family. The infrequency of the presence of intestinal ulcers in infants, in spite of the fact that the sputum is swallowed, would seem to point to the opinion that the intestinal tract is not vulnerable to tuberculosis at this period of life.

The foregoing observations tend to confirm the opinion that it is direct contagion which is responsible for most of the tuberculosis of infants rather than infection through milk or other foods.

The results of the study of the spinal fluid in lumbar puncture in tuberculous meningitis also gave valuable information as to the possibility of obtaining the bacilli. Of 42 consecutive cases of the disease the bacilli were found in every case. Some important points in technique have been developed in the course of this study which are of assistance in finding the bacilli. In withdrawing the fluid it was found advisable to collect the amount in several tubes, since the bacilli are more apt to be found in the last portion drawn than the first, probably because the bacilli are present in large numbers in the brain and come down with the last portion of the fluid. The bacilli were usually more numerous in late punctures than in those made in the early stage of the disease. The following technique of search is given followed in this series:

The fluid is allowed to stand in the test tube for 12 hours. If a film forms by the coagulation of fibrin in the fluid, this is fished out with a platinum loop and stained. Such film formation occurred in about half of the cases, and in it the bacilli are pretty certain to be entangled. If no film forms, the sides of the tube are scraped with a platinum loop. If the bacilli are not found in this way, the fluid is centrifuged. The chance of success after centrifuging are greatly increased by adding a drop of blood.

Of the 42 cases showing the bacilli in the cerebro-spinal fluid, 22 also showed the bacilli in the sputum, although 9 of them showed no evidence whatever in the chest, and in only 5 was there any consolidation.

THE AUSCULTATORY AND PERCUSSION FINDINGS OF THE HEART IN LATE CHILDHOOD. William J. Butler. American Journal of the Medical Sciences, July, 1907.

The heart findings in a physical examination are often misinterpreted in late childhood owing to two factors—the comparatively large cardiac area and the frequency with which murmurs are heard over the heart at this time. The author gives the results of the examination of 100 healthy children from this point of view. To sum up the findings in the 100 children examined, it may be stated that the upper border percussed in the parasternal line is most frequently found on the third rib, less often in the second or third interspace; that the right border may extend 0.5 to 2 cm. to the right of the sternum, as indicated by a slight relative dullness only, and that the apex, while most frequently found in the fifth

interspace inside the nipple line, may be found outside of it. It is seldom in the fourth interspace, in which event it is as often inside as outside the nipple line. It will be noted that in changing from the erect to the dorsal position no change is found in the level of the upper or right border in about 45 per cent. of the children, and that in many of the remainder a difference of 0.5 to 2 cm. was found either in elevation of the upper border or diminishing of the right border, there being no parallelism in the changes in these borders in most of the children. In a few children the upper border was lowered in the recumbent position. In regard to the position of the apex, in more than half it remained unchanged, though at times it became less distinct; in others it ascended the width of an interspace or a rib, or of both, and in a few instances, without changes in horizontal level, it glided slightly to the left.

The differences in the cardiac area, as found in the erect and the recumbent positions, undoubtedly depends upon the elevation of the diaphragm and gravity.

In auscultation over this area murmurs were heard in 64 cases. Of this number, in only 18 were they heard in the erect position, leaving 46 in whom they were audible only in recumbency. Murmurs heard in the erect persisted in the recumbent position. The murmurs were much influenced by position. Those heard over the pulmonic area and the apex were usually intensified on placing the child on the left side. The murmurs varied considerably at times in loudness under the auscultating ear, were sometimes inconstant, and frequently disappeared at the height of the inspiration or were greatly diminished in intensity, being usually heard best during the expiratory phase. From the mentioned characteristics of these murmurs it is evident that they do not conduct themselves as do organic murmurs, which are not markedly influenced by position or the respiratory movement. The writer looks upon them as accidental murmurs, dependent on the relation of the heart to its environments; in other words, we are dealing with extracardiac, paracardiac or cardiopulmonary murmurs occurring in the systolic phase of the heart cycle.

PNEUMOCOCCUS ARTHRITIS IN INFANTS AND CHILDREN. A. F. Furrer. Archives of Pediatrics, July, 1907.

The object and scope of this paper are:

1. The report of a case of pneumococcus arthritis in an infant 16 months old.

2. The tabulation of 26 previously-recorded cases of pneumococcus arthritis occurring in infants and children.

3. The presentation of a summary from a study of the literature. From a study of the reported cases of this specific form of arthritis occurring in childhood it is noted that the joint involve

ment is secondary to a pneumonia in about one-half of the cases. In 25 per cent. of the cases the joint lesions followed otitis media, bronchitis or measles. In 25 per cent. of cases the arthritis was apparently primary. On the other hand, pneumococcus arthritis in the adult is secondary to a lobar pneumonia in about 90 per cent. of the cases. A few cases have been reported in which the pneumonia followed the joint invasion, and three or four cases have been reported in which arthritis was the primary lesion. This comparison shows in a striking way the apparently much greater .vulnerability of the joints in the young to septic infection.

The writer gives the following points as to diagnosis and differential diagnosis:

1. An acute arthritis occurring in an infant or child coming on from 3 to 14 days after the onset of a pneumonia, and accompanied by pain and swelling, may be suspected to be a pneumococcic arthritis.

2. An acute or subacute arthritis developing without signs or history of pneumonia may be due to the pneumococci.

3. An acute osteomyelitis generally shows more profound constitutional symptoms. Pain is more likely to be referred to the shaft or epipheses.

4. Acute articular rheumatism is very rare in infants and uncommon in young children. A high leucocyte count favors arthritis of pneumococcic origin.

5. Tuberculous arthritis is insidious in onset and chronic in course, generally monoarticular.

6. Gonorrheal arthritis is less acute in onset.

THE PRACTICE OF PEDIATRICS. By American and English Authors. Edited by Walter Lester Carr. Illustrated with 199 Engravings and 32 FullPage Plates. Philadelphia and New York: Lea Brothers & Co.

The list of contributors comprises some well-known names in the field of pediatrics. While most of the diseases pertaining especially to infants are treated in a rather comprehensive manner, some are a little too brief to be of any great advantage. The article on infant feeding is especially well handled and covers the ground admirably from the general practitioner's point of view. The general principles involved in substitute infant feeding are clearly brought out, and many small points, which make the difference between success and failure, are dwelled upon. Diseases of the intestinal tract and infectious diseases occupy a large portion of the volume, as one would expect, and while most of the well-recognized conditions are satisfactorily handled, we observe nothing especially new. The diseases. of the blood, lymphatic system and glands are considered in a clear and concise manner. We think it would be better not to consider skin diseases rather than devote but 25 pages to it, most of which is taken up with illustrations and formulae. The book is well printed, making it rather agreeable to read.

Editorial and Publishing Committee.

ALEXIUS MCGLANNAN, M.D. J. A. CHATARD, M.D.

JOHN RUHRAH, M.D.

Secretaries of the County Societies are earnestly requested to send reports of meetings and all items of personal mention and of local or generai interest for publication addressed to Dr. Alexius McGiannan. 847 North Eutaw Street. Baltimore.

NOTICE.

THE active campaign, which began October 4th., to raise funds for the new medical library building, is being pushed with renewed vigor this year; and it is expected not only to have the $50,000 in hand by April 1908, but to be able to announce at that time the completed fund and plans for the building.

The enthusiastic support of every member of the Faculty, both in the cities and counties, is needed and we expect will be forthcoming.

The Committee has planned to graphically show the progress on large charts, showing "blocks" in the new building with the donor's name on them; these blocks will represent $10.00 each or more according to amount of gift. A chart with a completed building on it (see illustration), showing in the beginning a splendid foundation, will announce the weekly and monthly progress, which we hope will be most rapid.

A list of the names of the paid subscribers, previous to October 4th., is to appear this month, and each month thereafter the new names will be given and full progress of the work.

It is earnestly hoped that all members when going to the Faculty building will be sure to see that their names are entered upon the book there and the questions in it, as regards the new building, answered. At least put your name down even if you don't do anything else. This will help the Committee greatly and aid in the work.

A BENEFIT performance for the New Building Fund is to be given on Tuesday, December 3d. at Ford's Grand Opera House. The play is one of the latest and best musical comedies called "Comin' Thro' the Rye." All must try to be present on medical night and make it a great success. Tickets will be sent out in advance or may be obtained from any member of the Committee or at the Faculty building. A list of patronesses of the occasion will be published next month.

All communications and inquiries concerning the New Building may be addressed to Dr. John Ruhräh, 847 N. Eutaw St. and all subscriptions, either pledges or payments, may be sent to him. Make all checks payable to the Building Committee of the Medical and Chirurgical Faculty of Maryland.