judgment in weighing the early symptoms, and lack of honesty in facing their plain conclusions, that cause the usual delay in recognizing phthisis until after the time for successful treatment is impossible.

The Earliest Physical Signs. A respiratory murmur of slightly higher pitch and of lessened intensity in the very earliest stage of deposit, with an increasing intensity and harshened quality as the deposit increases, a jerky or cog-wheel respiration, an abnormal transference of heart sounds, a slight dullness of the percussion note, increasing in dullness as the infection increases, pleuritic fric tion sounds in a very limited area, râles either moist or dry. These are physical signs that may often be detected before the appearance of bacilli. These signs vary in value, and are more confirmatory the more there are of them. The cogwheel respiration is of little value standing alone; confirmed by other signs it becomes valuable. Dullness on percussion or limited areas of râles are almost positive, even standing alone. Bacilli often appear in the sputum early, and a great advance in the diagnosis of phthisis would be made if each case were recognized as soon as this occurs. But previous to this, and even when the physical signs are too indistinct or insufficient to make a reasonably certain diagnosis, the personal and family history and clinical symptoms will enable us to reach probable conclusions. A history of much sickness in the parents previous to the birth of the individual makes phthisis more probable; such a family history of tuberculous diseases increases the probability, and the same is true of previous sickness of the patient. But we must not err here. While a bad family and personal history increases the probability of phthisis, it does not prove it; nor does the reverse exclude it.

The clinical history of phthisis is as variable in the early as in the later stages of phthisis. A slight persistent cough is often the first symptom to attract the patient's notice. Sometimes a slight hemorrhage is the earliest symptom. Provided the blood is proven to be from the lungs, a hemorrhage is a quite positive proof of phthisis. Pleuritic pains in the upper part of the thorax and under the scapula are very significant of phthisis. Were it necessary a thermometer alone would enable us in most cases to reach a reasonably certain conclusion of phthisis at a much earlier stage than the disease is now usually recognized. To diagnose with a thermometer a temperature record taken every two or three hours is kept for ten or twelve days. Physical exercise to the point of fatigue is required two or three times during the record making; also severe mental exercise. A rise of temperature of one or two degrees following this exercise, even though normal at other times, is, other diseases excluded, a reliable indication of phthisis. A rise of one degree or more following hearty meals is indicative of phthisis. Anorexia, indigestion, repeated chilly sensations, proneness to "take cold"—all these are symptoms which sometimes occur in early phthisis, and are of some value in connection with other evidence. By weighing all the evidence we may reach conclusions of reasonable certainty without the use of tuberculin. Tuberculin has advantages in obscure cases, but it has also dangers, and should be used only by the expert and cautious.

Denny, in the same journal, has a paper on the same subject. He follows the same line of argument as Barbour, and adds indications of phthisis from pulse conditions, and mentions the use of the X ray. The X ray certainly promises to be of great help in diagnosing early phthisis.

Memphis Medical Monthly

Subscription Per Annum, One Dollar in Advance.

The MONTHLY will be mailed on or about the first of the month. Subscribers failing to receive it promptly will please notify us at once.

We cannot promise to furnish back numbers.

Cuts elucidating the text of original communications will be supplied by us without cost to the author, when photographs or sketches accompany the article. Communications of a literary character, as well as books for review, should be addressed to RICHMOND MCKINNEY, M.D., EDItor,

Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee; Memphis Medical Society and Yazoo Delta Medical Association.

Communications relating to advertisements or subscriptions should be addressed C. H. BRIGHT, Business Manager,

to

Porter Building, Memphis, Tenn.

A TRIUMPH OF MODERN METHODS.

The cause of isolation and sanitation in the control of the spread of epidemic disease could not desire a better advocate, a more potent argument, than is to be found in the manner in which the outbreak of yellow fever in the National Soldiers' Home, near Hampton, Va., was controlled and stamped out by the Marine Hospital Service.

Coming in midsummer, there was every reason to be apprehensive of the rapid spread of the disease; and under ancient conditions we do not doubt that from this focus would have gone forth throughout the Southland numerous infected persons, and that we soon should have had epidemic yellow fever disseminated broadcast. But the government authorities, acting with a celerity born of a knowledge that here indeed was an opportunity to make good their claim that they could handle such an emergency, promptly instituted measures for quarantine, isolation and care of those in whom the disease had developed, and of those who had been exposed to infection. Thus speedily was the disease brought under control, and in

a short while the number of cases began to diminish, and the Marine Hospital authorities were soon enabled to report that all danger of further spread of the disease was past. At this writing we believe that all traces of the fever have disappeared.

This is assuredly to be regarded as a triumph of modern methods of isolation and sanitation in the prevention of the spread of yellow fever, and we think that the U. S. Marine Hospital Service deserves congratulations.

THE ETIOLOGY OF YELLOW FEVER.

Since Professor Sanarelli first announced his discovery of the bacillus of yellow fever-the bacillus icteroides-there has arisen the usual number of claims, counter-claims and disputations. In order to throw light upon these, and to substantiate, if true, the claim of this famous scientist, the U. S. Marine Hospital Service, under date of November 8, 1897, appointed a commission to investigate in Havana the nature of yellow fever. This commission was composed of P. A. Surgeon (now Surgeon) Eugene Wasdin and P. A. Surgeon H. D. Geddings. Their report has been received and is now made public by the Bureau. In this report they arrive at the conclusion that Professor Sanarelli has isolated the true cause of the terrible scourge. This conclusion is based upon a careful bacteriologic study, in the well-equipped laboratory of the Marine Hospital Service in Havana, Cuba, of twenty-two cases of disease thought to be yellow fever by the native physicians in attendance.

We append the conclusions of the commission:

1. That the microorganism discovered by Prof. Guiseppe Sanarelli, of the University of Bologna, Italy, and by him named "bacillus icteroides," is the cause of yellow fever.

2. That yellow fever is naturally infectious to certain animals, the degree varying with the species; that in some rodents local infection is very quickly followed by blood infection; and that, while in dogs and rabbits there is no evidence of this subsequent invasion of the blood, monkeys react to the infection the same as man.

3. That infection takes place by way of the respiratory tract, the primary colonization in this tract giving rise to the earlier manifestations of the disease.

4. That in many cases of the disease, probably a majority, the primary infection or colonization in the lungs is followed by a "secondary infection" or a secondary colonization of this organism in the blood of the patient. This secondary infection may be complicated by the coinstantaneous passage of other organisms into the blood, or this complication may arise during the last hours of life.

5. That there is no evidence to support the theory advanced by Prof. Sanarelli that this disease is primarily a septicemia, inasmuch as cases do occur in which the bacillus icteroides cannot be found in the blood or organs in which it might be deposited therefrom.

6. That there exists no causal relationship between the bacillus "X" of Sternberg and this highly infectious disease, and that the bacillus "X" is frequently found in the intestinal content of normal animals and of man, as well as in the urine and the bronchial secretion.

7. That, so far as your commission is aware, the bacillus icteroides has never been found in anybody other than one infected with yellow fever, and that whatever may be the cultural similarities between this and other microorganisms it is characterized by a specificity which is distinctive.

8. That the bacillus icteroides is very susceptible to the influences injurious to bacterial life; and that its ready control by the processes of disinfection, chemical and mechanical, is

assured.

9. That the bacillus icteroides produces in vitro, as well as in vita, a toxin of the most marked potency; and that, from our present knowledge, there exists a reasonable possibility of the ultimate production of an antiserum more potent than that of Prof. Sanarelli.

"ADENOIDS" IN CHILDREN.*

It is not an unusual thing in the history of medicine for a valuable discovery to lie dormant for many years, so it is not surprising that the epoch-marking disclosures made by Hans Wilhelm Meyer, of Copenhagen, in 1870, of the important relation that hypertrophy of the pharyngeal or Luschka's tonsil bore to the causation of many of the then little understood affections of childhood, and also of some diseases occurring in the adult as well, should have been relegated to comparative oblivion for a period of a decade or two. But now "adenoids," as they are wrongly called, are in the ascendant. Every practitioner is awakening to the realization that this hypertrophied tissue in the naso-pharynx is an intruder upon which many evil results can be fastened. Beginning with the characteristic adenoid facies which, in pronounced types, distorts the countenance, we may enumerate general physical deterioration, chronic suppurative otitis media, mental hebetude, chronic catarrh, and various other disorders which may be traced to the influence of the hypertrophied Luschka's tonsil.

Of the etiology of adenoids little is known beyond peradventure, for several authors and clinicians claim as many dif ferent etiological factors. Bosworth, with some few others, believes that they are due to the effects of chronic catarrh, while, per contra, it is claimed by some that this catarrhal condition is secondary, being a sequence of the adenoid growths. And now, as the result of recent investigations, the claim is advanced that they are due to the inroads of the tubercle bacillus—that is, in adenoids we have a benign, localized tuberculosis of feeble virulence.

But, laying all consideration of the etiology of these growths aside, it has been amply demonstrated that they must be removed, for no operative procedure can exhibit more marvelous results, or pay more splendid tribute to the achievements of modern special surgery. After their removal, as though under the influence of the touch of a fairy wand, the little

*The subject of chronic hypertrophy of the pharyngeal tonsil is treated at length in an article by the editor of this journal, appearing in the April issue of the MONTHLY, and to which the reader is referred.-ED.