The adulterators who places this output on the market very naturally know that, were chemical preservatives forbidden, their business could not be maintained for twenty-four hours.

Manufacturers of pure food suffer in the eyes of the public because the consumer does not know in most cases how to discriminate between the innocent and the guilty, and to be on the safe side, has spells of refusing to buy all canned products.

Nothing is more sanitary, beautiful, clean and wholesome, however, than the factories which are putting up pure food, guiltless of preservatives.

Although the worst evil is the spoiled materials covered up by the use of benzoate of soda, the chemicals themselves are more than doubtful. It may be possible for robust young men, pre-examined and found sound, to absorb small quantities of this for a few months and not suffer serious injury-such constitutions might throw off disease in any form;-but that delicate children and old people, and those with stomach, liver or kidney disorders, persons weak and impoverished would be so fortunate is extremely unlikely.

Even small quantities of poison continually administered to the system make for cumulative harm, and and an eight-course dinner might easily contain poisons whose combination would be most harmful.

Even if some chemists discredit the idea that small quantities of preservatives are vitally narmful, they scarcely could maintain that they are beneficial. Therefore, it would seem unnecessary and very unwise to deliberately introduce these into the human system.

Benzoate of soda has been compared with salt as no more poisonous, but aside from the absurdity of such a proposition, it at least cannot be tasted, and nature rebels at overdoses of salt and sugar. The Referee Board in its wisdom has decided that an individual may eat one-half gram per day of benzoate of soda and live; how is each individual-compelled to consume what he can get, in this hurried and complicated civilization-to ascertain when he has absorbed his one-half gram of poison?

That the first-class food manufacturers are unanimous in their theory and practice of not using preservatives, and are willing to forget that they are business competitors, and join hands in the fight against adulteration, notwithstanding this finding of the Referee Board is an unanswerable argument.

When President Roosevelt realizes the position of these great manufacturers who have proven their contention by their own experience he will doubtless realize the benefit to the American public in sustaining Dr. Wiley in his unflinching opposition to food preservatives.

In its fight against adulterated food products, the American Association for the Promotion of Purity in Food Products is waging a battle for eighty millions of people in this country, every one of whom is innocently exposed to the dangers that lurk in chemically-treated foods.

The New Library of Medicine, Newark, New Jersey. The Medical Library, established by the physicians of Newark, is just entering on the fourth year of its existence. Medical men of other cities which are now without libraries on medicine may be interested to know how the Newark collection came to be established and how comparatively easy it has been to bring it to its present admizable status.

A few of our leading physicians several years ago discussed the city's need of a collection of recent medical books and of the best current periodical medical literature. It was concluded that 'he County Society ought to father the plan. The subject was brought up before the Essex County Medi

cal Association, but the action taken did not bring results. The suggestion of a Medical Library Association was then made; this association to have independent ́existence for the sole purpose of establishing a medical library. A subscription list was quietly but persistently circulated among the physicians of Newark and adjacent towns. This list was headed with a general statement in regard to the Medical Library. It was plainly shown that if it were established, no medical interest would be neglected. It also stated that the medical library association, if formed, would have the co-operation of the Free Public Library. All subscribers were asked to pay the same amount, $3.00 a year. When the number reached 130 an organization was effected. A small working board of trustees was decided on and the purchase and installation of books and journals began.

The association made arrangements with the Public Library whereby the latter institution agrees to house and care for the association's books and promote their use and to furnish a good line of medical journals each year. The members of the Medical Library each pay $3.00 per year. This has brought in nearly $500 annually, which has been expended in the purchase of the latest medical books, title to which remains with the Association. Choice has usually been made of books which the average medical practitioner finds too expensive or too special for his shelves. For periodical literature and other minor expenditures, the public libary has contributed several hundred dollars annually. The collection contains now about 500 volumes of good books, and 200 volumes unbound, of the best medical journals of England, France, Germany and America, with current numbers of the same, all conveniently arranged and easily accessible in the Free Public Library.

In view of Newark's peculiar conditions-its medical men being only an hour away from the great library of the Academy of Medicine in New Yorkit has naturally been the policy of the Newark Association to keep its collection distinctly modern. In time it may prove wise to add to it complete files of two or three of the best medical journals, American and English. Beyond this, in medical history, it does not seem wise for it to go. The collection will be kept fresh and up-to-date and special stress will be laid on indexes of all kinds. Thus, the physician coming to this working collection, can see what has been said in the past twelve or eighteen months on the subject in which he is interested; then, from the indexes, he can learn whe.e and when and how it has been treated in previous years; and can easily send to the Surgeon General's Library in Washington for such reference as he wishes to see or can himself make a few trips to the Academy of Medicine Library in New York.

At the close of its third year, the medical men of Newark who have fostered this collection feel that, as the membership has not fallen off and as the use of the books has steadily increased, the venture may be pronounced a decided success.

The Secretary of the Association is Dr. F. W. Pinneo, 199 Garside street.

Don't pour hot oil into the ear to relieve pain. Heat can be applied much better in a hot mixture of glycerin, alcohol and water, which will not turn rancid or clog up the ear, and can be removed by syringing with water. A towel or large pad of gauze wrung out in boiling water and closely applied over the ear, covered with oil silk, or "protective" rubber tissues, is better than a hot water bag. Amer. Journ. Surg.

Panorama of the

Medical Sciences

ORTHOPEDICS.

Under the Charge of

ARCHER O'REILLY, M. D.

Much interest in Anterior poliomyelitis among orthopedists has recently been stimulated by epidemics in Sweden and New York. As a result, much has been written on the subject and the recent orthopedic journals have had many valuable and instructive articles.

Dr. W. R. Townsend, in an article on "The Necessity of Early Orthopedic Treatment in Poliomyelitis" (American Journal of Orthopedic Surgery, Vol. VI, No. 1), points out that it is most important to have an orthopedist see the cases early to prevent deformity, and to allow as complete recovery as possible. His treatment of early cases is based on an experience with 300 cases from July, 1907, to April, 1908. At the onset he advises complete rest in bed without any attempt to induce or allow the patient to exercise the paralyzed limb, at the same time maintaining an equilibrium between the paralyzed and non-paralyzed muscles. Later, when the weakness and hyperesthesia have disappeared, electricity and salt baths may be employed with gradual use of the limb. An apparatus should be used to prevent any deformity. Rest in bed or on a movable frame until the amount of improvement has been determined, will hasten the recovery. In the later stage care must be taken that no paralyzed or weakened muscle is overlooked which would allow deformity. Deformities may also result from weakness or the improper application of weight. By this early treatment, deformity is reduced to a minimum and the limb is put in a better condition for the successful performance of nerve or tendon transplantations or arthodesis. The conclusions drawn are that: "The majority of cases of poliomyelitis are followed by deformity. The amount of deformity depends on the character of the attack, on the muscles involved and on the treatment. Practically all these deformities can be prevented by appropriate treatments. Deformities may occur very soon after the attack. The prevention of the primary deformities tends to greater degree of recovery and prevents the secondary deformities. Orthopedic treatment is desirable from the beginning."

Dr. Sachs (Amer. Journal of Ortho. Surg., Vol. VI, No. 2), in an article on "The Present-Day Conception of Acute Anterior Poliomyelitis", points out that our conception of the disease has changed considerably in the last few years, especially as a result of the work of Dr. Wickman, of Stockholm, who proposes to call the disease Heine's-Medin disease, in commemoration of Dr. Heine, who has given us the clinical picture, and of Dr. Medine, who has contributed much to the understanding of the complications as studied in the recent epidemics. Wickman desires this change because he claims that the disease, at times, involves the whole gray matter of the cord, the gray matter of the medulla and even the cortex. Sachs admits this, and also that at times there may be a neuritis, but thinks that, as the anterior horns are the ones most affected, the name should not be changed. The etiology has not yet been determined, though the disease has been proven to be infectious.

The early symptoms are those of an acute infectious disease which may appear several days before the paralysis. In some cases the infection seems to manifest itself in a multiple neuritis. The prognosis, also, is much more favorable than formerly, especially when seen and treated early. Some cases recover without, or with only very slight, paralysis; some cases may prove fatal, but these early show great malignancy. Electricity is useless except as an exercise; massage is of value, but methodical exercises are of great benefit when given by a competent person. Much is to be gained by surgical treatment, by tenotomies and transplantations.

Drs. E. H. Bradford and Robert Souther, in a paper on "The Ultimate Results in the Surgical Treatment of Infantile Paralysis" (Amer. Journal of Ortho. Surg., Vol. VI, No. 2), review the early treatment by apparatus, both for preventing deformity and in giving a useful limb. They also review the various operative methods, such as tendon transference and transplantation, nerve transplantation, arthrodesis and the more recent use of silk in lengthening tendons and as a substitute for ligaments, as used by Lange. They doubt the value of arthrodesis and think that silk tendons and silk ligaments will accomplish the same results. The technic of tendon transplantation and the use of silk tendons is reviewed fully, also the care of the limb and aftertreatment.

As a result of the latest advances in pathology and surgical technic, "it is not necessary now for a patient attacked by this dreaded affection to anticipate complete disability, except in the rare instances in which the attack is so severe as practically to destroy a large part of the muscles of the frame.

"In conclusion, it may be said that to obtain the best results, it is important that there should be a careful selection of cases before operation, that the treatment should be in no sense a routine treatment and that the muscles to be transferred should be selected in each case with care; that the strictest asepsis should be employed; that there should be great care in the treatment both to promote healing by first intention, in protecting the freshly healed tissues from pressure, and to prevent the accumulation of serum or blood in the freshly incised tendons; that there should be careful protection from pressure, by the use of plaster bandages, to the recently incised tendon; that all constriction should be removed as soon as possible, and muscular development be aided by the use of gymnastics as soon as possible; great attention should be paid to footwear, preventing not only undue strain, but also undue pressure; that with these precautions results of satisfactory nature can be expected in a large number of cases."

The Influence of Weight-Bearing on the Treatment of Tuberculous Hip-Joint Disease.

Dr. V. P. Gibney (The American Journal of Orthopedic Surgery, August, 1908) reports a number of cases of tuberculosis of the hip which were treated in whole or in part by the German method, which consists in immobilizing the joint with a plaster spica, then allowing weight to be borne on the joint. He reviews the early and unsatisfactory expectant treatment and the present American method, which consists of the use of traction splints. Even with this method the results are not entirely satisfactory. Pathologically, it would seem that the body weight should not be put on the diseased hip until all danger from exacerbations from the active process has passed, but Dr. Gibney thinks from clinical experience that this danger is fancied, and that "if the motion of a joint thus affected be put out of commission, the weight of the body in walking may be

useful rather than harmful." A number of cases are reported in which the patients were treated either entirely by immobilization, but allowing weight-bearing on the joint, or by traction first and later by immobilization. In all these cases the results were most satisfactory. In concluding, Dr. Gibney states: "Let it be understood that this is not intended to do away with traction by weight or pulley or apparatus, but this communication is intended to show the value from clinical records of the weight-bearing function when the joint is well immobilized."

Non-Tuberculous Bone Infections about the Hip-Joint.

A Clinical and Roentgenological Study. In the early days, before the x-ray, any condition in the hip-joint which gave the classical signs of hip-joint disease, was considered and classified as tuberculosis of the hip. Since the discovery of the x-ray, our views have changed somewhat, and we are finding that there are other conditions about the joint which, in the early stages, simulate tuberculosis of the hip.

Drs. Legg and George have taken up this question in an interesting paper in the Boston Medical and Surgical Journal, September 17th, entitled "NonTubercular Bone Infections About the Hip-Joint— A Clinical and Roentgenological Study."

The authors think that hip-disease is a bad term, because it is usually taken to mean tuberculosis, while it may cover any condition of the joint. As a result, cases diagnosed as hip disease may be given a routine tubercular treatment while in reality they may be some other condition, such as some acute or chronic pyogenic infection. The acute cases are, as a rule, easily differentiated on account of the acute onset, but very often the chronic infections are difficult to differentiate, especially early. The x-ray, however, has been of great service in making this differentiation. In the pyogenic conditions, the infection may start in the periosteum, giving early a periosteal thickening and irregularity. The tubercle bacillus does not cause a periosteal reaction, but affects the epiphysis and the joint, causing early a marked atrophy of the cortex. In the pyogenic infections there may be bone destruction, shown in the marrow with thickening of the bone and with or without sequestrum formation. There may also be periosteal involvement.

The authors think that there is not much difficulty in diagnosing the acute cases, but that, "in chronic cases of pyogenic infection, with symptoms identical with symptoms of tuberculosis of the hip, we believe that we should hesitate in making a differential diagnosis when, after careful observation, if destruction is taking place, operative interference is demanded, in the meantime, of course, keeping the cases under protective treatment."

Dermatology

Under the Charge of

W. H. MOOK, M. D.

SYPHILIS IN ITS RELATION TO GENERAL PARALYSIS OF THE INSANE. Andrew P. Biddle Jour. Cut. Dis.. Nov., 1908), reviewing the causes that lead to the production of general paresis of the insane, shows the chief one is syphilis, and emphasizes the importance of the early treatment. His idea is to extend, in an appropriate man

ner, a more general knowledge of syphilis to the public, and impress upon the syphilitic the necessity for a carefully regulated and extended course of mercurialization.

The Eastern Michigan Asylum admissions for 1907 show an average of 8.9 per cent of paretics; for 1908, 9 per cent. Quoting from the reports filed in the library of the SurgeonGeneral during the last forty years, the Worcester Lunatic Hospital gives for the years 1867-'71 and 1891-'96 the same percentage5.5 to 5.6. Of the total number of admissions in the State Hospital System of New York for thirteen years (1889-1901) of 49,787, there were 3,307 paretics-6.6 per cent. In the Taunton (Mass.) State Hospital for 1905-'06 there were 39 paretics in 330 admissions-over 11 per cent. In the Connecticut Hospital for the Insane, the yearly average for seven years was 5.4 to 7.8. In the Toronto Hospital the average was 6 per cent. For twelve years (18891901) the Kharkoff Zemskoi Hospital gives 11.28. In other parts of Europe the percentage is higher, particularly Berlin and Munich, in which the male paretics average 36 per cent to 45 per cent respectively. He suggests this may be due to a relatively smaller percentage of other forms of psychoses.

The proportion of male to female paretics averaged 1 to 7-due probably to other fac tors than syphilis as etiological factors in gen eral paralysis, as alcohol and sexual excesses. All reports emphasize the strong influence of city life on the origin of dementia paralystica. The average from rural districts was 1 per cent to 2 per cent, while in the urban centers the percentage ran as high as 10 to 16 per cent. "The proneness to the development of general paralysis accredited to certain employments would seem to be due rather to the physical and moral condition of the patient than to his employment, especially to his addiction to excessive drinking and sexual excesses, but primarily to his having acquired syphilis."

Nageotte found the characteristic lesion in general paralysis of the insane to be a cellular infiltration in the walls of the minute blood vessels and in the perivascular lymph spaces of the cerebral cortex. The cells are lymphocytes. plasma cells and mast cells. These accumulations of plasma cells and lymphocytes in the walls of the minute blood vessels and perivascular lymph spaces of the cortex are characteristic and constant features in general paralysis. Bramwell states that this perivascular infiltration of plasma cells belongs to the same class as the lesions which are certainly syphilitic.

No spirochaetes have been found in any stage of the disease and the Wasserman reaction in cases of general paralysis of the insane have not been positive enough for general applica tion.

KERATOSIS FOLLICULARIS RESULTING IN

MULTIPLE EPITHELIOMA.

Report of a Case.

Mi

Grover W. Wende (Jour. Cutan. Dis., Dec., 1908). The patient was a man, age 37 years. The trouble began at 17, affecting palms and soles; at 22, appeared over the body, and at 27, superficial deepseated and papillary epitheliomata developed. croscopical examination showed the Darier's bodies; pseudo-psorosperms, found in the primary lesions, were also to be found in the various conditions of epithelioma. The study of the case is complete. His idea of the significance of the case is best given in quotation "Chiefly as an additional factor in showing a certain relationship between this group of skin lesions and cancer by a direct development from one to the other. Senile keratoma and Paget's disease are recognized as types of precancerous conditions which ultimately take on every malignant characteristic. Keratosis follicularis, in the light of the case reported, appears to be one more condition of this character. Until the present observation, so far as ascertained, no case of malignant transformation has taken place. This fact was frequently emphasized as an argument against the intrinsic relation of epithelioma to a disease with characteristic inclusions, presenting certain anomalous types of epithelial proliferation, and which, until the present observation, failed to furnish the final link of evidence necessary to correlation between it and epithelioma."

Pemphigus in Children.-R. L. Bunch (Brit. Jour. Derm., Oct., 1908) reports a case of pemphigus in a girl 7 years of age in whom bullæ of all sizes were distributed over the entire body. Cultures showed staphylococcus aureus and streptococci The streptococci corresponded to the type of streptococcus salivarius, a comparatively non-virulent type which is not pathogenic for the mouse. The opsonic index to streptococci was found to be .64. An injection of five million streptococci was made and a week later the index has risen to .88 and clinically the patient was greatly improved. Another injection was given and within another week the index has risen to 1.2 and the bullæ had all dried up and the patient was convalescent.

The author discusses the theories of the toxic origin of the disease. Whether true pemphigus is primarily a microbic disease or not, micro-organisms have been found in the bullæ by different observers, notably Demme's diplococcus, staphylococci bullæ are sometimes sterile. No differential or leucocyte count was made in the case reported.

On a Spirochaete Found in Variola.-K. Sakurane (Japan. Zeitscho. f. Derm. Urologie, Feb., 1908, VIII, p. 20, abstract Brit. Jour. Derm., Nov., 1908.) At the Medical Society at Osaka in May, 1907, Sakurane described a case of smallpox in a man in which he found spirochete. a The patient had never had syphilis. Mature smallpox lesions were excised and stained by Levaditi's method and the spirochæte were found in the necrotic tissue, the deeper epidermis and the papillæ. They were somewhat similar to the S. pallida of syphilis. The author does not think it was an instance of smallpox occurring in a syphilitic, nor does he assert the spirochete is the cause of smallpox,

Book Notices

The W. B. Saunders Company, of 925 Walnut St., Philadelphia, have just issued a new illustrated catalogue of their books. Their description of it, as an edition de lux, is well justified, for it is beautifully gotten up and illustrated. They have a list of new books and new editions which includes many books of interest and value. There is, also, a general classified index which makes it easy to find books on various subjects.

The catalogue would be of value to all medical men, for they would be sure to find some book they want. Saunders Company will be glad to send a copy to any member of the medical profession who writes for one.

A Text-Book of General Bacteriology. By Edwin O. Jordan, Ph. D., Professor of Bacteriology in the University of Chicago and in Rush Medical College. Five hundred and fifty-five pages. fully illustrated. Published by W. B. Saunders Company, Philadelphia and London. Cloth $3.00 net.

We have read this book with a great deal of pleasure. The style is so clear and lucid and facts are marshalled so skillfully that we grasp his meaning and follow his lead without conscious effort. Though the writer states that the book is the outgrowth of his lectures to his students in Chicago University, the pages have lost all trace of the didactic atmosphere which settles down so oppressively over the average lecture hall.

The book is not an exhaustive treatise; it is not a laboratory guide; it does not emphasize the subject from the standpoint of a physician. But it does give an excellent resume of general laws and principles. The author has abstracted and edited the mass of literature in this field, selecting those works worthy of perpetuation and casting aside the spurious and unimportant, and correlated these into symmetrical and intelligible form. A valuable list of references accompanies the text.

We heartily recommend this book to all teachers and students.

A Text-Book of Operative Surgery. Covering the Surgical Anatomy and Operative Technic Involved in the Operations of General Surgery. Written for Students and Practitioners. By Warren Stone Bickham, Phar. M., M. D., Visiting Surgeon to Charity and Touro Hospitals, New Orleans. Third Revised Edition. Octavo of 1206 pages, with 854 illustrations, entirely original. Philadelphia and I ondon: W. B. Saunders Company, 1908. Cloth $6.50 net, Half Morocco $8.00 net.

The third edition of Bickham's Operative Surgery is a very complete treatise upon the technic of modern surgery. That the book should require a third edition within five years amply testifies to its place in medical literature. The book has been thoroughly revised; many old pictures and descriptions have been withdrawn. and about 300 pages of text with 331 new pictures added. The general arrangement of the work, however, is the same as in the previous editions.

We firmly believe that the work will continue to maintain its popularity, since in its conception, clearness of description, and delineation of detail, it stands today the best single volume upon operative surgery in the English language.

The National Standard Dispensatory. New and Thoroughly Revised Edition, containing the National History, Chemistry, Pharmacy, Actions and Uses of Medicines, including those recognized in the Pharmacopeias of the United States, Great Britain and Germany, with many references to other Foreign Pharmocopias. In accordance with the Eighth Decennial Revision of the U. S. Pharmacopoeia, by authorization of the Convention. By Hobart Amory Hare, B.Sc., M. D., Professor of Therapeutics and Materia Medica in Jefferson Medical College, Philadelphia; Charles Caspari, Jr., Ph.G., Phar. D., Professor of Theoretical and Applied Pharmacy in the Maryland College of Pharmacy, Baltimore; and Henry H. Rusby, M. D., Professor of Botany and Materia Medica in the College of Pharmacy of the City of New York; Expert in Drug Products, Bureau of Chemistry, Department of Agriculture, Washington, D. C.; Members of the Committee of Revision of the U. S. P.; with valuable assistance from Edward Kremers, Ph. D., Daniel Base, Ph. D., and Joseph F. Geisler, Ph. C. New (2d) edition, thoroughly revised. Magnificent imperial octavio, 2050 pages, with 478 engravings. Cloth, $6.00, net; full leather, $7.00, net. Thumb-letter index 50 cents extra. Lea & Febiger, Publishers, Philadelphia and New York.

The second edition of the National Standard Dispensatory is an immense, impressive and comprehensive volume. It contains 2011 pages with something of value on every page that the reviewer observed. To attempt to do justice to such a book is well nigh impossible. The volume contains not only every article in the United States Pharmacopea, with necessary comments and explanations, but also all the important unofficial drugs and preparations of value.

In a word this single volume presents encyclopedic information concerning all substances used in pharmacy and medicine at the present time. The complete Pure Food and Drugs Act and Regulations have been appended, together with the official decisions necessary to their interpretation. The Na tional Formulary is enclosed in abstract. Many unofficial formulæ are also given. The names of Hare, Caspari, Kremers, Houghton and others give testimony to the care and accuracy of the preparation of the book The publishers claim that this is a reference work of the highest authority is entirely warranted. Physicians, pharmacists, or any one studying drugs will find this work extremely useful, in looking up the pharmacy, pharmacognosy, pharmocology or therapeutics of every preparation.

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 through out the world. W. T. Longscope, M. D., Editor, Philadelphia. Vol. IV, 1908.

The first article in volume IV. is a plea for the more extended use of physical therapeutic agents by Joseph H. Pratt. This article is rational and embodies the result of careful personal observations both in America and Europe. John A. Lichty summarizes current news on the treatment of Gastric Ulcer and reports his personal experience with 149 cases. The paper is well presented and his cases have been fairly well worked up. Psychotherapeutics as discussed by Chauncy D. Palmer presents nothing very attractive to the physician. His paper is such as might be read before a lay assemblage with perfect freedom.

Wainwright's article on gout presents nothing which cannot be found better presented in any good text-book. T. R. Brown's paper on Splanchnoptosis gives an instructive summary of the diagnosis, prognosis and treatment of this often mis-treated disease,

but could have been made somewhat more useful by adding a bibliography. F. Parks Weber discusses the various forms of splenomegaly and reports a case which he thinks may later develop typical signs of Banti's disease. The article is very well written, but is open to the same criticisms as the preceding. Benedict reports a case of gangrenous appendicitis with spontaneous cure due to discharge through the intestine. This case teaches its lesson in a negative way, the fact that the patient died of cancer of the esophagus before the healing was complete showing that gangrenous appendicitis inoperated leads death, even if nature has to produce a cancer of the espohagus to accomplish it.

to

"Acute Dilitation of the Stomach" receives scholarly treatment at the hands of Albert Nichols. He reports eight cases followed by discussion of the etiology, symptoms and physical signs, morbid anatomy and pathogenesis, differential diagnosis and treatment. The article concludes with a very well selected bibliography.

The opening article in the department of surgery is a discussion of "Fractures of the Skull" by George Tully Vaughn. He reports three cases, cases one and three being accompanied by X-ray photographs. A. N. McGregor writes on traumatic lesions of the semi-lunar cartilages of the knee-joint; he gives an abstract of 14 cases in tabular form, a very good plan for comparison. "Pneumonia Complicated with Pneumococcic Arthritis" is the title of a case report with discussion by Hand and Jopson. The case is very instructive but the method of presentation might be improved.

George W. Ely gives the results of his personal experience with Bier's hyperemia and suggests some new methods of application. The article is accompanied by illustrations of methods and appliances which are undoubtedly useful. Paronychia Lateralis is discussed at some length by Charles Green Cumston and diagrams for an operation are submitted.

An illustrated article by Brooke M. Auspach on buried catgut and sub-cuticular stitches in plastic operations on the perineum briefly but clearly describes the author's method. Bushnell and Kerrawalla discuss a series of malignant neoplasms and Smith gives a clinical report of the work of the gynocological ward of the Western General Hospital, Montreal. Harry Hudson's descriptions of a new form of scoliometer presents what seems to be a useful addition to the instruments of precision for orthopaedists.

The Role of Insects in the Transmission of Disease by Mark A. Brown gives the author's opinion on this important subject.

In the department of Neurology are two interesting articles, "Pseudobulbar Palsy" by James H. Lloyd and the Neuresthenic Syndrome by D. J. McCarthy. The relation which Hypertrophy of the Various Tonsils of Waldeyer's Ring bears to the Etiology of Disease is carefully considered by Rufus B. Scarret. The article is accompanied by 40 well selected references. McKee's article on the Symptomatology of Anterior Polio-Myelitis reviews the literature and draws some practical conclusions. The Serum Treatment of Epidemic Cerebrospinal Meningitis is carefully considered by Charles Hunter Dunn. This article is in many respects the best in this volume and is accompanied by an excellent list of references.

William H. Deaderick considers the Etiology and Treatment of Pernicious Malaria. He treats his subject systematically and thoroughly and accompanies his statements with abundant references. The report of a case of Bronchial Calculi by Clifford Farr closes this number.

International Clinics as a whole is too. well known to require more than a review of the contents.