As illustrative of different results in the most opposite conditions of hygiene, I shall cite two cases. But first let me state that I have never had any but the best results where the management of the case was in my hands before, during and after confinement.

On April 16, 1897, a negro asked me to attend his wife, whom he said had been in labor for two days under the care of a midwife. Going with him I found a woman as dirty as the race can get, lying on a bed so filthy that I doubt if even my pointer dog would relish it as a sleeping place. The woman was clad in garments in which she had, for a fortnight, labored in the fields. I instructed her to take a warm bath and change her clothing, but bathing facilities were not available and she said she had no change of clothing. After delivering her under these circumstances, I left customary instructions for cleansing the patient's person, removing soiled clothing, frequent change of the vulva pad, and the use of a warm douche. On calling the next day the same filthy conditions were found; she had not even washed her face. When I scolded her for this, she said: "Doctor, I have no one to do it for me." Passing her cabin on the fourth day after confinement I went in to see her, and my olfactories were greeted with a most offensive odor, and everything was exactly as I left it on my first visit. I told her if she died I could not be blamed for it, but she said that she had had two babies already under the same circumstances and got along all right. She made an uneventful recovery, and I don't suppose she changed her clothing till her "month was up," as they pay more attention to that than to cleanliness of person.

Now to relate case number two, in order to vindicate the foregoing proposition that septic poison does, or sometimes must, arise from internal as well as external factors:

On the third day of confinement I was asked by the family physician of Mrs. N., multipara, to come to see that lady immediately, and, promptly responding to the summons, I found her in a semi-conscious state, circulation rapid and weak, countenance flushed, with anxious expression. Her abdomen was swollen, tender and tympanitic; temperature 103° F. The attending physician said that he had no idea what her trouble was. I diagnosed septic pelvic peritonitis, which he said he had never before heard of, and wished to know the treatment. I had a hot carbolized douche given, which brought away quite a quantity of offensive clots, as

the flow had ceased. Gave morphin, gr., strychnia sulph., gr., hypodermatically, acetanilid to reduce fever, and quinin for its anti-periodic and anti-malarial effect, for in our country malaria is an ever-present factor in all diseases. I questioned the doctor as to his management aseptically. He said he had her take a warm bath and change her clothing, and had the bed properly attended to. In fact, had done all that was customary in usual country practice. I found everything as clean as possible, so far as I could judge. She made a good recovery. I attended her again in another confinement in January, 1898, without the slightest trouble.

I do not write this to take issue at all with any advanced theory in obstetric practice, but to show city doctors what we country doctors have to contend with, and it would seem. that after all there is not so much in the germ theory. However, I am in favor of doing everything we can, in a modest way, aseptically. Then, should anything occur, we have nothing for which to chide ourselves. I think Dr. Moore's paper an able effort theoretically, and as such endorse every word of it. I simply mention these facts to bear me out in my belief of internal as well as external causes for any septic condition. Long live the MEMPHIS MEDICAL MONTHLY and its able corps of editors! If this is published, I may at some future time give my experience in the medicinal treatment of appendicitis. J. TACKETT, M.D.

Richland, Miss., Feb. 17, 1899.

Through this toilsome world, alas!
Once and only once I pass;
If a kindness I may do
To a suffering fellow-man,
Let me do it while I can,
Nor delay it, for 'tis plain
I shall not pass this way again.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.

Visiting Physician St. Joseph's Hospital, Memphis.

Bacteriological Study in the Etiology of Yellow Fever.

P. E. Archinard, R. S. Woodson and John Archinard (N. Y. Med. Journal, vol. 69, no. 4) contribute the results of their investigations in the bacteriological diagnosis of yellow fever. Their interesting experiments are summarized in the following conclusions:

1. In a large proportion of autopsies (thirty-two times in thirty-nine) of yellow fever cases of 1897 in New Orleans, a bacillus was found either in a pure state (two times) or in association (thirty times), similar to the Sanarelli “bacillus icteroides." This bacillus has some points in common with the coli communis, but differs from it in some of its essential characteristics.

2. In live blood taken from the veins of the elbow in well- marked cases of yellow fever, we were able to isolate our bacillus four times in five cases.

3. In the exhaled breath mixed up with secretions from the mouth and nose (sometimes bloody), we isolated our bacillus twice in twelve cases.

4. In the scrapings of the surface of the body of the sick, principally face, neck, and the upper part of thorax, we isolated our bacillus two times in every twelve cases.

5. Our bacillus injected intravenously to the rabbit, and subcutaneously to the guinea pig, in large doses, from five to ten cubic centimeters, of a bacillus culture, is always fatal, and sometimes very quickly. In smaller doses (one to

two cubic centimeters) the animals are made sick, but generally recover. The animals that die show characteristic lesions of the liver, kidney and stomach. Cultures from these organs give pure growths of the inoculated bacillus.

6. Our bacillus is identical in almost every respect with Sanarelli's bacillus icteroides, obtained from himself and from Dr. Sternberg, but differs somewhat in its cultural aspects from Sanarelli's description of his bacillus.

7. The blood of yellow fever cases or of recent convalescents from this disease agglutinates the bacillus icteroides of Sanarelli, and also our bacillus, in over eighty per cent. of the cases in the proportion of one part of serum for forty of culture within one hour. In less than twenty per cent. the reaction does not take place.

8. The blood of typhoid and dengue with eruption and malarial fever when properly diluted, one in forty, does not agglutinate the bacillus icteroides or our bacillus, except in exceptional instances.

9. The blood from a number of diseases other than yellow fever, when properly diluted, one in forty, does not react on the bacillus icteroides or our bacillus.

10. Normal blood properly diluted, one in forty, does not agglutinate the bacillus icteroides or our bacillus.

11. The blood of persons who have had yellow fever seems to retain its agglutinative power for a number of years. The great majority of the cases tested by us who had had yellow fever in 1878 gave the reaction. Those who had had yellow fever previous to 1878 gave us a blood which possessed no agglutinative power with bacillus icteroides or with our bacillus.

Malaria.

Thayer (Maryland Med. Journal, vol. 41, no. 6) concludes an address on the subject of malaria, delivered before the Maryland Public Health Association, November 10, 1898, thusly:

1. Malarial fever is a specific, infectious disease, due to parasites which exist in the blood of the infected individual in great groups and give rise to paroxysms at the periods of their sporulation.

2. There are three varieties of malarial parasites--one associated with quartan fever, one with tertian, and one with paroxysms, which occur usually about forty-eight hours apart, but occasionally at more frequent intervals, while often the fever is irregular or continued-the estivo-autumnal parasite.

3. Either of the first two varieties of parasites may also give rise to quotidian fever, owing to the presence of multiple groups of organisms undergoing sporu lation on successive days.

4. The paroxysms in infections with the tertian and quartan parasites are usually regularly periodical in their time of onset. In infections with the estivoautumnal organism they are often irregular and associated with continued fever. 5. We do not know how the parasites live outside of the body, or how infection takes place.

6. Experiments tend to show that it is improbable that infection occurs through the gastro-intestinal tract. It is possible, though not proven, that it may occur through the respiratory apparatus or through the skin, being introduced by the bites of insects, especially the mosquito. By analogy with the course of events in similar infections in birds, it is highly probable that the mosquito may play the part not only of an intermediate host of the malarial parasite, but also of a direct transmitter of the infection from one individual to another.*

7. Quinine, properly administered, is a true specific against the disease. 8. Relapses may occur after weeks or months, but they are in turn amenable

to treatment.

Since the delivery of this address, studies by Grassi, Bignami and Bastianelli in Italy, with the parasites of human beings, have entirely confirmed the observations of Ross on the parasites of birds. The entire extracorporeal cycle of existence of one of the human malarial parasites has been followed within the intestinal wall and salivary gland of the mosquito, and infection by means of the bites of such mosquitoes has been produced.

SURGERY.

UNDER CHARGE OF W. B. ROGERS, M.D.

Professor of the Principles and Practice of Surgery and Clinical Surgery, Memphis Hospital Medical College.

Chronic Appendicitis the Chief Symptom and Most Important Complication of Movable Kidney.

Edebohls (Post-Graduate, vol. 14, no. 2) says:

Chronic appendicitis, as proven by the writer's clinical and operative work, is present in from 80 to 90 per cent. of women with symptom-producing movable right kidney. This frequency constitutes chronic appendicitis, one of the chief, if not the chief, symptom of movable kidney.

Chronic appendicitis, by reason of its frequency, the protracted suffering and serious impairment of health which it entails, and the dangerous possibilities of implanted acute attacks of appendicitis, may be considered the most important complication of movable right kidney.

The writer's statistics show: That 20 per cent. of all women have movable kidney or kidneys; that 4 per cent. of all women have symptom-producing movable kidney or kidneys; that 4 per cent. of all women have appendicitis; that, while 3 per cent. of all women have both symptom-producing movable kidney and appendicitis, only per cent. of all women have appendicitis and well-anchored kidneys. The startling nature and importance of the conclusions to be drawn from these statistics do not invalidate the latter.

Satisfactory investigation of the relations of movable kidney and appendicitis became possible only after the discovery and elaboration of the writer's method of palpation of the vermiform appendix. It remains impossible to those not practically familiar with the method.

Chronic appendicitis may be the only symptom of movable right kidney. Some of the symptoms commonly ascribed to movable kidney are often in reality due to the concomitant appendicitis.

The relations existing between movable right kidney and chronic appendicitis are those of cause and effect, for reasons detailed in the paper. A movable left kidney never produces appendicitis.

Movable right kidney probably produces chronic appendicitis by indirect pressure upon the superior mesenteric vein, the return circulation of the appendix being hampered by compression of the vein between the head of the pancreas and the spinal column.

Chronic appendicitis, associated with movable kidney, shows no tendency to resolution or spontaneous cure, with restoration of a normal appendix, while the right kidney remains movable. The only cure possible, under these conditions, is by slow progress to appendicitis obliterans.

In 12 of the writer's cases of coexisting movable right kidney and appendicitis, the appendicitis apparently ended in resolution and remained permanently cured, after right or bilateral nephropexy, without any attention to the appendix.

Recovery from appendicitis after right nephropexy may only be expected in cases in which the associated chronic appendicitis is of comparatively recent origin.