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been preserved intact the osseous obliteration of the loss of substance was produced over the entire surface, whereas it was not produced where it had been destroyed. Of 9 cases of old traumatism, 3 patients, suffering from lesions of the cranium of an apparently slight character, were not operated on; 2 of these were at present the subject of Jacksonian epilepsy, while the third presented mental trouble. The other 6 were trephined, as they all presented before the operation epileptic symptoms; in 3 the dura mater was untouched; the occlusion of the loss of substance was affected by a hardened and possibly osseous plate. In the 3 remainder, the dura mater was removed, reossification did not take place, and the epilepsy was cured; 2 of these were children, one of which presented an interesting history. It was a girl, st. 10, in whom, after a fracture of the left side of the head, produced by a fall from a one-story window, hemiplegia of the right side had developed, as well as a cephalo-hydrocele. This latter was opened, and the rent in the dura mater sutured. Some time after this operation, the child was seized with epileptic fits, which continued for a year at more or less long intervals. Another operation was advised and accepted. This time the cranium was resected in the region already repaired, after the first intervention, and a portion of the dura mater removed. Since that moment, a year and a half ago, the epileptic fits had ceased.
M. Chipault communicated 6 other cases of essential epilepsy, in all of which the dura mater was preserved, with the result that when ossification was completed the primary affection returned, and concluded, in the great majority of operations for recent or ancient traumatisms, followed by Jacksonian epilepsy, in interventions for essential epilepsy for microcephalos or intracranial neoplasms, that, first, the ablation of the bone should be complete, and, secondly, the removal of the dura mater subjacent to the orifice should be definitely removed. Only by such means could a permanently favorable result be obtained.
CLIMATOLOGY AND PHTHISIOLOGY.
UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., BOULDER, COLORADO. Immunity in Tuberculosis.
(Editorial, Journal American Medical Association, May 20.) It is a fact to which no exception can be taken that many of those afflicted with lung tuberculosis eventually recover from the disease. We attempt to explain this by saying that the natural physiologic resistance of the tissue walls in the diseased areas prevent the spread of the pathologic process. But with the march of the disease of any disease, in fact, if unrecognized because then untreated-would we not rather look for a diminution in the so-called physiologic resistance and a consequent increase in the rapidity of spread of the pathologic process? Why should not this physiologic resistance have been more efficient in the erection of its barriers in the very incipiency of the disorder, when the body as a whole was undoubtedly in a condition more capable of resisting invasion? The discovery of the value of vaccination in preventing smallpox or in limiting its ravages long since pointed out a fact the importance of which has only of late years begun to be fully realized. It is absurd to explain the legitimate cure of such a disease as typhoid fever, which so commonly attacks an adult in perfect health and leaves him in a few weeks a weakened wreck, as due to an increased physi
ologic resistance. Increased-how? Undoubtedly some subtle change has been going on within that economy which gradually rendered the soil untenable to the growth of that particular germ. This change we have called immunity. Immunity may be hereditary or acquired, and it may be acquired by artificial or natural means, as by passing safely through an attack of the specific disease. Immunity may be permanent or very brief. When recovery from an infectious or contagious disease occurs, the growth and increase of the specific micro-organisms within the system has brought about a change in the tissues of that body that renders further existence on the part of that particular germ at that time impossible. The term "immunity" is in a sense but another cloak of ignorance; we do not know of what the change or changes consist.
Koch and others have shown us that even in guinea pigs, susceptible as they are to the tubercle bacillus, an artificial immunity can be produced; that these animals, by the gradual immunity acquired by the use of the tubercle bacillus substance (Koch's tuberculin K) are able to resist a very virulent infection, while the, animals kept for control, not so injected, rapidly succumb. The autopsies demonstrated typic, active tubercular processes in the latter animals, while the protected ones at most, if infected before injections were begun, showed only fibroid changes, and no tubercle bacilli. We know then that tuberculosis belongs to that group of diseases in which cure, when it occurs, is brought about by the aid of an acquired natural immunity. If immunity is due, and we think it is, to the action of the products of the particular germ producing the disease on the tissues of the body, it is strange how often a failure must be registered and the process extend to such a degree that the victim dies from the direct impairment of some vital force. This failure occurs in all forms of tuberculosis, both acute and chronic. When we reflect that in the chronic form bacterial activity is not very great, that to produce and maintain immunity the products of the tubercle bacilli must be present in all the tissues, carried by the blood, and in all probability must be frequently supplied; when we take into consideration the difficulties in the way of dissolving the tubercle bacillus substance, owing to the protection afforded by the non-vascular tubercles, we at least have a plausible explanation for the cases that pursue a slow and tedious downward course. In the acute cases, on the other hand, where most of the organs of the body become involved, the patient is overwhelmed from the outset by the virulence and amount of the toxins absorbed, and subsequent exhaustion that follows the high fever and its accompaniments so lowers the resisting power that caseation of the tubercles ensues with great rapidity. Here, while the immunizing substance is present in great abundance, it has made its appearance too late. For while the tubercle bacilli do not thrive, as is shown by their paucity in microscopic sections, the exhaustion produced by the breaking down of tissue substance, often the entrance of the germs of suppuration, is sufficient to cause speedy dissolution.
Reasoning from these theoretic standpoints we can see why it is that so little success has followed our attempts at artificial immunization; that to do good immunity must be produced early-before caseation has occurred.
The above editorial follows about the same line of thought as one in the Journal of Tuberculosis for April. The editor of the Journal of Tuberculosis, however, dwells more on the fact that the absorption of tubercular bacillus substance
is necessary to the production of immunity. That not much absorption of the bacillary substance can take place in most cases of chronic tuberculosis. But that immunity can be produced by artificial injections of the tubercle bacillus substance in the form of "Tuberculin R " (Koch) or "The Watery Extracts of Tubercle Bacilli" (Von Ruck). The injection of this substance in early conditions of tuberculosis produces an immunity against further invasion, and thus a practical cure.
Tuberculosis in a Fetal Calf.
Dr. M. P. Ravenal, in Proceedings of the Pathological Society of Philadelphia, vol. 1, no. 6, justly points out that each undoubted case of congenital tuberculosis is instructive and worthy of report, although the observed cases are as yet so rare that this method of transmission may be practically excluded from our calculations in considering the transmission of the disease. Dr. Ravenal's case is as follows:
In the latter part of 1898, a cow far advanced in tuberculosis was sent to the Veterinary Department of the University of Pennsylvania. December 22, 1898, without assignable reason, the cow aborted, the fetus being about seven months along. In the liver of the fetal calf were found two whitish nodules, which were proven to contain tubercular bacilli. A post-mortem was ultimately held on the mother, and the uterus was found to be free from tuberculous lesions. The disease was confined to the lungs and lymph glands of the mesentery. The case is a good example of fetal tuberculosis, the germs transferred through the blood channel. More instances of this kind have been reported during the last few years than formerly, though as yet they are few, all told.
Other Important Papers of the Month on Tuberculosis and Climatology. 1. Tubercular Cervical Lymph Nodes -C. N. Dowd (Annals of Surgery, Philadelphia, May).
2. Tubercular Peritonitis, with Report of Cases Apparently Cured by Laparotomy-Thos Jameson (Buffalo Medical Journal, May).
Plea for Better Appreciation of Tuberculin Test for Latent Tuberculosis— Chas. A. Denison (Journal of Tuberculosis, April).
4. Tuberculin Test in Early Diagnosis of Tuberculosis Taylor (Journal of Tuberculosis, April).
5. Report of Twelve Cases of Tuberculosis-John Hay Williams (Journal of Tuberculosis, April).
Care of Digestive Tract in Tubercular Patients-H. J. Chapman (Journal of Tuberculosis, April).
7. Choice of Climate for Consumptive Patients-R. M. Phelps (Northwestern Lancet, May).
8. Tubercular Meningitis in Infants-Samuel S. Adams (American Journal of Obstetrics, May).
9. Tuberculosis of Lymph Glands. J. W. Kyger (Kansas City Medical Index-Lancet, May).
Use of Valerianates of Creosote and Guaiacol in the Treatment of PhthiA. B. Briggs (New York Medical Journal, May).
11. Seeking Health in Colorado-L. H. Wood (Denver Medical Times, May). 12. Treatment of Pulmonary Tubeculosis-R. O. Cross (Kansas City Medical Record, May).
13. The Danger of Infection in Tuberculosis-G. Cornet (Berliner Klinische Wochenschrift, March).
14. Infection of Tubercle from Song Birds a Fertile Though Unsuspected Source of Phthisis-A. Tucker Wise (Lancet, London, May).
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Mr. Lawson Tait, the famous British abdominal surgeon, died June 13, 1899, at Llandudno, a fashionable watering place in Wales. Mr. Tait's aggressive individuality and capability as a surgeon gained for him world-wide renown, and his death removes from a group of unique figures in the medical profession one of its most conspicuous and talented members.
Dr. Thomas Osmond Summers, of St. Louis, Mo., committed suicide on the evening of June 13 by shooting himself through the head. Dr. Summers' career had been a varied one, and at the time of his death he was Professor of Anatomy in the St. Louis College of Physicians and Surgeons and Editor of the St. Louis Clinique.
The Twenty-Fifth Annual Meeting of the Mississippi Valley Medical Association will be held in Chicago, October 3, 4, 5 and 6, 1899, under the Presidency of Dr. Duncan Eve, of Nashville, Tenn. The local arrangements are in charge of Dr. Harold N. Moyer, ably assisted by an excellent committee. Elaborate arrangements have been made for the entertainment of the members, and a special feature will be a series of clinics in every department of Medicine and Surgery, given in honor of the Association at all of the colleges and hospitals. Full details of these will be published later. Dr. J. A. Witherspoon, of Nashville, Tenn., will deliver the address in Medicine, and Dr. H. H. Mudd, of St. Louis, the address in Surgery. Titles of papers should be sent in early to obtain a place on the program. There will be two sections - -a Medical and a
Surgical. There will be a flat one-fare, round-trip rate without certificates, on account of the Autumn Festival to be held in Chicago. This is the lowest railroad rate ever obtained for a meeting.
A Permanent Injunction Granted. We are informed by the California Fig Syrup Company of San Francisco, California, that they have just obtained a permanent decision in the United States Circuit Court against Clinton E. Worden & Company, of San Francisco, a large non-secret manufacturing concern. They are permanently enjoined from using the name Syrup of Figs or Fig Syrup as the name of a laxative medicine which they manufacture, and are required to pay costs and to account to the California Fig Syrup Company for sales of the imitation. This suit has been hotly and ably contested for two years past by special counsel employed by the defendants for that purpose. We are also advised that during the past year injunctions have been granted this company against a number of smaller concerns. They are determined to protect their rights.
The Louisville Medical Monthly has passed into the hands of the Louisville Medical Monthly Company, with Dr. Henry E. Tuley as editor. Dr. Tuley is a young man of marked ability, and we feel that the patrons of the Monthly should be congratulated upon his success to the editorial helm of that journal.
Chemische Fabrik auf Actien. To Messrs. Schering and Glatz, of New York City, are we indebted for a pamphlet containing a collection of excellent photographic views of that splendid chemical plant established in 1853 by E. Schering. The complete equipment of this great establishment cannot easily be conceived, but an examination of the photographs here so attractively presented, together with a perusal of the accompanying descriptive matter, will enable one to more readily grasp an idea of the vast proportions and complete appointment of this enterprise.
A Textbook of Anatomy. By American Authors. Edited by Frederic H. Gerrish, M.D., Professor of Anatomy in the Medical School of Maine at Bowdoin College. In one magnificent imperial octavo volume of 915 pages, with 950 engravings in black and colors. Cloth, $6.50 net; flexible waterproof binding for the dissecting table, $7.00 net; full leather, $7.50 net. Lea Bros. & Co., Publishers, Philadelphia and New York.
For many years it has seemed as though to claim that there could possibly exist any other textbook of anatomy than Gray's would be treason, and truly the author or authors who essayed to produce a work to compete with Gray's splendid book were temerarious indeed, but recent years have witnessed the shying into the anatomical field of several anatomist's castors in the shape of some very praiseworthy contributions to the list of textbooks of anatomy. American anatomists have not been enabled heretofore to gain a foothold with the student population of the United States so far as their attempts at textbook production were concerned, but there now comes to us an American work which gives promise of early and enduring popularity. In Gerrish's "American Textbook of Anat