DIFFERENTIATING THE PUS-TUBE. Pyosalpinx due to the gonococcus is, according to Schridde, characterized by superficial ulcers of the mucosa, adhesions between the fimbriated ends of the tube, swelling of the extremities of the fimbria, the presence of plasma cells in the walls of the tube and lymphocytes in the pus!

Pyosalpinx due to the streptococcus is characterized by the absence of the above symptoms, by marked lymphangitis of the tubular wall, and the presence of leucocytes in the pus.

Bismuth Poisoning.

In Surgery, Gynecology and Obstetrics, September, 1912, Drs. Leo Mayer and George Baehr, of New York, present an elaborate article warning against the dangers of toxicity involved in the use of bismuth pastes and powders in surgical practice.

Their study leads them to believe that bismuth is absorbed from granulating areas by the action of the phagocytes, and that when so absorbed it is dangerously toxic. They advise that dermatol and other forms of bismuth never be applied to extensive granulating areas. Bismuth paste has caused death in as small amount as 25 grams and a warning is issued against the safety of the whole procedure.

Iodine on the Operative Site.

In New Orleans Medical and Surgical Journal, October, 1912, we find credited to Prof. L. Sabbatini, of the University of Padua, the following excellent suggestion: After the application of the iodine, the surface is covered with a layer of sterile absorbent cotton, and about five_minutes later the cotton is soaked with a 5 per cent. solution of hyposulphite of sodium at a temperature of 104 degress F.

The iodine is changed to iodide of sodium, which removes the irritating qualities of the iodine and makes it painless even to wounds and tissues other than the skin.

Cactus Finds a Friend.

Denver Medical Times, September, 1912, asserts that Sir Clifford Albutt (Saunders' Handbook of Practical Treatment, 1911) has found cactus the best remedy for the irritable symptoms of functional heart disease, and very useful in convalescence from heart strain by effort. [Our own experience bears this out fully. Also we freely commend the alkaloidal granules of spartein sulphate, especially when a diuretic effect should be added to that possessed by cactus. We have thought a combination of these two drugs would be a happy one.-EDITOR.]

Scarlet Red.

This is an aniline dye formerly used as a laboratory stain and as an ingredient of paints exclusively. In 1906 Fisher showed that it would produce a new growth of normal epithelium. Prof. John S. Davis, of Johns Hopkins University, is to be credited with its American introduction into therapy.

In International Journal of Surgery, September, 1912, Dr. Joseph H. Fobes, of New York, reports favorable results, using 10 per cent. scarlet red in the U. S. P. ung. ac. boric. for a base. Granulating wounds, varicose ulcers, skin graft cases, burns and other lesions were favorably influenced. Manufacturers are improving upon this rather crude prescription, but it does excellent work.

Alcohol in Patent Medicines.

The Medical Fortnightly, September 25, 1912, is authority for the statement that over three hundred patent medicines are now classed by the Internal Revenue Department as alcoholic beverages and are taxed accordingly.

Tounecek's serum for subcutaneous injection in arteriosclerosis is made as follows:

R Sodium chloride, 10 grams;

Sodium sulphate, 1 gram;

Calcium phosphate, 0.75 gram;
Magnesium phosph_ate, 0.75 gram;
Sodium carbonate, 0.40 gram;
Sodium phosphate, 0.30 gram.

One gram of this is dissolved in 15 c.cm. of sterile distilled water. Treatment is begun by hypodermic injections in the region of the buttocks of 2 c.c. of the solution every other day, being increased in amount by 1 c.c. each injection until the dose of 8 c.c. is reached.

Full doses sodium citrate, if given early, will cause rapid lysis in pneumonia.

One hundred thousand Eastern invalids annually go West to die, ofttimes in poverty. Don't send a hopeless invalid West unless he has $1,000 over and above what his family needs. It is not fair to the invalid or to the West.

Kava kava is useful in the treatment of intestinal indigestion, and it markedly promotes appetite.

Irrigations of bisulphate of quinine (1:3,000 to 1:1,500) given daily, is one of the best remedies in acute gonorrhea. Use it warm, dissolving in hot water and allowing to cool to about 100 F.

BOOK REVIEWS

The Chemic Problem in Nutrition. By John Aulde, M.D., Philadelphia, Pa. Cloth, 8vo, gut top, pp. xvi, 410; illustrated. Philadelphia, 1912. Published by the author, 1305 Arch street. Price, $3.00, postpaid. This is a work which, while giving adhesion to the bacterial origin of many diseases, lays emphasis upon problems of nutrition and cellular chemistry. Especial emphasis is placed upon magnesium infiltration and the lack of lime in pathologic conditions. The work shows elaborate study of the question, and is interesting.

In regard to the validity of the contentions of this work opinions may differ. In the thought of the reviewer, the author so fully proves his contention that he nearly disproves it. One would naturally conclude that he would have made a study of conditions in the Southwestern United States, where magnesium excess would be, from the point of view of the author, a great peril; but we do not find such reference. The scientific student of nutrition, the tissue-salt student, the biochemist and the homeopathic physician will find much in these pages with which he will agree, while the more materialistic therapist will not, but should, make a study of the work. Any physician can study this book with profit. It is an addition to science.

Manual of Medicine. By A. S. Woodwark, M.D., M.R.C.P., Physician to the Royal Waterloo Hospital and the Miller General Hospital for South-East London. Oxford University Press. American Branch, 35 West Thirty-second street, New York City, 1912. Cloth, p. 409. illustrated. Price, $3.75.

This work covers the general range of diseases, inclusive of insanity. The author has adopted a plan of bringing out the symptoms and the diagnosis under a single heading, thus very cleverly associating what every diagnostician is

compelled to consider together. Where necessary, differential diagnostic points are separately stated. The pathology is rather practically elaborated and in a form to be suggestive rather than exhaustive. As the book is meant to be chiefly one of reference, we do not question the wisdom of the author in his arrangement; but this book can not take the place of the usual text-book on medicine, nor does it pretend to do so.

The notes upon treatment are confined to those authoritatively elaborated and appear to be wisely selected, although more brief than in most works.

The work is a safe up-to-date guide within its professed limitations, and is to be commended for its accuracy and its truly scientific basis.

Uncomplicated Pregnancy and Labor. By Finley Ellingwood, M.D., Editor of Ellingwood's Therapeutist. Published at the office of that journal, 32 North State street, Chicago, Ill., 1912. Cloth, p. 160. Price, $1.60. We are very much pleased with this practical little work, which is quite out of the ordinary in presentation, and is well written. Dr. Ellingwood is an author of note in the Eclectic School, and this book goes far to justify their enthusiasm for carefully selected drugs in ordinary conditions such as all physicians meet. The work is just what it claims to be a guide for the treatment of disorders of the pregnant term and uncomplicated labor. And the man who feels there is nothing to do in uncomplicated pregnancy has much to learn from this volume, which is based upon a large experience and well conveys its lessons to others.

Bacteria. By Dr. Max Schottelius. Translated by Staff Surgeon Herbert Geoghegan, R.N. Oxford University Press, American Branch, 35 West Thirty-second street, New York City, 1912. Cloth, p. 324, second edition, illustrated, 10 in color. Price, $3.50.

This is a simple and direct presentation of the facts of bacteriology from all points of view-of medicine, industry, agriculture and pure science. Research methods, the means of combating infectious diseases, immunity and protective inoculation, specific bacteria and protozoa and disease carriers are all treated of in semi-popular form. It is not a book of technic, nor is it an elaborate text-book, but the physician who feels perplexed by this latter class of writing will be instructed and entertained by a reading of this charmingly simple book by a highly trained specialist in the subject of which he treats. We would especially commend this work to the physician who has never enjoyed the instruction of a modern laboratory.

Surgery and Diseases of the Mouth and Jaws. By Vilray Papin Blair, A.M., M.D., Professor of Oral Surgery in the Washington University Dental School, and Associate in Surgery in the Washington University Medical School. St. Louis, C. V. Mosby Co., Grand avenue and Olive street, 1912. Cloth, p. 637, with 384 illustrations, mainly made for this work. Price, $5.00. Dr. Blair has produced a monumental work, and has ransacked the periodical and library field of the surgical and dental world to bring within the compass of one volume so much of value to the operator. That he has admirably succeeded does not need our testimony. Such a work stands for itself, and is an instance of patient research, thorough study, careful writing and excellent execution by the illustrator and publisher. We predict that this work will be a standard for years.

LAST YEAR we printed some conclusions

relative to the injection of embryonic tissue in the treatment of cancer. For the information of our readers we will comment upon some very strange researches with reference thereto.

Mayoral and Jimenez, in La Medecine Scientifique, have been reporting researches based upon the Elsberg cancer reaction, which is as follows: From the blood of a healthy person is abstracted a cubic centimeter of red corpuscular matter; this is made into an emulsion with isotonic chlorid of sodium solution, and a small quantity is introduced under the skin of a person suspected of being cancerous. A positive reaction is in the form of a painful erythematous spot within six hours.

These scientists claiming an analogy between cancer and pregnancy in that in both conditions the subject contains large quantities of embryonic tissues and their antigens, endeavored to ascertain:

"1. If a pregnant woman, injected with an emulsion of the red corpuscles of the person who, supposedly, impregnated her, would give a positive Elsberg reaction. Results: three pregnant women, injected with emulsionized red corpuscles from their husbands, gave a positive Elsberg reaction.

"2. If a pregnant female, injected with the corpuscles of a male who had never had

sexual contact with her, would give the rewomen, action. Results: one of the above women, injected with erythrocytes from her husband, and at the same time from a stranger, gave a positive reaction with the former and a negative reaction with the latter.

"3. If a woman, once fecundated by a certain man, would thereafter, and always thereafter, give a positive Elsberg reaction when injected with the red blood corpuscles of his blood. Results: thirteen pregnant women were injected with the emulsion from males with whom they had never cohabited, twelve of whom gave negative results, while in one the reaction was doubtful.

"4. If the mere fact of cohabitation, without offspring, between a man and woman would produce Elsberg reaction in the woman when injected with the red blood corpuscles of her male participant. Results corpuscles from two husbands gave positive reaction when injected into their pregnant wives, but negative results in three other pregnant women whom they had never known. In five non-pregnant women who had previously borne children to their husbands, there were negative results in four, and a doubtful reaction in one."

The editor of Texas Medical Journal, in a bright editorial in his December number, raises the question of the diagnosis of pater

nity and speculated upon the possible reaction in the children. What a medico-legal question that would precipitate!

Passing that question by, to us the interest centers very tangibly about the relationship between cancer and embryonic tissues. On pages 86, 126 and 188 of the 1912 volume of THE MEDICAL COUNCIL, this matter was discussed. The researches of Mayoral and Jimenez throw a flood of light upon this question, and appear to determine a close relationship between cancer and embryonal tissue. When we add to this the fact that the Wassermann reaction

muscarine, and is intensely poisonous, causing nausea, pain, depression and dangerous bowel difficulties of an obstructive order.

If any of these amin ptomaines or the allied amanitine and muscarine are exploited as new, don't believe it. We have old literature showing their therapeutic use long ago, and, with the exception of muscarine, no useful results are scientifically recorded. Muscarine is better known and is of some value in checking night sweats.

Enhancing Nutrition in Tuberculosis.

liver of a syphilitic fetus, and consider some editorial speculations upon "Colle's Law and the Wassermann Reaction" in our last issue, and remember that Calmette's, Von Pirquet's and Moro's tests for tuberculosis give ophthalmic or cutaneous reactions biologically much like the Elsberg reaction, a host of questions arise that can be answered only by elaborate and patient investigation. We do not feel justified in drawing any conclusions as yet, but all phases of the great cancer problem interest us. What do our readers think?

N

Ptomaine Therapeutics. EURINE dissolves nearly all bacilli, possesses considerable bacteriolytic action and promises to be useful in the preparation of antigens. All this is very interesting. The unfortunate thing about it is that an effort is being made to introduce it into therapeutics, the claim being made by Deycke and Much that it can be rendered non-toxic. "Coming events cast their shadows before," and, if a serious effort is made to exploit this poisonous ptomaine, we advise our readers to let others do the experimenting. We have enough "made in Germany" therapeutics to give this dangerous preparation a very conservative reception.

Neurine is an amin derivative resulting from decomposition of nerve tissues and the suprarenal capsule. It is a cadaveric alkaloid or ptomaine; is chemically allied to

the most important feature of the work of the physician who attempts to fight "the great white plague" is to enhance the nutrition of the sufferer. Nutrition is everything in tuberculosis. Because of this it has become almost standard to "force" the feeding of this class of patients, and in many of the most prominent institutions in this country and abroad, as well as in the practices of our best clinicians, it has been the custom to feed the tuberculous "as much as they can possibly stand."

However, it is beginning to be appreciated that fully as much harm as good has been accomplished by the extremes of feeding that have resulted from the knowledge that nutrition was such an important feature. Toxemias have resulted which have undone much of the good that the hygienic and other associated procedures have accomplished, and while many cases have been benefited by increasing the amount of food given, unquestionably many have had their digestions ruined beyond hope.

In this connection it is interesting to note that, beginning in France and spreading throughout Europe and America, an interest has been aroused in the treatment of tuberculosis by the use of certain animal extracts, particularly that secured from the spleen. It is said, and we have as our authority the interesting and quite extensive writings of Professor Bayle, of Cannes, France, that splenic extract increases the weight and nutrition in a remarkable de

gree, and therefore is claimed to be a most valuable adjunct remedy in the treatment of tuberculosis.

The philosophy of Dr. Bayle's method is based upon the theory that the spleen produces certain preferments or hormones, which influence nutrition both directly and indirectly. In one of the doctor's communications, Revue de Medicine, Paris, June 10, 1911, he refers to 146 out of 150 cases which have shown "the unquestionable and rapid effects of this treatment." As many as 75 per cent. of favorable results have been found, and emphasis is laid upon the fact that many of the patients treated were in an advanced stage.

We realize, of course, that since the fight against tuberculosis is such a formidable one, there is a natural tendency to try anything and everything, buoyed up by the clusive hope that some day a specific will be found. Time and again have our hopes been raised only to be rudely dashed to the ground, but no one can deny that progress has been made.

It is possible that Dr. Bayle's enthusiasm is well grounded, and in this connection emphasis may be laid upon the statements of Drs. Herzon and Bellamy, British Journal of Tuberculosis, October, 1910, in which these writers state that they have proved that the spleen furnishes a definite internal secretion, the function of which is to transform the precursors of the pancreatic ferments, changing them into the active and hence useful trypsin. It is, therefore, quite reasonable to believe that any beneficial effects of spleen extract in tuberculosis are due to this reinforcement of tryptic diges

tion.

Aside from this, we know that bio-chemistry has proved that the administration of certain enzymes stimulates the production of the corresponding.substances in the body and this is borne out by the fact that the administration of spleen extract influences phagocytosis in a noticeable way, and probably also the production of red blood cells.

It is far too early to say that in extract of spleen we have a specific for tuberculosis,

and naturally its value will be limited, but doubtless its use will be found to be another weapon in our hands.

Guess Work in Interpreting Blood Pres

sure.

IN OUR ISSUE for July, 1912, Dr. J. B.

McAlister discussed blood pressure largely from a life-insurance point of view, while Dr. J. Boyd Campbell, in the December number, raised some clinical issues. Now, in the present number, Dr. I. L. Nascher, in an important letter, raises the question of normal blood pressure in the aged. We have in hand for prompt publication, an article by Dr. J. W. Gregg, who

takes issue with other methods and advocates taking blood pressure from the temporal artery. All of these gentlemen, whose articles, if read together, show discrepancies, are working under a disadvantage to which we wish to refer.

It is a simple enough procedure to take the blood pressure, although it must not be forgotten that the Basch and Potain instrument uses a scale different from the RivaRocci and others, and Gregg has a scale of his own. Converting these scales to a uniform basis may give rise to more or less trouble, and it is wise to state any pressure in mm.hg. giving artery tested and the age of the subject.

So far as we apprehend the matter, the present difficulty lies in the interpretation of blood pressure findings. The laboratory side of the question seems to have been very well worked out, but the clinician has yet a good deal to do upon the subject of proper interpretation. Dr. Nascher is undoubtedly right in his contention, so far as it goes, while Dr. Gregg raises another important issue as regards the influence of the muscles in taking the radial pressure, We apprehend that still other points will arise which will tend to render more complex than at first thought the interpretation of blood pressure findings.

Meanwhile, we should be a bit cautious in our estimates of blood pressure and, the