PATHOLOGY.

Under the Charge of R. L. THOMPSON, M. D.

Arthritis Deformans.

EDWARD H. NICHOLS, M. D., and
FRANK L. RICHARDSON, M. D.

The Journal of Medical Research, September, 1909.

The object of this study primarily has been to determine the actual lesion or lesions present in these joints and the relation of the lesions to clinical symptoms, and the study of the etiology of the cases has been carried on only incidentally.

"Our own studies have convinced us that these joint lesions can be divided with great definiteness into two pathological groups. 1. Those which arise from primary proliferative changes in the joints, chiefly in the synovial membrane and in the perichondrium. 2. Those which arise primarily as a degeneration of the joint cartliage. These two groups correspond very closely to clinical groups (one) and (two) of the classification adopted in the preliminary report mentioned above. These two pathological groups are characterized by distinct gross and histological differences. These two pathological types, however, do not correspond to two definite etiological factors; i. e., to two definite and distinct diseases; this point we wish to emphasize. The tissues which enter into the joints of the body are bone, articular cartilage, synovicae membrane, ligaments, capsule. These tissues are all of mesenchymal origin, although differentiated into tissues of very different histological appearance. The cells of which these tissues are composed either may proliferate if stimulated by any one of various irritants, or may degenerate from the effect of any one of various agents. Yet the actual cell and tissue changes which may occur are limited in number, al though the gross appearances vary with the special tissue which proliferates or degenerates. Hence the same end result may be produced in these joints by a variety of irritants or agents, and a given irritant or agent may produce a variety of gross appearances."

As has been stated, we believe that the original lesions arise either in the synovial membrane or in the cartilage. Different causes may produce the primary change either in the synovial membrane or in the cartilage. Traumatism, acute suppurative infections, gonorrhea, syphilis, probably faulty metabolism, and probably also a variety of other things may induce primary proliferation of the synovial membrane; while old age, traumatism, dislocations, the presence of tumors of bone, gout, disease of the central nervous system, and other causes we have seen lead to primary degeneration of the cartilage.

From whatever origin the primary change in the joint is produced, the process once started tends to continue, i. e., the primary cause may produce partial destruction of the joint, partial destruction may cause continued injury, and so the process once started continues in a "vicious" circle; or the pri mary cause may continue to act indefinitely. Hence, since the disease is a progressive one, the joints of each type may present a great variety of gross appearances and symptoms, depending upon the extent of the lesion, upon its duration and upon various incidental factors. Briefly stated, a given cause in

either of the two pathological types may produce a considerable variety of different appearances, while at the same time a number of different causes may lead to the same end result in either type. The process is analogous to that seen in arterio-sclerosis, in which the lesion may be started by any one of a variety of causes, and any cause may produce any one of a series of changes in the vessels. Moreover, in these chronic joint lesions examination of the gross or histological changes in the joint may fail to determine which one of a number of possible causes was the active cause in the specific case, and on the other hand, a known active cause may produce any one of a variety of gross appearances in a given joint. The authors' conclusions are as follows:

1. In non-tubercular deforming arthritis there are two pathological types of joint change: (1) the proliferative type, which tends to destroy joint cartilage and lead to anchylosis of adjacent joint surfaces, and (2) the degenerative type, which tends to destroy the cartilage, and produce deformity with. out anchylosis.

2. These two types do not correspond to two definite diseases, but each type represents reaction of the joint tissue to a considerable variety of

causes.

3. In neither type if the original injury is suf ficiently severe, or if the causative factor continues to act, is there likelihood of the regeneration of a perfect joint.

4. A joint injury of a sufficient degree even if the primary cause ceases to act, may of itself continue to act in a vicious circle as a cause of continued joint change.

5. Clinically the aim should be to recognize the type and stage of the lesion present, and then to determine and remove the active cause.

6. The prognosis should be guarded because of the difficulty in determining the active cause, because of the unlikelihood of complete regeneration of a severely injured joint, and because of the known clinical history of many of the cases.

7. The nomenclature used in this article is sug. gested because it describes the pathological process, without any assumption that the etiology is known in any given case.

8. Future advance in the study of these processes may be expected from a study of their etiology.

The Influence of Thyroidectomy on Alimentary Glycosuria.

By JOHN MCCURDY.

The Journal of Experimental Medicine, Nov. 1, 1909.

For some years there have been reports in the literature of a lowered carbohydrate assimilation limit on the feeding of thyroid extract.

Alimentary glycosuria was chosen as the condition most easily produced for study. At first lactose was fed by the stomach tube, this sugar being chos en on account of its low assimilation limit. Efforts to determine what quantity can be assimilated were highly unsatisfactory for reasons which may be understood, if one considers the fate of a carbohydrate administered per os. Carbohydrate may pass out with the feces; it may be absorbed by the lymphatics of the intestine, and so reach the general blood stream, or it may be changed in the intestine to dextrose and reaching the liver be stored there as glycogen. It was therefore decided to continue this work

by injecting a given amount of dextrose into one of the systemic veins.

The urine was collected by a catheter (female dogs with perineal section being employed) at the end of each hour subsequent to injection; the urine was treated quantitatively by Benedict's method and qualitatively by the polarimeter.

A word may be said as to the probable action of the internal secretion of the thyroids. It is evident that it inhibits the combustion of carbohydrate. It may do this in two ways: by inhibiting that action of the pancreatic and muscle ferments which causes the actual oxidation of dextrose or by inhibiting the transport of dextrose to the muscles.

Removal of the thyroid glands causes a rise in the assimilation limit for dextrose. If the parathyroids are left, this result is permanent. The thy. roids probably inhibit normally the direct combustion of the sugar in the muscles.

Critical Remarks on Ehrlich's Side-Chain Theory of Immunity.

J. W. McLaughlin, of Austin, Tex., intends to show that immunity does not result from chemical transformations, but from physical, catalytic transformations. The properties of a catalyst, including pathogens and toxins, are due to physical rather than chemical structure of the substance. The author wishes to show how a catalytic transformation differs 1rom a chemical one, and describes an original theory of molecular energy and its bearing on catalytic energy, and an original theory of pathogenesis and immunization. Mechanical, radiant, electrical, chemical, and catalytic energy all cause substances in stable equilibrium to become decomposed. The energy of a catalytic agent differs from that of a chemical agent in origin, and neither ptomains, vegetable alkaloids, nor other chemical substances can produce antibodies in animals inoculated with these substances. Catalytic reactions are not chemical ones. The forms of energy which chemical substances manifest are derived from the chemical and physi cal structure of their molecules, and energy waves are ether waves. A molecule can influence other molecules through its wave of energy. A catalytic substances is a substance whose extent of molecular surface is greatly exaggerated and largely out of proportion to its mass, which is a characteristic of colloids. The author accounts for the production of antibodies by the noncoincidence of the crest and trough of the energizes in the catalyzer and the end products. Pathogenesis is a catalytic reaction in which a pathogen as catalyst acts on a group of protein molecules as a substrate, the result being an antibody. The catalytic theory of toxic immunity is simpler, more uniform, and more extensively applicable than the side-chain theory. The toxin causes a catalytic reaction when inoculated into a normal animal, the catalyst acting on a vulnerable mass of protein molecules and producing an antitoxin. The side-chain theory does not satisfactorily explain immunity, nor do its premises seem to be based on truths that have a basis in fact or analogy. Hence we should not accept it. It offers no explanation of lasting immunity. The explanation of disease immunity is that the harmful agent weakens the specific catalytic function of the bacteria, by changing the arrangement in space of the atoms in the molecules. The antibody brings about similar changes in the molecules of the substrate, and transforms them into isomers, which makes them specifically immune.-Medical Record, October 23, 1909.

Hemolysis in Cancer.

O. P. Johnstone, and C. H. Canning, Pittsburg, Pa. (Journal A. M. A., October 30), have studied the hemolysis reactions in tuberculosis and in malignant growths, with the object of determining their value as aids to early diagnosis. They found that only the advanced or decidedly active cases of tuberculosis gave reversed hemolysis, the others being negative. In carcinoma cases the positive reactions were in a great majority, and several of the cases giving negative ones showed slight hemolysis after from 48 to 78 hours. In carcinoma of the rectum, 2 cases out of 3 gave a negative reaction, but those 2 were not examined microscopically so a clinical diagnosis was not verified. In 9 cases of sarcoma of various types, all gave more or less positive reactions but less pronounced than the carcinoma cases, but with one exception they were all small or of moderate size. One patient who had been operated on and treated with Coley's fluid gave a negative reaction six months after the operation. There has been no recurrence one year after operation. In one of the 9 cases the sarcoma was incompletely removed and treatment with Coley's fluid employed. The final examination showed but a very slight hemolysis. Two patients with endothelioma were examined, the reaction was positive in each. No benign tumors showed hemolysis. A considerable number of patients suffering from various diseased conditions were examined and the results tabulated, together with those from 85 normal individuals. The technic employed was that of Crile, with very few minor variations. The authors' conclusions are given as follows: "1. The hemolysis reaction appears to be of decided value in the diagnosis of malignant neoplasms. Negative results do not rule out malignancy, but speak strongly against it. 2. The reversed hemolysis appears to offer valuable information with regard to the extent and activity of the tuberculosis lesion. 3. Several examinations should be made in doubtful cases. 4. The reaction does not appear to occur in other conditions that would lessen its value in the diagnosis of malignancy."-Medical Record.

The Preparation of Romanowsky Stains.

Roscoe W. King, of Las Animas, Col., describes minutely the method of preparation of the Romanowsky stains. Methylene blue prepared by alcohol is perfectly neutral, and is a permanent stain, remaining stable for months in the open air. It may also be prepared by ammonia. Experiments were made as to the amount of each reagent necessary to prepare a permanent stain. Failure will generally be due to an excess of acid or alkali, and the addition of a drop or two of either may convert a poor stain into a good one.-Medical Record, October, 30, 1909.

News and Notes

ITEMS.

An examination will be held by the Civil Service Commission for the position of Medical Supervisor, Indian Service, on November 24.

The Presbyterian Church is to erect a large tuberculosis sanitarium near St. Louis in which the serum treatment is to be used extensively.

Mr. A. D. Brown has given $100,000 to the building fund for the Missouri Baptists's Sanitarium, contingent on the raising of $50,000 additional.

A change in the staff of St. Mary's Hospital, recently announced, seems to promise an era of increased usefulness to that institution. Drs. Louis Rassieur and John Mc H. Dean are now surgeonsin-charge, and Dr. R. L. Thompson, pathologist.

The addition to the Baptist Hospital, which we mentioned some time since, is nearing completion. It will double the capacity of the hospital and is an excellent example of hospital construction. mately the older building will be replaced by one harmonious in style with the new wing.

Ulti

An open-air school for children suffering from incipent tuberculosis has been opened in Rochester, New York; twenty children have been enrolled. They will have desks in a big tent, will be wrapped up warmly and will have their legs in bags to protect them from the cold. Buffalo, it is stated, is contemplating a similar school.

The M. V. M. A. brought so many medical friends to St. Louis, and their stay was so pleasant for us that we are again impressed with the fact that such gatherings have an importance even greater than that which is measured by the scientific work done.

A free tuberculosis dispensary was opened in the Associated Charities Building, Kansas City, September 22. In addition to instructions and advice in the proper methods of care for themselves, Dr Charles B. Irwin of the health department has provided each patient with cuspidor, pocket flask, and porch cup. The new tuberculosis pavilion on the grounds of the old Kansas City General Hospital was presented to the city October 16, by the Jackson County Society for the Relief and Prevention of Tuberculosis. The pavilion was built at the personal expense of William Volker, and will accommodate fifteen patients. Dr. John G. Hayden is physician-in-charge. The Kansas City Postgraduate Medical College has established a free clinic for nervous diseases every Tuesday, Thursday and Saturday morning.

Dr.

A gift of $1,000,000 by Mr. John D. Rockefeller, to fight the hookworm disease has been announced, and at a conference of a number of well known educators and scientists, principally from the South, with Mr. Rockefeller's representative, the Rockefeller Commission for the Eradication of Hookworm Disease was organized, to carry on the war against the disease. The members of is commission are: Dr. William H. Welch, professor of pathology in Johns Hopkins University; Dr. Simon Flexner, director of Rockefeller Institute for Medical Research; Charles W. Stiles, chief of the Division of Zoology, United States Public Health and Marine Hospital Service; Dr. Edwin A. Alderman, president of the University of Virginia; Dr. David F. Houston, chancellor of Washington University, St. Louis; P. P. Claxton, professor of education in the University of Tennessee; J. Y. Joyner, State Superintendent of Education in North Carolina and president of the National Educational Association; Walter H. Page, editor of The World's Work; Dr. H. B. Frissel, principal of Hampton Institute; Frederick T. Gates, one of Mr. Rockefeller's business managers; Starr Murphy, Mr. Rockefeller's counsel in benevolent matters, and John D. Rockefeller, Jr.

J.

The president of the American Gynecological Society has appointed a committee to report at the

next annual meeting in Washington, on the Present Status of Obstetrical Teaching in Europe and America, and to recommend improvements in the scope and character of the teaching of obstetrics in America.

The committee consists of the professors of obstetrics in Columbia University, University of Pennsylvania, Harvard, Jefferson Medical College, Johns Hopkins University, Cornell University and the University of Chicago.

Communications from anyone interested in the subject will be gladly received by the chairman of the committee, Dr. B. C. Hirst, 1821 Spruce street, Philadelphia, Pa.

The Municipal Commission on Tuberculosis has prepared ordinances providing for the establishment of an emergency hospital for the care of persons afflicted with acute contagious and infectious diseases, and transferring the appropriation for the maintenance of the smallpox and quarantine hospital to the maintenance of this hospital; making provision for the exclusive use of Building "A" of the City Hospital for the care and treatment of advanced cases of tuberculosis; providing for the conversion of the present quarantine and smallpox hospital into a tuberculosis sanatorium; providing for the establishment of two clinics at the eastern ends of the fourth and second sanitary districts for the free treatment of persons afflicted with tuberculosis; providing for the appointment of seven nurses to visit consumptives in their homes; providing for the appropriation of $10,000 for the relief of indigent consumptives; providing for the payment of part of the salaries of city employes while undergoing treatment in the hospital or sanatorium; the abolition of the common drinking cup in the city; providing for the proper ventilation of street cars; providing for the medical inspection of children for the prevention of contagious and communicable diseases, and for the correction of physical defects, and providing that persons afflicted with tuberculosis, applying to the city for treatment in hospitals or dispensaries, or for relief in their homes, shall not be considered as paupers.

TUBERCULOSIS BEING WIPED OUT.

One Institution or Organization Being Established Every Day.

During the year that has passed since the International Congress on Tuberculosis met at Washington, one institution or organization for the treatment or prevention of tuberculosis has been established every day, Sundays and holidays included, according to a bulletin of the National Association for the Study and Prevention of uberculosis. Fifteen new beds in hospitals or sanatoria have been provided also for every day of the year.

A year ago the rate of increase was one organization or institution every other day, only onehalf as fast as now. Less than a year ago there were 40 consumptives for bed every hospital provided. Today the number has been reduced to 30. Nearly 20,000 beds are now provided in institutions for the treatment of consumption, increase of over 5,500. The number of special tuberculosis dispensaries in the United States has more than doubled the number of anti-tuberculosis associations has increased 68 per cent, and the number of hospitals and sanatoria 43 per cent.

an

In one branch of anti-tuberculosis work, par

ticularly emphasized by the International Congress, a signal advance has been made, that is, in the provision of hospital accommodations for advanced cases. In all parts of the country, state and municipal authorities have been urged to provide hospitals for dangerous cases of tuberculosis, with the result that over 1,000 beds have been established in the past year. At the present time there are, however, only 6,000 beds, and 75,000 advanced cases which ought to be in hospitals. Fully 75,000 others could be treated at home,but it would be safer for the community to segregate them in institutions. Every advanced case of tuberculosis is a center from which the disease spreads, and unless the patient is taught how to be careful in his habits, and unless he has the proper home surroundings, he should be in a nospital, where he will not be a menace to others.

The National Association for the Study and Prevention of Tuberculosis declares that at least 70,000 more beds in hospitals are needed for advanced cases of consumption. Until these are provided, tuberculosis cannot be wiped out. If everybody in the United States gave $5 to provide hospitals for the dangerous consumptives, sufficient funds would be procured to destroy forever the threat of tubercalosis from this country.

Army Medical Corps Examinations.

The Surgeon General of the Army announces that the first of the preliminiary examinations for the appointment of first lieutenants in the Army Medical Corps for the year 1910 will be held on January 17, 1910, at points to be hereafter designated.

Full information concerning the examination can be procured upon application to the "Surgeon General, U. S. Army, Washington, D. C." The essential requirements to securing an invitation are that the applicant shall be a citizen of the United States, shall be between twenty-two and thirty years of age, a graduate of a medical school legally authorized to confer the degree of doctor of medicine, shall be of good moral character and habits, and shall have had at least one year's hospital training or its equivalent in practice after graduation. The examinations will be held concurrently throughout the country at points where boards can be convened. Due consideration will be given to localities from which applications are received, in order to lessen the traveling expenses of applicants as much as possible.

The examination in subjects of general education (mathematics, geography, history, general literature, and Latin) may be omitted in the case of applicants holding diplomas from reputable literary or scientific colleges, normal schools or nigh schools, or graduates of medical schools which require an entrance examination satisfactory to the faculty of the Army Medical School.

In order to perfect all necessary arrangements for the examination, applications must be complete and in possession of The Adjutant General on or before January 3, 1910. Early attention is therefore enjoined upon all intending applicants. There are at present eighty-one vacancies in the Medical Corps of the Army.

Committee on Credentials and Arrangements for the United States Pharmacopoeial Convention. President Horatio C. Wood has appointed the following committee on credentials and to make arrangements for the United States Pharmacopoeial Convention which will be held in Washington, D. C., beginning Tuesday, May 10, 1910. Professor O. T.

Osborne (chairman), Yale University, New Haven, Conn.; Dr. H. C. Wood, Jr., University of Pennsylvania Medical Department, Philadelphia, Pa.; Mr. L. S. Hilton, Washington, D. C.; Mr. W. L. Cliffe, Philadelphia, Pa, and James H. Beal, Scio, Ohio.

The following officers of the convention are exofficio members of the committee: President H. C. Wood, Sr., University of Pennsylvania Medical Department, Philadelphia, Pa.; Secretary Dr. H. M. Whelpley, Washington University Medical Department, St. Louis, Mo., and Assistant Secretary Dr. Murray Galt Motter, Hygienic Laboratory, Washington, D. C.

Philadelphia Number.

The American Journal of Surgery will produce in December a Philadelphia issue of their journal, the subject matter of which will be composed entirely of contributions from among the leading men or that city. Among the subjects to appear and their contributors are as follows:

"A Consideration of the Diagnosis and Treatment of Retro Displacement of the Uterus," by E. E. Montgomery, M. D., Professor of Gynecology, Jefferson Medical College.

"Polypoid Growth of the Rectum and Report of a Recent Case," by Lewis Adler, Jr., M. D., Professor of Diseases of the Rectum, Philadelphia Polyclinic.

"Tumors of the Urethra in Women," by Barton Cooke Hirst, M. D., Professor of Obstetrics, University of Pennsylvania.

"The Control of Hemorrhage During Pregnancy," by Edward P. Davis, M. D., Professor of Obstetrics, Jefferson Medical College.

"Cyclodialysis," by Walter L. Pyle, A. M., M. D., Ophthalmologist to the Mt. Sinai Hospital, Assistant Surgeon of Willis Eye Hospital, etc.

"Roentgen Treatment of Malignant Diseases," by Charles Lester Leonard, A. M. M. D., Ex-President of the American Roentgen Ray Society.

"The Conservation of the Middle Turbinated Body," by William A. Hitschler, M. D.

"The Diagnosis and Treatment of Ectopic Pregnancy" by F. Brooke Bland M. D.

The following well-known surgeons will also contribute and their titles will be announced at a later date:

Ernest La Place, A. B., A. M., M. D., Professor of Surgery, Medical Chirurgical College.

Prof. William Campbell Posey, Professor of Ophthalmology, Philadelphia Polyclinic.

John G. Clark, M. D., Professor of Gynecology, University of Pennsylvania.

H. M. Christian, M. D., Clinical Professor of GenitoUrinary Diseases, Medical Chirurgical College. John A. McGlinn, A. M. M. D., and others.

Literary Notes

Professor W. S. Franklin and Professor Barry MacNutt have completed the volume of their Elements of Physics which has to do with light and sound. This makes this work complete with the exception of the chapter on heat. They are at work on that at the present time, and it is our plan to publish it in one volume with the Mechanics. The chapter on heat will be ready some time in January, and it is hoped to publish the work complete not far from the first of February.

In the field of philosophy and psychology there has also been great activity. Professor Creighton,

of Cornell University, has entirely revised and rewritten his well-known Introductory Logic. The book has been slightly increased in size, although not very materially as far as the text itself is concerned. There has, however, been a very notable addition made in respect to the number of questions and exercises which are given in the back of the book for class purposes. One hundred and eight pages have been devoted to these exercises, and it is believed that they will prove a most acceptable feature of the book, as they are sure to render it more teachable and practical.

On September 22 the Macmillan Company published a new Outlines of Chemistry by Professor Kahlenberg, of the University of Wisconsin. Professor Kahlenberg is preeminently a teacher and his ideas of how and what the undergraduate should be taught are based on personal knowledge. In this book he has accomplished his purpose to write a text-book for first-year students which would not only give them an insight into the subject of chemistry, but would interest them in the subject by showing wherein it was of practical worth. Professor Kahlenberg aims to lay for them a foundation which will lead them to carry the study of the subject further.

The publication of a new edition of Professor itchener's Outlines of Psychology has been awaited for a long time. It was found impossible to bring out a complete revision this year, and it was, therefore, thought advisable to publish the new edition in two parts-one part this summer and the next during the summer of 1910. Part I has received a very cordial reception, and the opinions written of it indicate that Professor Titchener has prepared a book which, when completed, will be the most teachable text-book on the subject. It is natural, of course, that Professor Titchener should have carried out in this book his plan of teaching the students almost entirely from the experimental side. This certainly is the side of psychology which appeals most strongly to the student and the side from which Le is today getting the greatest benefit.

Joseph M. Rogers, who is one of the best known journalists in the East, has a forceful paper in the November Lippincott's, in which he calls attention to some notable defects in our criminal code. He declares that while a law recently passed in New York, deciding that no child under sixteen should be called a criminal, is a step in the right direction, a great many such steps will be necessary before we can have a system of criminology which will really make for the betterment of social conditions. Mr. Rogers is now at work on an important series of articles on our public schools, which bids fair to attract the same wide attention as his previous series on the secondary schools-"Educating Our Boys"-which appeared in Lippincott's some months

ago.

Book Notices

America As It Is, and Is to Be.

The appearance this week (November 3), of The Promise of American Life, by Herbert Croly, suggests at once Bryce's The American Commonwealth. Since the publication of that classic there has been nothing to compare with Mr. Croly's study of American political conditions and tendencies. Unlike the great English critic, however, Mr. Croly's aim is not merely analysis and description. He aims to provide

a sufficient basis in theory for the program of a nationalized democracy, to demonstrate that American democracy can trust its welfare to the dictates of its national interest, to reconcile the ideals of democratic liberty and national strength. In the accomplishment of this task, he provides us with a brilliant and penetrating review of past history and present conditions, arriving from conservative premises at conclusions which will doubtless appear radical to many. Though one may disagree with the results, however, no one can question the intellectual power of the argument. Not the least interesting portion of the work is devoted to the work and character of four noted reformers, Jerome, Hearst, Bryan and Roosevelt.

"The Temple."

The Temple, the new book by Dr. Lyman Abbott which the Macmillan Company publishes this week (November 3), takes its title from the conception of the human body as the earthly temple in which is enshrined the soul. In the book Dr. Abbott is writing of the body and its uses, but entirely from the standpoint of their relation to the things of the spirit. Thus there are, for example, chapters on "The Eye," "The Ear," and "The Tongue." In them Dr. Abbott considers what we should see and speak and to what we should listen in order to develop and nourish the best that is in us. As a writer on religious topics, Dr. Abbott has long enjoyed a deserved reputation for sanity, balance. The new volume affords an opportunity to come into closer touch with the views and spirit of the editor of The Outlook than is possible through the medium of discussions of current events.

International Clinics.

A Quarterly of Illustrated Lectures and especially prepared original articles on treatment, medicine, surgery and the allied sciences by leading members of the medical profession throughout the world. W. T. Longscope, M. D., Editor, Philadelphia. Vol. III, Series 19, 1909.

The third volume of International Clinics for 1909 contains the following contributions:

Treatment of Tuberculosis-A. P. Francine, Philadelphia.

Present Position of Antitetanic Serotherapy-L. Lagane, Paris, France.

Mesmer and Perkin's Tractors-D. Waterson, Baltimore.

Clinical Observation in 500 Cases of Typhoid-J. H. Barach, Pittsburg.

Graves' Disease, Raynaud's Disease, and Some of the Allied Forms of Vasomotor Disorder (Vasomotor Ataxia)-S. S. Cohen, Philadelphia.

Gonococcus Septicemia - G. Dieulafoy, Paris,

France.

Women in Medicine-J. J. Walsh, New York. Association of Migrating Thrombophlebitis with Thromboangeitis Obliterans-L. Buerger, New York. Exophthalmic Goiter from the Standpoint of the Clinical Surgeon-A. J. Ochsner, Chicago.

Post-Operative Complications-D. N. Eisendrath and D. C. Straus, Chicago.

Pathology and Surgical Treatment of Bilocular Stomach-C. G. Cumston, Boston, Mass.

Early and Complete Resection of Varicose Veins of Leg-O. Alglare, Paris.

Cases at the Samaritan Hospital for Women, Montreal-A. L. Smith, Montreal.