soldiers, etc., culminating in the cornerstone laying of the city's new $1,000,000 Public Library. An industrial pageant, under the auspices of the Million Population Club, with floats depicting the city's industries. The Veiled Prophet annual pageant, with special Centennial features. An all-week Centennial festival in the downtown streets, with brilliant illuminations, music and fireworks. The mayors of 3,000 cities have been invited by Mayor Kreismann of St. Louis to be guests of honor of St. Louis during Centennial week. Each mayor accepting will receive an invitation and souvenir of the Veiled Prophet ball, which this year will be held at the New Coliseum, instead of Merchants' Exchange, as heretofore. This change will enable an attendance three times as large as that at any previous Veiled Prophet ball. The decoration scheme will embrace scenes which are a part of the history of St. Louis, and it is prophesied that the Veiled Prophet ball of Centennial week will overshade in point of brilliancy and attendance all other balls in the history of America, not excepting that great quadrennial event, the inaugural ball at Washing ton. Centennial week will be the occasion of many notable gatherings in St. Louis, including a national convention of retail merchants for an exchange of ideas on salesmanship, advertising, window and showcase display, store arrangement and other matters of vital interest to all retailers. The St. Louis Centennial Association has obtained reduced railroad rates for Centennial week from practically all parts of the United States, including the Pacific coast. Literary Notes In Labrador, Dr. Wilfred T. Grenfell and others who have assisted him have put down in readable and attractive form for the first time an enormous amount of valuable information about a little-known region. The world has only recently awakened to the splendid work Dr. Grenfell is doing along the bleak and ice-bound coast of Labrador. The new book not only conveys valuable information, but will heighten our admiration for the devotion of its chief author. Mexico, by William E. Carson, a companion volume to Dr. Grenfell's Labrador and Mrs. Higginson's Alaska, is an entertaining account of a country more extensively but in some ways hardly better known. The traveler who crosses the Mexican border finds himself at once in an utterly different world. The fascination of it all and also a thoughtful appraisal of its merits and faults are well set down in Mr. Carson's interesting volume. Anatomy for Nurses. How far the scientific training of nurses has advanced in recent years is forcibly demonstrated by a Text-book of Physiology and Anatomy for Nurses, by Diana Kimber, revised by Miss Carolyn E. Gray. As assistant superintendent of the New York Training School for Nurses on Blackwell's Island, Miss Gray has had ample opportunity for familiarizing herself with the needs of nurses. In her revision of Miss Kimber's well-known work, she has brought the volume abreast of the most recent developments in medical science. Illustrated with numerous cuts, both black and white and colored, the book will unquestionably prove an invaluable text. Book Notices The American Pocket Medical Dictionary. New (6th) Edition. The American Pocket Medical Dictionary. Edited by W. A. Newman Dorland, M. D., editor "The American Illustrated Medical Dictionary." Sixth revised edition. 32 mo of 598 pages. Philadel phia and London. W. B. Saunders Company, 1909. Flexible Morocco, gold edges, $1.00 net; thumb indexed, $1.25 net. This practical work commends itself to the busy worker as being even better than its five predecessors. It contains nearly 600 pages filled with words, their pronunciation and meaning, and satisfies the want of those who desire a complete yet brief dictionary of medical words. The various tables are useful and are well selected. The book is clearly printed and neatly bound in flexible leather. Principles of Pharmacy. The Principles of Pharmacy. By Henry V. Arny, Ph. G., Ph. D., Professor of Pharmacy at the Cleveland School of Pharmacy, Pharmacy Department of Western Reserve University. Octavo of 1175 pages, with 246 illustrations, mostly original. Philadelphia and London. W. B. Saunders Company, 1909. Cloth, $5.00 net; Half Morocco, $6.50 net. While the book is written specifically for the instruction of students in Pharmacy it nevertheless should be of inestimable value to physicians, especially to those who dispense their own drugs. The author discusses comprehensively the pharmaceutical processes, the galenic preparations, the inorganic chemicals, the organic chemicals, chemical testing, perscription, writing, and laboratory work in the above subjects. The book contains 1200 pages, has a satisfactory index, a good table of contents, and the work of the publishers is indeed credible. The reviewer takes pleasure in stating that this book is the best of the kind that has come under his scrutiny for a good while. Diet In Health and Disease. Diet in Health and Disease. By Julius Friedenwald, M. D., Professor of Diseases of the Stomach in the College of Physicians and Surgeons, Baltimore; and John Ruhrah, M. D., Professor of Diseases of Children in the College of Physicians and Surgeons, Baltimore. Third revised edition. Octavo of 764 pages. Philadelphia and London. W. B. Saunders Company, 1909. Cloth, $4.00; Half Morocco, $5.50 net. The length of time which has elapsed between the appearance of the first and third editions of this work speaks well for its popularity. This edition has been thoroughly revised and enlarged and differs from the preceding editions in several particulars. The articles on milk and alcohol have been rewritten. Certain additions have been made to the articles on tuberculosis, the salt free diet, rectal feeding and the coloric needs of infants. Some tables showing the coloric value of foods and Winton's table showing the composition of diabetic foods have also been inserted. In view of the recent pure food agitation the addi tion of descriptions of certain simple tests for food adulterations seems worthy of special note as it 1 most often the general practitioner who is brough: in contact with such adulterations. All in all the third edition is a worthy successor to the first two, and for the general practitioner is the most valuable work on diatetics we have seen. The book can be heartily recommended to progres sive physicians to be placed by them after careful reading it themselves, in the hands of intelligent patients. Tuberculosis a Preventable and Curable Disease. Modern Methods for the Solution of the Tuberculosis Problem, by S. Adolphus Knopf, M. D., Prof. of Phthisio-therapy at the New York Post Graduate Medical School and Hospital. Associate Director of the Clinic for Pulmonary Diseases of the Health Department; Attending Physician to the Riverside Sanatorium for Consumptives of the City of New York, etc., New York, Moffat Yard & Co., 1909. The profession has long felt the need of a book, authoritatively written, which could be placed in the hands of tuberculosis patients. It is a well known fact that verbal instructions, explanations, etc., are often accepted by the patient suffering from tuberculosis with considerable reluctance, while the same facts if, "read from a book" immediately become gospel. Dr. Knopf is perhaps better posted to write such a book than any other American on account of his long contact with the general public in the crusade against tuberculosis. The little volume which he presents is indeed worthy of consideration. He tells the patient suf ficient, not too much. He discusses sanatoria sanely and suggests methods of approaching sanatorium treatment at home. The suggestions which he offers for those "predisposed" to regulate their lives are distinctly worth while. The duties of the City, State and Nation are placed before the patient that he may use his inffuence in bettering conditions for those who follow him. BOOK, PAMPHLETS, ETC., RECEIVED. From Lea and Febiger, Philadelphia. A Treatise on the Principles and Practice of Medicine. By Arthur R. Edwards, M. D., Professor on the Principles and Practice of Medicine and Clinical Medicine in the Northwestern University Medical School Chicago. New (second) edition thoroughly revised. Octavio, 1246 pages, with 100 engravings and 21 full-page plates in colors and monochrome. Cloth, $5.50, net; Leather, $6.50, net. From Wm. Wood & Co., New York. Manual of the Diseases of the Eye, by Chas, H. May, 6th, revised edition, 362 original illustrations, including 22 plated with 62 colored figures. Price, $2.00, net. From Parke, Davis & Co., Detroit, Mich. Manual of Therapeutics. Referring especially to the products of the Pharmaceutical and Biological Laboratories of Parke, Davis & Co. Progressive Medicine, September, 1909. A quarterly Digest of Advance, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M. D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo 336 pages, with 37 engravings. Per annum, in four cloth bound volumes, $9.00; in paper binding, $6.00, carriage paid to any address. Minor and Operative Surgery, Including Bandaging. By Henry W. Wharton, M. D., Professor of Clinical Surgery in the Women's Medical College, Philadelphia. New (seventh) edition, enlarged and thoroughly revised. 12 mo, 674 pages, with 555 illustration. Cloth, $3.00, net. From J. B. Lippincott Co. International clinics, a quarterly of illustrated Clinical lectures and Especially Prepared Orig. inal Articles. By W. T. Lonscope, Phil., Vol. 3, 19th series, 1909. From Treasury Department Public Health and Marine Hospital Services of the United States. Studies upon Leprosy. Upon Utility of the Examination of the Nose and Nasal secretions for the Detection of Incipient Cases of Leprosy by Walter R. Brinckhoff, LB. M. D., W. L. L. Moore, Honolulu. From St. Louis Maternity Hospital. "A Statement"-as to its service to patients and the public, its managers, physicians and nurses and on account of its work in 1908. "Standing Orders for Nurses." Medical Ass'n Vol. V. 2, 1909.) (Journal Mo. State From J. W. McLaughlin, M. D., Austin, Texas. Personal Observations in Latent Malaria, (Reprint from Texas State Journal of Medicine, April, 1909.) A Catalytic Theory of infection and immunity (Reprinted from the Medical Record May 1, 1909.) From John Aulde, M. D. Magnesium Infiltration. A prelimanry study of its Pathology Clinical relations and developments in both acute and chronic diseases embracing diagnosis and treatment. (Reprinted with additions from The Wisconsin Medical Recorder.) Price 25 cents. From J. D. S. Davis, M.D., L.L. D., Birmingham, Ala. Blood Transfusion. (Reprint from the Alabama Medical Journal, July, 1909.) Report of a case of Urethral Transplantation.( Reprint from the Southern Medical Journal, Feb., 1909.) Pages 556-557. (Reprinted from From Britton D. Evens, M. D. From C. A. Henry, M. D., Farson, Iowa. From Wm. H. Welch, M. D., Baltimore, Maryland. From Bulletin of University of Missouri School of A Monthly Journal of Medicine, Surgery and the Allied Sciences. COMPLETE SERIES, VOL. LVIII, No. 10 NEW SERIES, VOL. III, No. 10 ST. LOUIS, MO., OCTOBER, 1909 Contributed Articles SOME RESULTS WITH THE WASSERMANN REACTION FOR THE SERUM DIAGNOSIS OF SYPHILIS. BY JOHN W. MARCHILDON, M. D., Assistant Professor of Bacteriology in St. Louis University, School of Medicine, St. Louis. Syphilis, by the variety of its manifestations and because of its transference from parent to offspring, was early recognized as a disease of the blood and numerous attempts were made to find out if there was not some substance in the blood serum of syphilitics which might distinguish it from other infectious diseases of its class. The earlier studies were made upon the cellular elements of the blood, and cells were described which were thought to be peculiar to syphilis. Numerous bacteria have been found and proved of no importance: the variations in number of white and red blood corpuscles, and their morphological changes have been attributed to the disease. The quantitative changes in haemoglobin. the alkalinity of syphilitic blood serum, the amount of albumen, and the freezing point of the serum were all determined without any practical value. With the discovery of the presence in blood sera of agglutinins, haemolysins and precipitins, these substances were studied in syphilitic sera and it was found that luetic serum was practically the same as normal serum in its agglutinating, haemolytic and precipitating prop erties. After the discovery of the cause of syphilis, in late years, spiracaeta were found (Raubetschek) in the blood serum, but so sparingly as to be of no diagnostic value. Other scientists studied the serum from the chemical, physical and physiological point of view, and to this class belongs our present Wassermann reaction for the serum diagnosis of syphilis. From the advent of the demonstration of antibodies in the blood serum came our present new era of serum diagnosis, developed largely from the study of syphilitic sera. This serum diagnostic test, as first given to the scientific world by Wassermann, was so very complicated that it could not be made in small laboratories, and the practitioners were not $2.00 YEARLY able to use it. This technic I have described elsewhere in detail.* The reaction is made by mixing serum from the patient with extract of syphilitic liver and fresh guinea pig serum, and let stand 30 minutes in an incubator. Then a hemolytic serum and red blood corpuscles are added. Now, most all of these substances degenerate: they will not keep, and since their dosage is determined with difficulty the making of the test must be painstaking and laborious. It is to be desired that all the materials used in the reaction be made stable, if the test is to be more widely used. I have found that alcoholic extracts of syphilitic liver are just as good as the watery extracts previously used and that they will keep.** It was known that human hemolytic serum keeps well on ice, and that it could be used with the red blood corpuscles of the patient; this made the test more practical. The guinea pig's serum used for the complement is very easily destroyed at room temperature, and it has been the rule to kill a guinea pig to get fresh serum every time the test was made. Noguchi, of New York, has modified the test by soaking filter paper in guinea pig serum and drying it in cold air. These slips of paper degenerate also and are not reliable. During the past year Mr. L. H. Shackell, of the Physiology Department in St. Louis University, and myself have applied his method of freezing and drying substances in a vacuum, in preparing and preserving the materials used in making the Wassermann reaction. A preliminary report of our work will be published soon. plement in powdered form. All that is necesSuffice to say we have prepared guinea pig comsary is to add this powder to a definite amount of physiological salt solution and you have. fresh guinea pig complement. This powder will keep, as far as we know, at least for months. We trust we shall have made the technic of the serum diagnosis of syphilis simpler, thus making it more available for the smaller laboratories and the profession. As regards results with the Wassermann reaction for syphilis, I have classified my cases as follows: *Theory. Technic, and Practical Results of the Reaction for the Serum Diagnosis of Syphilis. St. Louis Medical Review, November, 1908. **A Comparison of Alcoholic and Watery Extracts in the Serum Diagnosis of Syphilis. Journal A. M. A., December 19, 1908. (a) Cases showing signs and symptoms of manifest syphilis and giving a positive serum reaction. (b) Cases showing no signs or symptoms of syphilis and giving a positive serum reaction. (c) Cases showing signs and symptoms of syphilis and giving a negative serum reaction. (d) Cases showing no signs and symptoms of syphilis and giving a negative serum reaction. Of the cases with symptoms present, and diagnosed by the clinician as syphilis, there were 103, and all gave a positive reaction. It is true that in manifest lues the reaction is practically always positive. Of patients showing no signs nor symptoms of syphilis at the time of examination there were 41 which gave a positive reaction. In these cases there was a definite history of syphilitic infection and, in many cases, of apparent good treatment. It is still a question as to what we shall do when we get a patient who has had syphilis and has apparently been well treated and who has no signs nor symptoms of syphilis since infected and yet a positive reaction is given. I have always left it to the clinician to decide and to judge whether or not such patients should receive mercurial treatment. Treatment was begun in all these cases, ten patients having been re-examined after a period of three months' mercurial treatment; all gave a negative reaction. I have never had a patient who gave a positive reaction with no history nor symptoms of syphilis being present. I have never had a syphilic blood serum giving a positive reaction but that it would disappear under mercurial treatment and become negative. There are nonsyphilitic blood sera which give a positive reaction. These I referred to last year (Journal A. M. A., Dec. 14, 1908) and have no bearing upon the practical value of this test. There were two cases with symptoms of syphilis present which gave a negative serum reaction. In the first case spirocaeta-pallida were found in the ulcer on the penis. A week later a positive reaction was obtained and the patient was at once treated for syphilis. The second case was a young woman with a healing ulcer on the lip. A negative reaction was given and a few weeks later a secondary eruption appeared. In patients which showed no symptoms of syphilis at the time of examination and giving a negative serum reaction, I have had 61. Of these 34 were non-syphilitic and 27 were cases giving a history of syphilis and having received mercurial treatment. The non-syphilitic cases were patients with other diseases than syphilis, or were normal, healthy individuals. None gave a positive reaction. The cases having had syphilis and giving a negative serum reaction had all been repeatedly treated by the clinician. None had received any mercury for a period of from three months to several years. The value of the Wassermann reaction to the clinician: My work upon serum diagnosis has shown that the reaction is of great diagnostic value when taken in conjunction with the clinician's findings and the history of the patient. There are always cases which are problems for the physician, and in these laboratory findings are especially desired. In the diag nosis of syphilis, as in all diseases, we need all the information possible. There must be team work between the clinician and the laboratory man. All laboratory diagnosis is only of relative value. Even a histological diagnosis of carcinoma may be wrong, and likewise the clinician may be entirely wrong in his history and physical findings of the case. However, the patients that have been referred to me for a serum examination have been almost every one cases where the diag nosis was in doubt. And in many instances the reaction has cleared up the doubt or confirmed a diagnosis previously made. A case of especial interest that I have had was referred by Doctors Engman and Fuchs. The patient was a young man with a tumor of the clavicle following spontaneous fracture, and looked very much like a sarcoma. The clinical diagnosis of probable syphilis was confirmed by a positive serum reaction, and the tumor cleared up under mercurial treatment. Another doubtful case was a man of 40 years, belonging to Dr. W. W. Graves, complaining of severe pain in the head. The patient was a miner and had advanced arteriosclerosis and ulceration of the tonsil and palate to slight degree. A negative serum reaction was given, and later a histological examination of the tonsil showed carcinoma. A woman, with obscure nervous symptoms, under the care of Doctors Gayler and Unterberg, with no history nor findings of lues, gave a positive serum reaction. A more careful search lead to the diagnosis of tabes. A young woman with reddened vocal cords and obscure throat findings, in the care of Dr. H. W. Loeb, gave a positive reaction and confirmed the diagnosis of syphilis. I have had a large number of these throat cases where a positive reaction has established a diagnosis of syphilis and in others a regative serum reaction has pointed to some other condition as a cause. A boy of 7 years, at the St. Louis Skin and Cancer Hospital, service of Dr. Engman, was one of those obscure cases, the diagnosis of which lay between a congenital syphilis, with small multiple disseminate gummata, and tuberculosis, with multiple lesions over the skin, which are called by skin pathologists tuberculides. There were no general symptoms of either disease. The boy, with the exception of the small ulcerative lesions scattered over the integument, was perfectly healthy. In this case a positive reaction was given, and the lesions rapidly healed under mixed treatment. I could refer to many more cases where the serum examination for syphilis was of great moment. Although the literature concerning this test has been very largely read, and although many know its value, the test has not yet been used by the profession. I trust this valuable diagnostic assistance will eventually come into broader use, as no disease is more fatal and far-reaching in its effects upon the human race. This serum reaction is the only known method by which the insidious nature and subtle disposition of syphilis can be exposed. DISEASES OF THE GALL BLADDER.* BY C. H. POWELL, M. D., St. Louis. In attempting to elaborate a paper upon my subject, "Diseases of the Gall Bladder," I feel that the question has been pretty thoroughly threshed out by eminent writers over different parts of the world, and accordingly nothing new is to be anticipated. It is always appropos, however, to reflect upon pathological conditions in a viscus whose function in the main is in the nature of a receptacle only, and yet whose functional activity, when arrested or otherwise disturbed by morbid action, presents such well-marked influences upon the organism. The medical profession at large are too prone to arrive at a diagnosis of gall bladder disease from paroxysms of pain and icturus only, and the word gall stone colic receives the blame for attacks that operative interference demonstrates the absence of such bodies but in their place changes in the bile is determined; one time it is thick and grumous, at another it is brown or black; it shows a tendency to congeal into soft masses that are regarded by pathologists as the starting focus for the formation of gall stones. Cholecystitis is present, and fortunate indeed is such a patient to have had his gall bladder opened up and drainage executed, inasmuch as failure to relieve the condition will gradually lead to a train of symptoms which will bring the subject to an eventual state of invalidism from which death alone may claim the victim. I will briefly refer to the symptoms that *Read before the meeting of Section on Internal Medicine, of the St. Louis Medical Society, October 9, 1909. invariably occur at some stage of inflammation of the gall bladder, and which are often erroneously attributed to other affections. Perhaps gastric derangement should be placed first, dyspeptic irregularities always stand out conspicuously, there is uneasiness after eating, eructation of food and gases, and often hyperacidity, epigastric pain often develops-it may be very slight, moderate or unusually severe in some cases and palpation of the epigastrium is attended with marked soreness. Constipation which is attributed to hepatic torpor is usually a counterpart of the gastric difficulty, and the patient lapses into the habit of inordinately using laxatives and cathartics which generally includes patent nostrums of every conceivable description. A gradual loss of weight is noticeable in certain cases. The skin may or may not manifest an icturic hue. Usually, however, if the affection persists, as it invariably does if not properly attended to, the skin will manifest appearances that are highly distinctive and suggestive of gall bladder disease that is, it becomes dry, unduly dark and shows a tendency to be thrown into rugosities. The sclera may or may not be icturic, and the same is true of the urine. The development of icturus in disease of the gall bladder depends mainly upon obstructive interference in the cystic duct from swelling or gall stone impaction, and in the case of gall stones the persistency of obstruction or its temporary nature determines the presence or absence of icturus in a given case. Epigastric pain is always to be noted in the disease we are considering. This pain often radiates to the shoulder blade, and is at time very harrassing to the patient. Aside from the symptoms referred to, the differential diagnosis offers at times considerable difficulties. Appendicitis may manifest its presence by pain in the epigastrium or right hypochondrium, and the investigation of the appendiceal region should always receive its proper attention in suspected gall bladder disease. Gastric ulcer also merits attention, especially where loss of weight is predominant. However, in ulcer haematemesis is usually determinable in the clinical history, and palpation will sometimes reveal, especially in very thin subjects, evidence of cicatricial thickening. Gastric carcinoma may deceive the examining physician, but the age of the patient, the absence of muriatic acid in the gastric secretion, the usual tumor found upon palpation characterized by fixation, and often associated with haematemesis, great loss of flesh and the Hippocratic facies in advanced cases, ought to enable us easily to differentiate this disorder. Gastralgia, or so-called neuralgia of the stomach, is an exquisitely painful affection usually coming on suddenly, and is to be discriminated from diseases of the gall bladder, but an inquiry into |