Northwestern Lancet.

ence Hand-Book of the Medical Sciences" says "There are very strong reasons for believing that the specific poisons, or germs, of a number of

SEWER GAS AND INFECTION.

Not long ago a leading official in one of the American cities caused a good deal of trouble by persistently maintaining that a prevailing epidemic of typhoid was due to defective house. drainage rather than to contamination of the water supply. This he stubbornly maintained in the face of a united medical profession, and owing to his position he was able to hinder needed. improvements in the water system and prevent the inauguration of the only measures which could be expected to prevail against the disease. For public opinion is strong to the effect that there is no more satisfactory explanation for an infectious disease than to find somewhere a defect in the plumbing; beyond this point it is seldom thought necessary to try to carry the search.

There is a good deal of medical authority to support the public in the view that defective drainage is the principal cause of many of the communicable diseases, particularly typhoid fever and diphtheria. Indeed it is not many years since medical opinion was quite as strong as popular opinion in going to the sewers first of all to seek the source of infection. The writer of the article "Sewer Air" in the "Refer

air. That dysentery, diarrhoea, and periodic fevers are frequently produced by sewer-emanations cannot be doubted. It is also believed that the poisons of typhoid fever, of cholera, of yellow fever, have been transmitted from house to house by the medium of the sewers. Indeed the evidence of such transmission amounts almost to a positive proof." Parkes, in his work "Practical Hygiene," edition of 1890, speaking of sewers says: "There can be little doubt, too, that the air in contact with such infected materials also becomes imbued with specific contagious properties. The infective material is in all probability -although actual demonstration is still wanting -due to active, living organisms or their germs of the class bacteria, which after evacuation from the body of the patient, find a suitable soil for growth and propagation in sewage and sewer deposits." Parkes goes on to explain that the organisms of disease probably get into the air of a sewer through evaporation or by the bursting of bubbles of gas upon the surface of putrefying sewage.

On the other hand numerous careful examinations of sewer air by competent bacteriologists have shown that it is not rich in microbic life, ordinarily containing merely the spores of molds and similar organisms rather than the germs of disease. As Leffmann says in the "American Year-Book of Medicine and Surgery" for 1896. bacteria are not flying fish; though they may develop in sewage they cannot get out of it themselves to contaminate the air, and there is no known agency to lift them out of the fluid contents of sewers and set them floating in the air. for Parkes' bursting bubble theory is a little fanciful and generally inadequate, while evaporation falls to the ground as accounting for raising solid bacteria from the surface of a stream. So that Walford is justified in a statement he makes in the "Sanitary Record" of July, 1897, that "there is very little reliable evidence to show that the ordinary specific infectious diseases are caused by inhaling sewer gas, and usually, where sewage is responsible for their causation the mischief has arisen through swallowing either water or food which has become contaminated

with sewage matters." Indeed it is claimed by one writer that even the classical poisoning that has been attributed to sewer gas has arisen chiefly from the leakage of illuminating gas into the

sewers.

It is far from the intention of this article to show that sewer gas is harmless and that the plumbing of houses need be no longer looked after. Apart from the question of cleanliness and bad odors there is every reason for taking the utmost pains to prevent the escape of sewer gas into the living rooms of houses. For it would at least contaminate the air, and even if it did not directly produce disease, experiments have shown that by lowering the tone of the organism it diminishes the power of resistance of the body to the poison of disease, thus laying the individual open to infection from various disease germs that abound everywhere. The point to be made is that in wrongfully ascribing to defective drainage the causation of an epidemic there is danger of overlooking the real cause and of missing the chance to take the proper steps to stop the spread of disease.

BOOK NOTICES.

A Text-Book upon the Pathogenic Bacteria. By Joseph McFarland, M. D., Professor of Pathology in the Medico-Chirurgical College, Philadelphia, etc. Second edition. Revised and Enlarged. Illustrated. Phila: W. B. Saunders. 1898. [Price, $2.50.]

It goes without saying that the second edition of this book will be very welcome to bacteriologists; to the surgeon, also, it appeals particularly because of the intimate and essential relation between the knowledge of germs and the asepsis that is indispensible to the surgeon. To the general practitioner it also appeals as an important work, for although he may not use its technical directions for the examination and cultivation of bacteria, he cannot know too much of the natural history of microorganisms, not only to perfect his medical education, but also to aid him directly and practically in the management of cases and more particularly in hygiene, that most important branch of medicine. Besides the general consideration of bacteria, their detection, cultivation and inoculation upon animals this edition contains a new and excel

lent practical chapter for the bacteriologist upon the method of determining the thermal death point of microorganisms and the value of disinfection, a study of the bacteriology of whooping cough, mumps, yellow fever and other diseases and a description of a few new bacteria. The subjects treated of in the first edition have also been rewritten and brought thoroughly up to date..

Diseases of Women. By F. H. Davenport, A. B., M. D., Assistant Professor of Gynæcology, Harvard Medical School; etc. Third Edition. Illustrated. Phila: Lea Brothers & Co., 1898. [Price, $1.75.]

Davenport's book is particularly the book of the physician rather than of the surgeon, that is to say, it deals with gynecology with the medical side uppermost. Some gynæcologists maintain that there is no medical side to this subject, and that medical treatment of the diseases of women is for the most part time lost. Dr. Davenport's book would be valuable to refute the extreme view of the gynæcological surgeon if for no other purpose.

It must not be supposed that the book does not deal at all with the surgical side of the subject. On the contrary, it gives a clear and plain account of the various operations most commonly performed, and advises resort to them in a wisely conservative manner.

An America Text-Book of the Diseases of Children. By American Teachers. Edited by Louis Starr, M. D., Consulting Pædiatrist to the Maternity Hospital, Philadelphia; etc. Assisted by Thompson S. Westcott, M. D., Instructor in Diseases of Children, University of Pennsylvania; etc. Second Edition. Revised. Phila: W. B. Saunders. 1898. [Price, $7.00.]

As contrasted with the first edition, the second has been generally revised and rearranged. Tuberculosis and maliaria are now included in the section devoted to infectious diseases, new articles have been written upon modified milk and lithæmia, a section upon orthopedics has been added and a number of chapters have been rewritten or subjected to a careful revision in order to bring the subjects treated of fully up to the times.

As stated in its title the Text-Book is the work largely of teachers of diseases of children or of kindred subjects, teachers in the prominent medical schools of this country, some of them young men and some older ones. There is scarcely a man in the country whose name is familiar in connection with the diseases of chil

dren who does not appear in the list of contributors to this work, which is the largest and most complete upon this subject that has been written on this side of the water.

Guide to the Clinical Examination and Treatment of Sick Children. By John Thomson, M. D., F. R. C. P., Ed., Extra Physician to the Royal Hospital for Sick Children, and Lecturer on the Diseases of Children in the School of Medicine of the Royal College, Edinburgh. Illustrated. Phila: Lea Brothers & Co., 1898. [Price, $1.75.]

This little work, which is devoted exclusively to the diagnosis and treatment of the diseases of children contains a great many useful hints that will well repay a careful reading. Although written by an Englishman the remarks it makes about children are entirely adaptable to Americans. It is conservatively written, taking middle ground in many disputed questions of pædiatrics such as the propriety of feeding with condensed milk and the importance of teething as an ætiological factor. To the American reader it is gratifying to find that great importance is given to American methods of infant feeding. An American Text-Book of Gynecology.

By

Many Writers. Edited by J. M. Baldy, M.
D. Second edition, revised. Illustrated.
Phil W. B. Saunders, 1898. [Price, $6.00.]

To lay great stress upon the typographical and pictorial excellence of a book is pardonable in the case of a second edition whose text has already received favorable notice, when, as is the case with this work the mechanical and artistic part is of unusual superiority. The colored plates are works of art, the illustrations in black and white are accurate and original and the diagrams are of great help to the understanding of operative technique, which in gynæcology is often difficult to explain clearly.

The first edition of the Text-Book was published so lately that there are no new subjects to be treated of in this edition; but the whole book has been revised, much has been rewritten and many new plates substituted for old ones, particularly where changes in methods of operating have demanded new figures and diagrams.

NOTES.

RHINOLITH OR NASAL CALCULUS.

By William H. Poole, M. D.,

Mr. President and Members of the Wayne County Medical Society: The pathological

specimen I have the pleasure of exhibiting to you this evening is one of unusual interest, even to those of us who limit our practice to diseases of the eye, ear, nose, and throat, from the infrequency with which we meet these cases, and also from the circumstances which led up to its discovery, owing to the fact that it was situated somewhat differently from most cases of this kind.

Miss L. K., aged twenty-four years, from whose nose this was taken, consulted me January I, 1898, regarding her nasal catarrh, with which she stated she had been afflicted ever since her childhood. Ten years ago she had been treated for about a year by one of the leading rhinologists of this city, rceiving considerable benefit, but for the last two or three years she has had a rather profuse nasal discharge, thickened, and increasingly offensive in character, with obstruction to nasal respiration, loss of smell, nasal voice, and the other usual symptoms which we find in an aggravated case of chronic rhinitis.

I suggested an operation for the removal of the hypertrophied tissue of the lower turbinal, and on January 15th, I operated.

Hemorrhage was not very profuse and was readily controlled at this time. The patient returned home, and soon after suffered from an attack of nervous sick headache.

As usual, the headache ended with an attack of retching, after which straining the hemorrhage started in afresh and rather profusely. I tried again to control it with styptics and plugging the naris with absorbent cotton, but did not succeed in thoroughly arresting the flow of blood, and, as the patient was getting very weak. with the kind assistance of Dr. Suttie. I tamponed through the posterior naris with a sponge tent, which instantly stopped the hemorrhage. I then ordered her to be liberally supplied with beef extract, for the double purpose of nourishment and to increase the arterial tension.

The next day she was doing nicely, but was very weak; there was no recurrence of the hemorrhage, but I did not think it advisable to remove the tampon as she was too weak to bear it. January 17th, the patient was a little stronger. but owing to debility I could only remove a part of the tampon from the anterior naris.

The next two days I removed still more of the sponge anteriorly, in all about two thirds of it being removed up to this time, the patient still being too weak to bear much manipulation.

On January 20th, I attempted to remove the remainder posteriorly, but found it so firmly fixed that it could not be dislodged except with extreme force under anæsthesia. I called in Dr.

Chittick and anesthetized the patient, when, with considerable difficulty, we removed the remainder of the sponge.

Next morning she came to my office for treatment and stated she had enjoyed perfect freedom in breathing through that nostril until about four o'clock in the morning, when, changing her position in bed, that side became suddenly obstructed. After cleansing the nostril, which was seemingly full of an offensive discharge, I discovered this body which was attached at the posterior end on the outer side of the inferior meatus, lying, as it were, in a groove or pocket.

The anterior or loose end of it was sharp like a spiculum of bone, and black in color; it was freely movable about its long axis, so that you could pass a cotton holder around it and lift it from its bed. After cocainizing, I grasped it with a dressing forceps and, giving it a twist, removed it. I then thoroughly cleansed and disinfected the cavity with the hydrozone solution, which removed the odor and rendered the cavity wholesome.

The next day the two smaller pieces were removed while cleansing and treating the nose. They were loose and seemed as though they had just scaled off from the bed where the larger piece had lain.

The spraying of the nasal cavity with hydrozone, followed by the use of glycozone, constituted the treatment for the next four days, by which time the offensive odor had entirely disappeared, and the parts had assumed a healthy

condition.

This concretion formed on the outer side of the inferior meatus, and as it grew larger it obstructed the flow of tears through the naso-lachrymal canal, as evidenced by the overflow of tears from the left eye, which condition ceased immediately after removal of the rhinolith.

The secondary hemorrhage was evidently due to a relaxation of the pressure on the vessels of the turbinate, owing to the calculus being disturbed in its position when the patient was retching.

Being desirous of ascertaining, if possible, what served as a nucleus, and at the same time of finding out the composition of the formation, I cut it in two.

Microscopical examination reveals that it is composed of amorphous phosphates, undoubtedly the phophates of calcium and sodium, which came from the tears.

There has been a marked improvement in the young lady's condition since the removal of the rhinolith; overflowing of the tears in the left eye has ceased, nasal respiration has become perfect, her voice has lost the nasal twang, and her gen

eral health has improved rapidly, as indicated by the fact that she has gained four pounds in weight since the operation (four weeks ago), and is still improving.-New York Medical Journal. 270 Woodward Avenue.

TUBERCULAR OSTEOMALACIA (VER

TEBRAL)-BONE NECROSIS.

The following interesting case is reported from the Sound View Hospital, of Stamford, Ct.:

Mrs. T, Portchester, N. Y.; American; age 39; May 27, 1898: sent by a brother physician. Examination revealed the fourth, fifth and sixth dorsal vertebræ badly diseased. The spinous process of the fifth was almost destroyed, and had a sinus leading down to it which exuded a large quantity of foul-smelling sanguineous pus. I urged immediate operation, but it was refused. Then put the patient on a teaspoonful of bovinine in old port wine every hour; also twenty grains glycero-phosphate of lime every three hours; besides twice a day giving a hypodermic injection of kreasote in liquid albolene, between the shoulder blades. The sinus was

syringed out with peroxide-on-bovinine followed by Thiersch, then filled with bovinine and dressed. There being so much diseased tissue and in such a broken condition that it was impossible to build it up, I insisted on a slight operation, merely removal of the spinous processes of the fifth and sixth vertebræ, and a thorough curettement of the cavity and uncovered vertebræ. This was

finally consented to, and on June 6th, assisted by Dr. Friedenberg, with the patient under a. c. e., I cut down, and removed the spinous process of the fifth and sixth vertebræ, and thoroughly removed by curettement the pathological tissues of the cavity and surrounding parts. Following this, the cavity was thoroughly washed out with Thiersch solution; and then, in order to destroy any bacilli that might have been left in the wound, the depuration by peroxide-on-bovinine was employed; cavity was washed out with Thiersch, dried, and packed with plain sterilized gauze saturated with bovinine pure. The outer wound was dressed with bovinine changed daily until the 14th, when the cavity was found filling up all over with healthy granulations, and the denuded bone surfaces rapidly covering with new periosteum. The daily dressings being continued to the 26th, the bone was then found covered, and the cavity nearly filled with healthy tissue; thence to the 29th, when removal of dressing showed entire healing of the wound. July 2d, the case was discharged cured.

This is an unusually interesting demonstration of the efficacy of supplied blood in so-called incurable bone disease.

INSTRUCTIVE EXHIBITS.

"One of the chief attractions at the annual gatherings of The American Medical Association is always the exhibition hall, where the principal drug, instrument and food products of the world, the results of years of experimental research and labor, are placed in view."

"Among the many attractive exhibits at this year's Denver meeting, that of IMPERIAL GRANUM, recognized by many leading physicians as the standard among prepared foods, occupied a prominent space and the representative in charge was kept busy explaining to the visiting physicians the superiority of this preparation. Handsome sample boxes of the FOOD, and copies of The Imperial Granum Co.'s valuable clinical record, were presented to each physician in attendance."-From The Journal of the American Medical Association, Chicago.

Tuberculosis and its Treatment by the Later Methods.

The Journal of the American Medical Association, July 23rd, 1898, presents a report of A. G. Deardorff, M. D., San Francisco, made to the annual meeting of the American Medical Asso