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6. A poison is a substance which being in solution in or acting chemically upon the blood is capable of causing death or serious bodily harm. Example : Carbon monoxid, opium, nux vomica, arsenic trioxid, hydrocyanic acid.

7. IMPACTED STONE IN URETER. Symptoms: Colic pain shooting along ureter, tenderness over ureter, bematuria, anuria (if opposit kidney is blocked or diseased), abdominal tumor (persistent or intermittent). Urin contains crystals, blood, or pus. Prolapse of ureter into bladder. Skiagram shows stone. In the majority of cases the symptoms are simply those of renal calculus, and diagposis is only complete on lumbar exploration and passing ureteral sound.

In some cases the stone can be felt per rectum or per raginam.

From encysted vesical calculus: impossible clin. ically.

From cystitis.—In this : Urin is alkaline; pus at beginning or end of micturition.

From ureteritis.—Difficult in absence of bistory of colic.

From vesical tuberculo818.-In this : Tubercle in urin; polyuria; frequent micturition; slight hematuria ; symptoms not relieved by rest.

From prolapsed inflamed ovary:-Ovary lies behind broad ligament and at greater distance from vaginal wall. Stone is felt in anterolateral fornix.

Hardness and outline are more definit.

The skiagram shows a shadow in the course of the ureter, but this has to be distinguished from that of calcareous illac glands or that of an appendix concretion (the latter very rarely throws a shadow).

Ureteral catheterization thru the cystoscope not only shows which side is affected, but the end of the catheter may touch the stone and a waxt tip receives a scratched impression.—(Graves' Synopsis of Surgery.)

8. Acetone and diacetic acid are found in the urin' in diabetes mellitus.

Acetone may be found in the urin in typhoid, scarlet fever, pneumonia, high fevers generally, some di. gestiv disturbances, carcinoma, autointoxication, and chloroform narcosis.

Diacetic acid may be found in the urin in the same conditions as acetone.

9. Babinski's reflex: If the skin of the sole of the foot is irritated, extension of the toes occurs Instead of flexion ; found in organic hemiplegia and lesions of the pyramidal tract.

Stellwag': sign: Absence or diminution in the frequency of the winking movements of the eyelids, and abnormal width of the palpebral fissure; seen in exophthalmic goiter.

Kernig's sign: If the patient lies on his back and his thigh is flext to a right angle with his body, he is unable to extend the leg on the thigh; found in meningitis.


DIFFERENTIAL DIAGNOSIS. Volume II. Presented thru an analysis of 317 cases. By Richard C. Cabot, M.D., Assistant Professor of Clinical Medicin, Har vard Medical School. 709 pages, 254 illustrations. Philadelphia and London: W. B. Saunders Co., 1914. Cloth, $5.50; half morocco, $7.

The first volume took up twelve symptoms, this one nineteen. The plan is to select, analyze, and illustrate individual cases, giving the outcome. A valuable feature under each head is the diagrammatic table showing the relativ frequency of various diseases manifesting the symptom under consideration, thus giving the investigator a fair start as to the probabilities in the case. Exceedingly rare conditions are thus located at a glance, and one may take them up if extended examination and research fail to lead to a diagnosis of some of the commoner forms of ailment. The plan is novel and attractiv to the earnest student, and savors much more of clinical instruction than does the average text on diagnosis. This volume covers the following: Abdominal and other Tumors; Vertigo; Diarrhea; Dyspepsia; Hematemesis; Glands; Blood in the Stools; Swelling of the Face; Hemoptysis; Edema of the Legs; Frequent Micturition and Polyuria; Fainting; Hoarseness; Pallor; Swelling of the Arm; Delirium; Palpitation and Arhythmia; Tremor; Ascites and Abdominal Enlargement. Each section has considerable space devoted to general considerations, and this prepares the reader for an intelligent survey of the case under consideration with reference to the cardinal symptom and the relativ frequency of the various diseases likely to be encountered. We are most favorably imprest with the plan, scope and method of execution.-A. L. R.


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THE TUBERCULOSIS NURSE. By Ellen N. La Motte, R.N. 316 pages:

Publisht by G. P. Putnam's Sons, 6 W. 45th St., New York. Price, $1.50, net.

In the great problem before humanity of eradicating tuberculosis is the necessity to secure effectiv workers. The experience of one who has labored in this field since it has expanded sufficiently to require capable efficient nurses is here given and it includes all phases of the subject, from the executiv to the routine work of the nurse. All the little details that one would meet in this work seem to have been encountered and a satisfactory method of handling them is offered. This book gives the functions and qualifications of the nurse who would join the great work of eradicating tuberculosis and constitutes a handbook for practical workers-physicians and nurses-in the tuberculosis campaign. J. C. R.

The first number of the Virginia Motorist has appeared, with Dr. C. A. Bryce, editor of the Southern Clinic, of Richmond, Va., as editor. It is the official organ of the Virginia Automobile Club, and publisht monthly at $1 per year. It is a very attractive and interesting magazine of 28 pages and cover.

Acknowledgments. Health News. Bulletin of N. Y. Dept. of Health, Albany, N. Y. Roster of Summit Co. Medical Society, Akron, Ohio.

American Public Health Problems. Publisht by Prudential Insurance Co., Newark, N. J.

The Advantages of Medical Associations. By E. C. Register, M.D., Charlotte, N. C.

Age.-Young children

and young adults. Cause. —No local cause,

but symptoms of tu

bercle elsewhere. Course.—Longer than

simple, especially the

prodromal stage. Convulsions. Common,


even during the com-
pression stage; often
precede death.
Abdomen.—Markedly re-

Morbid changes.-

1. Those associated with the presence of tubercle, and formation of peculiar greenish pus.

2. Attacks the base of brain.

3. Ventricles are dis. tended, and hydrocephalus may follow. Lumbar puncture.-Fluid

much less turbid or almost clear ; lymphocy. tosis.


markt. Morbid changes.

1. Those of simple or suppurativ inflammation.

2. Attacks convexity of brain.

3. Ventricles not distended.

Lumbar puncture.-Fluid turbid; polymorphonuclear leucocytosis.

-(Wheeler and Jack's Handbook of Medicin.)

"Tall" may be separated from THE WORLD by cutting this leaf on this line. Thus "Talk" without the medical port may be passed among


The German reply was disappointing—"evasive.” But it suggested investigation as to certain facts.

Then came from many of our people the bombastic June 12, 1915.

cry of “honor”; nothing to arbitrate, nor even to One of our subscribers writes: “I am crazy to investigate! The cry of “honor" and unwillingness see what you will say about Bryan.” I didn't to arbitrate or investigate always indicates weakexpect to say anything about him; but I can say ness of the side that does so. As beautiful a literary things about the State Department situation that production as President Wilson's first note was, I have not seen in any of the numerous and nauseat- there were some important points that he left ing editorials that have appeared in the prominent untouched. The same is true of his second note. papers. We all agree that John Hay and Philander I believe that Mr. Bryan could have done better, Knox were great secretaries of state. But let us and would have done better if he had had the suppose that a great crisis in the State Department opportunity that should have belonged to one in had occurred during the incumbency of either, that his position. Thousands of my readers will be the president took the entire matter into his own startled at what I have just said; but in a year hands, retired into seclusion for several days while from now you will be able to reread these lines studying the matter, then emerged with the “note" without any shock. ready to submit to the entire cabinet, all this time You indignantly say: “Wasn't the boat sunk ignoring the Secretary of State. Do you think the without warning and were not our people de president would have found Mr. Hay or Mr. Knox stroyed? Is there any doubt about this? What is still at the head of the State Department when he there to investigate?" emerged from his seclusion? Up to this time I Too true. But why were they there, in a belligerhave always resented the charge that our President ent's ship, in waters which had been, months is carrying. “school teacher”. methods into his previously, declared to be a dangerous zone administration. I fear that this charge has a basis war zone,” in a ship built partly by British of fact, however, in his relations to the Department Government funds with view to using it as an of State. I have not seen a single reference to this auxiliary. British cruiser, and was then carrying as a reasonable cause for Mr. Bryan's resignation, ammunition to be used against the German soldiers and I suppose Mr. Bryan was too patriotic to urge in the field? Elaborate warnings by the German a personal reason for leaving the cabinet. The embassy had been given, both publicly and inpapers have for a long time carried news concerning dividually, to the passengers, particularly to the the ignoring of the Secretary of State by the Presi- American passengers, warnings to the effect that dent. It is right and proper for a president to give it would be dangerous to sail on that ship, parhis personal attention to any department when ticularly on that trip, as special efforts would be there is an important and unusual crisis that said made to destroy it. department has to deal with. But official propriety Have these facts anything to do with the case? and every other consideration demands that such Some say not, claiming that our people have a attention be given in conjunction and in con- right to take passage on an unarmed passenger sultation with the head of the department involved. ship, under the protection of "international law." Else why have departments at all? Why not the And what is international law? Nobody knows. president be the whole thing, with only irresponsible All the nations now at war have riddled it so thoroly subordinates?

that there is scarcely a shred of it left. New and The above does not touch the issue between exceedingly destructive agencies have entered into this country and Germany. Perhaps you want me this war, upsetting old rules and demanding new to go into this, and Mr. Bryan's relation to it. ones, which cannot be made and agreed to until I did not wish nor expect to do so, but of course this war is over. I have opinions, and if partizans will only possess Another question of right may well arise: Has themselves in peace, I think I can give both sides any citizen of the United States a right to tempt something to think about. Will you agree-you fate by deliberately taking a passage on a belligerwho can see only one side (whatever side that is)? ent's ship, which can readily be changed into a Are you big enough to listen to one who looks upon naval vessel, and which is then carrying munitions every side, without shouting "stop my paper"? of war to be used on the European battlefields as Unless you can permit an editor to speak frankly soon as it can be transported, when that particular what is in his heart, what's the use of having an ship (conspicuous in any sea by its size) has been editor?

specially threatened, and when there are plenty of With this understanding I will go ahead. And opportunities for sailing on neutral ships? Has first I will say that Mr. Bryan is only one man. any United States citizen a right thus to put our He is not the question at issue, tho the newspapers country to the risk of serious complications? You see nothing else. In the following discussion I will may answer, “Yes, a legal right. Perhaps. But speak of Mr. Bryan only incidentally.

it is a legal right that may be pushed dangerously Everything revolves around the Lusitania dis- near to the line of treason. aster; so we will come directly to that. It was a The next day after the disaster, Dr. Dernburg horrible and revolting crime that shocked the said: "Screening munitions with American pasentire world; and it will stand in history as a blot sengers!” Then the feeling ran so high thruout upon twentieth century so-called civilization. Over the country that he wisely said no more, went into a hundred of our citizens, largely women and seclusion, and left the country to-day (June 12th). children, perished—“drowned like rats.' We all He and the other German partizans think that we wondered what our Government would say or do. should not sell munitions to the Allies. Here Our President ignored his Secretary State, and think that the German partizans are absolutely emerged from his seclusion with an official note wrong. Our manufacturers will sell as readily to that will stand in history as a literary gem. The the Germans as to the Allies, but the Germans note was sent to Germany, and practically the cannot transport them. That is not our fault. If entire nation rallied to the President's support. it is a sin for private firms in a country to sell war

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materials to foreign countries, what firm in the tember 3d on a neutral (Danish) ship. Our course world has been as great and as persistent a sinner lay across the North Sea. We were anxious about in this respect as the famous Krupp works at those mines—it should be a crime to put floating Essen, Germany? This firm has corrupted indi- mines in the open sea, endangering every kind of viduals connected with purchasing departments of shipping wherever the mines may be carried by foreign governments, it has gotten up fake war varying currents. Our captain skirted the Norscares, and has used every possible method, honest wegian coast about as far north as Iceland, then and dishonest, to sell its goods. Now the complaint cut across west for the open Atlantic, calculating that we sell war materials on the open market that he could thus go around the mines. We comes with poor grace from Germany.

reached the Atlantic, and finally America, in But, of course, Germany will oppose the delivery safety, but we were anxious all the time we were in of such goods to her enemies with every means in the North Sea. I would not have sailed on any her power. This is but natural, and it is a part of sea at that time (nor since) if it had not been the war. This is no concern of ours after the important that I should come home. I wonder at goods have left our shores. But we should recognize so many passengers going abroad in these times, the fact that it is a very deep concern of the German and in belligerent ships, when they could as well Government, and that is the chief motive that

go on neutral ships, tho it is a risk now to go abroad led to the destruction of the Lusitania. Germany in any kind of ships. I think it the height of folly claims the right (in war) to prevent such deliveries to permit a few hundred who persist in tempting by every means in her power. The submarine is fate by traveling in the most dangerous way, her only means. It is a new instrument in naval during these dangerous times, to jeopard the warfare. Such ships as the Lusitania depend upon peace of our country, threatening the loss of huntheir speed to avoid the comparatively slow sub- dreds of thousands of our best lives and billions marines. Hence such a ship must necessarily be of treasure in war. taken by surprise if the effort to destroy it is to Here the bully will come forward with the ques. have any chance of success. Hence the old rules tion, “Haven't our people got a right to travel if of "visit and search" and then provide for safety they want to?". I would reply, "Yes, of course; of passengers in case of destruction—the things but at their risk, not ours." Then the rejoinder that President Wilson is insisting upon, are abso- will come: Of what account is a government lutely impossible with a submarine.

that cannot or will not protect its citizens on the Then, insists our President, stop the submarine high seas?" Well, our Government has many and warfare on unarmed merchant ships. As strongly serious things to do. If you insist that the proanti-German as I am in this war, I hold that, as tection of our flag should go with you wherever long as war is the hell that it is, it is unreasonable

you go, it is your duty to be somewhat discreet as to expect Germany to deliberately put aside her to where you go. If you go among the lions of only means of preventing or limiting the delivery Africa, Uncle Sam will not agree to protect you. of war materials to her enemies. And if the carry- War is as savage and as relentless as lions. If you ing of a few American passengers is to be an effective go where war is, you must expect to take the shield to such a cargo, all that England or France

consequences, and we deny your right to drag us would need to do would be to hire a few Americans into war. This is rather new doctrine, but is it to take passage on every ship carrying munitions. not sound? It must occur to all who think that passengers We have a complaint against Great Britain for and munitions should be separated.

interfering with our foreign trade. This is ako I do not think anybody expected the Lusitanie against the rules of so-called “international law," to go down so quickly, whatever might happen to but this war has proved that there is no such thing her. We have heard so much about those wonderful as international law. To be consistent, President safety compartments, that maybe the passengers Wilson should send one of his “notes” to the expected to be saved in any event. We used to British Government, also. Mr. Bryan wanted to hear that it would be almost impossible to sink a

But I don't think it would do any good, modern passenger ship; that if the ship were cut and it would embarrass us just as, in my humble in two, the two parts would remain afloat, owing opinion, the attitude that our Government has to the water-tight compartments. Perhaps the assumed toward Germany will lead us to embarGermans who fired the torpedo thought that the rassment. ship would not actually sink until plenty of time We find the rules of war to be, keep out or take had elapsed for the escape of the passengers. On the consequences. You say, “This is not according the day following the disaster, the captain of the to the rules of civilization-not according to interLusitania said that only one torpedo struck the national law. True. But war is not civilized. boat; but that soon after there was a second, You can no more civilize it than you can civilize internal, explosion. This suggests the presence of a rattlesnake. Belligerents know no international war explosives, and accounts for the sudden de- law. They are out to defeat their enemies, and if struction and sinking of the ship.. I think the cap- you get in the way you are going to get hurt. If tain tells a different story now. If you will examine your commerce with one side strengthens that side, the papers which appeared the first few days after the other side will stop it if it can. That is natural the disaster you will find his statement as I give in a fight. It seems to me absurd for us to expect it above. I remember it very well. It made a normal conditions on the sea during this greatest strong impression on my mind. However, this is war in history. my only evidence concerning the above.

We hear much of the freedom of the sea-the I know what the feeling of safety is on a big neutrality of the ocean. But who is going to maintain ship. Since the Titanic and Lusitania, it is well to the neutrality of such a vast domain? I saw the realize that this feeling may be misleading. And reserves called out in Sweden during the first month in time of war, no ship is safe. During August, of the war, to guard the coast; and in Denmark I 1914, many mines were strewn in the North Sea saw trenches constructed, trees felled in parks so by the Germans. I sailed from Copenhagen Sep

(Continued over next leaf.)



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that artillery might better defend a certain point,

This for consistency, at least; aod etc. All this to defend the neutrality of these little for making an effort to have the old "international countries. And I understand that Switzerland and laws" observed. But it may as well be recognized Holland have been very busy from the beginning that in time of war, particularly such a war, as is with nearly every available man at the colors, now raging in Europe, these "international laws" ready at a moment at every point to defend their become "scraps of paper" as soon as they get is neutrality. Who will defend the neutrality of the the way of the fighting. It will always be so unti vast expanses of the watery wastes on the globe? an international government is established, with Wherever belligerents can get together they are sufficient power to maintain its laws. All efficient going to fight. And why shouldn't they, as long government must rest finally upon force. Sentias war exists? It is my humble opinion that no ment immediately gives way to force, if sentiment power will "rule the wave" with greater justice, is on one side and force on the other. We should consideration and restraint than Britannia has, put force behind the best sentiment, and the force during peace and war, until there shall be an should be superior to any other force, else it cannot international navy to render this service for the stand. That means that hereafter no nation can peace of the world. At present every nation is rely upon itself alone. As powerful and as "presupposed to be responsible for the ocean out to pared” as Germany is, she will have to succumb an imaginary line three miles from its coast; beyond in this contest. Civilization cannot permit Ger this line being "no-man's-land"-or water. The many's selfish ambitions to be realized. However, fact is, force will always rule here as it always has German civilization, minus the militarism, must everywhere. Let us make it intelligent force, and and will be preserved. govern it in the spirit of justice in the interest of all. If Germany had, during the past 25 years, spent

Query: What if the Lusitania had been destroyed 10% of the time and treasure she has to build her just within three miles of the Irish coast, instead fighting machine, in cultivating international amity of ten miles out? The loss of life, etc., would have instead of selfishness, she would have friends been probably about the same. Would being instead of “enemies." The same truth can be within the three-mile limit have made any difference applied to other nations, but to most of them in in international relations?

less degree. But if all had devoted only 1% of Also, considering the danger to the Lusitania, their military expense during the last 25 years her value, her cargo both human and munitions of to developing an international goverment, of which war, could not our Government reasonably make a all would be a part, as each of our states is a part complaint of the failure of the British Government of our national government, this war would have to give a convoy for safety thru the danger zone?

been prevented. All would gain by such a proThere seems to have been a total lack of pre- gram, as each one of our states gains by being in cautions of all kinds, giving the enemies to this the Union. The German Government has led its ship every opportunity to do just what they said people to the shambles for the glory of the Governthey would try to do. Now who is to answer for ment, but it will be in vain. When the German the consequences?

people are led in the paths of peace, so that their I believe that Germany began this war. I

sterling qualities may have an opportunity to win believe that it wanted the war, tho not on such a their proper reward, it will not be in vain. May large scale. I believe that it was prepared for the all the nations learn that in war, all lose; but in war, and perceiving that its neighbors were not

peace, all win. prepared, it determined that then was an opportune Later: It is a great pleasure to me to be able time for "der Tag" (the day). Its plans were to state that the newspaper reports above menambitious. It seized on the Serbian incident as a tioned concerning the ignoring of Mr. Bryan as pretext. It rather counted on the adherence of

secretary of state by the president are entirely Italy, and expected England to stay out. It

erroneous. In the newspapers of Saturday, June expected Belgium to submit as Luxemburg did. 19th, and in a personal letter to me of same date, We see now, even with Italy out, with England Mr. Bryan states that "not a single statement has neutral, Germany and Austria could have had

been issued by the president, or prepared by him, France and Russia by the throat long ago. That about which I have not had the privilege of conaccomplished, England could not then have made

ferring with him beforehand, and the opportunity effective resistance even if she wanted to. Germany to offer suggestions after it was prepared." would then dominate Europe. Possibly the German Eagle would have been a wise and generous domi

Observations of An American Surgeon. nating power, but I very seriously doubt it.

This is my view, and I have studied the situation The inhabitants of the warring nations to-day to my own satisfaction from many points of view. are divided into two classes, those who are killing But this is my point: As thoroly anti-German as man and those who are saving man. There is no I am in this war, I will not allow my opinions to other occupation. Railways are hauling food, amdegenerate into prejudice, and thus become blinded munition and men to the battle line, and hauling to the German side (and there is a German side) back the wounded. Factories are turning out uniof the Lusitania incident and the submarine, forms and guns, powder and shot. Telegraphs and munitions, etc., situation. President Wilson has telephones speak only of war. The printing press not dealt with these matters adequately, and the describes battles and records the names of the indications are that Mr. Bryan would have dealt dead. Hotels and schools are hospitals and parks with them more adequately; I do not believe that are drilling grounds. Iron and steel, copper and the course outlined by President Wilson's two lead, are implements of injury and death, while notes will lead to a satisfactory nor permanent

the universities and scientific laboratories are desettlement of the points at issue. Mr. Bryan was

serted sanctuaries. Wealth and station, titles and disposed to recognize the important facts in the honors, are lost; man is stripped of his trappings case, which is a necessary basis for a satisfactory of civilization and has reverted to a common brute settlement. He was also in favor of protesting to level.-DR. G. W. Crìle, in The Nation, June 3, England against interference with our foreign 1915.

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