after 606, instead of signalizing a cure, as indicating when to begin treatment by mercurial injections.

Dr. E. C. Henry, reporting from the Clinics of Berlin, (2) says: "The largest clinic here gives small doses of 606 three times a week for one month, followed by mercury injections for six weeks. Even with this care they have a recurrence of 20 per cent. This clinic believes that 606 attacks only the spirochaete in the blood and has no power to kill those in the tissues."

The Berlin clinic teaches that regardless of the number of doses of 606 given it must be followed by

mercury.

Our friend Dr. Frederick S. Mason, of New York, made extensive observation on the use of salvarsan in the clinics of Paris, with the summary that its use in syphilis must be followed by mercury injections. Speaking of its use in New York, he says: "I may say that the general consensus of opinion among physicians in this city is that 606 treatment is unreliable for the cure of syphilis in any stage, as the number of recurrences after two, three and four injections are common." I give it to suppress acute, primary and secondary symptoms of syphilis where patients are liable to infect others, or, to control tertiary symptoms where mercury does not accomplish the desired results." Such cases are given sixty centigrams two or three times, at fifteen-day intervals, with mercury injections after two weeks. If a Wasserman is negative in six months the mercury is renewed with a like Wasserman and three months renewal of mercury in the second year when the disease is probably under control. Dr. Mason disclaims self-credit, but says, "it is the opinion of every one in Paris and New York. We must not rely on 606 injection; mercury in some form should always be given after the 606 treatment."

Dr. William B. Trimble (3) of the New York University clinic and the New York Skin and Cancer Hospital, says the combined use of arsenobenzol and mercury in treating syphilis has

(2) Western Medical Review, December. 1911. (3) Modern Treatment of Syphilis, p. 26, Vol. IV, International Clinics.

given "especially good results." He gives arsenobenzol till the Wasserman is negative and then puts the patient on mercury. Should a subsequent Wasserman be positive he renews 606 till a negative Wasserman is obtained, again renewing and continuing the mercury "until the case has received a sufficient amount of treatment."

Trimble hopes" salvarsan "will materially shorten the treatment" and believes the "combined treatment" is the best and the only therapeutic promise we have as yet, showing us a way to possibly prevent the eventuating terminal pathology, underlying the symptom-pictures of general paresis and tabes dorsalis. If this therapeutic accomplishment is a future possibility Ehrlich's dream will not have been in vain, and real joys will supplant grandiose delusions and pedestrial inco-ordinations of other days. S.G.B.

Examining Boards Meet.

The next session of the Kansas State Medical Licensing Board will be held at the National Hotel, Topeka, February 13. Dr. H. A. Dykes, secretary, Lebanon. The Iowa State Board meets February 6-8, at the Capital Building, Des Moines. Dr. G. H. Sumner, secretary, State House. The Nebraska Board meets at State House, Lincoln, February 14, 15. Dr. E. A. Carr, secretary, 141 S. 12th street.

Expenditures in War on Tuberculosis.

The figures of the third annual statement of expenditures issued by the National Association for the Study and Prevention of tuberculosis show that during 1911, $14,500,000 was expended in the campaign against tuberculosis. Of this $11,800,000 was spent for the treatment of patients in sanatoriums and hospitals and for the erection of sanatoriums; $850,000 for examination and treatment of cases of tuberculosis in dispensaries and $500,000 for educational campaigns, and the remainder, $1,300,000 for the treatment of patients in open-air schools, prisons, and insane hospitals, and for local boards of health.

International Clinics. A quarterly of illustrated

clinical lectures and original articles. Vol. IV. 21st series, 1911. Philadelphia and London: J. B. Lippincott Co, (Price $2.00.)

Volume IV contains an interesting chapter on the Treatment and Causation of Enuresis, by James Burnet of Edinburg; Prophylactic Treatment of Prostatic Hypertrophy with Remarks on an Efficient Method of Treating Acute Gonorrhea, by Edgar D. Ballinger and Omar F. Elder of Atlanta; Agar-Agar in the Treatment of Constipation and Diarrheas, by Dudley Roberts, of Brooklyn; Kerosene, as a Remedial Agent in Dysentery, by James C. Johnson, of McAlester; The Modern Treatment of Syphilis, by William B. Trimble of New York; Senile Degenerations, by Medwin Leale of New York; Senile Mentality by I. L. Nasher of New York. These, with numerous contributions on general medicine, diagnosis, surgery, pediatrics, ophthalmology, otology and some medico-legal facts in surgical cases makes this volume of interest. Dr. Trimble's article is the practical up-to-date treatment of syphilis, and is worth many times the $2.00 to him who thinks he does but does not know how to treat this most mistreated disease. S.G.B.

Skin and Venereal Diseases: The Practical Medicine Series of Year Books. By W. L. Baum, M. D., and Harold Moyer, M. D. Chicago: The Year Book Publishers.

The present volume of this excellent and practical series is the annual review of dermatology, syphilis and genito-urinary diseases, and covers many of the important papers that have appeared during the past year. The discussion on pellagra is particularly good. The contributions of Tucker, Hartzell, Stern and Spiller are reviewed more or less in detail. Leprosy, also, is given considerable space. Duval's culture experiments, and Bibb's article on the classification and symptomatology of the disease are particularly emphasized. White's valuable paper on alopecia is reviewed, as are also his contributions on trophic ulcer of the foot in an hysterical subject, granuloma annulare, and der

matitis exfoliative.

W. B. Steward's report on sporothichosis is excerpted, and Cranston Low's excellent article on fungus infections of the nails thoroughly discussed. This volume of the practical medicine series is fully up to the usual high standard, and is well worth careful perusal. R.L.S.

Modern Otology. The Principles and Practice of Modern Otology. By John F. Barnhill, M. D., Professor of Otology, Laryngology and Rhinology, Indiana University School of Medicine; and Ernest de W. Wales, B. S., M. D., Clinical Professor of Otology, Rhinology and Laryngology, Indiana University School of Medicine. Second edition revised. Octavo, 598 pages, 305 original illustrations, many in colors. Philadelphia and London: W. B. Saunders Company, 1911.

This most beautiful volume, "Modern Otology," in its second edition, continues as a practical up-to-date work on the diseases of the ear. The illustrations are superb and helpful. The preface to the second edition states, "Not many extensive changes have been made. Among the more important are the following: (1) The chapter on the function of the ear has been entirely rewritten and includes the description and formula of a uniform system of tests accepted by the Eighth Otological Congress at Budapest in 1909. (2) A more extended statement regarding the operative injury of the facial nerve. (3) A description of the 'Conservative Radical Mastoid Operation,' commonly called the Health operation. (4) Several paragraphs relating to the symptoms, pathology and surgical treatment of labyrinth suppuration. All illustrated new material has been wherever to do so would be helpful to the student."

Personal Hygiene and Physical Training for Women. By Anna M. Galbraith, M. D., Fellow of the New York Academy of Medicine. 12mo. of 375 pages. with illustrations. Philadelphia and London: W. B. Saunders Company, 1911. (Cloth, $2.00 net)

The title of this book explains its contents and it can be consistently recommended to the lay reader for whom it is intended. It contains much that could be read with profit by the general practitioner. The hygienic information is imparted in a simple straight forward manner and should be in the hands of all growing girls.

2. Describe salpingitis.

pathology and treatment.

Give causes,

3. Describe stenosis of the cervix, giving etiology, symptoms and treatment.

4. Define Menorrhagia and metrorrhagia. Give treatment of each.

5. Differentiate pelvic hematocele from acute pelvic peritonitis. Give treatment in pelvic hematocele.

1. Ovaritis may present in different stages, acute or chronic, due usually to some form of infection, more commonly as a sequela to puerperal infection in which case the history should aid in reaching a diagnosis. The ovary is more sensitive than normal on careful palpation, and may be enlarged much or little. It must be differentiated from salpingitis, varicocele or even pelvic abscess when adhesions are present.

Treatment. Rest and relief of pain. If acute the early use of ice over ovarian region, later iodine painting of vault of vagina with the use of 10 per cent ichthyol and glycerine tampons. Some chronic cases, especially if abscessed, demand extirpation. Too many ovaries have been removed for pain which was often due to an existing varicocele or ovaralgia.

Ovaralgia or neuralgia of the ovary is most often associated with a general nervous condition approaching a hysteria-more frequently it is found on the left side. The pain is rather spasmodic and radiates to the back and down the limb. Pressure often produces exaggerated symptoms in excess of those produced in an inflammatory condition.

Treatment. Anodynes, of faradisin, or galvanic electricity with tonics may relieve. Ovarian extracts have proven efficacious in some cases.

2. Salpinigtis, or inflammation of the Fallopian tube, varying in degree from a mild catarrhal to purulent or a pyosalpinx. The cause is generally some form of infection, most often of

gonorrheal or puerperal origin, communicated by continuity through uterus and tube or through the lymphatics or veins. The mild, or earlier cases, consist of an inflammation of the mucous membrane lining the tube. Later the process involves the deeper, or submucus layer of the tube and is termed an interstitial salpingitis. Usually, infection is bilateral, the tubes being thickened in varying degree and containing a variable amount of pus.

Ca

Treatment is first, in so far as opportunity presents, prophylactic. tarrhal, or mild cases may be checked by rest, hot vaginal douches, laxatives, etc. The more chronic, if able to afford the time and expense, may get some benefit from well directed general and local treatment. If the case presents an elevation of temperature with great tenderness, there is doubtless present pus that may properly be best treated by evacuation per vaginum if sacculated, or by an ab. dominal extirpation of the tubes. It is now well agreed that to operate in the acute stage is an error, delay affording an opportunity for the establishing of a certain degree of immunity and giving far better results, excepting, possibly, a very early opera tion.

3. Stenosis of the cervix is not so very common, as such, and when observed is frequently associated with an elongated, infantile cervix, which is congenital. Stenosis due to attresia is extremely rare. Symptoms are those of obstruction in proportion to the menstrual flow. If excessive, pains from over-distension may occur-a pinhole os is usually observed on examination with a speculum. The occlusion is usually confined to the cervical opening and the internal os at entrance of the corporeal portion of the uterus. A soft, flexible sound, dextrously manipulated, will usually pass into the uterine cavity.

Treatment. Dilatation may, in some cases, give temporary relief. Usually, if pregnancy does not occur (which, by the way, is the best cure), a recurrence of symptoms may be expected. Aggravated cases may be relieved by doing an operation upon the cervix to maintain a patulous condition (see Dudley's Gynecology). Discissions once performed are obsolete. Stem pessaries are of questionable utility.

4. Menorrhagia is an excessive flow at the normal menstrual period, due to a multitude of causes, both general and local. Perhaps the most frequent cause is an inflammation of the lining of the uterus, endometritis-a subinvolution following full term, abortions or miscarriages-a fibroid in the wall of the uterus, or a polypus inside it. Some general diseased conditions predispose and result in menorrhagia. Not infrequently, menstruation ushered in by excessive and prolonged flow. Symptoms are those of a greater loss of blood than commensurate with good health, such as anemia, weakness, etc.

is

Treatment.-Ergot, rest, unstimulating diet, tonics. If there is intrauterine disease it may be necessary to curette or dilate and drain. Remove any growths.

Metrorrhagia is a flow occurring at any time independent of the menstrual epoch, often caused by some of the things mentioned above, and more frequently inflammatory trouble in or about the uterine addenexa. If occurring after the supposed menopause, it is very significant of cancer.

Treat according to the demonstrable etiology and pathology.

5. Pelvic hematocele is an accumulation of blood in the pelvis from rupture of an extra-uterine pregnancy, or a rare, but possible regurgitation, so to speak, of menstrual flow, or any trauma giving rise to intra-abdominal hermorrhage, with a gravitation of the blood to the pelvis. It is usually of sudden onset, not preceded by a suggestive history. There may be a boggy feel with a crackling of the blood clot.

Treatment. Evacuation is now the most direct and effective treatment.

With time the clot may be absorbed, if not extensive. Acute pelvic peritonitis differs from hematocele in the sudden, severe pain being more continuous with a rise of temperature and quickened pulse. In hematocele the temperature usually is lowered. The anxiety of the face in peritonitis is quite characteristic, differing from hematocele, which is rather placid, pale and expressionless. Usually there is a distension of the abdomen in acute pelvic peritonitis, with tenderness and rigidity, the converse of hematocele, which is soft. With peritonitis more often may be elicited a cause as the use of instruments, gonorrheal or puerperal infection, etc., not forgetting tuberculosis as a possible cause.

I cannot subscribe to the old method of expectancy in the treatment of hematocele. Clean, direct attack should save the patient weeks of convalescence and just as safely.

H. C. C.

International Congress for Gynecology and Obstetrics.

The date for the approaching sixth international congress has been appointed as May 31 to June 2, 1912, to meet at Berlin as previously announced. Prof. E. Bumm is to preside, and the secretary general is Prof. E. Martin, Artilleriestr. 18, Berlin N. 24, Germany. The main subject for discussion is to be "The Treatment of Peritoneal Wounds in Relation to Obstetrics and Gynecol

"The committee of organization includes Professors Doderlein and A. Martin of Germany, von Ott of Russia, and Mangiagalli of Italy.

Dr. Luther B. Stevens, of Des Moines, will shortly open a tuberculosis sanitarium in Florida.

New Jersey has passed a law requiring its insane and defectives to be sterilized, and Governor Wilson has appointed a commission composed of two physicians and two laymen, who are connected with public institutions, to supervise the work.