As a result of the health survey, it is expected that the local health department will be completely reorganized on a departmental basis, and that many important municipal health activities will be established. The East St. Louis survey is the sixth important survey to be carried out by the State Department of Health during the past two years. On the completion of the East St. Louis survey a similar survey will be made in the city of Alton.

POSSIBLE RECURRENCE OF INFLUENZA

In view of the recognized possibility that influenza will recur in epidemic form during the coming autumn and winter, extensive plans are being made by the State Department of Public Health and by the Amercan Red Cross to adequately meet all of the needs of such an emergency. The American Red Cross will be prepared to furnish nurses to be sent into communities which may be afflicted and will also have on hand supplies which may be necessary for the establishment and equipment of emergency hospitals.

The State Department of Public Health is arranging for the mobilization of medical emergency forces and contemplates the employment of local physicians for this purpose under the State and county collaborating health service.

NEW CIRCULAR ON THE CARE OF BABIES

A new thirty-two page circular on the care of babies is being issued by the State Department of public health for free distribution. While somewhat similar to the circular issued in 1917, this pamphlet has been entirely rewritten and contains a large amount of entirely new material. It is expected that the pamphlet will have very wide circulation in connection with the Child Welfare activities which are being promoted in many sections of the State.

PUBLIC HEALTH ACTIVITIES AT THE ILLINOIS STATE FAIR

The health exhibits of the State Department of Public Health at the Illinois State Fair to be held in Springfield during August, will be much more extensive than ever before. The Baby Health Conference which has been a feature of the Fair for a number of years past, is being developed on a larger and broader scale than ever before. Among the special features of the general exhibit this year will be a model nursery, demonstrations of all phases of health work, special venereal disease exhibits for men and women, generous employment of motion pictures and automatic stereopticons and several mechanical devices.

The Director of the Department of Public Health has been made Superintendent of public health for the State Fair, and all of the Division Chiefs will be present throughout" the Fair for the purpose of consultation with visiting health officers and physicians.

A cordial invitation is extended to health officers and doctors to make the offices of the State Department of Health at the Fair grounds their headquarters.

MORTALITY DATA FOR 1918 For the first time in the history of Illinois, accurate mortality figures are now available for public and official information. These improved records are made possible through a more satisfactory vital statistics law and through the higher degree of efficiency made possible under the Civil Administrative Code. From the statistics for 1917 and 1918 that have just been completed, it is found that during 1918 there were 103,138 deaths in the State and that 44,605 of these deaths occurred in the city of Chicago. The death rate for the State as a whole was 16.3 per thousand of population. The deaths during 1918 exceeded those of 1917 by over 18,000, this increase being attributed to a large extent, to the influenza pneumonia epidemic of last autumn which was responsible for 32,334 deaths. There were 17,879 deaths ascribed to influenza and 14,445 due to complicated pneumonia.

It was found that there were 341 deaths in 1918 due to measles, twenty-five times as many as died from smallpox and more than twice as many as died from scarlet fever.

There were 533 deaths from typhoid fever, only 38 of which occurred in the city of Chicago with 495 in the rest of the state. The typhoid death rate outside of Chicago was ten times as high as the Chicago rate. Through adequate consideration of sanitation measures, Chicago has now attained the lowest typhoid death rate of any large city in the civilized world.

Deaths reported from other communicable diseases are as follows: tuberculosis 7,619, smallpox 14, scarlet fever 154, infantile paralysis 144, epidemic meningitis 164, malaria 17, and diphtheria 1,152.

The diphtheria mortality is regarded by the State Department of Public Health as inexcusably high inasmuch as diphtheria antitoxin is supplied free to all persons in the state and is made available through five hundred distributing stations.

COUNTY COLLABORATING HEALTH OFFICERS

The State Department of Public Health is again urging all county medical societies to make nominations of representatives on the state and county collaborating health service with at least one county collaborating health officer in each county. This service has been pretty well organized in many sections of the state, but there are still some counties in which the country medical societies have not acted.

County collaborating health officers will report to the State Department of Public Health and in the absence of full-time medical health officers or in the face of emergency will be called upon to act for the state, compensation being made on a reasonable per diem basis. It is the plan of the Department to have conferences from time to time at which all the collaborating county health officers will be present and where the more recent advances in preventive medicine will be taught and demonstrated by specialists and authorities on these particular subjects. One of the duties of the county collaborating health officer will be to pre

sent to his county medical society the results of these conferences.

MOTION PICTURE FILM SERVICE The State Department of Public Health is now prepared to furnish motion picture films and motion picture machine and operator for the uses of county medical societies. When public meetings are arranged under the auspices of county societies, the Department will assist in every way possible. On account of the large number of requests for this motion picture service, county societies are asked to communicate with the State Department of Public Health as far in advance of their meeting as may be possible so the reservations of machines and operators can be made.

COMMUNICABLE DISEASES FOR JULY During July there has been noted a decided increase in the number of cases of poliomyelitis. The larger number of these cases being reported from Chicago and the Northern part of the state. During the month, five cases of poliomyelitis were reported from Standard, Putnam County, with two deaths. It is an interesting coincidence that the first case of poliomyelitis in the epidemic beginning three years ago was reported from the same town and by the same physician. A rather serious epidemic of scarlet fever developed in Morris, Grundy County, with seventeen cases reported within one week.

Typhoid fever was more prevalent during July in several sections of the state than at any time for a number of years past. A number of cases were reported from Mount Carmel, Allendale, and Bellmont in Wabash County, and at Stonefort, Saline County.

The State Department of Public Health is urging the more general use of typhoid-para typhoid vaccines as means of immunizing against the disease.

Correspondence

WHY NOT A DOCTOR'S UNION?

Chicago, Ill., July 20, 1919.

To the Editor: Free consultations, advice and prescriptions in the columns of the daily press. Free Wassermanns, free salvarsans, free medical treatment of all kinds for the affluent. Pitiful salaries for public medical officers; free medical services to the government, and as yet no free food, free raiment or free rent for the doctor. The doctor pays the same taxes as the next fellow (note the "excess profits tax" of last year) and his funeral is just as expensive as is a layman's. Similar conditions in labor circles would cause a few bloody riots. "Scab" labor is not popular.

But labor soon cures such ills. Why? Because

labor is organized and its votes command respect.

It is true that small groups of doctors occasionally do organize and get behind one or another candidate in election. If these men were asked why, the majority of them could not give an intelligent answer. The interested few would not answer, or at least truthfully. Did any one ever hear of the profession organizing itself politically and getting behind a big principle in the interest of the profession as a whole? Individual doctors get behind candidates for public office, it is true, but rarely on principle. Most of these medical men bob up in politically filled offices later on.

A certain medical gentleman in high political office once said, "The doctors can go to hell.” This gentleman knew the spirit of the public and he also knew the medical profession.

If the doctors of this country ever intend to strike for their rights, now is the time. The profession has just demonstrated that, in the last analysis, it is the most useful of all professions. Governments are so crude and reversionary that they cannot sustain themselves without war, and -no doctors, no army. The government now might listen to us if we hurried.

All of which is purely gratuitous and supererogatory.

Why seek for an esprit du corps in the doctor, who, being the only known organism that has not the instinct of self-preservation, consequently is the humblest creature of which biology takes cognizance.

Not only does the doctor lack the instinct of self-preservation, but he evinces great activity in legislating against himself. N. B. If a practitioner of repute in his own state wishes to practice in another, in which there is no reciprocity, he is confronted with an examination-often at the hands of men who could not even formulate their own questions, much less answer them, without the aid of a medical library. All the same, the United States government drew no lines of discrimination against any state or method of licensing when physicians were needed for the army.

The present trend toward social upheaval suggests that the doctors would better "get in out of the wet." A doctor's union might enable us to pass as "wage earners." This would be a big

Many physicians are refusing to prescribe narcotics owing to the danger and disrepute now attached by law to the legitimate use of these agents. They are doing this even at the risk of the suffering entailed upon their patients in order to compel attention to the necessity for the repeal of a law which places the practice of medicine in this State under a commission like pugilism, race track gambling, vice, and the public utilities.

The following comment appeared in the New York Tribune on July 6, 1919:

"It was also announced by State Commissioner Herrick that summonses for nearly eight thousand delinquent physicians, druggists, and veternarians authorized to dispense narcotic drugs and who failed to register with the State Department of Narcotic Drug Control on or before July 1st will be obtained from magistrates throughout New York State beginning next Thursday. Of the 17,000 physicians, dentists and veterinarians who are required to register, only 8,000 have complied with the law," said Commissioner Herrick. "I attribute the failing of the doctors to re-register to the fact that many are out of town. Some undoubtedly have been careless, but some probably are antagonistic to the law and these must be compelled to conform to the law."

It is said that "ignorance of the law excuses no one but the lawyer."

Commissioner Herrick, a lawyer as well as narcotic drug commissioner, is in error when he states that "doctors are required to register under this law." They are required to do so only in order to prescribe what the law calls habit forming drugs.

JOHN P. DAVIN, M. D.

Last year we called them war gardens. This year. they are peace gardens; and with just as much need for them as there was for the war gardens of 1918.

Playgrounds are always supplied with plenty of fresh outdoor air and sunshine. This is why they are fine for children, who should be encouraged to play out of doors whenever they can.

Society Proceedings

THE CHICAGO LARYNGOLOGICAL AND
OTOLOGICAL SOCIETY

The regular monthly meeting of the Chicago Laryngological and Otological Society was held on Tuesday, December 17, 1918, at the Hotel La Salle at 8:15 p. m.

The Vice-President, Dr. Charles H. Long, in the chair.

Dr. Harry Kahn presented a new otoscope.

Dr. L. W. Dean, Iowa City, Iowa, exhibited a specimen of a brain which showed an abscess of the cerebellum and a tumor at the cerebello-pontine angle. He was interested particularly in the case because it had been possible to positively demonstrate before death the definite symptoms of acute suppuration of the labyrinth and of the cerebellar lesion in the same patient. Operative procedure and post-mortem examination confirmed the diagnosis which was made of the intracranial cerebellar lesion and the abscess as well. The patient had an acute labyrinthitis and a tuberculamo of the angle, with an abscess of the cerebellum.

The diagnosis was based on the presence of nystagmus of two types, the cerebellar and the labyrinthine. There was also a falling in the direction of the lesion irrespective of the position of the head.

Dr. L. W. Dean also presented a paper entitled, "The Proper Procedure for External Drainage of Retropharyngeal Abscess Secondary to Caries of the Vertebrae."

The author stated that since this procedure was demonstrated to him a number of years ago by Professor Prentiss, he had proved to his complete satisfaction both the simplicity and practicability of the operation. In his opinion, not only should every case of retropharyngeal abscess which was secondary to caries of the vertebrae be drained externally, but every case of retropharyngeal abscess should be drained in that way. There was no reason why the operation should cause shock of any importance, even with a child that was suffering from extreme toxemia. By this method the pus discharged externally and not into the respiratory and alimentary tract, where it was liable to do much damage. The external operation was also indicated because of the fact that the infection of the retropharyngeal space extended in to vertical direction, between the fascial planes. It might reach from the basilar process of the skull to the upper part of the thorax. When the external operation was performed, the finger was introduced into the retropharyngeal space and the extent of the abscess cavity could easily be determined. Drainage tubes could be inserted as high up as the base of the skull, or as low as the clavicle if such a procedure was indicated, and the drainage secured in this way was far superior to that obtained from the stab operation on the posterior wall of the pharynx.

The operation did not necessitate the incision of any muscle except the platysma. The incision should extend through skin, platysma and vaginal fascia. No

careful dissection was necessary; it was simplicity itself and could be performed almost altogether with the index finger.

The operation was described in detail and the paper was accompanied by drawings which illustrated clearly the anatomical conditions met with.

DISCUSSION

Dr. Alfred Lewy asked if after they were through the fascia all the rest of the operation was done with the finger.

Dr. Dean replied that he went in with the finger and found the abscess, which was just like a full bag in front of the finger, and then inserted any blunt instrument which would not do a damage and lacerated the sac.

Dr. Harry Kahn was not sure whether he had understood Dr. Dean to say that all retropharyngeal abscesses should be drained externally. In some experience with such abscesses he had used an opening through the mouth, but with blunt artery forceps, as recommended by Abt. His practice has been to make the opening, using the finger first as a guide, and then pressing the forceps into the mass, opening them and allowing the pus to flow out. The child was held with the body raised and the head down. No difficulty had ever arisen from the aspiration of pus. The child was put to bed with the head down and kept in that position until the abscess completely drained. Good results had been obtained by this method, and he did not remember any ill results. The patients recovered in a few days and the glands disappeared. Occasionally a case had required a second stab, and once in a great while a third, but they had had no fatality.

Dr. Robert Sonnenschein understood that the paper referred to cases where there had been caries of the vertebrae and not to ordinary abscesses.

It was important to remember that in retropharyngeal abscesses the pus might be differently located, depending on the origin of the infection.

In the usual cases the abscess arose from infected lymph glands lying in the region of the pharynx. In such instances the pus formed between the prevertebral muscle and the pharyngeal mucosa and tended to point toward the pharynx. The treatment there,of course, was opening the abscess by the usual incision in the throat. But where a caries of a vertebral body was the cause of the pus, and the pus behind the prevertebral muscles and might burrow towards the mediastinum, the operation so well described and perfected by Dr. Dean ought, it seemed, to be decidedly indicated.

was

Dr. Dean stated that the title of the paper conveyed that impression, but that in the course of it he had stated that as the procedure was so simple, in his judgment it was the best, and he was opening all retropharyngeal abscesses by the external route. He did not wish to make this a dogmatic statement because so many men with much experience were doing the internal operation.

Dr. A. A. Hayden thought the presentation of the subject of retropharyngeal abscess that Dr. Dean had given the Society was indeed interesting. The advantage of this method in the treatment of abscesses low down, especially when they were large and accompanied by bone necrosis, was obvious.

Where the abscess was located higher up, however, the old method of incision through the mouth was a satisfactory and safe surgical prosedure, if done under proper precautions. Most important among these were the use of an efficient suction machine and the immediate lowering of the head (if a child, holding up by the heels), so that none of the pu could be aspirated into the lungs to invite a septic aspiration pneumonia.

Dr. J. Gordon Wilson said the Society was indebted to Dr. Dean for the history and post-mortem findings of this interesting case. It presented a distinct lesion of the peripheral end organ of the right VIIIth nerve and a tumor of the right cerebello-pontine angle with changes in the cerebellum. There was a combination of cerebellar nystagmus and labyrinthine nystagmus. It was now generally accepted by physiologists and neurologists that the cerebellar and labyrinthine types differed, as Dr. Pike and Dr. Wilson demonstrated some years ago. the labyrinthine nystagmus one saw the slow quick type and

In

in the cerebellar the ataxic type. The difficulty was that in so many of the clinical cases of tumor there was a combination of the two. This case showed how a careful observer could arrive at a clear view of what was present. Dr. Wilson had for many years used glasses of 18 diopters to cut out fixation and more easily differentiate the two types. Dr. Dean was puzzled as to why the patient lay on the right side, but it might be assumed that he was most comfortable on that side-that there the vertigo was at its minimum. Dr. Wilson recalled to Dr. Dean's attention his experimental findings were (a) the left half of the cerebellum was removed and (b) the left labyrinth was removed. As a rule, in the former the animal preferred to lie on the right side and in the latter on the left. This case furnished interesting information which, as Dr. Dean showed, must be interpreted in the light of physiological knowledge.

Dr. Wilson never had been called on to operate on a case of caries of the vertebrae. However, within the last two years, as an otologist, he had been able to diagnose two cases of early vertebral caries on account of pain in the ear. It should not be astonishing to find that pain in the ear might be an early symptom of caries, since fibers of the second cervical nerve are distributed to the region of the ear.

Dr. Otto J. Stein was reminded by Dr. Wilson's remark concerning pain in the cases of beginning vertebral caries of a case he had of retropharyngeal abscess due to middle ear involvement, which was a well known condition, but he did not believe it had been touched upon. It was possible for such an abscess to form behind the vertebrae, where it could dissect its way down, following the canal and going in behind the fascia. That type of abscess should be borne in mind in these cases. He complimented Dr. Dean upon his method of procedure and thought it was one of the greatest advances in the treatment of retropharynbeal abscesses. He considered the points brought up by Dr. Wilson exceedingly interesting.

Dr. Robert Sonnenschein asked whether Dr. Dean curetted the bodies of the vertebrae.

Dr. Charles H. Long inquired as to whether any effort had been made to determine the cause of the caries and how long it took for it to clear up.

Dr. Dean, closing, said his only excuse for giving this paper at this time was because a recent article in an English Journal had seemed to him so erroneous. He had had it in mind for

three or four years and after reading this article had decided to present it at this time. All of their cases had been secondary to bone tuberculosis and came from the orthopedic department, where they had been treated for that disease. They had not curetted the bodies of the vertebrae in any case, but simply inserted the drainage tube. Most of the cases had disappeared from their service or had died with the usual symptoms. The fact that these did not clear up, but kept constantly discharging illustrated to him the necessity of doing an external operation for tuberculous processes. He had seen cases of tuberculous caries that had been opened into, that for months and months continued to discharge tuberculous material into the pharynx, which was very bad for the patient. A sugges tion was made that they go to the bottom of the abscess. When they go in they find that they can go to the top and bottom with the finger, and sometimes drainage tubes were placed both up and down. Very frequently the abscesses extended much further than was suspected preceding operation.

Dr. Austin A. Hayden read a paper entitled "The Ear, Nose and Throat Examinations of Aviators, With Special Reference to the Technic of vestibular Reaction."

The report was made for a two-fold purpose:

(1) To give those who expected to do the work some of the more importan technical details that had been elaborated and which had enabled them to carefully examine as many as sixty applicants in a single day.

(2) To further stimulate interest in the functional tests of the semi-circular canals. This field. though

old, had never been widely explored until the war created a national demand for the work Jones had systematized and put to practical use.

The applicants had been almost without exception the finest type of red-blooded young American manhood and the percentage of rejections had, consequently, been very small. There was no malingering to escape service, but many had tried to "get by" with disqualifying defects.

The routine eye, ear, nose and throat examination embraced the history of any ear, nose and throat trouble, including head injuries and dizziness from all causes; examination of nose, throat, naso-pharynx, external auditory canal, tympanic membranes, cochlea; test of hearing by whisper and watch; semi-circular canals, equilibration by rotation tests, caloric tests, nystagmus, vertigo, past-pointing, falling. These examinations were most carefully carried out. Tonsillectomies were required of three classes of men: (1) Those who had had recurrent tonsillar infections as often as once a year. (2) Those whose tonsils were obstructive. (3) Those from whose tonsils free pus could be expressed in considerable quantities. On this basis about 5 per cent of the men were operated upon.

For hearing 20/20 was required for the high and low whispered tones and 40/40 was considered normal for the watch, or possibly a smaller fraction if the whisper had showed fill 20/20.

Both spontaneous and induced nystagmus were tested for, the nystagmus referred to being the afternystagmus of the second degree. No after-afternystagmus has been seen. Pierce had observed that nystagmus stopped with vomiting. The author, in douching etherized patient's ears, had seen the ocupar deviation disappear when emesis occurred.

In counting and recording past-pointing, the following sources of error were noted: (1) Fast-pointings; (2) cross cutting; (3) preconceived ideas as to just how the pointing should be done; (4) prolonged turning. Strict silence and rigid discipline aided greatly in doing rapid, accurate work.

Of the 3,748 applicants only 142 were rejected for abnormalities of the Kinetic Static Sense; of these 118 failed in past-pointing, 17 in 'nystagmus and 7 in falling; 22 men were nauseated and 31 more vomited. Of the total number examined 692 were rejected as being unfit to become flyers, while 3,056 were pronounced about 100 per cent physically perfect by the examining unit. The disqualification percentage for all causes was 18.04 per cent.

It was decided to hold a special picnic meeting at Bernnadotte at a time to be set by the president and secretary later.

On motion the secretary was instructed to invite Dr. Adkins and companion, the officers of the County Red Cross Society, the officers of the County Tuberculosis Association and the County Sanatorium Committee to the Special Meeting at Bernnadotte.

A communication from the National Health Service was read conveying the information that this service was prepared to take care of any disabled soldiers, sailor, marine or military nurse who required hospital care and physicians were requested to notify them of any such patients that came to their notice.

Dr. Davis, of Avon, gave an excellent paper on "The Practice of Medicine in the Country," which was freely discussed.

A unanimous vote of thanks was tendered Drs. Adkins and Davis.

Dr. Adams moved that a County Fee Bill be adopted. Carried.

On motion the President appointed the following to draft a County Fee Bill and report at the Annual Meeting in October, Drs. Adams, Chapin, McCumber, Crouch, and Connelly.

Fifteen members and two visitors were present.
D. S. RAY,

MADISON COUNTY.

Our June Meeting.

Secretary.

The Madison County Medical Society met at Elks' Club, in Granite City, on the afternoon of June 6, 1919, with President Dr. Chas. R. Kiser in the Chair. Seventeen members and three visitors were present. The minutes of the last meeting were read and approved. Drs. James E. Watson and Maurice R. Williamson, both of Alton, were elected to membership.

An invitation from Dr. Geo. A. Zeller, to hold a meeting at the State Hospital, was unanimously accepted for the afternoon of June 27, 1919. Senator Bardill's letter on osteopathic legislation was read and ordered filed.

. Dr. B. H. King made a report of a visit made by him and Dr. Chas. R. Kiser, to the legislative committee with reference to the chiropractic bill and expressed the conclusion that vicious legislation could only be fought with a legislative fund. The report of our State Delegate, Dr. W. H. C. Smith, who' was unavoidably absent, was read by Dr. Mather Pfeiffenberger, of Alton. This report was published in the Madison County Doctor. Dr. Berry and Dr. Schroeder made verbal reports of their observations at the meeting. of the State Society.

It was announced that Dr. John H. Siegel was a patient in St. Anthony's Hospital and that Dr. J. W. Scott was seriously ill at his home. On motion of Dr. Pfeiffenberger, the secretary was instructed to send to each a message of heartfelt sympathy with our very best wishes for a speedy recovery. It was