1. That tuberculosis is a communicable disease.

2. The sputum and nasal secretions are the chief sources of infection.

3. Infection by tubercle bacillus may be prevented.

4. The prevention of tuberculosis must be brought about by concerted action.

5. Such action embracing all laws and hygiene properties on the part of the tuberculous patient on the one hand and the public on the other.

6. The education of the public through the endeavor of the medical profession, local boards of health, and by free public lectures.

7. Dairy herds to be investigated by the tuberculosis tests.

injection of nitrogen gas for the arrest and cure of consumption, at Denver in 1898, he employed the salt solution for the arrest of intractible or severe pulmonary tuberculosis, with to him satisfactory results.

Some

of these cases being also subject to tubercular pleurisy and being apparently decidedly improved by the treatment, he was induced to apply it directly for treatment of the pleural trouble. This has been given in 83 cases with satisfactory results in 77. The number of injections given varied from one to eight.

"After these pleural injections, a very profuse perspiration developed with an increased action of the kidneys; the heart invariably becomes normal, the patient becomes free from pain, and the temperature drops to normal, sometimes below. Under no circumstances is the patient allowed to assume an erect posture under twenty-four hours; indeed, in most instances he should be kept quiet from forty-eight to seventytwo hours."

In the discussion of the paper Dr. McKittrick, of Burlington, Iowa, and Dr. Carl von Ruck, of Ashville, North Carolina, declared the injection into the pleural cavity to be positively dangerous. The author himself reports in the paper two cases corroborating this position.

ize the means of defense. The membership is to consist of physicians or scientists holding diplomas from French or foreign universities and colleges. The annual fee is $2.50. Thẹ general secretary is Dr. George Petie, 51 rue du Rocker, Paris, France.

THE SUCCESSFUL REMOVAL OF CERE

BRAL TUMOR.

Pope and Cartledge (Medical Fortnightly, Vol. XXVII, No. 6) report the successful removal of a cerebral tumor. The patient, an electricial engineer, aged 33 years, gave a history of a fall upon the head from a hay wagon in early youth and also of luetic infection six years prior to examination. After a constant frontal headache of one year's duration, he experienced the first "attack" in September, 1892. This consisted of a feeling of numbness in the left leg, inability to move the limb, followed soon by a cry and unconsciousness. The last condition continued for forty-five minutes, during which clonic convulsions of the leg occurred constantly. Upon awakening to consciousness, the patient was nauseated and vomited. After two

hours in bed he felt normal.

A week later a seizure practically identical with the last, but involving the right leg, occurred. He remained in bed two days, but, upon getting up, could not use the right leg, in which, however, sensation remained perfect. The use of the limb was regained in six weeks. In December, a third attack again involved the left leg. After peculiar feeling in the member, jerking commenced, the patient became unconscious, remaining so for twenty-five minutes, vomited, and in a few hours

was again all right. Thereafter attacks became frequent.

Opthalmological examination showed perfect vision, no contracture of the field of vision, no pupillary symptoms, nor scotoma. There were well advanced choked disc in the right eye, and slight swelling and blurring of the margin in the left eye. There was no disturbance of the extra-ocular muscles. A diagnosis of tumor cerebri was made. Predominance of attacks involving the left leg determined the opinion that the growth was located on the right side of the brain in the leg area a short distance from the longitudinal fissure.

A two-inch trephine was placed over the supposed lesion and when, by this means, a large button of bone was raised, a thickened bulging dura impinged upon the opening. The tumor underneath was 11⁄2 inches in diameter, almost circular, and was quickly removed by simply nicking the healthy dura at the margin of the severed bone and running a pair of curved scissors around, excising it. A rapid operative recovery followed, as did also the complete relief from headache. The patient had a slight convulsion lasting a few seconds on the sixth day and the same in the third week following the operation.

Convalescence was slow because of an intestinal trouble. However, in a

year he grew stout and headache, except such as could be attributed to ordinary causes, never returned. After six years there has been no return of his former malady. The patient was kept

on anti-luetic and constructive treatment for two years.

The tumor proved to be an unusually large, circumscribed, and organized gumma.

THE TREATMENT OF CANCER.

In delivering the Bradshaw lecture before the Royal College of Surgeons, London, Mr. A. W. Mayo Robson, D. Ss., F. R. C. S., said that the only etiological factor in producing cancer certainly known was local irritation; that at first the disease was not constitutional; and that the disease, though otherwise probably not communicable, was doubtless capable of distribution by contact and by inoculation. No hope of cure except by surgical means could at present, in Mr. Robson's opinion, be entertained. The various other treatments, such as electrical, phototherapeutic, medicinal etc., had all failed and were harmful to this extent that they often kept the patient from resorting to the only real cure-surgical procedure-until even that means. was of no avail for effecting a permanent cure. Rodent ulcers had been effectively treated by some of the methods of treatment specified above but were not really malignant.

Mr. Robson spoke of a precancerous condition as the best time to operate if the cancerous bud could be recog

nized, as, for example, in the breast. He had operated in 62 private cases of cancer of the breast, of which there had been a recurrence in 29 cases and 8 other cases could not be traced. Of the recurrences, 8 were after the lapse of the three years' limit. He had been sucessful in operating in cases of cancer of the stomach. One man's stomach had been almost wholly removed and the patient two months thereafter resumed business and had suffered no inconvenience and no recurrence of the disease, although four years had since elapsed. Many other similar cases were described. With regard to advanced cases, palliative operations were all that could do much to prolong life and relieve suffering-The London Daily Times, December 2, 1904.

PHYSICAL EDUCATION.

In a lecture before a session of the National Federation of Head Teachers' Association at Cambridge, England, Sir Lauder Brunton discussed the merits of physical education (London Daily Times, January 6, 1905). A

teacher, he said, should impart mental, physical, and moral instruction. It was almost useless to attempt to instruct the ordinary adult upon the benefits to be derived from proper ventilation and exercise; but the children may be taught these lessons and thus the next generation of adults will have better ideas about the proper mode of living. Sir Lauder thought it a great misfortune that people were flocking in such numbers from the country to the already over-crowded cities. Within the last half century the urban population had thereby increased three times as rapidly as the rural. Something should be done to arrest this transfer of population. Particularly, landlords should afford greater home comforts to his tenants; but teaching the rising generation how to make home comfortable was most important. Furthermore, the teacher should especially teach the care of the teeth, the avoidance of promiscuous spitting, and the baneful effects of alcohol when habitually taken into the human system. He should impress upon the mind of the pupil that health to the poor man is of more importance than money in the bank to the rich.

The speaker placed a high estimate on the value of all sorts of games of ball for developing all forms of coordination and particularly the co-ordination of action of the muscles of the eye and arm. From the most ancient

records of the Egyptians and from all subsequent history, subsequent history, it is known that games of ball have ever been universally popular and had doubtless been of incalculable value in developing the human race. At the present time provision for such sport should be made in all schools and all the pupils should be encouraged to participate in it.

A medical inspector should classify the children as to physical strength and the sports should be regulated in accordance with that classification. Little children should be taught marching and sticks with bits of ribbon should be provided for every child to increase the interest. But as mental and physical exercise were but lamely possible for children improperly fed as many school children were in consequence of ignorance as well as poverty, there should be courses of instruction in the art of cooking and the children should eat the food thus prepared, paying, if able, for the material used.

UNUNITED

FRACTURES OF NECK OF
FEMUR.

In the Annals of Surgery for October, 1904, Leonard Freeman consid

ers "The Union of Ununited Fractures of the Neck of the Femur by Open Operation." He says, "In spite of the disability often accompanying fractures of

the femoral neck, the union of the fragments by open operation has attracted but little attention, although it is feasible and seems to give fairly good results."

The choice of cases for operation is of the greatest importance. Advanced age is a contra-indication. The resisting powers deserve the most careful attention. The amount of the disability must be considered in connection with the age of the patient.

This open operation has been advised, at various times, for recent frac

tures.

An anterior incision is recommended, which begins a short distance below and external to the anterior superior spinous process of the ilium, and extends directly downwards 3 or 4 inches. It should lie just outside of the sartorius muscle. The dissection should be blunt, as far as possible.

The fragments are freshened by the removal of the interposed connective tissue. This must be cut away with scissors and it may be difficult. The bone is soft and friable and care must be exercised not to remove too much bone with chisel or curette, so as to avoid shortening.

The fixation is a difficult and important problem. Whatever method is adopted, the trochanter should be supported from behind, as it has a marked tendency to drop backward, thus producing displacement of the fragments and outward rotation of the limb. Simple extension and trochanteric support may be followed by union in many instances, but fixation by means of nails, screws, or bone or ivory pegs is better.

Without special consideration it would appear that perfect immobility of the pieces of broken bone could always be obtained by nails, pegs, or screws, especially the last mentioned. But this is not true, because the upper end of the femur often becomes so extremely soft and porous that the instrument of fixation will not hold.

Freeman recommends the use of a clamp which he has employed successfully in two cases of ununited fracture. It consists of three or four screws, which are inserted in a longitudinal line of holes drilled into the bone, their projecting ends being tightly held by two metal side clamps lined with strips. of wood. The efficiciency of the apparatus lies in the fact that the screws bury themselves in the wood as firmly as if screwed into it. Such an apparatus, having its foundation two or three inches down the shaft of the femur in solid bone, would certainly be more satisfactory than screws alone.

Temporary drainage through the anterior wound, is all that will be necessary. An additional posterior opening is not recommended.

About ten weeks in bed will be required in the usual case.

The results have been, on the whole, encouraging. There always remains, however, some shortening, varying from 2 to 11⁄2 inches or more.

While Freeman's case is not a perfect recovery, the result has been a marked improvement.

Brief abstracts from 13 cases collected from the literature are appended.

In connection with this article upon the treatment of ununited fractures of the neck of the femur, attention might