found to be in the greatest degree of favor among observers, most of whom express their reliance in the curative action of this drug. bromides are generally esteemed valuable agents. Almost all authors regard whooping cough as a self-limited affection whose course occupies four to eight weeks; while some are silent on this point, others are sure that we possess no means of bringing about a cessation of the disease by medicine.

From my experience and study of the disease during the past five years from the standpoint of a sanitarian as well as a medical practitioner, I am confident that whooping cough is not a self-limited affection, and that we can bring about a curative termination by therapeutic measures.

Along with, this I give as an antispasmodic the bromide of sodium in doses of five grains every four hours, generally in solution and with unvarying regularity. This tends to cause a longer time to elapse between the paroxysms of cough, and thus we score a decided point in favor of the patient.

I have found very material assistance in allowing the Schering's formalin lamp to burn in the sleeping room of these patients. By keeping the flame of the lamp low only one formalin pastile is consumed in three or four hours. This causes little if any iritation and after a short time the child goes to sleep. The inhalation of the disinfectant exerts a decided curative action upon the affection.

These patients should be adequately fed; in fact I am very sure that we very often overlook the importance of this matter. They invariably vomit when an attack of coughing comes on, and very often as a result they become emaciated to an advanced degree. When nourishment by ordinary means is inadequate, recourse must be had to peptonized milk and to predigested foods.

By reason of the presence of a catarrh of the bronchial tubes as a necessary part of the disease in question, they very naturally and easily take on pneumonia and other complications. Emphysema as a resultant affection is often seen after an attack of whooping cough which has not been successfully or properly treated. I am, in view of its complications and its possible terminations, always particular to see that parents are cautioned against allowing children to expose themselves to the inclemencies of the weather.

Treated on this basis-on the lines laid down-I have notes on one hundred cases of whooping cough. Of these cases seventy-five recovered in ten days from the time they came under treatment; ten cases were extremely delicate children and they were ill for fifteen days; in ten cases complications set in before the treatment was begun; and five were not seen after the treatment was fairly begun, but they presumably recovered without incident.

The treatment here advocated brings about a termination of the disease in a period much shorter than any method which I had employed.

REMARKS UPON AN EAR AND THROAT INFECTION
WITH SUBSEQUENT INVOLVEMENT OF
THE NECK.*

BY ERNEST H. COLE, M.D., ST. LOUIS.

HE patient was 14 years old, a handsome IrishAmerican girl. She consulted me because she feared her ear was annoying to her girl friends. At 3 years of age she had an attack of scarlet fever which left her predisposed to periodic recurrent attacks of subacute otitis media, which appeared to be becoming chronic. When first seen the left auditory canal was filled with pus. For three days I syringed with a weak antiseptic injection, each succeeding day the discharge diminishing materially, when on the fourth there was no discoverable pus anywhere in the canal or in the tympanic cavity. On the fifth day she complained of marked sore throat. On inspect

ing the mouth and fauces, marked evidence of erosion of the tonsils was seen, which, to me, indicated frequent attacks of possibly follicular tonsilitis; also, in the left region, a slight swelling which was very tender on palpation. On that day she had a temperature of 100°. The jaws were somewhat restricted in their movements—could be separated only to a finger and a half's breadth. Having frequently succeeded with early incisions in that part of the throat, I decided to do so then. I incised the tumor in the most sensitive part and secured a few drops of pus and also a few drops of bluish blood. The next day I saw the patient, and she complained of pain in the muscles of the neck, and the head was drawn in a marked measure towards the left shoulder. There had been no manifestations of heat, redness, or swelling in or about the region of the left mastoid bone. The symptoms had somewhat subsided, but the orifice made by lancing the throat was still open. On the seventh day the pain in the neck was more severe; there was really no tumor discernible, but I felt it fair surgery in such a location to make an exploratory incision. I plunged the lance down well towards the base of the neck to what I felt might be the most prominent part of the tumor, the knife going in about 1 inches, and was rewarded with at least two drachms of thick, greenish, yellowish pus. Irrigated for several days. All her symptoms had improved. She did not go to bed, but was on liquid food for three or four days. The orifice was still patulous when I made the incision at the base of the neck. I was much tempted to take a bougie and see if these cavities were connected, but previous experience prevented me from doing this.

My reflections were: Could this possibly be autoinfection from the orifice in the Eustachian tube?

*Read before the St. Louis Society of City Hospital Alumni, February 2, 1899.

THE North Missouri Medical Association will meet at Carrollton, on June 15th and 16th. The following is the program: 1. Some Practical Points on Vaccinating, Dr. J. Franklin Welch, Salisbury. 2. LaGrippe and Its Complications, Dr. U. S. Wright, Fayette. 3. Hysteria and Its Treatment, Dr. T. A. McLennan, Mt. Leonard. 4. Vaginal Hysterectomy, Dr. H. Crowell, Kansas City. 5. Diagnosis and Treatment of Gonorrhoea in Women, Dr. Ernest Lowry, Norborne. 6. Report of a Case, Dr. W. T. Lindley, Hamilton. 7. Paper-subject not announced, Dr. L. O. Rodes, Mexico. 8. Intestinal Indigestion, Dr. C. A. Jennings, Salisbury. 9. Inflammations, Dr. Jabez N. Jackson, Kansas City. 10. Intra-Cranial Tumor, with presentation of a specimen, Dr. F. J. Tainter, Warrenton. 11. A Five Minutes' Paper on Inflammation of the Knee Joint, Dr. Herman E. Pearse, Kansas City. 12. A Talk-subject not announced, Dr. P. Kaufmann, Columbia. 13. Pleurisy with Effusion, Dr. C. W. Watts, Moberly. 14. Serum Therapy of Diphtheria, Drs. Dewey and Hughes, Keytesville. 15. The Tongue, Dr. L. W. Dallas, Hunnewell. 16. Six Cases of Empyema in a Country Doctor's Experience, Dr. J. W. Kincaid, Bowling Green. 17. Paper-subject not announced, Dr. O. B. Campbell, St. Joseph. 18. Typhoid Fever, J. M. Gallemore, Keytesville. 19. Iritis and Its Sequence, Dr. Chas. King Dutton, Moberly. 20. Destructive Neoplasms, Dr. Eugene R. Lewis, Kansas City.

21.

A Review of Modern Surgery of the Rectum, Dr. J. S. Wallace, Brunswick. 22. Report of Some Surgical Cases, Dr. E. S. Garner, St. Joseph. 23. Pneumonia, Dr. W. H. Gatlin, Carrollton. 24. Heredity, Dr. T. F. Martin, Brunswick. 25. Heredity and Crime, Dr. George R. Highsmith, Carrollton. 26. Urinary Fevers, with report of cases, Dr. C. McD. Bridgford, Mexico. 27. Paper-subject not announced, Dr. Isaiah Knott, Keytesville. 28. Report of a Case of Prolapse of Sigmoid Flexure, the Result of Constipation, Dr. T. C. Cooper, Carrollton. 29. Emergency Calls, Dr. A. B. Miller, Macon City.

The officers are: Dr. J. D. Brummall, president, Salisbury; Dr. E. H. Miller, first vice-president, Liberty; Dr. N. M. Baskett, second vice-president, Moberly; Dr. L. W. Dallas, recording secretary, Hunnewell; Dr. J. F. Welch, treasurer, Salisbury; Dr. C. B. Clapp, corresponding secretary, Moberly.

MEDICAL REVIEW

A WEEKLY JOURNAL OF MEDICINE AND SURGERY

CONDUCTED AND EDITED BY

H. W. LOEB, M. D., 3559 OLIVE ST., ST. LOUIS, Mo. H. N. MOYER, M.D., 103 STATE ST., CHICAGO, ILL.

AND A CORPS OF ACTIVE COLLABORATORS

YEARLY SUBSCRIPTION, $1.00

Entered at the St. Louis Postoffice as Second-Class Matter

WOMAN, LADY, AND FEMALE.

At a recent medical society meeting we were much impressed with the different status of the patients of some of the members. Thus one reporter stated that he had removed a very large suppurating and exceedingly offensive fibroid tumor from a lady. Another spoke of a lady who had been delivered of a horriblelooking monster, in which there was practically no head and only one eye. A third stated that, after a lengthy and somewhat anxious gestation, a female had been delivered of a remarkably healthy female child. We cannot understand why the distinction was made in these cases; and if the term lady was to be applied to one of these patients, it certainly ought not to have been accorded the woman who had the fibroid or the one who brought forth the monster, but rather to the one who was delivered of the healthy, well-formed and vigorous child.

Another contributor to the same meeting was down for a paper upon certain aberrations in the female pelvic organs. We concluded at once that the paper was to be one upon comparative embryology, but were somewhat surprised to learn that all the material which he had gathered related to abnormal structures in adult women. We certainly think that some confusion is creeping into our use of these terms, and it is unfair to the male sex not to apply the term gentleman to them if we use the term lady to designate our woman patients. The andrologist should in the future be described as one who devotes his attention to diseases of gentlemen, and we must speak of having removed the prostate of a gentleman, if any. thing like equity is to be accomplished in our use of polite terms.

WHAT ARE THE PRIVATE PARTS?

We are not infrequently regaled from the bench by a judicial decision in which medical expert testimony is ridiculed or sneered at. Perhaps there is no single bit of testimony which excites greater contempt in the legal mind than the statement by an expert witness that an accused person is insane and irresponsible and at the same time knows the difference be

tween right and wrong. Such an answer is usually followed by a short catchising of the witness from the bench, about as follows: "Did the accused person understand what he was doing at the time he committed the act? If so, did he know it was wrong?" The next question is: "If the person knew it was wrong, why did he do it?" To which the expert naturally replies that it was done because the person was of unsound mind; that if he was possessed of perfect reason and understanding such as he once might have had he would not have committed the act.

The soundness of the legal decisions of insanity has seemed to the legal mind quite incontrovertible. We therefore refer to a new rule laid down in a recent decision by a Supreme Court. In the case in question it was held that it was correct to exhibit to a jury an injured portion of the person, providing that the latter did not involve the private parts. We are very much interested in this decision, for it is evidently freighted with most important consequences from a medico-legal standpoint; it is a new rule of law, and being once established as a precedent, it will probably furnish ground for legal differences for the next three hundred years. Of course, it did not occur to the learned bench to tell us what they meant by private parts; and they did not say whether the judgment as to what constituted these particular parts of the human body is to be left to the court, the jury, or the contending counsel; perhaps it will be left to the judgment and discretion of the one who is to make the exhibition; and, if so, he may readily conclude that the private parts include the back of the neck, or any other portion of the anatomy. Indeed, it is difficult to see what a person might be compelled to show under such a rule, and probably all that could be exhibited would be the top of a bald-headed man, providing he did not wear a wig.

HOW TO PALPATE THE ABDOMEN.

We believe that the investigation of the abdomen is far too infrequently made by physicians in examining patients. It is quite a routine practice to examine the thoracic viscera in almost every case of chronic trouble presenting itself to the physician, and in cases of women an investigation of the pelvic organs. Unless, however, there be very distinct and positive signs pointing to abdominal disturbances,