neighbor, had violently assaulted her (not carnally); had struck her on the head and knocked her down, etc. She claimed to be seriously injured thereby. From a very close examination, I could, find no indication of any physical injury, and so informed the friends. This did not please them. They seemed anxious that I should find something seriously wrong with her, and since I did not, they asked me the next day if I did not think it would be advisable to have a consultation. I said I did not think

it was necessary; that it would be just so much trouble and expense for nothing, but if they desired it I had no objection to their calling in another physician. Consequently a consultant from a neighboring town was sent for, and after a very thorough examination, confirmed my diagnosis, namely, malingering, with perhaps a complication of hysteria. The treatment was very limited, consisting of sedatives and some placebos. The patient did not recover, however, for several monthis. In fact, not until after the second trial. A few months after the alleged assault, Mr. M., who was quite wealthy, was sued for $5000 damages. The jury failed to agree, and another trial was held. Again the jury could not agree. I must mention, in passing, as a point of evidence indicating that this was a case of feigning, that the plaintiff testified at the second trial that her health was so

THYROTOMY.- Mr. P. de Santi (Lancet) read a paper on the operation of thyrotomy, with a short account of the cases in which it has been performed at St. Bartholomew's Hospital during the last nine years. Thyrotomy was first performed at St. Bartholomew's Hospital in 1886; since then nine thyrotomies had been performed there for malignant disease and eight thyrotomies for innocent growths and other causes. Butlin's private cases were nine for malignant disease and two for innocent growths, which altogether make twentyeight thyrotomies. Mr. de Santi preferred chloroform to ether in this operation on account of the excessive secre

Mr.

seriously impaired that she "had to take medicine from the doctor all the time." That once she ran out of the medicine for a week, and became so much worse that she had to send after more medicine immediately, and continue the use of it. This medicine was really a placebo, consisting mainly of aqua pura, to which was added a little gentian or cinchona to give it a flavor, and was only given for a moral effect. After the second trial, the plaintiff being unable from lack of funds to prosecute the case further, she apparently regained her accustomed health, and has so far as I am aware, enjoyed good health since that time. This case, gentlemen, I consider a typical one of feigning disease for a money consideration. The plaintiff hoped to obtain damages for the alleged injuries. She pretended to have received severe injury to her side. Also that her head ached constantly as a result of her injuries. And then, when it was proven that she had not been struck, in fact, had not received any physical injury whatever, the case being over, and no prospect of a new trial, she immediately regained her normal degree of health. There was no further cause for simulation.

The treatment of malingering must necessarily suggest itself in each individual case. I believe, however, that it should be mainly psychical or moral in its modus operandi.

tion of saliva.

He also laid stress upon the sponge round the Hahn's tube being aseptic. He advocated the use of a five per cent. solution of cocaine to the larynx after division of the cartilage, to lessen the hemorrhage and remove reflex excitability. The sponge cannula is to be removed, and the wound dusted with iodoform and covered with gauze ; the patient should be kept on his side with the head low in order to facilitate the flowing away of the discharge and lessen the risk of pneumonia. The feeding of the patient during the first two days is chiefly done by nutrient enemata ; on the day following the operation the power of swallowing should be tested.

FOR the past twenty years' sanitary science has made great strides, due undoubtedly to the extension of bacteriology and no subject has received closer and more careful attention than the analysis of milk. Milk is the nearest substance we have to a perfect food and were it not for its deficiency in iron we would have in it an ideal preparation for the support of human life.

When we consider the large quantity of milk used in this country for food it is easy to comprehend the dangers arising from chemical changes and pollution.

A large percentage of the infants of the United States are artificially fed, and the principal article of food is cow's milk in one form or another; hence the large infant mortality that confronts us every year.

Sanitary officers have long been in error as to the purity of milk, basing their standards upon the total amount of solids without regard to contamination with bacteria. This is perfectly correct from a commercial standpoint but is not sanitation.

At the present day we are in possession of almost exact knowledge as to the manner of the distribution of diseases by milk, and know that serious dangers arise from the contamination of the food by microbes.

We are all more or less familiar with the examination of milk carried on by the greater number of health boards, being simply an analysis as regards total solids and chemic composition. The contamination of milk by specific microorganisms from disease among the milkyielding animals or among the persons about the farms is an undisputed fact, and possibly there are many that do not fully appreciate the extent to which tuberculosis exists among dairy cows and infects human beings. Dr. Leffman, Food Inspector of Pennsylvania, very

truthfully asserts that the production of cow's milk for human food under the present methods of collection and use is one of the most dangerous of human industries.

The Medical Record of January 6, 1894, speaks of the enormous practical value of tuberculin in animal industry. The positive existence of the disease, determined by the use of this lymph in cattle affected by tuberculosis, is sufficient to laud the name of the discoverer, Prof. Koch, forever.

The State Board of Health of New York reports the case of a valuable herd of thoroughbred cows that were pronounced healthy by veterinarians, being examined twice in six months in the usual way. A third examination with the aid of tuberculin caused a condemnation of over half the herd. This same board of health is killing by the hundred animals condemned by diagnosis with tuberculin and the pathologists say the autopsies show the diagnosis to be correct in every case. A temperature of 103° or over after an injection with tuberculin condemns the animal.

It is rather peculiar that the early deposit of miliary tuberculosis causes the animal to improve in weight and general appearance, often producing richer milk; nevertheless it is a fact and we can readily see the impossibility for veterinarians to discover the disease by physical examination, until it is far advanced and probably has infected the whole herd. Unprincipled dealers take advantage of this fact and inoculate their cows with the tubercle bacillus in order to improve the general appearance and thereby bring a higher price in the market. There have been 15,000 tests made with tuberculin in England.

We are slowly realizing the relation of milk to the prevalence of disease,

which is claimed to be the cause of oneseventh of the deaths in civilized countries. The conveying of disease by milk, from persons affected upon the premises where it is produced, may be frequently traced. I had an experience with three cases of enteric fever, all in the same neighborhood in this city, which was clearly traced to the milk supply. Each one of these individuals was supplied with the same milk by an old man that kept one cow in the suburbs and by careful investigation I found that his son had not long recovered from an attack of typhoid fever. The stools not having been disinfected were deposited in a shallow sink fifteen feet from the well from which the family obtained their water supply.

There are any number of infectious diseases that may be traced to dairy farms. The Massachusetts State Board of Health gives some interesting data regarding several epidemics of enteric fever traced to farms where the disease existed and which were conveyed through the medium of milk. If you visit these farms, I dare say in 90 per cent. of them you will find a total disregard of all sanitary measures. Frequently you find the well from which the water supply is derived close to the stable or sink and it will surely become polluted sooner or later. This water is used for drinking and cleansing purposes not to speak of what goes in the milk. The cow sheds and mangers as a rule are in a filthy condition.

When milk is taken from cows entirely healthy and on farms where no disease exists, it may also become a dangerous article of food, due to the decompositions which are induced in it by bacteria, serving as it does as an admirable medicine for their growth. Many species of bacteria produce marked changes in the casein and highly poisonous compounds are set free. Careless methods of milking favor the contamination of the milk with all kinds of common bacteria of air, water and soil, and as ordinarily furnished in summer temperature, the bacteria multiply with great rapidity. To this fact we may attribute the high infant mortality from

intestinal diseases occurring every warm spell.

It is claimed that the tubercle bacillus enters the lacteals and prevents the absorption of food and we have death by starvation. Sterilization is a happy solution of the bacteria problem and should be generally practiced, although we occasionally find cases that do not take kindly to this preparation of milk. There is quite a diversity of opinion in regard to the propriety of allowing milk to be used that is produced by cows fed upon brewers' grains or distillery wash.

Professor Konig of Munster, an eminent authority on cattle feeding, says there is no objection to giving 45 or 50 pints of distillery wash a day provided other suitable food is also given. He also says that it would be better not to give it in a sour condition and milk from cows fed with this food should be sterilized. He thinks all the objections could be overcome by using distillery wash in the dried state.

Professor Mercher of Halle, also an eminent authority, says we have no good ground for the belief in the injurious effect produced by the feeding of cows upon distillery wash. He claims the distillery wash is thoroughly sterilized in its manufacture, and if the milk from such cows has produced illness it is due to the improper sanitary condition of the cowsheds and mangers. such conditions any food might produce similar ill effects.

Under

The annual register of the diseases of children of Germany publishes the first evidence on the subject founded on exact observation, and which is the result of the investigations of Uffelman and Ohlsen of Rostock. This report says: The milk from distillery fed cows is of neutral reaction, sometimes alkaline. Acidity did not set in for forty-eight hours. If suitable food is given in addition, the milk does not appear unsuitable for feeding infants. There is no proof that the milk produces indigestion or rachitis. Microscopic and bacteriologic examination did not prove any difference from other milk.

The adulteration of milk except by water is not practiced to any extent of

late years. Watered milk may be detected by specific gravity or by the amount of solids by evaporation. The specific gravity varies from 1026 to 1035. A very large quantity of cream lowers it, and after the cream is removed the specific gravity may rise under ordinary circumstances about 2°. The average specific gravity of unskimmed milk may be taken as 1030 at 60° F., and the range is nearly 4° above and below the mean. At 60° F., there is a loss of 3° for every ten per cent. of water added. The principal substances of adulteration are starch, dextrin or gum, to conceal thinness, and the bluish color produced by water; annatto or turmeric is added to color; emulsions of hemp or almond seed to thicken or cream; chalk to neutralize acid and give thickness; sodium carbonate to prevent acidity or souring.

It is quite necessary from an economic standpoint that adulteration should be suppressed, hence the necessity for a standard. The Society of Public Analysts of England, which is represented by the highest judgment on the subject, fixes the standard at 8.50 per cent. solids not fat, and 3.00 fat.

The condemnation of skimmed milk is certainly unjust, and it should be sold, being properly labeled. It is thoroughly wholesome and possesses all the nourishing properties excepting the fat that whole milk does.

The effects of what is ordinarily called bad milk are sometimes brought under our notice in practice. Professor Mösler has directed attention to the poisonous effects of "blue milk," that is to say milk covered with a layer of blue substance which is in fact a fungus, either oidium lactis or penicilium, which seems to have the power in certain conditions of causing the appearance in the milk of an aniline-like substance. Milk

of this kind gives rise to gastric irritation, and in four cases mentioned by

SPONTANEOUS RUPTURE OF THE NONGRAVID UTERUS.-Meinert (British Medical Journal) remarks that this accident is believed by many to be mythical. He has, however, observed two cases. In the first there was hematometra

Mösler it produced severe febrile gastritis. Milk which is not blue, but which contains large quantities of oidium, appears from Hessling's observations, published in Virchow's Archives, to produce many dyspeptic symptoms and even choleraic-like attacks as well as aphthous affections of the mouth. The contamination with pus from an inflamed udder or an abscess on the udder will give rise to stomatitis in children and to aphthæ on the mucous membranes of the lips and gums. Cows feeding upon rhus toxicodendron, which is supposed to give them the trembles, produce milk that causes in children extreme weakness, vomiting, fall in bodily temperature, swollen and dry tongue with constipation. Several of our health boards are awakening to the necessity of the scientific inspection of milk and live stock, and have adopted measures for carrying on this work.

In our State we have practically no sanitary regulations in this direction, all efforts being in a commercial direction. Auyone that will examine into our food inspection, I am sure, will agree with me that it is a grand farce.

This is a subject of no mean importance, and the physicians and sanitarians of Maryland should agitate the question. We want a bacteriological laboratory established and controlled by a competant bacteriologist. Not only for this. work is it sadly needed, but for the use and convenience of the general practitioner in infectious diseases. Where time and general environment will not permit of his own investigations, there should be a thorough sanitary inspection of all milk-producing animals by the aid of tuberculin. It would no doubt cost the State considerable money to reimburse all owners for cattle killed that have been found unfit for use, but the benefit derived from such an expenditure would well repay the residents of this State.

with extreme retroflexion; rupture occurred, abdominal section was performed, and the patient recovered. In the second case pyometra existed. The uterine walls gave way. The abdominal cavity was opened. Operation was also successful.

MRS. C., aged 47, plethoric, always healthy until she arrived at that critical period (menopause). Since that time she has not enjoyed very good health. I will here give you a history of her case and I want an opinion from every physician in the house.

She has suffered from muscular rheumatism, not constantly, but with very short intermissions. On the 12th day of June, my partner, Dr. Smith, was called in for the first time, diagnosed acute articular rheumatism with all the characteristic symptoms, namely, swelling of the joints, pain, slight elevation of temperature, etc.

She improved under treatment, got out of bed in three days, but not well. On the 14th day of July I was called in, found the same thing, except that it was confined to the right hand, badly swollen and great pain. On the 18th inst. I was sent for at 12 o'clock M. The messenger came for me in great haste, stating that Mrs. C. was dying. When I arrived I found the following symptoms: Sitting up in bed, stomach very much distended, pulse 80 and good, temperature normal. She said to me when I went in "that she was going to die." She was praying, calling all her family together and bidding them good-bye. I gave her every assurance that she would not die at present. Pupils dilated.

She finally got to belching. I gave her an enema of warm water. In a short time she was quiet and went to sleep. The next morning I found her better, and she apologized for her actions of the previous night and was apparently all O. K. No fever for three days; pulse good. On the 20th, at 7 P. M., I was hastily summoned. Dr. Smith and myself went over and found the following condition: She was lying perfectly quiet in a comatose condition, pulse 114,

temperature 98°, right pupil dilated, left slightly contracted, limbs cold to the knees; stuck her with pins, she did not flinch. We went into another room and consulted and decided she had apoplexy. We so informed the family and told them she would not recover. She lay in this condition until 11.30 P. M., when another physician came in and diagnosed the case hysteria. We disagreed with him. We agreed to apply a test. Applied a small faradic battery. After some little time she asked us to take it off. (Passed urine and feces involuntarily.) We did so, fully satisfied that we did not have a case of apoplexy, but still not satisfied in regard to it being a case of hysteria.

For several days she did not seem to improve; finally she began to improve and got so she could talk fairly well. On July 29, she had another attack and was totally paralyzed. Right pupil dilated and left contracted, temperature per vaginam 100°, axilla normal, pulse ranged from 114 to 120. She lay in this condition for two days and died at 8 P. M., on the 31st. Her pulse increased in frequency until it reached 170.

I forgot to mention that her mind was very much impaired; in fact, most of the time during her sickness. It resembled very much a case of acute mania, and was so diagnosed. I hope the physician who made the diagnosis will give symptoms as they existed at the time he saw her.

I will give what the P. M. revealed after I hear from the Society. On P. M. examination, found the dura mater very much congested, blood vessels very much distended, one clot in the left lateral ventricle, evidently an old one, because it resembled dry blood, and the brain tissue was beginning to soften around it. Another in the right lateral