THE tendency of the present day seems to be towards erecting small hospitals for an

especial object and the quesSmall Hospitals. tion is, Do these small hospitals answer every purpose and are they as great a benefit to the patients for whom they are erected as the larger buildings? In some cases they are and in others the erection of a small hospital is only for the gratification of some desire on the part of a body of men or of a denomination.

The Germans say that the worst insect in American is the sect, because in most parts of Germany there are only the Roman Catholics and the Protestants, which are usually Lutherans. In this country, however, denomination runs riot and churches split and divide to form separate weak and struggling branches differing from the parent stem in some trifling point but which involve principle with a large P on the part of those interested. These denominations seek to keep their own together whether in a state of health or disease and for this reason denominational hospitals have sprung up in so many cities. Here the denominational spirit holds all other interests subservient to it. It is doubtful if the best scientific work is done in such institutions and if the best interests of the patients are always preserved.

The latest denomination in Baltimore and Maryland to agitate the subject of a hospital is the Baptist, which is one of the most powerful and far reaching sects in this country. As an outcome of a large Baptist convention held in Baltimore in July at which it was necessary to erect a hospital tent in which to care for the large number of those needing medical advice, it has been decided to take steps to erect a Baptist hospital in Baltimore. Other denominations have their hospitals and why should not the Baptists have theirs? The methods of treatment will not be different from those used in other advanced hospitals, but it is a question whether the application of all the machinery necessary for a small as for a large modern hospital is not a waste of material and if one large and complete hospital would not do more good than several small ones.

Of course the hospital for the treatment of a certain class of diseases, as an eye hospital, or one for the treatment of diseases of women, can do better work when apart; but when it is considered that there are seven schools in

Baltimore and each one demands a hospital and there are many denominations also, and if each religious sect sets out to care for the bodies as well as for the souls of its members and the number of weak hospitals be multiplied here, poor work will be encouraged and good work will be sacrificed to a belief, and the amount of good will not be in proportion to the money and energy expended. Perhaps the Baptist hospital may follow Pastor Kneipp's methods and thus combine religious belief and special treatment. Churches should make haste slowly to erect denominational hospitals, even such powerful and influential denominations as the Baptists.

Another phase of the case is the statement that the Church Home and Episcopal Hospital which has lately acquired money through a legacy is now taking steps to erect a small hospital in the neighborhood of Baltimore for the care and treatment of consumptives. This does not profess to be a denominational hospital but it is an institution for the treatment of a certain class of cases and it will be so comprehensive in character that all diseases of the chest may receive attention and the object of the hospital will be kept steadily in view while the denominational character of the institution will in no way affect its progress. A movement made about a year ago to start a hospital for consumptives was a failure on account of insufficient backing but in this new move supported by prominent men, and an institution already in existence with no ideas of personal advancement, the chances for success are very favorable.

***

MANY a physician pays long professional visits when shorter ones would be better for the patient, more acceptable to More Time. the family and would do less harm to the physician, who can be exact, careful and clear in his directions without being fussy.

An exchange very pertinently asks how it was that Marion Sims, Flint, Agnew, Keating, Fordyce Barker, Sir Andrew Clark, Charcot, Billroth, and others, had so much time for literary work? And yet their professional duties were certainly as pressing as any one's we know. It would seem that they felt the necessity of keeping their brains in good working order by writing; and if they thought so, no one could hardly be excused from saying, "Oh! I can find no time for writing."

There are more than 300,000 persons, according to careful estimates, connected with the drug trade in the United States.

Dr. Howard A. Kelly of Baltimore will deliver the address on gynecology at the fall meeting of the Tri-State Medical Society, in Des Moines.

The Sultan Drug Company of St. Louis has just issued an anatomical model painted in different colors, a great help to the student and physician.

Dr. B. B. Browne of Madison Avenue has purchased the house of the late Dr. Frank Donaldson and will soon leave his present home for his new house at 510 Park Avenue.

Dr. J. H. Mitnick has removed his office to 309 North Exeter Street, and Dr. L. E. Neale has taken the offices corner of Calvert and Read Streets, Baltimore.

Dr. James V. Crawford died last week at his home in Warwick, Harford County, in his fifty-sixth year. Dr. Crawford was graduated from the University of Maryland.

Dr. Benjamin S. Mackie, Passed Surgeon United States Navy, committed suicide last week at his home in Philadelphia. This is the second suicide in the service within a short time.

Among the papers read at the meeting of the Litchfield County (Connecticut) Medical Society on July 9, was one by Dr. William H. Welch of Baltimore, on "The Antitoxine Treatment of Diphtheria."

By the will of Mr. Thomas O. H. P. Burnham, a wealthy old bookseller of Boston, the Massachusetts General Hospital is made residuary legatee and has already been paid over two hundred and fifty thousand dollars.

A training school for nursing attendants has been established in New York City, the ob ject of which is to furnish skilled and trained attendants who shall be able to take care of the chronic cases and will not demand such high pay as the ordinary trained nurse.

Dr. A. J. Dalrymple, a retired physician of Baltimore, died in that city last week. Dr. Dalrymple was graduated from the University of Maryland in 1854, and after a few years of practice he retired to assist his brother, the well known pedagogue. Dr. Dalrymple was born in 1820.

Eye, Ear, Nose and Throat Clinic is the title of a new quarterly publication emanating from Kansas City, Mo., and edited by Drs. Flavel B. Tiffany and James E. Logan, and containing a department of neurology under the charge of Dr. John Punton.

The Third International Congress of Physiologists will be held at Berne, from September 9 to 13, 1895. Membership of the Congress shall be open to all professors and teachers of biological science, belonging to a medical faculty or any other similar scientific body, as well as to all scientific men engaged in biological research:

The Fifth International Congress of Otology will be held at Florence, Italy, from September 23 to 26. The Committee of Organization includes the following American names: Drs. C. J. Blake and Orne Green of Boston; A. H. Buck, H. Knapp and St. John Roosa of New York; C. H. Burnett and Laurence Turnbull of Philadelphia.

An order has been passed in Boston that all lunches sold in school buildings must be approved by a committee on hygiene. The object of this order is to exclude from the pupils' menu the deleterious articles of food of which children are especially fond, but which threaten proper digestion, and hence proper nourishment of the brain. It is wise to begin the development of intelligence thus from the source, and the practical lessons in restraint of the appetite so given the children must be exceedingly valuable if they can be daily enforced.

PUBLIC SERVICE.

OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF MEDICAL OFFICERS.

UNITED STATES ARMY.

Week ending July 29, 1895.

Leave of absence for one month, with permission to apply for an extension of one month, is hereby granted to Captain Junius L. Powell, Assistant Surgeon, United States Army.

The extension of leave of absence on account of sickness, granted First Lieutenant Alexander S. Porter, Assistant Surgeon United States Army, is further extended two months on account of sickness.

BOOK REVIEWS.

THE CARE OF THE BABY. A Manual for Mothers and Nurses, containing Practical Directions for the Management of Infancy and Childhood in Health and Disease. By J. P. Crozer Griffith, M. D., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania. Octavo, cl., pp. 392. Price $1.50. Philadelphia: W. B. Saunders, 1895.

This little book is a very reliable guide for mothers and intelligent nurses. It opens with a chapter on the hygiene of pregnancy and then follows a consideration of the characteristics of a healthy baby and the growth of its mind and body. The chapter on baby's diseases has been written with a view to making it comprehensible and useful to mothers who for reasons may not have a physician at hand and this chapter is particularly well done and will serve as a guide to the mother when in doubt, but only of course when the physician cannot be obtained, for knowledge acquired in this way by a woman, however intelligent, cannot compare with the experience of a physician. Illustrations are inserted here and there and in many cases they are good. The author has made his statements clear and they can be understood by almost anyone of ordinary intelligence. This book at this season of the year should be of immense value to mothers, but, as in all such works, it is difficult to draw the line between what a non-professional person should know and what should be left to the physician. Books like this, on the whole, are of benefit but in too many cases they fall into bad hands and work harm to the innocent infant. This

is one of the best works of its kind that has been presented to the people for many a day. The publisher is to be congratulated on the attractive appearance of the cover and the fine press work generally.

REPRINTS, ETC., RECEIVED.

Medico-Chirurgical College of Philadelphia,

1895-1896.

Denver School of Medicine. Fifth Annual Bulletin, 1895-1896.

Missouri Medical College. Fifty-fifth Annual Announcement, 1895-1896.

Annual Announcement and Catalogue of the Baltimore Medical College. 1895-1896.

Thirteenth Annual Announcement of the Medical Department of Niagara University. 1895-1896.

College of Physicians and Surgeon, Baltimore, Md. Annual Announcement and Catalogue. 1895-1896.

Evisceration of the Eyeball. By L. Webster Fox, M. D., Philadelphia. Reprint from the Medical Bulletin.

Woman's Medical College of Baltimore, Fourteenth Annual Announcement and Catalogue. 1895-1896.

The Annual Announcement of the New York Post-Graduate Medical School and Hospital for 1895-1896.

The Fifty-second Annual Report of the Mount Hope Retreat for the year 1894. By Charles G. Hill, M. D.

Report for the year 1894-1895. Presented by the Board of Managers of the Observatory of Yale University to the President and Fellows.

The Medical Profession and the State. The Alumni Oration. By Hon. Marriott Brosius, Lancaster, Pa. Reprint from the Medical Bulletin.

The Use of Vaccine-Serum in the Treatment of Variola. By Llewellyn Eliot, A. M., M. D., of Washington, D. C. Reprint from the Medical News.

Burns of the Cornea; Electric Light Explosion causing Temporary Blindness; Traumatic Injuries to Eyes; Hypopyon. By L. Webster Fox, M. D. Reprint from the Medical Bulletin.

CURRENT EDITORIAL COMMENT.

NURSING.

Kansas Medical Journal.

THE physician who makes his regular calls has much the advantage of the nurse, who in close proximity to the patient soon learns all the faults and foibles, and if there be in her makeup anything antagonistic to the individual traits of the patient, it will be a very unpleasant association. It is frequently the case that a change of nurse makes a wonderful difference in the progress of the case. This is not necessarily because of a difference in ability, but in many instances it is simply the individualism.

The Index MEDICUS.

Southern California Practitioner.

IN the cessation of the publication of the Index Medicus, the profession of America has met a great loss. How great it is, now is impossible to tell. It does not speak well for the general intelligence of the profession that their patronage was so small that it could not exist thereby. Those who have depended upon it will feel the loss deeply; all will be injured by its suspension, even though they may not realize the fact. We hope that the united efforts of the journals and leading physicians may create so great a demand for such a publication, that the Index Medicus may be revived.

INVASION OF TUBERCLE BACILLI.

Archives of Pediatrics.

THE respiratory tract is by far the most common portal of entrance for these bacilli in young children. The lymph nodes at the bifurcation of the trachea present in a large number of cases the oldest lesions. Cavities, shrunken fibrous tissue and calcareous masses are well known to be older than cheesy masses, the miliary tubercle being the most recent lesion. Experiments have shown that dust particles readily reach these nodes, but do not pass beyond them, the glands acting as a filter. It has been demonstrated that tubercle bacilli may penetrate the mucous membrane and traverse the lymph channels without causing any lesion, the first lesion being found in the lymph glands, by which their progress has been arrested. These glands make a strong effort to withstand the ravages of the bacilli, and frequently succeed.

PUBLISHERS' DEPARTMENT.

All letters containing business communications, or referring to the publication, subscription, or advertising department of this Journal, should be addressed as undersigned.

The safest mode of remittance is by bank check or postal money order, drawn to the order of the Maryland Medical Journal; or by Registered letter. The receipt of all money is immediately acknowledged.

Advertisements from reputable firms are respectfully solicited. Advertisements also received from all the leading advertising agents. Copy, to ensure Insertion the same week, should be received at this office not later than Monday.

Physicians when communicating with advertisers concerning their articles will confer a favor by mentioning this Journal.

WHOLE NO. 750

IT is not my intention in this short paper to enter into a detailed description of this disease, but to speak more particularly of those features characteristic of the disease in children.

Although it was formerly thought that nearly all cases of pneumonia in children were broncho-pneumonia, yet more recently competent observers claim that the croupous variety comprises onethird of all the cases.

Etiology. As in adults, croupous pneumonia in children is nearly always a primary disease. While the chief predisposing cause is exposure to sudden cold or dampness, yet it occurs as frequently in warm as in cold climates. It is more often seen in winter and spring, yet the percentage of cases seen in summer is greater than in adults. Susceptibility increases with age and it is most common from the third to the seventh year. Robust, well nourished children are more prone to this form than the weak and debilitated. Rarely croupous pneumonia is secondary to measles, whooping cough, typhoid fever, scarlet fever, etc.

The exciting cause is believed to be the pneumococcus of Fränkel, although this is also found in a large percentage of the cases of broncho-pneumonia, in cerebro-spinal meningitis and in the saliva of healthy persons. It is supposed to become more active after exposure to cold

or the lungs become less resistant to its influence.

Pathology. This disease passes through the three stages of congestion, red and gray hepatization, although these three conditions often coexist in different portions of the same lobe. Another noticeable feature is that the consolidation at times begins in the center of the lobe and does not reach the surface until the second or third day, a condition which explains the late appearance of the physical signs. Rarely a portion of the lobe may remain unaffected. The lower right lobe is the most frequent seat of the lesion although the apices are more frequently involved than in the adult, and some competent authorities claim that the apex is the most common location. Bilateral pneumonia is by no means uncommon. An accompanying bronchitis is nearly always present, affecting the opposite, less often the diseased lung. When the inflammation reaches the surface, the resulting pleurisy is seldom serious and empyema is rare, except when following typhoid or other debilitating conditions. Abscess, gangrene and chronic pneumonia are fortunately less frequent than in the adult.

Symptoms. As in the adult, the disease begins suddenly, but instead of the prolonged chill, vomiting is the most common symptom at the onset and is