declared openly that they will not divulge the professional confidences reposed in them by their patients under any circumstances. Mayor Nevin declares that he will arrest them if they fail to report such diseases. A man who called himself a naturopath and styled himself professor was arrested recently in New York for the illegal practice of medicine. Ground was broken recently for the new wing to the City Hospital of St. Louis. This addition is to cost $800,000 and is expected to be completed within two years. Tulane University has added to its faculty I. S. Kliener, M. D., Ph. D., as first assistant in Physiological Chemistry. Dr. Kliener has for two years past been connected with the Sheffield Scientific School of Yale University. The Tennessee State Board of Health at a recent meeting decided to isolate all known cases of pellegra now existing and those discovered in the future. The cities and counties in which the cases are found are to meet the expenses of such isolation. During the visit of the foreign warships to New York for the Hudson-Fulton celebration the visiting naval surgeons were invited to a special surgical Iclinic at the Roosevelt Hospital. The clinic was under the direction of Dr. George E. Brewer. The American Proctologic Society elected the following officers and fellows at its recent annual meeting: President, Dwight H. Murray, M. D., of Syracuse; vice-president, T. Chittenden Hill, M. D., of Boston; secretary-treasurer, Lewis H. Adler, Jr., M. D., of Philadelphia; executive council: George B. Evans, M. D., Dayton, Ohio, chairman; Dwight H. Murray, M. D., of Syracuse; Louis J. Hirschman, M. D., of Detroit; Lewis H. Adler, Jr., M. D., of Philadelphia. The place of meeting for next year is St. Louis, Mo. Headquarters, Planters' Hotel. Time, June 6 and 7, 1910. The following were elected fellows of the society: Dr. Charles S. Gilman, 419 Boylston street, Boston, Mass.; Dr. Donley C. Hawley, Burlington, Vt., and Dr. Frank C. Yeomans, 19 East Forty-fifth street, New York City. The Northern Tri-State Medical Association (Michigan, Ohio and Indiana) held its thirty-sixth annual meeting in Toledo, on Tuesday, July 13, 1909-forenoon, afternoon and evening. Ten papers were listed on the program, one of which-"A Case of Appendicitis of Twenty Years' Standing"-was contributed by Dr. J. Henry Carstens, of Detroit, and another"Edward Alanson: A Forgotten Pioneer Who Established Correct Methods of Wound Treatment"-by Dr. Charles B. G. de Nancrede, of Ann Arbor. Officers for the ensuing year were elected as follows: President, Dr. Charles B. G. de Nancrede, of Ann Arbor; vice-president, Dr. Joseph A. Duncan, of Toledo; secretary, Dr. George W. Spohn, of Elkhart, Ind.; treasurer, Dr. J. A. Weitz, of Montpelier, O. criminologist and alienist in the civilized world. His books on this subject fill volumes. Most prominent among these are "L'Homme Criminel," published in 1895; "Crime Politique," 1891; "Gli Anarchici," 1894. Of his writings, several volumes are in English and about fifty in Italian. His particular study was the development of the criminal mind, and he devoted years to the study of insane criminals all over the world. For thirty years he engaged in long clinical studies upon the origin of pellagra, the terrible disease which for so many years has devastated Southern Europe and which is now gaining a foothold in the United States. His studies were from a purely pathological and chemical standpoint. For years he traveled through the parts of the country where the disease was most prevalent and gave popular lectures on the measures to be adopted for its cure. He wrote voluminously on the causes and cure of pellagra, and distributed thousands of tracts among the peasants. This crusade won for him the enmity of the land owners, and he was driven to Turin. American Association of Clinical Research. The promotion of scientific clinical research is the purpose of establishing an association to be designated by the above caption. Physicians and surgeons interested in advancing clinical medicine to attend a meeting the 27th of October, 1909, at the Boston Medical Library, 8 Fenway, Boston, Mass. The object of the meeting is stated specifically to be: First, to establish an American association of clinical research; secondly, to establish clinical research on an incontrovertible scientific basis in hospitals; and, thirdly, to institute an American journal of clinical research, in which the work of members of the American association and of others doing clinical research work in a scientific manner shall be published. Notwithstanding the medical profession would seem to be fairly well provided for, as regards general and special societies, the claim is advanced that there is still a niche for one devoted to scientific clinical research. The movement to create a guild of this kind is not intended to disturb existing medical society affiliations. The circular call sets forth that: "It is of the utmost scientific importance to establish conclusively all that is at present true in medicine and surgery, and only upon such proved knowledge, to base any further advancement. The clinic deals with clinical entities and not, like the laboratories, with parts as entities. Therefore, clinical research differs, and must differ, from experimental laboratory researches. Clinical research must consider clinical entities, and when considering parts it must consider them only as parts and not as wholes. All that subserves the object of obtaining and investigating clinical facts and principles belongs to clinical research, and the laboratory is a part of the means of clinical research, but only a part." The chairman of the invitation committee is Dr. James Krauss, 419 Boylston street, Boston, Mass. Prehistoric Skeleton Found. The discovery is announced of a fossilized human skeleton in the Department of Dordogne in Southwestern France. Accredited scientists declare it to be 20,000 years old. The area in which the fossil was found, where Dr. Capitan, professor at the College of France, has been carrying on researches for three years, is about four miles from Bugue. The skeleton, which is absolutely intact and surrounded by the fossilized bones of animals, was imbedded in the middle of a quaternary formation. Calculations as to its age are concurred in by four well-known geologists. The Prevention of the Pollution of Streams By Pulp Factories in Germany. Although the factories manufacturing wood pulp are located along the principal streams in Germany, yet the rivers have been practically free from pollution, owing to the strict regulations and thorough control which prevent any waste from being emptied into the rivers. Manufacturers are required to use every precaution possible to prevent the waste reaching the streams. The water which is to be emptied into the river must leave the factory in an uninjurious and clean condition, free from any remnants from the manufacturing process. This is accomplished by passing the discharge through one or more settling ponds and, if necessary, through filters. The streams are controlled by the authorities, and any justified claim against the quality of the waters, due to pollution from the factories, is at once investigated and the condition corrected. There are no regulations setting forth the exact method which a manufacturer must employ to prevent the pollution of the streams, as each manufacturer may carry out his own ideas upon the subject, so long as his method successfully prevents the pol lution of the streams. Settling ponds are invariably used and the results are satisfactory. The service which inspects the disposition of the waste material of factories is under the immediate jurisdiction of the county authorities and has charge of the licensing of factories. Army Medical Corps Examination at Washington, Chicago and San Francisco. The Surgeon General of the army announces that the War Department has appointed permanent boards for the preliminary examination of applicants for appointment in the medical corps of the army to meet at Washington, D. C., Fort Sheridan (near Chicago), Illinois, and San Francisco, Cal., in addition to the usual preliminary examination boards that are assembled at various army posts throughout the United States from time to time. The permanent boards will hold sessions on the second Monday of each month. A limited number of successful candidates will be appointed First Lieutenants in the medical reserve corps (salary $2,000 per annum) and assigned to army posts until the next session of the army medical school, when they will be ordered to attend the school as "student candidates." Applicants must be citizens of the United States, between 22 and 30 years of age, graduates of reputa ble medical schools, of good moral character and habits, and shall have had a year's hospital training after graduation, or its equivalent. Full information concerning the examination can be procured upon application to the Surgeon General, U. S. Army, Washington, D. C. Medical Supervisor-Indian Service (Field). The United States Civil Service Commission announces an examination on November 24, 1909, to secure eligibles from which to make certification to fill a vacancy in the position of medical supervisor in the Indian field service at $250 a month and expenses, and vacancies requiring similar qualifications as they may occur in that service, unless it shall be decided in the interests of the service to fill the vacancy by promotion, reinstatement, or transfer. Applicants must show in their applications that they have had at least three years' experience in medicine since graduation from a reputable medical college, and have had special training and experience in connection with tuberculosis and trachoma. Applicants who fail to indicate in their applications that they have had sufficient training and experience to entitle them to a rating of 70 per cent in the above subject will not be admitted to the examination. Applicants must accompany their applications with certificates from reputable physicians showing that they are free from tuberculosis in any and every form. Age limit, 20 years or over on the date of the examination. This examination is open to all citizens of the United States who comply with the requirements. Applicants should at once apply to the United States Civil Service Commission, Washington, D. C., for application form 1312. No application will be accepted unless properly executed and filed with the commission at Washington prior to the hour of closing business on November 13, 1909. Literary Notes Religion and Philosophy. Five books published this fall by the Macmillan company are remarkable for the variety of their interest. Four are distinctly religious in character, the fifth, The Philosophy of Change, by D. P. Rhodes, is a profound and, in some ways, radical effort to construct a complete philosophy of life. In the Bible for Home and School series. of which Prof. Shailer Mathews, of the University of Chicago, is the editor, there are two new volumes this monthGenesis, edited by Dr. H. G. Mitchell, and The Epistle of St. Paul to the Galatians, edited by Prof. Benjamin Winsner Bacon. These volumes are uniform with the series which has now become familiar to most students of the Bible. Its aim, as the title indicates, is to stimulate and facilitate the study of the Bible both in the home and the schools of the country. In carrying out this aim, the editing has been done with conservatism, but with a proper respect, nevertheless, for the latest results of critical scholarship. The result is to place the reader in possession of the facts which have been established upon a sound basis and to spare him the bewilderment born of a multitude of conflicting and irreconcilable theories. Professor Bacon and Doctor Mitchell have worked entirely in harmony with this scheme. Doctor Mitchell has perhaps had the hardest task of any in the series, for round the book of Genesis a lively controversy has waged for years. Doctor Mitchell, however, has devoted his life to the problems which he considers in this little volume, and the result is an extraordinarily clear statement of a very complex puzzle. More abstract in its character is Theism and the Christian Faith, published as a memorial to that much-loved and influential teacher, Dr. Charles Carroll Everett. The lectures that Doctor Everett delivered in his three courses at the Divinity School of Harvard University have been edited by Edward Hale and published as containing the essential part of the instructor's teachings and belief. In the first of his courses Doctor Everett was accustomed to deal with the psychological roots of religion, finding them in the three ideas of the reason-truth, goodness and beauty. The second course, on historical religions, showed the varying emphasis that different religions placed upon one or another of these ideas. In the third course Doctor Everett unfolded the philosophical applications of the three ideas in a doctrine of God as Absolute Spirit, and in their light considered the fundamental problems of theology. In his mind · Christianity comprehended all the three ideas of the reason. It was, therefore, to him the Absolute Religion, and it is this idea that is the center of the teaching of the volume now published. Since Doctor Everett will never lecture again, his friends and former students will be grateful to the men whose labors have placed his teaching in this enduring form. The fourth of the Macmillan books of the month devoted entirely to religion is also a memorial, but to an institution instead of to a man. Seventy-five years ago the Harvard Theological Seminary was founded. It occurred to those in charge of the celebration this summer of this anniversary that no more fitting tribute could be paid to the seminary than the publication of a volume which should be a record of the Christian progress that has been made in the lifetime of the institution. This idea has now taken shape in Recent Christian Progress, of which Prof. Lewis Bayles Paton is the editor, and many professors and former students of the seminary the authors. The record that they have compiled is an impressive one. They have covered the whole field, not only of dogma, but of missions and moral and social development. The information that they supply will bring encouragement to all who have at heart the betterment of the world. The Philosophy of Change, by D. P. Rhodes, is in rather striking contrast to the books already discussed. Mr. Rhodes is an original thinker, one who, as he himself says, sat himself down in his study to find, if might be, the explanation of the many perplexities of the universe. He has found this, he thinks, in the law of Change, which he states with the conviction of sincerity. The conclusions which he draws from his close-reasoned arguments will doubtless seem striking to many, yet it is hardly possible to read this book without finding a stimulus to real thought. At a time when philosophy of this kind has rather fallen into disfavor, the appearance of such a work as Mr. Rhodes' is more than noteworthy. Two Books for Colleges. One, In the Macmillan company's list are two college text-books of more than ordinary importance. Outlines of Chemistry, by Prof. Louis Kahlenberg, of the University of Wisconsin, marks a great advance in the clear treatment of the subject for college classes. The illustrations also have been prepared with the greatest care. The second volume is Representative Biographies, by Messrs. Copeland and Hersey, of Harvard. This is comprehensive selection a of biographies that are noteworthy for various reasons. The editors have worked so successfully that from cover to cover they have filled the volume with material intensely interesting in itself and for many reference purposes invaluable. Titchener's Psychology. Under the title A Text Book of Psychology, The Macmillan Company published in June a much enlarged and revised edition of Professor Edward Bradford Titchener's well-known work, An Outline of Psychology. The change in title was necessitated by the fact that the additions made by Professor Titchener were so extensive that it was no longer possible to describe the book as an "outline." Instead A Text Book of Psychology will take its place as the standard text in the difficult, complicated and important subject on which the author is so recognized an authority. Book Notices Third Report of the Wellcome Research Laboratories at the Gordon Memorial College Khartoum. Andrew Balfour, M. D., B. S., F. R. C. P. Edin., D. P. H. Camb., Director Fellow of the Royal Institute of Public Health, the Society of Tropical Medicine and Hygiene and the Society for the Destruction of Vermin; Member of the Incorporated Society of Medical Officers of Health and the Association of Economic Biologists; Corresponding Member Societe de Pathologie Exotique; Medical Officer of Health, Khartoum., etc. Toga Publishing Co., 45 Lafayette Street, New York City. This book continues on an even more elaborate scale than its excellent predecessors the reports of the Wellcome Research Laboratories at the Gordon Memorial College at Khartoum. These detailed records of many interesting experiments and researches, principally connected with tropical medicine, form nearly five hundred pages of valuable reading. The book covers so much ground that one can only mention a few of the most important topics for medical readers. Among these is considered the question of rats and rat infection in plague; articles on the poisonous snakes of the Sudan; medical customs and superstitions in Kordofan; sanitary work with especial reference to its relation with the chemical and bacteriological laboratories. A striking feature also is the review of the most important recent advances in tropical and veterinary medicine, bacteriology and hygiene. The book is profusely illustrated and printed on high-grade paper in excellent type. The numerous colored plates are of great value and represent the highest type of work in this line. Bier's Hyperaemic Treatment. Bier's Hyperaemic Treatment in Surgery, Medicine and all the specialties. A Manual of its practical application by Nilly Meyer, M. D., Professor of Surgery of the New York Post-Graduate Medical School and Hospital, and Professor Dr. Victor Schmiedem, assistant to Prof. Bier, of Berlin, Germany. Second revised edition. Octavo of 280 pages, illustrated. W. B. Saunders Co., Philadelphia and London, 1909. Cloth, $3.00 net. The second and revised edition of the principles of Bier's hyperaemic treatment, by Willy Meyer and Schmieden, attests to the popularity and excellence of the first edition, the merits of which we reviewed carefully several months ago. There have been some alterations in the text and additions of case reports, but the chief and most valuable addition is a complete bibliography. The typographical work is of the usual high standard of the publishers. The Etiogogy and Nature of Cancerous and Other Growths. By W. T. Gibson, A. R. C. S. London, John Bale Sons & Danielsson, Ltd. Oxford House, 1909. Price $1.50. The work begins with a statement of the case for the irritative origin of cancer. Attention is then drawn to tables showing the occupational incidence of cancer in England and Wales. The incidence is high among workers who come into contact with organic compounds-gaseous, liquid and solid-the result of the combustion and destructive distillation of coal and of the decomposition of animal matter, while within the same category are those who manufacture or sell alcoholic liquors. The mode of action of the products is discussed. They have direct and indirect (inflammatory) effects, not only in the inducing of cancer, but also of innocent growths. Attention is directed to the neurotic effects-generalized and upon the skin-of the chemical and mechanical agents, of the actinic and X-rays, and of extremes of temperature. There is considered the metabolism of malignant cells and of the reaction of the bloodserum in cancer patients. Progressive Medicine. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. By Hobart Amory Hare, M. D., assisted by H. R. M. Landis, M. D. Vol. xi, No. 3. Lea & Febiger, Philadelphia and New York. The contents of Progressive Medicine for September, 1909, is as follows: Diseases of the Throat and its Viscera, including the Heart, Lungs and Blood Vessels, by William Ewart, M. D., F. R. C. P. Dermatology and Syphilis, by William S. Gottheil, M. D. Diseases of the Nervous System, by William G. Spilles, M. D. This number of Progressive Medicine is prepared with the usual care, and the names of the contributors is sufficient guarantee of the character of the reviews. Books, Pamphlets, Etc., Received. From Navy Department, Washington, D. C.: U. S. Navy Medical Bulletin, No. 4, Vol. 3. From the University of Nebraska College of Medicine, Lincoln, Neb.: The Bulletin of the University of Nebraska College of Medicine. From Drs. Henry Thierry and Lucien Graux: L'Habitation Urbaine, Chambres de Domestiques Cuisines et Loges de Concierges. From Treasury Department Public Health and Marine Hospital Service of the United States: Notes on the Prognosis and Treatment of Pellagra by C. H. Lavinder, M. D. From Wm. Seaman Bainbridge, Sc. D., M. D., New York: The Enzyme Treatment for Cancer-Final Report. (Reprinted from the Medical Record, July 17, 1909.) From Bryan D. Sheedy, M. D., New York: Tonsil Removal, Opsonic Index and Immunity. (Reprinted from International Journal of Surgery.) From the Committee of One Hundred on National Health: Bulletin on National Vitality, its Wastes and Conservation. By Prof. Irving Fisher, of Yale University, Member of the Commission, July, 1909-No. 30. From Samuel E. Earp, M. D., Indianapolis, Ind.: Arthritis Deformans. (Reprinted from The Lancet Clinin, July 24, 1909.) Diagnosis of Pleurisy with Effeusion. (Reprinted from the Medical Council, Philadelphia, Pa.) September, 1909. From Charles S. Briggs, A. M., M. D., Nashville, Tenn.: Report of Surgical Operations at the Briggs Infirmary during its Eighteenth Season, from September 10, 1908, to August 1, 1909. (Reprinted from the Nashville Journal of Medicine and Surgery, July and August, 1909.) From Adoniram B. Judson, M. D., New York: From William R. Jenkins Co., New York: The Production and Handling of Clean Milk, Including Practical Milk Inspection and Essentials of Milk Bacteriology. By H. W. Hill, M. D. 367 pages, 101 illustrations, including one colored and 16 full-page plates. A complete, plain, practical and authoritive guide to the production, inspection, analysis, handling and distribution of milk for veterinary, agricultural and dairy students, farmers, health officers, milk inspectors, practical dairymen, sanitariums, country gentlemen, physicians, etc. Cloth bound, $3.25. From George M. Gould, M. D., Ithaca, N. Y.: The Role of Visual Function in Animal and Human Evolution. (Reprinted from the New York Medical Record, September 11, 1909.) Fifty-seven Varieties of Medical and Ophthalmic Blunders. Bibliography of the Contributions of George M. Gould, M. D., to Ophthalmology, General Medicine, Literature, etc. From Lea & Febiger, Philadelphia and New York: A Text-Book of Surgical Diagnosis. For students and practitions. By Edward Martin, M. D., Professor of Clinical Surgery, University of Pennsyl vania, Philadelphia. Very handsome octavo of 764 pages, with 445 engravings, largely original, and eighteen full-page plates. Cloth, $5.50 net. A Manual of Otology. By Gorham Bacon, A. M., M. D., Professor of Otology in the College of Physicians and Surgeons, Columbia University, New York. With an introductory chapter by Clarence J. Blake, M. D., Professor of Otology in the Harvard Medical School, Boston. New (fifth) edition, thoroughly revised. 12 mo., 500 pages, 147 engravings and 12 plates. Cloth, $2.25 net. A Text-Book of Practical Therapeutics. With especial reference to the application of remedial measures to disease and their employment upon a rational basis. By Hobart Amory Hare, M. D., Professor of Therapeutics in the Jefferson Medical College of Philadelphia. Thirteenth edition, thoroughly revised. Octavo, 951 pages, with 122 engravings and four full-page colored plates. Cloth, $4.00 net; leather, $5.00 net; half morocco, $5.50 net. A Text-Book on the Principles and Practice of Surgery. By George Emerson Brewer, M. D., Professor of Clinical Surgery in the College of Physicians and Surgeons, New York. Octavo, 908 pages, 415 engravings and 14 full-page plates. Cloth, $5.00 net; leather, $6.00 net. A Monthly Journal of Medicine, Surgery and the Allied Sciences. COMPLETE SERIES, VOL. LVIII, No. 11 NEW SERIES, VOL. III, No. 11 ST. LOUIS, MO., NOVEMBER, 1909 $2.00 YEARLY Contributed Articles ADVANTAGE OF THE COMBINED INTRA- By ERNST JONAS, M. D. Until a few years ago, and perhaps up to the very present, undoubtedly not a few appendices have been removed for so-called chronic appendicitis. Vague gastric disturbances and a moderate degree of local tenderness around McBurney's point were considered sufficient to warrant the diagnosis of chronic appendicitis and consequent removal of the appendix. No wonder, then, that the diagnosis frequently proved erroneous. It was a time when we were inclined to accuse the appendix as the cause of all kinds of abdominal troubles. Now the pendulum of opinion swings in the opposite direction and, in those cases in which no distinct spell of acute appendicitis has been observed, the conscientious surgeon is inclined to regard the appendix as not guilty until he can definitely prove it to be the cause of the trouble. Justly in these cases, without positive acute attacks of appendicitis, we demand a most painstaking physical examination before returning the verdict "chronic appendicitis" and recommending removal of the appendix. Justly in these cases we demand repeated thorough examinations of the urine (the catheterized specimen in women) in order not to overlook traces of blood (red blood-corpuscles), the presence of which points strongly to a diagnosis of stone in the kidney or ureter. Especially some time after the patient has experienced pain, or after firm palpation of the tender spot, the urine is likely to show traces of blood which may have been absent during 1909. *Read before the Am. Assn. of Obs, and Gyn. Sept. the spell itself. With evidences of blood (macroscopical or microscopical) in the urine, the next step is an X-ray examination, to be followed by cystoscopic examination and catheterization of the ureter. A skiagram of the kidney and ureter, to be of practical value, must show a shadow of structures less dense than the least dense calculi (phosphatic and uric acid). A good X-ray picture must show distinctly the processus transversi of the vertebral column and the structure of the last rib and crest of the os ileum; it should also show the oblique course of the psoas muscle and perhaps the quadratus lumborum. If plates of such character do not show any shadow in the region of the kidney and ureter, it is fairly safe to exclue a stone in the kidney or ureter. To skiagraph the kidney and the whole length of the ureter demands, as a rule, four good pictures from each side, and both sides should always be skiagraphed, if there is any suspicion of kidney or ureter stone. An X-ray shadow in the region of the ureter is, however, by no means a proof of a stone in the ureter. A phlebolith close to the course of the ureter (as observed by the writer in a case of cancer of the bladder), or a fæcal concretion in the tip of the appendix may easily be mistaken for ureter stone. It is, therefore, safest not to rely on any one method, but to combine with the Xray examination, the cystoscopic examination and catheterization of the ureter. An X-ray picture taken with the ureter catheter containing a wire stilet or filled with mercury makes the diagnosis an accurate one. (I have no experience with wax-tipped ureter catheters.) Having positive evidence of a ureter-stone, we have still to prove that there is only one. Again we have to resort to the Xrays and they alone can aid us in deciding this point. A ureter-stone being present, we should not allow more than two days to elapse before operation. If an operation cannot be performed within that time, another picture |