HOARSENESS IN SINGERS AND SPEAKERS.-Hoarseness is a very common symptom and usually the first one complained of in a beginning bronchitis. Most persons wish prompt relief, and especially do the singer and speaker, whose voice is their stock in trade, so to speak. With them, says Dr. F. A. Bottome in the New York Medical Journal, time is an important element, not of days and weeks, but of hours. The stage is usually a cold, draughty place, while the dressing-rooms are close and warm. Dr. Bottome prescribes a hot mustard bath, followed by rest in bed; ten grains of calomel to robust patients, full doses of aconite, cold externally and nose sprays. During this time the patient must keep quiet. In twelve to twenty-four hours the patient should get up, be rubbed with alcohol and take the tincture of iron;

after this local astringents should be used. Now the voice may be tested and then again rested. Occasionally treatment between the acts is necessary.

PESSSARY IN THE UTERUS FOR FIFTEEN YEARS.-R. de Bovis (British Medical Journal) places on record the case of a woman, aged seventy-six years, who had long suffered from leucorrhea. It was thought from her age and the fetid nature of the discharge that cancer of the uterus existed. In the vagina a metallic stem was found passing into the cervical canal, and the patient recollected that fifteen years previously a pessary had been inserted for prolapse. It was found impossible to withdraw the pessary, as the disc portion of it was imbedded in the cervical tissues. A transverse incision was made in the anterior vaginal fornix, the bladder was stripped off, and then the cervix was divided with scissors in the median line and the foreign body removed. There was purulent endometritis, and so douches were used and the vagina packed with iodoform gauze. There was complete recovery. The pessary must have been sucked into the uterus.

INFANTILE SCURVY.-The American Pediatric Society's collective investigation of infantile scurvy gives the following minority report:

"1. From a study of this report and from due consideration of other known

facts, scurvy appears to be a chronic ptomaine poisoning due to absorption of toxines.

"2. It follows the prolonged use of improper food, and abnormal intestinal fermentation is a predisposing factor.

"3. Sterilizing, Pasteurizing, or cooking of milk food, is not, per se, responsible for the scurvy condition.

"4. A change of food and the administration of fruit juice and treatment of any underlying cause is the rational therapeutic procedure in scurvy."

THYROID EXTRACT IN GYNECOLOGICAL AFFECTIONS.-Sachs (Kromka Cekarska.; La Gynécologie, April 15. 1898) used tablets containing four and one-half grains of the extract, one being administered daily at first, the dose being increased to four within a few days. No ill effects were noted. Dysmenorrhea and hemorrhage were the indications followed, but the results were unsatisfactory. In no instance was any improvement noted in a number of cases.

While much was expected of the thyroid treatment when it was first instituted, its true value has now been found.

TERMS OF SUBSCRIPTION, $3.00 a year, payable in advance, including postage for the United States, Canada and Mexico. Subscriptions may begin with any date.

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TO CORRESPONDENTS.-Original articles are solicited from members of the profession throughout the world. Reprints will be furnished at cost of production if the author's wish is so stated. CORRESPONDENCE upon subjects of general or special interest, prompt intelligence of local matters of interest to the profession, items of news, etc., are respectfully solicited. Marked copies of other publications sent us should bear the notice "marked copy" on wrapper.

MARYLAND MEDICAL JOURNAL, Fidelity Building, Charles and Lexington Streets, BALTIMORE, MD.

A CORRESPONDENT in a contemporary journal suggests that a chair of medical ethics be created in every good medical school. Ethics. This may sound at first like a very sensible proposition, but when analyzed such a suggestion does not seem worthy of serious consideration. Medical ethics differs very slightly from any other kind of ethics, and if a physician has not had the proper kind of bringing up at home in early youth it will be almost too late to teach him manners and politeness during his medical education. There is enough to do without touching on that.

A boy grows up and receives to a certain extent the impress of his home surroundings, and even at a good school he may behave in the most exemplary manner and use the most correct language; still he cannot shake off entirely his home training, and if that is defective he falls into the incorrect use of language and the faulty manners by which he is surrounded at home. It is no uncommon experience to have a young man take high honors at a college when he makes serious blunders in ordinary

grammatical rules and speaks with a local accent and manner which would scarcely make one suspect his good college training. In the same way while an untutored young man may hear lectures on medical ethics, he will break all the rules in the world after he is in practice if he has the tendency in him.

This is not an example of predestination, but it is intended to show that medical ethics differs in very little from ordinary good manners and a close observance of the golden rule. Let a man be well brought up and well grounded at home in the ordinary principles of a thorough training and he will never have to think of good medical ethics any more than the polished society man or woman has to consult a book of etiquette to see how he or she may enter a ballroom or follow any other of the unwritten rules of polite society. It is hard to make a silk purse out of a sow's ear; indeed, this is said to be impossible, and hence any attempt to inculcate principles of medical ethics in a man who has no ideas of what is right is wasted time.

Hot-Weather Literature.

*

THE Atlantic Medical Weekly has made a very sensible departure in the past week by annotating interesting news notes in its editorial column and apologizing for the change by saying that no one cares to read or write a leading article in warm weather. Those physicians who are away on a wellearned vacation probably want to forget all about medicine and are glad of the opportunity of escaping the weekly journal and the monthly heavy periodical. The stay-at-home also may prefer the cool spot, if he can find it, in his house and a light novel or the latest light magazine, and is perfectly willing to let medical reading pass unnoticed after hard work in a warm city.

In warm weather the energy is lacking to do any more than is positively necessary, and the writer and reader is excused from taking that interest in deep matters during this period of supposed rest.

When the warm weather is over, and the physician comes back to hard work, he can then take up his practice and heavy reading with renewed interest.

Artificial albumen has been discovered.

The sick soldiers in Cuba are said to take thirty grains of quinine a day.

Dr. Erwin Gibbs of Washington, D. C., died at Lynwood, Va., after a short illness.

An English exchange asserts that the Johns Hopkins University is situated in Washington.

Dr. Whitecarver has succeeded Dr. Scholle as resident physician at the Baltimore University Hospital.

Dr. George T. Walker, a prominent physician of Roanoke, Va., is dead. He was fifty years old and had practiced in Roanoke for twenty-five years.

It is said that the Emperor Menelek of Abyssinia has prepared a paper on smallpox vaccination for the International Medical Congress in 1900 at Paris.

The faculty of Nashville University, as well as the medical profession of Nashville, mourn the loss of Dr. Ambrose Morrison, whose death recently occurred.

A German scientist in Berlin is said to have succeeded in manufacturing solid diphtheria serum. The government will control its sale, which will be subject to the same conditions as the sale of fluid serum.

H. S. Caminero, sanitary inspector of the United States Marine Hospital Service, reports that Santiago is in a very filthy condition, and he is using all the means at his command to remove dirt and clean the city.

Dr. H. R. McGraw of Salt Lake City, Utah, has been appointed assistant resident physician of the Hebrew Hospital, vice Dr. Thomas S. Lowe. The new assistant is a graduate of the College of Physicians and Surgeons.

Dr. Senn comes out very plainly with the truth about Camp Wikoff. It is astonishing, with our boasted knowledge of hygiene and sanitary science, how much ignorance and carelessness have been exhibited in picking out camp sites.

While the politicians are having their private quarrels in public the poor soldiers are really bearing the brunt of the mismanagement. It looks very much now as if the Secretary of War would like to crawl into a hole and pull the hole in after him.

The appointment of Dr. Anita Newcomb McGee as acting assistant surgeon is a good example of the power of influence in appointments. While Dr. McGee is undoubtedly a woman of experience, it is probably carrying matters too far to make her a member of the government medical staff until women serve as soldiers.

The State Board of Health of Maryland has arranged to establish in Washington county three bacteriological stations. One will be in Hagerstown, one at Hancock and the third at Sharpsburg. The State Board will supply tubes in which will be placed organism taken from diseased persons and sent to the State Bacteriological Station, where microscopical examination will be made.

At the last meeting of the Medical Examining Board of Virginia the following schools were represented: Baltimore Medical College, eight candidates, four passed, three failed, one withdrawn; University of Maryland, two candidates, two passed; College of Physicians and Surgeons of Baltimore, five candidates, two passed, three failed; Howard University, Washington, D. C., two candidates, two failed.

Concerning the recent patent granted Professor Behring on antitoxine, Messrs. Parke, Davis & Co. of Detroit announce that they will protect and defend purchasers from any legal proceedings brought as a result of their purchase, sale and use of their serum, having retained the services of Messrs. Betts, Betts, Sheffield & Betts of New York city, patent lawyers, to fight the monopoly on antitoxine.

Washington Notes.

It has been decided by the attorney for the District that owners of property cannot be compelled to fumigate premises in which diphtheria has been treated. The Health Officer, however, may enter all such premises and disinfect them if necessary.

The compilation of the vital statistics of the District for the fiscal year ending June 30, 1898, has progressed far enough to indicate that the death rate for the period was the lowest that has yet been recorded—19.32 per 1000, against 20.71 for 1896-97 and 21.53 for 1895-96. The death rate of the whites during the year was 15.53; that for the colored race 27.51. Figures with reference to typhoid and malarial fevers and intestinal diseases are shown as follows: 1895-6. 1896-7. 1897-8. ..228 147 130

Typhoid fever.... Malarial fevers. Intestinal diseases...

Deaths from measles, scarlet fever, diphtheria, meningitis and whooping cough were considerably increased over the previous year. Those from acute lung diseases fell from 702 to 607, and those from phthisis fell from 776 to 667. The number of marriages during the year was 1598, and the number of births 4709.

An interesting question has arisen between Health Officer Woodward and Dr. Curtis, surgeon-in-chief of Freedman's Hospital. The matter has been referred to the District Commissioners, summed up in about the following manner: Dr. A. M. Curtis of Illinois was commissioned as surgeon-in-chief of Freedman's Hospital March 8, 1898, upon certification of the Civil Service Commission, after a competitive examination. He is not registered at the Health Department, as required by section II of the act of June 3, 1896. There is, therefore, no authority for the recognition of death certificates issued by him, but, on the contrary. under section 6 of the act of January 25, 1898. they cannot be received as a basis for the issue of burial permits. If the surgeon-in-chief of Freedman's Hospital is engaged in the practice of medicine without having been licensed and having registered at the Health Department, as required by act of June 3, 1896, he is doing so in violation of the provisions of that act, and death certificates issued by him should be very properly vised by the coroner. If, however, the treatment of patients is intrusted to

other physicians, known as the attending staff, the death certificate cannot in any case be properly issued by the surgeon-in-chief, but must be issued by the physician having had charge of the particular case.

Book Reviews.

RETINOSCOPY. By James Thorington, M.D. Philadelphia: P. Blakiston's Son & Co. Second Edition.

It is seldom that a book treating of so technical a subject as retinoscopy goes through its first and demands a second edition in the short space of a twelvemonth. This is the case, however, with Dr. Thorington's little work. It is small in size, but it contains a great amount of information on what is coming to be recognized as the most reliable of all objective methods of examining the refractive condition. As the subject is one concerning the oculist only, a more extended review here would be useless. The book shows the same painstaking care in adding to and correcting the first edition as was evidenced in the preparation of the latter.

REPRINTS, ETC., RECEIVED.

Resection and Ignipuncture of the Ovaries. Translation and Abstract by Hunter Robb, M.D. Reprint from the Cleveland Medical Ga

zette.

A Case of Cavernous Angioma (Vascular Nevus) of the Tunica Conjunctivalis. By H. O. Reik, M.D. Reprint from the Johns Hopkins Hospital Bulletin.

Renal Suppuration, Catarrhal, Specific and Traumatic, and the Value of Micro-Uranalysis of the Urinary Sediment as an Aid to Definite Diagnosis of It. By Thomas H. Manley, M.D. Reprint from the Journal.

The Presence in the Blood of Free Granules Derived from Leucocytes, and Their Possible Relations to Immunity. By William Royal Stokes, M.D., and Arthur Wegefarth, M.D. Reprint from the Johns Hopkins Hospital Bulletin.

A Case of Phlegmonous Gastritis Following Ulcus Carcinomatosum of the Pylorus; Dilatation, Perforation and Peritonitis; A Clinical History of Fourteen Months, with Chemical, Bacteriological and Histopathological Study. By John C. Hemmeter, M.B., Ph.D., M.D., and Delano Ames, A.B., M.D. Reprint from the Medical Record.

Vol. XXXIX.-No. 22.

Original Articles. TREATMENT OF ERYSIPELAS.

By John T. Winter, M.D.,

Professor of Theory and Practice of Medicine, Medical Department National University.

READ BEFORE THE THERAPEUTICAL SOCIETY OF THE DISTRICT OF COLUMBIA.

AS THIS Society is devoted to the study of therapeutics, I will not take your time to discuss the etiology or pathology of erysipelas further than to state that it is an acute, infectious, feebly contagious, febrile disease, attended with the usual signs of inflammation, heat, redness, swelling and pain, and is due to the presence of a streptococcus, which is found especially in the lymph vessels and lymph spaces of the inflamed skin and subcutaneous tissue, and produces at the point of inoculation a peculiar spreading inflammation, accompanied usually with considerable serous exudation. It is essentially an infectious lymphangitis, either superficial or deep-seated, and the anatomical alterations are sometimes both local and general.

Erysipelas has been spoken of as being of two forms-idiopathic, or that form which arises without apparent cause, involving chiefly the face and head, and traumatic, which originates at the site of a recent wound on any part of the body. The symptoms in both forms are both local and constitutional in character. There is good reason to suppose that the facial form of erysipelas is almost always traumatic in character, having its origin in some excoriation about the nose or face, or even in a fever blister. Still

Whole No. 911

Strumpbell says: "It cannot be denied that there are cases of facial erysipelas where it is absolutely impossible to make out any cutaneous excoriation, and where there is an initial stage, with feverish symptoms preceding the localized trouble in the skin. Such cases suggest the thought that erysipelas is like the acute eruptive diseases, and that it is at least possible that infection may take place in some other way than the one mentioned.”

The local invasion of the so-called idiopathic erysipelas is quite commonly preceded by sore throat, which may last for several days before the appearance of the cutaneous disorder. This angina is usually not sufficiently severe to cause any alarm, but in some instances it becomes a serious matter in itself, causing considerable swelling of the lymphatic glands, edema of glottis, general infection and nephritis. It is frequently accompanied or followed by a chill, or a succession of chills, by a severe headache, and sometimes by confusion of ideas, delirium or coma. There is also nausea and vomiting, tongue moist and coated with a uniformly white fur, and the pulse quick and compressible. These symptoms may continue for only a few hours or for several days before the first red spot makes its appearance.

From this first red spot an inflammatory blush, sometimes bright scarlet, sometimes dusky red in color, spreads more or less rapidly, fading away in healthy skin. The inflammatory area rapidly extends, the lips and ears swell, the cheeks enlarge, the eyes become closed by their puffy lids, and all traces of the natural features are completely lost. As the redness and swelling extends it