4

is either a slight elevation of a half degree to a degree and a half, or else a subnormal state exists. This latter is by no means uncommon, sometimes reaching as much as a degree below normal in the earlier stages, and is just as important as being one of the earlier signs of the disease as is the elevated temperature. It is the belief of the writer that a subnormal stage exists in the early morning in all cases of the disease, and often late at night-times when the applicant is not seen by the examiner."

"Another sign that bids fair to become one of the most important ones in the early diagnosis of the disease, and one over which the applicant has no control, is the vagus reflex as discovered and described by Dr. T. J.. Mays, the valued vice-president of this association. This consists of making uniform pressure over the two vagi; if a beginning tubercular condition exists in one lung, pressure over the nerve of the same side will cause greatly increased pain, sometimes even causing nausea, fainting or absolute unconsciousness."

In incipient pulmonary tuberculosis but little can be learned from inspection of the chest, therefore we must depend upon percussion and auscultation. The percussion note over the right infraclavicular space and above. the right scapula, is higher in pitch than on the left side.

and when it is recalled that the greater number of lesions are first found in the right apex, strict attention must be paid to any alteration of sounds in these parts. It is claimed by some

authorities that over the earliest spot of infection the percussion note is semi-tympanitic, and hyper-resonance exists, and that' dullness does not appear until later. The stage at which an examiner can make the diagnosis (often being handicapped in every way) is when dullness exists. Dullness may exist over the spot of an old pleurisy or recent pneumonia, and if it does exist it must be given careful weight in making a decision. An auscultation is the most important method on which the examiner must rely; it must be remembered that the normal inspiratory and expiratory sounds stand in a ratio as ten to two in regard to length, and that the pitch of the latter is lower than the former; therefore when the expiratory sound is found increased in length and the pitch raised there is trouble somewhere, and the trouble generally means a beginning tubercular condition. This is one of the most important signs, and when combined with enfeebled breath sound on inspiration and a slightly roughened, harsh, and prolonged expiratory murmur almost always indicates a tubercular condition in the incipient stage. Increased vocal resonance in any part of the lungs (except as above noted) is sufficient cause for investigation. Sometimes an examiner is fortunate enough to get his ear directly over a small spot of infection; consequently he hears

end of inspiration, an absolute sign of the disease, which is generally present before tubercle bacilli are found in the sputum."

"When a history of loss of appetite, bad taste in the mouth on arising, belching, discomfort after eating, nausea and rarely vomiting is reported, then there exists cause for the greatest caution."

Sweating, though localized to the forehead, hands or feet, is one of the valuable links in the chain of evidence. The doctor mentions cough, expectoration, hemorrhage, pain over certain spots in the chest on breathing, shortness of breath after slight exertion, loss of weight, mental symptoms and

tubercle bacilli in, the sputum as, occurring early in the disease; but because of the nature of his paper (the recog nition of the disease against the applicant's will), does not discuss them fully.

In the discussion of the paper the phthisical expression, dryness, harshness and peculiar clearness of the skin, also the brittleness of the nails, were spoken of.

In concluding the discussion Dr. Harbaugh referred to a pamphlet published by the Illinois State Board of Health, called "Early Diagnosis of Tuberculosis," and said that it was the best that he had ever read.

THE PROPHYLACTIC USE OF DIPHTHERIA ANTITOXIN.

I. When diphtheria develops in a family, each member, especially those under ten years of age, should receive a prophylactic dose of antitoxin. This is particularly true of the poor, owing to the difficulties attending complete isolation. When the value of prophylactic doses of antitoxin is generally known, it will be seen that the cost of the few hundred units of diphtheria antitoxin is much less than several weeks' treatment of a case of diphtheria.

2. If diphtheria develops in boarding houses, orphanages, asylums, childrens' wards, hospitals, or in any place

E. T. BOYD.

where a large number of children live together, all, especially those under twelve years of age, should receive. prophylactic doses of antitoxin.

3. In any case, the prophylactic doses should be not less than 250 to 300 units, and in children sick of other infectious diseases, particularly scarlet fever, whooping-cough, most of all measles, the doses should be not less than 500 units. Nursing children should receive the same dosage.

4. In hospitals for infectious diseases where diphtheria cases are being treated, each and every patient should receive a prophylactic dose of diphtheria antitoxin at least every four and much better every three weeks.

Children sick of measles should be given a prophylactic dose every fourteen days.-Ibrahim, in Deutsche med. Woch., No. 17, 1905.

QUININE AS AN OXYTOCIC.

I. Unquestionably quinine stimulates uterine contraction, and, while its action is not absolutely certain, in the great majority of cases the results from its use justify confidence in its oxytocic action. It is especially to be recommended in private practice where instrumental procedure is likely to result in infection.

2. Its action in increasing uterine contractions is especially prompt.

3. Its superiority over ergot is due to the fact that the contractions follow

ing its use are not tetanic but rythinic:

strong contractions followed by corresponding pauses.

4. It is best given in doses of 71⁄2 grains from 15 minutes until 2 or 3 doses have been given. The first dose often fails to cause contraction, but the second or third is often followed by violent contractions.

5. Large doses long continued may induce labor.

6. In no case have I seen undesirable effects from its administration.Josef Baecker, in Deutsche med. Woch., No. 11, 1905.

THE TREATMENT OF LARYNGEAL TU

BERCULOSIS BY SUNLIGHT.

Kunwald (Muench. med. Woch., No. 2, 1905, Wiener Lin. Woch., No. I, 1904) states that at present all cases

of laryngeal tuberculosis at the Alland Sanitarium are treated by sunlight.

The armamentarium is as follows: A strip of wood (board) 2 to 3 inches wide, 5 to 6 feet long; two pieces of wood nailed to the end so as to form a cross and serve as a base to the former, which is provided toward the opposite end with several holes provided with movable pins, several nails, an ordinary hand toilet mirror and the laryngeal mirror.

The technic is as follows: The patient sits with his back to the sun, fastens the hand mirror by means of the nails upon the upright board slightly above the level of his mouth. The mirror may be inclined to a proper angle for reflection by means of the wooden pins projecting through the upright back of the mirror. Seated in front of the mirror, the patient protrudes his tongue, holds it with his left hand, while with the right he passes the laryngeal mirror into his fauces, and so places it that a clear picture of of his glottis is seen in the mirror; with the pharynx clearly illuminated, this is not especially difficult.

The most favorable hours for treatment are the early morning and late afternoon. This is done to avoid as far as possible the heat of the sun's rays, which is important, because this causes dilatation of the capillaries, thus influencing unfavorably the inflammatory process, and, owing to absorption of the ultra-violet rays, the results are not so good. For these reasons the best results are to be had

during the spring and autumn months. Patients acquire the technic in a surprisingly short time.

The length of the sittings varies with the experience of the patient. At first not longer than five minutes is taken, eventually the time is extended to one hour, never longer nor more than one hour a day. In all, 20 to 40 hours are given.

Tumor-like infiltrations of the mucous membrane, irrespective of locacation, are most favorably influenced, while diffuse infiltration, especially of

the cords, improve slowly under the treatment, but a cure may be expected. For the present, oedematous swelling of the mucous membrane is regarded as a contraindication to treatment by the sunlight. Pharyngitis hypertrophica is made worse by treatment, as shown by increased redness and swelling of the mucous membrane. A sudden intense redness of the pharyngeal mucous membrane (healthy) was seen once; sudden intense redness of the laryngeal membrane, accompanied by difficult breathing, twice.

The regular monthly meeting of the Denver Clinical and Pathologic Society was held April 14th in the rooms of the Academy of Medicine, the president in the chair. The members were entertained by Drs. Grant, Sewall, Craig, Bergtold, and Rogers.

The records of the last meeting were read and approved.

Dr. Levy exhibited a patient, a female, seventy-five years of age, presenting a history of a growth in the right nasal cavity beginning in January, 1903. In August of the same year the obstruction had become complete. On December 27 and 29 large masses of the growth were removed and submitted to Dr. Mitchell, of Denver, and Professor Welch, of Johns Hopkins University, for examination. Both of

them pronounced it to be the roundcell variety of sarcoma. From June II to August 4, 1903, before operation, Coley's serum had been used with no result and the use of the X-ray was begun at the same time and continued for one year; that is, from June, 1903, to June, 1904, also with negative result. There was no recurrence of the growth on the right side, but the left side soon became involved, and to such an extent that the case seemed hopeless from the surgical standpoint. In addition, growths, to the number of six, presenting clinically the appearance of sarcoma, but which were not submitted to the microscope, appeared on the legs, the latter not being subjected to the influence of the X-ray. Shortly after the treatment had been discontin