The first death was of a man sick two weeks before calling a physician, who died of perforation following a meal of pork and beans. The second died of toxemia, the third and fourth of hemorrhage (ill ten days before treatment began), the fifth of intercurrent acute nephritis, the sixth seen after twelve days' illness died of coma, probably nephritic, and the seventh from perforation after being brought overland 120 miles for treatment. One other case of perforation recovered without operation. Considering the conditions this is certainly a remarkable record.

In the CLEVELAND MEDICAL JOURNAL, Dr John Phillips records 1070 cases of typhoid fever treated at the Lakeside Hospital. The form seems to have been mild since only about 10% had diarrhea. Baths were used when the fever exceeded 102.5. The drug treatment was symptomatic, headache met by ipecac and opium, vomiting by tiny doses of creosote, abdominal distention by turpentine to the skin and internally, or touching the surface with the Paquelin cautery. "Constipation is the most common cause of rise of temperature during convalescence."

It will be seen that with all the advantages of a thoroughly equipped modern hospital and the supplies to be secured in a great city the results were much worse than in the squalid tents and hovels of Alaskan camps, the mortality being almost double. The difference may be fairly credited to the better treatment of the Alaskan physician, who gives valid reasons for his practice of intestinal antisepsis and demonstrates its correctness by his results.

Lest it may be claimed that there is credit to be given the northern climate and conditions we add some data from a report made by Dr J. M. Heyde, of Walnut Creek, Ohio, in the American Journal of Clinical Medicine for October. Dr Heyde and Dr J. G. Stucky treated 26 cases of typhoid fever expectantly, with four deaths, or 15.4%. Fifty-four cases were treated with

sulphocarbolates, with one death, or 1.8%. The patient who died (of cortical cerebral venous thrombosis) could hardly be debited against the treatment as she was transferred to another physician ten days before death, who did not continue the sulphocarbolates. Of the cases treated by Dr Heyde 12 treated without sulphocarbolates averaged 29 days' duration, while 12 treated with sulphocarbolates averaged 17 days. Of the former, seven cases had complications, four of them hemorrhages; of those treated by sulphocarbolates all were uncomplicated.

Your editorial entitled "Anti-Vaccination Again" does not bring out the facts in as strong relief as the published reports of the City Health Department warrant. The statistics serve not only to undo the mischief done by Dr Friedrich's paper of 1902, but also to clinch beyond possible dispute the efficacy of vaccination as the sanitary prevention of small-pox.

SMALL-POX IN CLEVELAND FROM 1898 TO 1906

The epidemic of 1901 was “a mild, slightly contagious disease, which left no marks and seldom proved fatal." The Health Officer took charge at the tail end of this epidemic and complacently published the proclamation, "the death blow to this epidemic was dealt by formaldehyde !"

Following this supposed new discovery came the virulent epidemic of 1902 with its appalling fatality. Through "the prompt and vigorous initiative of the physicians and the intelligent energy of their lay coadjutors," 195,000 individuals were vaccinated during that year. The epidemic, which had been recurring since 1898 and reached its climax after and despite the campaign of disinfection in 1901, was brought to a halt so suddenly after the wholesale vaccination in 1902, that for the past two years it has become extinct.

M. ROSENWASSER.

Entered March 7, 1902, as Second-Class Matter, Post-office at Cleveland, Ohio, under Act of Congress of March 3, 1879.

EDITORIAL

Cleveland Medical Library Association

The Cleveland Medical Library Association formally opened its new building on Wednesday, October 17. In the afternoon a public reception was held from three to five, at which the refurnished rooms in the old quarters of the library, and the new building were opened for inspection.

The formal exercises were held in the evening in the new auditorium before a large audience of the Cleveland medical profession.

Dr Hiram C. Haydn offered an opening prayer, and was followed by Dr Beckwith, the Vice-President of the Association, who introduced Dr Dudley P. Allen, the President. Dr Allen gave a brief historical sketch of the growth of the Library from its foundation, and announced that owing to subscriptions from the profession and its friends, the Association would be able to start the year 1907 free from debt, with a property and endowment valuation of about $70,000, and a library of nearly 15,000 volumes.

President Thwing, of Western Reserve University, spoke briefly and after the ceremony of receiving from Dr Sherman,

of the Building Committee, the key to the new building, Dr Allen introduced Dr Abraham Jacobi, of New York, who gave the address of the evening, which will be found elsewhere in this number.

The audience at the close of the exercises was given an opportunity to visit the stack-room and the new club-rooms.

The members of the Building Committee, which had charge of the erection of the new building and the renovating of the old quarters, were Dr H. G. Sherman, Dr Dudley P. Allen, Dr H. E. Handerson and Dr Wm. Lincoln. To them is due the greatest credit for the most successful carrying out of the plans for the enlargement of the Association's plant.

The new building is of brick, two stories in height, directly adjoining the original building. Its first or basement floor contains the stack-room, which is built according to the latest ideas in stack-room construction, and with special features for keeping dampness from the books and for fire protection. The upper story is taken up by a very well arranged auditorium, seating three hundred, with most excellent acoustic properties, and efficient lighting and ventilation. It will provide a most ample and suitable meeting place for the Academy of Medicine. The rooms on the first floor of the old building have been completely transformed by redecoration and refurnishing into very comfortable club-room quarters for Library members. The second floor will furnish rooms for Council meetings and for a medical

museum.

Medical Inspection of Schools in Philadelphia

The writer has recently received the annual report of the Public Education Association of Philadelphia. This organization of over 800 members is one of the 150 independent organizations in this country which devotes its energies, directly and indirectly, to work for public schools.

When the fad for medical inspection of schools was appealing to public spirited citizens several years ago this association enthusiastically advocated the innovation, and through its efforts several dozen physicians voluntarily inspected several schools, each, and some good resulted, but soon the doctors got tired of giving away their services and the scheme collapsed. Then the Public Education Association agitated for a fund to pay medical inspectors and in time got it.

Six or seven pages of the current annual report is devoted to the medical inspection and a plea for trained nurses to follow up the recommendations of the inspectors and induce the parents to get treatment for defectives. Evidently they have found in Philadelphia, what they should have known in advance through the experience of many European and American cities, that medical inspection is largely futile. It would have saved time and patience if they had followed directly the example set by the cities of the older countries and at once instituted medical supervision of schools.

It is doubtful if the use of any number of nurses in this connection will remedy the matter. The state, through its appointed health authorities, must meet the issue and institute thorough medical supervision by competent medical experts, before the health of city school children will receive any real safeguarding or the physical defects of the masses of the children will be detected and remedied insofar as medical science can do this.

The report states that 133,021 children, reported by teachers, were examined. Of these treatment was recommended for 33,283. 12,741 of these were reported as having defective vision. 532 had adenoids. 3,405 were lousey. It has been evident for some time that the Quakers have been scratching their heads-politicallybut the report does not attempt to explain the connection, except to say that 1,695 pupils were excluded on account of head lice. It was often found that parents would not remedy matters when their children were excluded and would make no effort to reinstate them in school. In May one principal reported 55 exclusions which he claimed could have been avoided had there been adequate authorities to follow up these cases and insist on treatment, and immediate return to school.

The report is illuminating and should be of interest to those interested in public sanitation. Miss Dora Keen is the secretary of the association.

Small-pox and Vaccination in Cleveland

We publish elsewhere, page 408, a letter from Dr Rosenwasser, President of the Cleveland Board of Health, which calls attention to the fact that our editorial entitled "Anti-Vaccination Again" (see October JOURNAL) does not bring out the true situation in as strong relief as the published report of the City