Dr. Orr, Lincoln:

There are two matters in connection with this X-ray side of diagnostic work which seems to me will bear emphasis, although they have already been referred to. One is what Dr. Mick referred to in showing the picture of the baseball finger. A large number of patients are affected in this sort of way. They may be minor cases, but after all the neglect of that sort of condition in a patient by the physician causes a large amount of suffering to the patient and a large amount of grief to the physician afterward. Another thing, so few physicians right at the present time avail themselves of the X-ray in checking up on their fractures. A great many physicians seem not to be aware of the fact that after the ablest operation, or whatever else you may do, the results may be checked up without disturbing the dressings at all by taking an X-ray picture, and I have had a number of cases in which serious trouble was saved the physician and also the patient by the taking of an X-ray picture, and I feel as though these two points ought to be emphasized in this discussion.

Dr. Overgaard, Fremont:

I want to bring out some little points. Dr. Ballard spoke about the shape and size of the stomach. It is true that the stomach varies in each case but we must give you an idea what the majority are like. I also want to hit Dr. Mick while I am throwing baseball. I did not prepare this paper for X-ray experts, I came here to talk to medical men, but I did it to give you an idea of what we work from. You have to start at a certain point to get your foundation, that is all. I used these terms just simply as a matter of expression. In all of our stomach work and bowel work, if there si no other reason but a financial reason, we should quit using plates as it is too much of an expense.

I want to say that the X-ray is absolutely the best malpractice suit preventor there is in existence today. We have less mal-practice suits today by the men that depend on the X-ray fractures. If the surgeon would have an X-ray picture taken of the fracture at the beginning, then if afterwards the man gets a bad looking fracture in six months or a yaer, if you have got your original record you can sleep all night and not worry about what they are going to do to you in court because you can go into court and show your original plate and show what it was in the beginning and I do not think there is any surgeon in the country who would go on the stand and testify against you.

So far as Dr. Stokes is concerned, I do not think he ought to throw any bricks. It is a new subject with us, personally. Our German friends have been working on it for many years. There are no two cases alike, and we are covering a good deal of ground in a short space of time and we ought to have a little latitude.

The Fourth International Congress on School Hygiene, and the first to be held in America at Buffalo August 20-30th, according to an announcement of the executive committee, will be by far the most elaborate effort yet made in this country toward getting the problem of school hygiene before the world. The first International Congress was held in Nuremberg in 1904, the second at London in 1907, the third in Paris in 1910.

Langes reports eight pregnant women treated with salvarsan in the last three months of pregnancy; the Wassermann reactions were positive, the lues latent. Only one injection was given. In none of the women did the injection cause the advent of labor pains. All the children were born apparently healthy, and gave negative Wassermann reactions. He believes, however, that salvarsan should be followed up with mercury.

ABSTRACTS.

Ileocolitis, Infantile. Treatment.

In "putrefactive diarrhoea" of infants, all irritating found should be avoided as, by causing increased mucous flow, it favors bacterial pullulation. Use of proteid of cows' milk, obtained by removing whey from skimmed milk with chymogen or pepsin, advisable. Break up curd into fine particles and suspend in 5 per cent. gelatin water, to be heated before administration. After four or five days to a week replace gelatin water partly by buttermilk, and skimmed-milk curds by whole-milk curds, gradually getting child on albumin-milk and finally on wholemilk mixture.-Grulee.

Pediculosis Capitis. Treatment.

Lay patient on back on bed with head over edge, hair lying in a basin beneath head on a chair. Pour 1:40 phenol solution over hair into basin and sluice backward and forward until hair thoroughly soaked, especially over ears and at nape of neck. Continue sluicing ten minutes, then lift hair from basin and allow to drain, without drying it. Then swathe head with thick towel or large piece of flannel and allow to remain for an hour. Finally wash hair or simply allow to dry. Method entirely safe with children of 5 years and over. Hair not damaged.-Whitfield.

Pellagra in the United States.

There were from thirty to fifty thousand cases of pellagra in the United States within the last six years, with a death-rate of about 39 per cent. These figures constitute only a rough estimate of the number of cases, owing to the defective machinery for securing vital statistics in this country.

Lavinder, of the United States Public Health Service, has gathered figures on the prevalence and distribution of pellagra from state authorities, from public institutions and from private sources. A map shows that pellagra has been reported from every state in the Union except New Hampshire in the east and the group of western and northwestern states comprising Idaho, Minnesota, Montana, the two Dakotas, Utah, Wyoming and Nevada. The greatest prevalence is found in the group usually spoken of as the Southern states. Pellagra cannot be

compared in prevalence with such a disease as typhoid fever, for example, yet the large number of cases and the high mortality-rate together with its wide and apparently increasing distribution make it a disease of national importance, and afford an additional reason why every state not already having adequate vital statistics laws should at once enact such laws. The aid which accurate figures and facts concerning this important disease would give in the solution of the problem of pellagra, says The Journal of the American Medical Association, should alone be sufficient to demand the enactment of such laws in the coming legislatures of every state not now within the registration area.

Recurrence of Scarlet Fever.

Dr. L. A. Sexton, in a paper on return cases of scarlet, calls attention to the difficulty of determining how long scarlet cases should be quarantined as the contagion is due to throat, nasal and ear discharges and not to the desquamation as has been so long claimed. Some cases may go through the acute stage and even to complete desquamation without nasal discharge and later develop a contagious rhinorrhea. Dr. Northrup in discussing the paper said he was convinced the contagiousness of scarlet was limited to sneezing distance. (New York Academy of Medicine, Section on Pediatrics.)

NEWELL JONES (Omaha)

The Effect of Cane-Sugar on the Uterine Muscles.

Shaheen (The British Medical Journal) says that the action of cane-sugar of increasing the energy of the uterine contracions in labor has been made use of by French people in inducing an otherwise slack uterus to produce good effective labor pains. Sugar is given in solid form or in solution, and apparently with good results.

Referring to an Egyptian custom of giving infusion of caraway seeds well sweetened with sugar for at least one week after delivery, in order to hasten and increase the mammary flow and to bring about a speedy involution of the uterus, Shaheen holds that whatever good effect may be obtained from this medication is more due to the sugar than to the caraway seeds, and he suggests the employment of this home remedy in cases of subinvolution of the uterus when the administration of drugs may have some retarding influence on the mammary secretion.

Immunity From Diphtheria.

Cable dispatches to the lay press bring us the information that Prof. Emil von Behring of the University of Marburg in a lecture before the Congress of Internal Medicine recently held at Wiesbaden, announced a new antidote for diphtheria consisting of a mixture of toxin and antitoxin. From the preliminary tests it would appear that it is harmless and that in contrast to the old antitoxin which gave but a brief and often unsuccessful immunity this preparation affords an immunity prolonged and lasting. This new serum has been offered to certain hospitals for impartial trial and further observation.

Children's Diseases.

In 1911, the deaths reported from thirty states gave 6,251 as due to whooping cough, 4,232 due to scarlet fever and 9,579 to diptheria. This does not include the deaths from bronchitis and broncho-pneumonia, which so often complicate or follow whooping cough. The age incidence shows the extreme necessity of protecting the young. Ninety-six per cent of the deaths from whooping cough in the United States were in children under five years and 57% under one year. Quarantine for whooping cough should be at least six weeks or longer if the BordetGengou bacillus has not disappeared from the sputum and the paroxysmal cough stopped. (Dr. John Lovett Morse, president's address, American Pediatric Society, Washington, May 5, 1913.)

NEWELL JONES (Omaha)

Nystagmus an Important Symptom in Erysipelas.

Hirsch (Abst. in Zentralblatt f.. Ohrenheilk, xi, 4, 134), states that nystagmus, generally of the rotary-horizontal type, is a constant symptom of face and head erysipelas, and is of great importance in the diagnosis of those cases in which the hairy scalp alone is affected; also in cases in which threatening symptoms such, as meningeal irritation, vomiting, chills, and delirium might easily, in the presence of middle ear suppuration, lead to the diagnosis of a serious brain lesion. As an early or prodromal sign it may be useful in deciding for the isolation of suspected but not certain erysipelas. It may also help to determine the disputed question as to the length of the incubation period, which writers on erysipelas give variously as from 1 to 3 or even 8 days. (GIFFORD.)

Another Father Damien.

The English King has done a good deed. He has made Di George Turner a knight. Who is Sir George Turner? Few, in America at least, except medical specialists know him, but those specialists know him as one of the greatest authorities on the subject of leprosy. When he was practicing as a physician and medical officer in South Africa, the leper hospital at Pretoria made a great appeal to him; such a great appeal, indeed, that he gave up all his spare time to work among the lepers. He would go to their hospital morning and night, and devoted all of his Saturdays and Sundays to them. For years he labored among them without pay of any sort, investigating the nature of the terrible disease, and doing all he could to ease the lot of the sufferers. On reaching the age limit Dr. Turner retired from his official duties and went to England to pursue further his studies into the source of leprosy. After several years of work the disease attacked him. But he still labored on in his investigations though life now meant ever-increasing pain, disfigurement, and consequent seclusion. He has now, it is reported, lost his left arm. The story goes that he was recently asked to dinner by some admirer, to whom he replied: "I should be glad to go, but I am a leper, you know." It is a pleasure to learn that Dr. Turner's name was included on the King's own initiative. Outlook.

Effects of Chloroform and Ether on Kidneys.

The experimental work done by Apperly had for its object the determination of the extent and nature of the injury done to the cells of the liver and kidneys, by an acute infection, by chloroform and ether, the significance of a combination of the two, and finally a short series of experiments were done with the object of showing the value of glucose in combating the symptoms caused by such agents. After the first series of animals, experiments with ether were discontinued, as the results obtained were almost negative and merely bore out work which had already been very fully done. He found that chloroform has not only a profound effect on the cells of the liver, a fact which has frequently been shown, but that it has an almost equally harmful effect on the cells lining the tubules of the kidneys, a fact which, he says, has never been sufficiently emphasized. The damage done to the kidney seems of even greater import than that done to the liver. For the chloroform not only acts