probably greater among children than adults, and ascribes this to the fact that children are more susceptible to intestinal tuberculosis than adults and their diet being chiefly milk, they are probably infected by the milk.

From the preceding it will be seen that the status of milk as a producer of tuberculosis in the human subject has not as yet been definitely settled, even in the minds of the best writers.

TREATMENT.

Prophylaxis: In children of tuberculous parentage every effort should be made to strengthen the organism and increase the power of resistance to the tubercle bacillus. Herein will probably be found the most efficient means of lowering the death rate and saving the lives of a great number of children who otherwise would fall early victims to the disease. Prophylactic measures should be directed toward keeping the general health up to the highest standard. Such children should have plenty of fresh air not only in the home but they should spend a great part of their lives in the open air. They should have plenty of the most nutritious food. The milk supply should be investigated if the child is artificially fed, for, while this may not be so important as the air supply, yet every possible avenue of danger should be closed. They should wear flannels all the year around, should be protected from sudden changes of temperature, from the acute infectious diseases, whooping cough, measles, la grippe, pneumonia, bronchitis, etc. These diseases, either by still further weakening an already weakened organism, or by furnishing the stimulus to excite a latent tuberculosis, are potent agents in the production of acute tuberculosis. Frequent bathing and cold sponging to keep the skin active and stimulate the nervous system should be regularly practiced. Children who are mouth-breathers or the subjects of chronic nasal catarrh should be carefully examined for adenoid growths, hypertrophied tonsils or other obstructions in the naso-pharynx. If found, these growths should be promptly removed and the catarrh cured. Children of a scrofulous diathesis, which, according to some observers, is simply a passive form of tuberculosis, should be treated with remedies and by measures calculated to build up the tissues and eradicate so far as possible the scrofulous taint. Such remedies are the iodides, mercurials, iron, cod liver oil, etc. Aside from

these measures for the treatment of this condition, sanatoria at the seaside have been inaugurated in some countries.

In this connection Professor Ewald at the International Tuberculosis Congress said: "The sanatorium for adults is after all but an episode in the warfare against tuberculosis," and that the fruition of the sanatorium idea would be found in prophylaxis, or in other words in the expansion of the children's sanatorium. In institutions of this sort operated at the seashore the victims of scrofula would be cured and all those naturally predisposed to phthisis would be so fortified by care and instruction that they would be in position mentally and physically to resist to the utmost their natural and hereditary foe. It seems to me that sanatoria for this class of cases serve a good purpose, not only by placing these children in better sanitary surroundings where they can have treatment specially adapted to the building up of their weakened organisms, but perhaps a greater service is performed for them by removing them from direct contact with tuberculous parents or other tuberculous members of the family.

Since the contagiousness of tuberculosis has come to be more fully recognized and the direct transmission of the disease from one person to another has been over and over again demonstrated, the importance of the destruction of the sputum from a tuberculous patient becomes more and more apparent. Therefore, children in families containing a tuberculous member should be kept from contact with such member as much as possible. The sputum from the one afflicted should be carefully collected and destroyed, all bedding should be changed often and immediately placed in boiling water, all vessels used by such members should be carefully cleansed and disinfected, and every measure used, so far as possible, to preserve strict asepsis.

The treatment of active tuberculosis in the child does not differ materially from the treatment of the same condition in the adult. What has been said of fresh air and nourishing food in the prophylactic treatment also applies here. If a change of climate is considered necessary, a warm climate rather than a high altitude seems best.

Drugs: Creosote, cod liver oil and guaiacol are the drugs most commonly used. While they have no specific action on the bacilli, if they improve digestion and increase nutrition, they strengthen the resistance of the organism to the bacillus and are

in this way beneficial Guaiacol possesses an advantage over creosote in that it is indicated and can be administered at all stages of the disease while creosote is contraindicated when cavity formation and hectic are present. Jacobi is a firm believer in the benefits derived from the administration of arsenic either in the form of Fowler's solution or arsenious acid in small doses continued over a long period. Schmey recommends the use of cod liver oil and Peruvian balsam. Curasso advocates the inhalation of oil of peppermint and the internal use of creosote.

I shall say nothing of the symptomatic treatment of the disease except to advocate the use of small doses of heroin, where a sedative for cough is required, in preference to any of the other derivatives of opium.

Albany

Editorial

The sixty-ninth commencement of the Albany Medical College takes place at Odd Medical College Fellows Hall on May second. While it adds one more year to the age of the college and one more class to her graduates sent out to be tested as to their fitness and the efficiency of their alma mater, it records an important change in the college curriculum. From this time a four year graded course will be essential for graduation. This will permit more time to the senior students than was heretofore possible for bedside instruction, clinical records of cases and the study of the specialties. The inspection of the Albany Hospital will prove to the visiting alumni how well equipped their alma mater is to meet this ever increasing demand for clinical instruction.

As the citizens of Albany have so nobly responded to the medical needs of Albany by the erection of this hospital at a cost of about $250,000.and as a citizen has most generously given to medicine a splendidly equipped laboratory, an opportunity is offered the alumni to express their gratitude and to complete the needs of their alma mater by the erection of a new college building. No better site could be selected; no gift would better indicate the appreciation of our alumni than a medical college building located with a

modern hospital for clinical study on one side and a complete laboratory for the study of morbid processes in the living and dead on the other. It is to be hoped that this commencement will see the initiation of a movement which will lead to such a fruitful result.

The Psychoses of the Menopause

By invitation of the County Medical Society of Philadelphia Dr. John B. Chapin presented a contribution with this title, deprecating the use of this phrase if it is to be assumed that the mental disorders which appear at this time of life manifest special characteristics. This terminology results from an attempt to classify insanities as distinct entities due to causes alone, and to open the door to an endless nomenclature and confusion as to the nature of insanity itself. The psychoses of the climacteric comprise hypochondria, simple melancholia, melancholia with depressing delusions, melancholia with agitation or with stupor, acute delirium, and chronic degenerations resembling paranoia. There is a general agreement that melancholia is the most frequent form of mental disease at the menopause, and that acute mania rarely occurs. That the menopause is not an important factor in the production of insanity is shown by the fact that between the ages of forty-five and fifty-five, covering the usual period of the menopause, the admisssions of men and women to institutions for insane are equal. If the menopause were alone a serious and important factor in the production of insanity it would be shown in this connection.

It has been noted, however, at the Pennsylvania Hospital, during the last few years, that number of women have been received who had been operated upon for removal of the sexual organs, the majority of whom subsequently had melancholia, with many of the symptoms attending the menopause, which had been anticipated by surgical interference, indicating that whether the grand climacteric is brought on in the course of nature, or by the methods of science, the mental results are quite similar, when any have appeared. In these cases, as well as in those occurring independently of surgery, a neurotic or insane tendency has been established.

Dr. Chapin admits that the term "psychoses of the meno

pause" has some conveniences, but beyond certain narrow limits there is no sufficient clinical experience to warrant the recognition of a distinct class of insanities as due to a normal ending of an animal function that is universal. It is the province of physicians to remove the unfounded perturbations that worry and distress so many persons as they approach this period of their lives, and to hesitate about the performance of all those experimental operations that may precipitate it.

Scientific Review

Traumatic Aneurism of the Brachial Artery with Division of the Median Nerve.-KARL SINNREICH reports a case of traumatic aneurism of the right upper arm in the Wiener klinische Wochenschrift of February 22, 1900, and makes a rather extended study of the cases of brachial aneurism heretofore reported.

The patient, a man of fifty-one years, received a stab wound in the right upper arm. Blood spurted from the wound, the patient lost consciousness, the hæmorrhage ceased, and a bandage was applied. Some days later when admitted to the hospital an irregular, nodular tumor, somewhat larger than a fist, was found to occupy the lower three-quarters of the flexor surface of the right upper arm. The tumor was elastic, movable from side to side, and manifested a pulsation and a thrill synchronous with the heart beat. The pulsation and thrill disappeared with compression of the axillary artery. There was also evidence of paralysis of the median nerve, both sensory and motor. About two weeks after the occurrence of the injury, total extirpation of the aneurism was practiced. The brachial artery was ligated just below the region of the arteria collateralis radialis. The median nerve was exposed, and the swollen, severed ends were freshened and united by suture. The wound was closed with the exception of a very small drain in the lower angle. The wall of the aneurism varied from two to four millimetres in thickness. In removing the sac it was necessary to excise a portion of the brachial vein. The wound healed rapidly and sensation and motion both rapidly returned in the region of distribu