exists a functional disturbance of the meningo-cortical structures without demonstrable lesion capable of giving rise to symptoms, whether, in other words, the terms "pseudo-meningitis" and "meningism justify their existence. Incidentally the inferences that are to be drawn from the detailed examination of the cerebro-spinal fluid withdrawn by lumbar puncture are reviewed. The conclusions are largely based upon the examination of this fluid, and upon full and minute post-mortem investigation. The authors believe that the meninges are affected frequently in the course of the acute infections of the bronchiopulmonary system. Meningeal symptoms are, they think, due to attentuated or fugitive microbic infections either arising through the channel of the blood-stream or to direct infection from the mouth or nasal cavities; while in other cases they are due to the action of microbic toxins produced in more distant parts. But they do not believe in differentiating between a suppurative meningitis due to microbic infection, a serous meningitis due to the action of toxins, and a pseudo-meningitis due to functional disturbances of the corticomeningeal structures. For just as it is difficult or impossible to distinguish clinically between the various grades of secondary meningeal inflammation, so it is often almost equally difficult by methods of pathological research to divide these cases into their proper class pathogenically. The distinction between the true and the pseudomeningitis does not seem worth preserving, for there is no corresponding pathological distinction . . . Close attention always shows the existence of appreciable meningo-cortical changes, when there have been symptoms of meningeal irritation in the course of pneumonia and bronchopneumonia . . It cannot therefore at present be said that there exist meningeal symptoms due to a purely functional affection." Finally, they point out that similar considerations and conclusions apply equally well to other organs, such as the kidney, which become affected in the course of febrile infections of one kind or another.

S. VERE PEARSON.

NORTHROP (W. P.).

Therapeutics.

Treatment of Broncho-Pneumonia in Children. Medical News, April 30, 1904.

THIS is a racy, practical paper emphasising the importance of the hygienic aids in the management of children with broncho-pneumonia. The author insists with refreshing vigour upon the need for fresh air, plenty of cool water, a quiet room, and other such aids to the injured which are sometimes forgotten in the anxiety to prescribe some medicine and in the excitement of the sick-room. A few extracts will indicate the

practical nature of the paper:

"A child with a lame lung should not breathe five times when three times will do." Therefore" avoid steam and canopies and second-hand breaths," and see that the patient gets air which is "fresh, cool and flowing." "The one thing in treatment easily forgotten is tranquility and restfulness . . . A tearful grandmother should be removed . . . The sick-room should not be the gathering room of the clan . . . But yesterday I was obliged to clear a room of two old women, four big sons and a pug dog, leaving two doctors, a patient and a nurse.' "Good cleansing of the intestinal tract is the first aid to the injured . . . Correct indigestion; the pressure upon heart and lungs by a gas-filled stomach and colon does not leave a fair field to nature." Do not pay

Take

too much attention to the temperature. "To judge of a pneumonic child stand at the foot of the bed ten minutes, watch and think. your stethoscope and leave the thermometer and prescription book at home. . . . It is the toxæmic symptoms, stupor, restlessness and delirium which suggests the line of treatment." "Heart stimulation is not always needed. I have come to think that when a heart is acting badly in pneumonia it is time to see how much gas is in the abdomen, how clammy and cold the feet are, how hot.the head. . . . A child with cold feet cannot digest. Gas forms, the heart cannot find room to beat regularly... Hot foot-baths cure that kind of heart trouble." Finally the author ends up with: "How to kill a baby with pneumonia. Crib in far corner of room with canopy over it. Steam kettle; gas-stove (leaky tubing). Room at 80°F. Many gas-jets burning. Friends in the room, also the pug dog. Chest tightly enveloped in waistcoat poultice. If child's temperature is 105°F. make a poultice thick, hot and tight; blanket the windows; shut the doors. If these do not do it, give coal-tar anti-pyretics, and wait."

MARAGLIANO.

S. VERE PEARSON.

Specific Therapy of Tuberculosis and Vaccination against the Disease. The Medical News, New York, April, 1904.

THIS address, delivered at Philadelphia, is a striking and eloquent account of the author's work, and of the work which he has inspired. He states that in his belief (1) it is possible to produce a specific

therapy for tuberculosis; and (2) that it is possible to immunise the animal organism against tuberculosis, as is done in other infectious diseases, and that there is good reason to hope for an anti-tuberculous vaccination for man. He proceeds to state the grounds for his confidence. He has demonstrated the existence of anti-toxins in the blood serum of animals, and has succeeded in producing in certain animals a fairly high degree of immunisation by inoculating them with the dead bodies of tubercle bacilli or with a filtrate free from bacilli. Further, he believes that he has demonstrated the possibility of feeding human beings on a serum which will immunise them, and, further, since he has shown that the immunising properties are contained in the secretions of immunised animals he believes that we may before long drink milk and eat flesh which will have the property of giving immunity against tuberculous infection. The paper should be read in its entirety; a mere abstract completely fails to do justice to its enthusiasm, lucidity and scientific accuracy.

H. THURSFIELD.

RENOU. Influence of the Mediterranean Climate on Tuberculosis. Arch. Génér. de Méd., April, 1904.

AN enthusiastic account of the virtues of the climate of the French Riviera. It is at the same time temperate, for Dr. Renou points out that all forms of tuberculosis are not equally benefited. He regards it as unsuited to cases with hemoptysis or much fever, to patients of a neurotic or excitable temperament, and to those who have developed laryngeal complications.

H. THURSFIELD.

MARIANI.

Treatment of Pulmonary Tuberculosis by Injections of Phosote and Tuberculin. La Presse Médicale Belge, April, 1904.

A REPORT of the results obtained in a series of cases treated by the above method by Dr. Mariani, of Madrid. They seem to be good in nearly all instances. Phosote appears to be a mixture of creasote and phosphorus, but its exact composition is not given.

H. THURSField.

General.

Short Notes on Selected Papers.

By I. WALKER HALL, M.D.

Influence of Old Age, Diabetes, Arterial Sclerosis and Gout on the
Healing of Wounds. Eagleton (W. P.). American Medicine,
June 4, 1904. A case of gout in which an operation wound
presented no attempts at granulation.

Cancer and Uric Acid or Uric Acid as a cause of Irritation which
Predisposes to Cancer. Haig (Alex.). Medical Press and
Circular, June 15.

Paget's Disease. Krogius. Finska läkaresällskapets Handlingar,
1904, Bd. 46, S. 55. A woman, æt. 74, had typical eczema
of the areola mammæ and a mammary carcinoma with
infiltrated axillary glands. Amputation was performed. Death
followed some months later. Metastatic nodules were present
in the lungs, kidneys and liver. On microscopical examina-
tion, large round cells with chromatin-rich nuclei were
found in the epidermis of the areola, and in many of them
mitotic changes were observed. Under the epidermis there
was a broad zone of cell infiltration containing many plasma
cells and newly-formed blood-vessels. Three small nodules,
also in the areolar region, were situated in the midst of
proliferating sweat gland cells, and the neighbouring sweat
glands also showed cell proliferation of the duct cells. Similar
proliferation was observed in the cells of the lactatory ducts.
Krogius considers that the growth originated from the sweat
glands. He could not, however, find any direct evidences of
ingrowth from these glands nor of the presence of sporozoa.
The Action of Methyl-purins upon the Bacillus Coli and Bacillus
Typhosus. Roth (E.). Archiv. f. Hygiene, 1904, No. 49. The
addition of certain quantities of caffeine to culture media
entirely inhibits the growth of B. coli communis, but does not
affect the growth of the B. typhosus.

Retroperitoneal Sarcoma. Steele (J. D.). American Journal of
Med. Science, June, p. 939. Three new cases with collection
of thirty-two cases, making a grand total of 96 cases reported.
The tumours are therefore frequent, and are chiefly characterised
by their tendency to degenerate and exhibit signs of fluctuation
and by their pressure upon retroperitoneal structures.
The Sinus Frontalis in Man, with Observations upon them in some
other Mammalian Skulls. Lee (A. W.). Johns Hopkins
Hospital Bulletin, 1904, p. 115.

Bilharzia Hæmatobia. Rafferty (T. N. and H. N.). Medical
Record, June 4, p. 918. The organism was found in blood

obtained from the left lung, from the stomach, from the lower bowel, from the peripheral circulation (finger) and from the urine.

The Routes of Infection in Tuberculosis. Lubarsch (0.). Fort-
schritte der Medicin, 1904, Nos. 16 and 17.

1. The respiratory route is the most common.
2. The course of the infection is as follows:-

(a) The inhaled bacillus induces a tuberculous lesion in
a small bronchus, and the lesion extends along the
bronchiole to the lung (Type, Birch-Hirschfield-
Schmorl).

(b) The bacilli pass direct into the lung alveoli and induce a tuberculous pneumonic process (Type, Laënnec-Koch).

(c) The peri-bronchial tissues are attacked and a tuberculous lymphangitis follows.

(d) The bacilli pass through the alveolar walls into the intra-pulmonary lymph follicles and tuberculous nodules result.

(e) Extension to the bronchial glands, producing tuberculous lesions, and further extension by the blood-stream (Type, Ribbert) or by direct rupture into a bronchus (Type, Weigert-Hanau).

(f) Infection of the lung by the blood-stream from an old tubercle.

3. The alimentary tract furnishes a less frequent route of infection (Klebs, von Behring), and is principally concerned with tuberculosis in children.

4. Progressive tuberculosis arises frequently from old or latent foci and not as a necessary corollary to the first infection.

Circulatory System.

Relations of Cells with Eosinophile Granulation to Bacterial Infection. Opie (E. L.). American Journal of Med. Sci., June, p. 988. In the guinea-pig, the bacilli of tubercle and cholera cause the eosinophile leucocytes to gradually disappear from the circulating blood. Under severe infection eosinophile myelocytes accumulate in the spleen and may be found in the circulating blood. Bacteria appear to exert a chemotatic influence upon cells with eosinophile granules, attracting them from the circulating blood to the site of inoculation and from the bone marrow into the blood.

Indol in the Blood. Hervieux (L.). C. R. de Soc. Biol., 56, 622. The albumen is removed from the blood by lead acetate and then the presence of indoxyl proved by isatin. Indol was found in blood removed from the vena cava and vena colica and also in that taken from the carotid artery.