had said, many of these were reported as anemia, bronchitis, etc. If these places were all looked after it would do much to prevent the development of the disease among other members of the family. Dr. W. C. Mardorf thought that while the trend of the paper was most admirable, the establishment of a sanitorium for the cure of incipient tuberculosis in St. Louis under present conditions was not the most immediate or feasible way of taking up a most important problem. The difficulty of obtain ing money for medical institutions had been repeatedly shown, and any such hospital as might be obtainable would accommodate but a very small percentage of the cases of early tuberculosis; these must be large in number, for if it was true that there were ten to fifteen deaths from tuberculosis in St. Louis every day, multiplying this by the number of days average stay in sanatorium per patient would give some little idea of the size of building required. The average patient did not want to go to a tuberculosis hospital anyway, nor was a change of climate always within reach, and for these it was necessary to find some means of help at home, especially in the early stage, when the manifestations of disease were least impressive and treatment was of most avail. The importance of early diagnosis could be overestimated; many of the profession did not realize the comparative ease of curing this disease in its early stages, and the little value of drugs in its treatment. The number of patients being sent away only to die who might have been as well or better treated at home was appalling. Fresh air was a necessity, but most houses were so built that they did not permit fresh air to enter without a draught. The architects should be impressed with this thing, and the board of health could do good work in having incorporated in the building laws provision for proper ventilation. Not enough stress was laid upon the value of fresh air and suitable diet, and the inadequacy of drugs. Dr. Homan, in reply to the question asked by Dr. Green, said that the prevention of the communication of the disease lay in the proper care of and prompt destruction of the sputum. That summed up the whole thing. Dr. Green added that in a sanitorium, of course, it was possible to enforce an ideal arrangement for the disposal of the sputum and, as Dr. Soper had suggested, it was advisable to do away with sweeping, instead, mopping all the floors with a damp cloth. He had asked this question merely because he was desirous of knowing what methods were observed at Saranac Lake in preventing the occurrence of the disease among the employes. Dr. Homan, in closing, agreed with Dr. Soper as to the danger that lay in sweeping. He thought the modern broom and feather duster the deadliest weapons that could be brought to bear against human life. It was not in the poorer districts that consumption was contracted, but in the first class hotels, clubs and office buildings with acres of carpeting, where with broom and the duster the employes kept the germs moving from place to place. This was where these employes contracted the disease. It was true they lived in the poorer districts, but it was in such buildings that they acquired the infection. So far as the new city institution was concerned, he had suggested that some twelve years ago, while serving as health commissioner, and he was glad to see that it was to materialize at last. This would probably be. for the convalescents or the more advanced cases. For early cases the high hills of the Meramac are probably as good or better for St. Louis people than the Adirondacks or Colorado, as this was a home climate. In this connection Dr. Homan stated that it was planned to lay the corner stone of the new State institution for incipient consumptives at Mt. Vernon about the 24th of May. The profession should go down there by the train load, not only to give countenance and encouragement to the movement and the men having it in charge, but to show the people of the State and the members of the legislature that their support was still needed, morally and financially. Dr. Green referred to a pamphlet he had received from the new St. Regis Hotel, in New York, in which there was a very elaborate system of ventilation, and also a means of The ventilating removing dust and debris. system consisted in drawing in fresh air through cheese cloth screens by suction, the air then being passed over heated coils and carried to the rooms. Furthermore, a system of tubes was provided through which the dust of the rooms could be sucked up by a suction pump and conveyed to a receptacle in the basement. Some such method as that, where the fresh air was filtered through cheese cloth and the cleaning of the rooms done by suction might well be imitated in buildings of the future. NEVER advise an elastic stocking in cases. of varicose veins where thrombosis exists. The pressure may detach a part or whole of of the thrombosis, propelling it into the general circulation. THE MEDICAL FORTNIGHTLY Issued Tenth and Twenty-Fifth of Every Month. FRANK PARSONS NORBURY, CARL E. BLACK. With the following staff of Department Editors O. E. LADEMANN, Internal Medicine. R. B. H. GRADWOHL. Pathology and Bacteriology. W. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology. HERMAN STOLTE, Laryngology and Rhinology. F. P. NORBURY, Nervous and Mental Diseases. T. A. HOPKINS, Genito-Urinary Diseases. ROBERT H. DAVIS, Dermatology. EDITORIAL Medical Aspects of the Proposed Bond Issue. THE coming election on the question of bonding St. Louis for various improvements is in several points of such inand our patients that it terest to our profession would seem that every physician should support and urge support of all points of the proposition, but especially of those relating to hospital construction and reconstruction, sewers and parks. The following report bearing on this subject was presented at the meeting of the St. Louis Medical Society, May 12th, and unanimously adopted: The Committee on General Welfare wishes to call attention of the society to the fact that an election will be held on Tuesday the 12th day of June, 1906, when ordinance No. 22,366 will be submitted to the voters. This ordinance provides for an issue of bonds of the city of St. Louis not to exceed $11,200,000.00. Nine propositions are to be voted on. I. $3,500,000 for a free bridge. 2. $800,000 for the construction, reconstruction, and extension of hospitals, and the purchase of sites for the same. 3. $1,000,000 for the construction, reconstruction, and extension of and an addition to the Insane Asylum, and for the purchase of sites for the same. 4. $230,000 for the Fire Department. 5. $2,000,000 for buildings for Jail, Police and Health Departments and Police Courts. 6. 1,000,000 for bridges and viaducts. 7. $500,000 for King's Highway improvement and extension. 8. $1,500,000 for construction and extension of sewers. 9. $670,000 for purchase, construction and laying out of parks. Each one of these propositions is to be voted on separately, and in order for a proposition to carry, two-thirds of the voters of the city of St. Louis voting thereon must assent thereto. The medical profession is particularly interested in propositions 2 and 3, and your committee wishes to suggest that the members of this society exert themselves in behalf of these measures. No class of citizens are in a position to know as much as the medical profession about the crying needs provided for in propositions 2 and 3. Our opinion should be appreciated by the people, but if not, this committee feels it to be a duty of this society to publicly express itself. We therefore suggest that at the proper time, an appeal might be made to the voters of St. Louis in behalf of these two measures; this appeal to be made in an open letter, published in not less than two of the daily papers, and signed the St. Louis Medical Society of Missouri, with the names of its This committee President and Secretary. knows of no member of this society better qualified to prepare such a letter than our President, and therefore suggests that this duty be entrusted to him. Last year a committee was appointed to effect a non-partisian ward organization of the physicians of the city. The purpose of this organization was to render more effective the efforts of our profession in furthering those measures conducive to the health and general welfare of the public. If this organization is in a condition to carry out the purpose for which it was created this committee would recommend to its consideration the election of June 12. Antitoxin for the Poor. We are in receipt of the following letters from Dr. H. J. Scherck, Chief Dispensary Physician of the City Health Department: The enclosed copy of a communication addressed by the health commissioner to me is of such public interest both to citizens and to the medical profession that I take this opportunity of sending it to you. There are a great number of people who cannot afford to purchase antitoxin when any of their family are stricken with diphtheria. When assurances are given that people are too poor to purchase antitoxin, and I am notified, a physician of my staff will be immediately sent to the address and he will administer the antitoxin, with the assistance of the attending physician. Antitoxin will not be distributed to physicians generally for two principal reasons: Ist. The Health Department desires to know where each dose of antitoxin is used and to prevent the possible use of it in patients whose family can afford to purchase same. 2d. Inasmuch as antitoxin is issued by the Health Department the responsibility of its administration must rest with the physicians connected with the Health Department. The antitoxin administered will be purchased from one of the best and most reliable Eastern manufacturers, and a certificate will accompany it certifying to its purity and freedom from any contamination. A history will be kept of each case, which will serve to prove the efficacy of this treatment as well as its value as a preventive among those children who are directly exposed to cases of the disease. Very truly yours, H. J. SCHERCK, ST. LOUIS, MO., May 15th, 1906. Chief Dispensary Physician. Dear Sir: In the annual appropriation for the fiscal year 1906-1907 there is a fund for the purchase of diphtheria antitoxin; in order that this fund may be used to the best advantage the following suggestions occur to me as being of importance in the proper handling of this work: Ist. To prepare a blank form in the nature of a certificate to be signed by the attending physician to the effect that he certifies on honor that the patient or his family is financially unable to purchase antitoxin and is a fit subject for charity. 2d. Upon the receipt of this certificate you are to send a physician connected with your staff to the home of the patient to administer the antitoxin as often as it becomes necessary. 3d. That where the patient is surrounded by other children that an immunizing dose shall be administered to those who have come in contact with the case. 4th. To prepare a blank history form, on which is to be recorded a personal and clinical history of the case and the various points connected with it, together with a statement of the result obtained from the treatment of the case, certified to by the physician of your staff in attendance on the case. These histories to be kept properly filed and to serve as a basis of statistics in order to demonstrate the advisability of continuing this work. The details of management and supervision of this work to be under your direction. Very truly yours, (Signed) H. WHEELER BOND, Health Commissioner. TRI-STATE MEDICAL SOCIETY OF IOWA, ILLINOIS AND MISSOURI.-This association will hold its fourteenth annual meeting in Galesburg, Ill., on June 26 and 27, under the presidency of Dr. Wallace C. Abbott, of Chicago. The secretary, Dr. C. F. Wahrer, of Ft. Madison, has prepared an excellent program for the occasion, comprising fiftyeight papers, including the president's address. The other officers of the society are as follows: First vice-president, Dr. J. W. Hanna, Winfield, la.; second vice-president, Dr. H. B. Young, Burlington, Ia.; treasurer, Dr. Emory Lanphear, St Louis, Mo. MEETING OF INSURANCE EXAMINERS.-The seventeenth annual meeting of the American Association of Life Insurance Examining Surgeons will be held at Hotel Thorndike, Boston, Mass., Monday, June 4th, 1906. A most interesting program has been arranged and the meeting will be one of exceptional interest from all points of view. Those going to the meeting of the A.M.A. will do well to arrange their itinerary to reach Boston in time for the session of this Association. Following are the officers for 1905-1906: President-Henry Wells Dewey, Tacoma, Wash.; Vice-President-William Moore, New York; Vice-President-A. S. McDaniel, San Antonio, Texas; Vice President-M. A Robinson, Victor, Col.; Vice-President-William F. Amos, Portland, Ore.; Resident Secy.-Mark N. Richardson, Boston; Recording Secy-J. Carlisle DeVries, New York; Secy.-Treas.-John Guy Monihan, New York. The TRIP TO BOSTON.-A number of excursion parties are being organized in the West to attend the meeting of the American Medical Association in Boston, June 5 to 8. general plan of the various parties is to charter special cars at principal points and join hands in Chicago on June 1st, where arrangments have been perfected for a special train via the Grand Trunk Ry., to be known as the "Missouri Valley Special." This train will stop at Niagara Falls and Toronto, and from Kingston to Montreal, the trip down the St. Lawrence will be by boat, through the famous Thousand Islands. The Missouri Valley party will arrive in Boston morning of June 4 (one day ahead of the other delegations) affording members an opportunity to see Boston, attend the auxiliary meetings and get located before the rush. Members desiring to join this party at St. Louis should communicate at once with Dr. T. A. Hopkins, Century Building. Those who are located further west should make reservations through the secretary, Dr. Chas. Wood Fassett, St. Joseph, Mo. INTERNAL MEDICINE. O. E. LADEMANN, M. D. Ehrlich's Diazo-Reaction in Pulmonary Tuberculosis.-Junker (Beitr. zur Klinik der Tuberculosa, Bd. V, Heft 1, 1906) analyzed the urine of two hunderd consumptives as often as eight to thirty-five times. A positive reaction occurred in only the second and third stages of the disease. A negative reaction does not warrant the conclusion of a favorable prognosis, while a continued diazo is always significant of an evil omen, as may well be inferred from the clinical characteristics in general. Junker often observed a positive reaction occurring during the course of some intercurrent affection, as influenza, intestinal disturbances, etc.; thus it may be said that transitory reactions are of no prognostic significance. Consumptive individuals with a continued positive diazo-reaction apparently seemed to respond less favorably to tuberculin therapy than those otherwise in an advance stage. Anesthetics and Renal Activity.-Thompson's (British Med.. Jour., March 17, 1906) results of an experimental investigation into the effects of prolonged chloroform anesthesia are summarized as follows: 1. The volume of urine secreted by the kidney is, as a rule, affected during chloroform narcosis in two ways: In the early stages, when the anesthesia is light, the quantity is frequently increased. During full anesthesia the secretion is always diminished, and may be suppressed. 2. The after affect is invariably a great increase, which in certain periods may reach to four times the normal volume for the same period of time. The maximum outflow occurs about three hours after removal of the anesthetic. 3. The total excretion of nitrogen is, as a rule, greatly reduced-more so than the quantity of urine. The average taken from experiments with diminished urine volume show that during the anesthetic period the excretion of nitrogen fell to 18% of the normal, whereas the quantity of urine in the same series fell only to 35% of that amount. In the minority of the experiments with increased urine volume the total nitrogen per period was also increased, but to a much less extent than the volume of urine in the same experiments. 4. The urine secreted during chloroform anesthesia is almost invariably more dilute (contains less nitrogen per cent) than the normal urine. This holds good even when the volume of urine is diminished, hence it is inferred that chloroform affects not only the blood flow through the glomerulus, but also the secretion of nitrogenous solids into the man. tubules, and the latter even more than the former. The result, therefore, favors the theory of urinary secretion advanced by Bow5. There is a general but not accurate correspondence between urine outflow, kidney ship between the first and second is closer volume, and blood pressure. The relation than the first and third. A state of almost complete suppression may coexist with a comparatively high blood pressure. 6. In prolonged narcosis, with marked diminution dation into the renal tubules of leucocytes, of urine volume, there is a considerable exuwhich subsequently escape with the urine. The condition is probably produced by more or less vascular stasis in the glomerular vessels. 7. The excretion of chlorides is much increased both during and after chloroform narcosis. In the fourth period after removal of the anesthetic the amount may be ten times the normal quantity in the urine of the dog. 8. Albumin appears in a small proportion of experiments after chloroform inhalation. 9. Reducing substances other than glucose are almost invariable increased. The nature of the reducing substance has not been definitely determined. Belladonna Poisoning Due to Belladonna Plasters. Doland (Am. Jour. of the Med. Scs., April, 1906) reports three cases of belladonna intoxication following the application of belladonna plasters. The symptoms in each case were typical. In one case the toxic symptoms evidenced themselves two hours after the application of a small belladonna plaster applied to the chest, while the symptoms in the other two cases did not appear until a few days after. Recurrent Motorocular Paralysis as a Complication of Typhoid.-Jockmann (Deutsche med. Wochenschrift, No. 16, 1906) defines periodical paralysis of the third nerve as a manifestation making its first appearance in infancy or early life, limited to the motorocular associated with headache and vomiting, and recurring at irregular intervals (Möbius). He next discusses the theoretical aspects regarding the nature of the condition, and reports in detail an interesting case as follows: A young man, 19 years old, with a negative family history. His first attack appearing at the age of eight years with headache, vomiting and a paralysis of the left aculomotor nerve. During the ensuing years attacks of migraine occurred at frequent intervals, three of these attacks with a concomitant motor ocular paralysis, the last occurring during an attack of typhoid fever. It is hardly probable that the simultaneous occurrence of ty. phoid fever can be regarded as a mere coincidence. It is more likely that the typhoid infection, in lowering the vitality, acted as an exciting factor in a predisposed individual. The prolonged existence of the paralysis in this attack (three months) is strongly suggestive of the late presumption, while in the first attack the paralysis lasted eight days, and only four days in the second and third. The case in question presented all the characteristics of a periodic oculomotor paralysis in the sense of Möbius; the attacks beginning in childhood and were of a longer duration than the ordinary attacks of migraine, a complete absence of visual aura, nothing suggestive of anything hereditary, and a non-occurrence of migraine in the other members of the family. Somewhat out of the ordinary were the frequent rudimentary attacks without any paralysis, the latter being in evidence but four times. Noteworthy is the fact that the attacks were limited to the left side, quite unlike ordinary migraine, which is apt to shift from one side to the other. Jockmann regards the occurrence of the paralysis in the first attack as a significant differentiating feature from the ordinary migraine, as those cases in which a motorocular paralysis followed hemicrania did so only after severe and repeated attacks, and sometimes years after its existence. What Causes the Pylorus to Relax ?-Benedict (N. Y. Med. Jour., April, 7, 1906) offers the following summary as his objections to the acid theory of relaxation and closure of the pylorus: 1. The local changes in reaction are physiologically inevitable. 2. The relative acidity of the chyme is not diminished by the passage outward of a small portion, yet the pylorus does not remain patulous. 3. While this failure of a continuous relaxation of the pylorus may be explained by distal acidity, it is in close analogy with the action of other alimentary sphincters, which close without any exciting reflex that can be ascribed to differences in clinical reaction. 4. Fully half the stomach contents normally escape before it is conceivable that any great proportion of hydrochloric acid is present. 5. Clinical experiences with dietaries shows that other things being equal, meats that call for considerable hydrochloric acid secretion usually remain in the stomach longer than those which do not. 6. Clinical experience with stomach. contents proves conclusively that deviation from the normal standard of hydrochloric acid secretion produces just the opposite effect to that which would be expected if this were the cause of pyloric relaxation. Even in achylia gastrica, there is no necessary ab normality of pyloric function, certainly not in the direction of retention. Di-methyl-amido-azo-Benzol as an Indicator for Free Hydrochloric Acid in Gastric Analysis. -Elmer (Jour. A. M. A., April 14, 1906) speaks of the sources of error observed in using di-methyl-amido-azo-benzol as an indicator for the quantitative determination of free hydrochloric acid in the gastric contents. The principal difficulty with this indicator is not in its lack of delicacy, but the fact that certain organic acids found in the gastric contents, when in proper concentration, will give the same color change as free hydrochloric acid. Of these, lactic acid is the only one occurring in sufficient amount to interfere with the reaction. Elmer proposes the following remedy: The test meal is to be practically free from lactic acid, and for this purpose one consisting of one shredded wheat biscuit and 300 cc. of water, administered after a fast of eight to twelve hours, and removed from three-fourths to one hour, meet all indications. Should lactic acid be present in the expressed gastric contents the error may be practically eliminated by sufficiently diluting the contents. By repeated trials the author determined one part in fifteen hundred the smallest amount of lactic acid that would respond to the di-methylamido-azo-benzol test. The highest dilution of lactic acid which would give a characteristic Kelling reaction was in the proportion of one to twenty-two thousand, or approximately fifteen times the dilution required to give the di-methyl-amido-azo-benzol test. Attitude in Angina Pectoris.-Minervini (Riforma Medica, Nos. 46 and 47, 1905) describes nine cases of angina pectoris to illustrate the position assumed during an attack. This peculiar attitude consists in throwing the head backwards and straightening the body, somewhat simulating the attitude of opisthotonus, the arms hang down, or one may be placed over the region of the heart. Patients invariably seek such a position when an attack manifests itself, regardless of the posture prior to the attack. If standing he leans against a wall throwing his head backwards, if possible; if seated he leans his head over the back of the chair. This attitude sign, as the author styles it, is an apparent diagnostic index of stenocardia and is in direct contrast to asthma and kindred conditions, when the patient leans forward in order to have as free access to the air as possible. Minervini regards this characteristic posture as an instinctive act on part of the individual, who seemingly aims to get away from the heart. By means of the forced backward flexion of the head the venous flow in the neck is hindered, and in consequence thereof there is an increased intracranial pressure |