ginning of the small-pox outbreak, vaccine points of a standard make were employed extensively. In a large number of cases, small-pox in a virulent form occurred among patients who had been vaccinated with points. This shows that the inflammatory reaction which took place at the site of vaccination was due to staphylococcic infection and was not true vaccination.

From Philadelphia, Indianapolis, Chicago, Gloucester Co., Va., Pittsburg, Allegheny, Standwood, Ia., Lisbon, Ia., and over forty small towns thruout the country responses to inquiry show that while no accurate records were kept the glycerinized vaccine, in comparison with points, had proved so superior in producing successful vaccinations (averages from 90 to 95 per cent.) and in affording freedom from septic complications, that points had been largely abandoned in those places in which comparative tests had been made.

In Porto Rico, under the supervision of Dr. George G. Groff, Major and BrigadeSurgeon U. S. A., extensive vaccination was practised. Vaccine points in this climate failed entirely while glycerinized vaccine yielded about 90 per cent. of successful vaccinations.

Dr. R. T. Hammond, Jessup, Md., had vaccinated 236 patients with glycerinized lymph and had but one failure; no excessively sore arms resulted.

A series of 70 vaccinations in private practice in Indianapolis, with glycerinized lymph, showed successful takes in all but one case. No septic complications.

Dr. F. V. Ely, Pittsburg, secured 36 successful takes in a series of 40 vaccinations with glycerinized lymph. This is remarkable, inasmuch as at least one-third of these cases were secondaries.

Dr. F. A. Crosby, Beach Ridge, N. Y., reports 100 per cent. successful vaccinations with glycerinized lymph in a series of 60 cases. Sore arms were not noted.

Dr. G. G. Rusk, Baltimore, vaccinated 360 persons with glycerinized lymph and obtained a successful "take" in every instance.

Dr. C. T. Mattefeldt, Catonville, Md., employed glycerinized vaccine in a series of 157 cases, 20 per cent. of which were secondaries; 155 successful vaccinations resulted.

Dr. D. W. Dodson, Nanticoke, Pa., reports that in a series of 250 cases he secured 100 per cent. successful vaccinations with glycerinized lymph.

Dr. J. R. Faust, Mann's Choice, Pa.. vaccinated 130 school children and teachers, every one of which was successful.

Dr. A. J. Taylor, member of Board of Health, Caribou, Maine, reports 200 primary vaccinations with 30 failures; of the latter 27 were vaccinated with 14 successful takes. This experience shows the value of revaccination in those cases in which successful results did not follow first vaccination. The average in this series of cases was over 90 per cent. successful "takes."

Dr. W. F. Beyer, Punxsutawney, Pa.. vaccinated 300 cases, primary and secondary, and secured 98 per cent. successful "takes "-in other words, there were but six failures.

A large number of other private reports show that glycerinized lymph yielded from 90 to 100 per cent. of successful takes in primary cases and from 60 to 75 per cent. in secondaries.

Conclusions: This investigation proves conclusively that the recommendation of the United States Marine Hospital Service that "glycerinized vaccine only should be employed" ("Public Health Reports," January 9, 1899) is well substantiated by experience, because:

1. Properly prepared glycerinized vaccine is pure and free from staphylococci, streptococci, and other pathogenic organisms which are invariably found (Copeman, Crookshank, Pfeiffer, Reed,U. S. A.) on vaccine points.

2. Glycerinized vaccine affords absolute protection against small-pox; vaccine points are uncertain in this regard.

3. Vaccination with the glycerinized products does not cause excessive inflammation of the vaccinated area. Cellulitis and inflammation of the lymph vessels and glands, amounting at times to abscess formation, is a not infrequent sequence of the use of vaccine points.

4. Vaccine points are apt to lead to a false sense of security, inasmuch as they induce a local staphylococcic or streptococcic infection which is entirely distinct from true vaccination. Such a result is not protective against small-pox.

5. A high estimate of successful takes from vaccine points, is by these and numerous other reports shown to be not over 60 per cent. in primary cases and a much lower percentage in secondary cases.

6. Glycerinized vaccine has been officially adopted by the governments and health authorities of the United States,

Great Britain, Germany, France, Russia and Belgium. It should be universally adopted in private practice.-A. C. Barnes, M. D., Philadelphia.

Book Reviews.

A Text-Book of Diseases of the Nose and Throat. By D. Braden Kyle, M.D., Clinical Professor of Laryngology and Rhinology, Jefferson Medical College; Consulting Laryngologist, Rhinologist, and Otologist, St. Agnes Hospital; Bacteriologist to the Philadelphia Orthoepedic Hospital and Infirmary for Nervous Diseases; Fellow of the American Laryngological Association, etc. With 175 illustrations, 23 of them in colors. Philadelphia: W. B. Saunders, 925 Walnut Street. 1899. Price in cloth $4, and in sheep and 1⁄2 morocco $5. Net.

This is the best book for the general practitioner we have ever seen on these subjects. Paper is good, cuts superb, and typography perfect. His classification is unusual, "according to the pathological alterations;" and this necessarily causes some repetition. In treatment he is lavish in prescriptions and methods, and this feature will be appreciated. He has, moreover, "endeavored to be specific for definit conditions." For examinations, "the method of Garcia and Turck is best, but not practical, since sun rays cannot always be obtained. The Welsbach light is the best." He believes, contrary to most practitioners, that the hand atomizer is capable of as good work as the comprest air apparatus. He objects to the term "catarrh,' and then unconsciously uses it himself thruout the book. Catarrh does not "run into consumption;" "disease, like tissue, never changes type." His plan of placing tablets of sodi chloridi in the nostril until dissolved is new. For an acute cold he recommends cleansing and protection; depletion by contraction; heat and a purgative. Ozena is not in any sense a disease in itself; it is but a symptom. In glanders, "while the curative effect of Mallein is still doubtful, it should be employed." He does not like "the narrow, slit-like nasal cavity," and says where many think they have inherited certain diseases it is only the family nose they have inherited. In diphtheria he advocates the energetic use of local measures in addition to heroic antitoxin dosage. Only one page, without cuts, is devoted to direct inspection of the larynx. Eight pages, with an excellent cut, are devoted to intubation. The same space is taken up in discussion in tracheotomy. Chapter XXIII, on "Operations on the Larynx," has been written by Prof. W. W. Keen. It comprises but six pages. The author is at times startlingly original; for instance, when he recommends nasal douches of milk with the addition of sodium chlorid; and again when pledgets of cotton, saturated with coal oil, are advised to soften inspissated nasal secretions. The work has 614 pages, and a good index. general excellence is such that it will attract attention; and the true merit which it possesses will secure for it an immense sale.-A. L. R.

Its

The Medical Council Physician's Pocket Account Book. Designed by Dr. J. J. Taylor. Price, $1.00. Publisht by the Medical Council, Twelfth and Walnut streets, Philadelphia, Pa.

This book is the author's idea of a convenient

It can be produced in court to prove an account against a decedent's estate or to prove for the estate of the deceased physician himself the several accounts against those who employed him in his practice, This is because it provides for the complete entry of services in plain language and not in hieroglyphics. The physician who has had experience in the courts will appreciate this fact.

It consists of 162 pages, including cash book and obstetric record. Each page is devoted to one principal account. It may begin at any time, not being restricted to any given week or month, and will continue until the account is closed or the page is exhausted, when it may be carried over to a subsequent page. No posting into a ledger is required. The condition of each account is always shown at a glance.

Following each account is a brief acknowlledgment of the correctness of the account, constituting a due bill, which being signed by the debtor, bars all further dispute of the account. The physician will have some of these signed as a settlement at the close of a series of protracted or complicated services, others at regular periods, others not at all, according to the individual peculiarities of his patrons. It is merely a safeguard, to be made use of or not at his discretion.

When the book is exhausted, another can be opened in regular sequence. For this purpose the leather binding is made so that it can be readily detacht, the manilla-bound book itself filed away in the desk or safe and another one securely inserted. For this purpose the subsequent books, securely bound in manilla boards, cloth back, same size and identical in every way with the first one, will be sold for 30 cents each or four for $1.00. The leather binding will wear for two or three years. For many physicians one inside book will last a year. For a busy practice it may take three or four. We believe this book will be found convenient and practical for the every-day practitioner, and that it will save himself and his estate the loss of many accounts.

An American Text-Book of Diseases of the Eye, Ear, Nose, and Throat. Edited by G. E. DeSchweinitz, A.M., M D., and B. Alex. Randall, M.A., M.D., Ph.D. Illustrated with 766 engravings, 59 of them in colors. Philadelphia: W. B. Saunders, 925 Walnut Street. 1899: Price $7 net in cloth, and $8 net in sheep or 1⁄2 morocco.,

The book has been written by sixty eminent men, each a recognized authority. It is offered to both practitioner and specialist, with the hope that it will be a "good introduction for the beginner, a valuable handy reference book for the practitioner, and at least quicken some weakening memories in the advanced specialist." "Each author is responsible for the statements and opinions in his article." "Occasional editorial comment is always suitably markt." The effort to combine four specialties in one volume is defended. "Specialism has often been carried much too far in the exclusion of attention to the adjacent fields." Some feature not commonly found in such works are "standards of form and

color vision required in railway service," "the Roetgen rays in ophthalmic surgery," "the practice of ophthalmic operations on animal's eyes," and "the most important micro-organisms having etiological relationship to ocular disorders." The first chapter, on the embryology, anatomy, and histology of the eye has been written by Piersol, and every one who knows the man personally or by reputation will know that it has been written thoroly and exactly right. He covers 70 pages. Brubaker covers the General Physiology of Vision in 13 pages. Dennett and Cutler write on General Optical Principles in 41 pages. DeSchweinitz himself writes on Examination of Patient, and External Examination of Eye and Functional Testing, in 28 pages. Randall on The Ophthalmoscope and its Use and the Normal Eye-ground has 24 pages. Jackson on Methods of Determining the Refraction of the Eye, and Normal and Abnormal Refraction has 39 pages. Spectacles and their adjustment, by Phillips, 5 pages. Diseases of the Eyelids, by Millikin, 20 pages. Diseases of the Lachrymal apparatus, by Theobald, 13 pages. Diseases of the conjunctiva, by Weeks, 31 pages. Diseases of the cornea and sclera, by Burnett, 26 pages. Diseases of the iris, ciliary body and choroid, and sympathetic inflammation and irritation, by Randolph, 39 pages. Injuries of the eye and its appendages, by Hubbell, 27 pages. Glaucoma, by Lippincott, 13 pages. Diseases of crystalline lens, Hopkins, 12 pages. Diseases of the vitreus, Carrow, 6 pages. Diseases of retina, Howe, 27 pages. Diseases of the optic nerve, Gifford, 25 pages. Amblyopia, amaurosis, and disturbances of vision without ophthalmoscopic change, Wood, 13 pages. Amblyopia of the visual field, scotomas, and hemianopia, Wurdemann, 19 pages. Intraocular growths, Holden, 8 pages. Movements of the eyeballs, Duane, 26 pages. Injuries and diseases of the orbit, Buller, 36 pages. Operations, by seven authors, cover 64 pages. Appendix, 11 pages. Part second, the Ear, is treated in the same way, and by writers of equal prominence. Part three, the Nose and Throat, follows same lines. A critical review in any reasonable bounds is impossible. The work will hold its own with the others in the American text-book series. One somehow feels that it ought to have been issued in four volumes.-A. L. R.

A Text-Book on Practical Obstetrics. By Egbert H. Grandin M.D., Gynecologist to the Columbus Hospital: Consulting Gynecologist to the French Hospital; late Consulting Obstetrician and Obstetric Surgeon of the New York Maternity Hospital; Fellow of the American Gynecological Society, etc. With the collaboration of George W. Jarman, M.D., Gynecologist to the Cancer Hospital; Instructor in Gynecology in the Medical Department of the Columbia University; late Obstetric Surgeon of the New York Maternity Hospital; Fellow of the American Gynecological Society, etc. Second edition. Revised and enlarged. Illustrated with 64 full-page photographic plates and 86 illustrations in the text." 65x91⁄2 inches. Pages xiv-461. Extra cloth, 84 net; sheep. $4 75 net. The F. A. Davis Co., Publishers, 1914-16 Cherry Street, Philadelphia.

The book contains too many illustrations, or rather contains many unnecessary illustrations. It would seem that "washing the eyes immediately after delivery" and "dressing the umbilical cord" and "clamping the cord and cutting between the clamps" etc., are superfluous. Others

of the cuts are decidedly valuable to the student. A number, illustrating the application of the forceps, have been taken from life. All the various presentations are illustrated by infantile cadavers and pelvic bones. The authors advocate obstetrical anesthesia; chloroform for ordinary. and ether for operative cases. The Goodell method of relaxing the perineum by drawing the rectum forward by traction with the finger is illustrated by a cut taken from life. Speaking of vomiting of pregnancy, they mention a point not often found in text-books. "In rare instances, by a curious coincidence, the sign fails to appear at all in the woman, but is present to a marked degree in the husband." Quite a number of illustrations are taken from photographs on the manikin. The various instruments used in craniotomy are shown in cuts. Nine pages are devoted to ectopic gestation. The book contains nineteen chapters, ten of which are devoted to obstetric surgery. The Schultze and the Byrd-Dew methods of artificial respiration in the new born are well illustrated. The authors prefer digital to instrumental pelvimetry. The statement that "there are many undoubted instances of protraction of pregnancy beyond the 320th day after the supposed conception" is rather indefinit. The work will serve a good purpose for those who have not had the advantages of clinical experience, or who have not been instructed in the various obstetrical procedures on the manikin.-A. L. R.

Diseases of the Ear, Nose, and Throat and their Accessory Cavities. By Seth Scott Bishop, M.D., DCI, LL.D., Professor of Diseases of the Nose, Throat, and Ear in the Illinois Medical College; Professor in the Chicago Post-Graduate Medical School and Hospital: Surgeon to the Post-Graduate Hospital, one of the Editors of the Laryngoscope, etc. Second edition. Thoroly revised and enlarged. Illustrated with 94 chromo-lithographs and 215 half tone and photo engravines. 6x9 inches. Pages xix-554. Extra cloth. $4 net: sheep er half-Russia, $5 net. The F A. Davis Co., Publishers, 1914-15 Cherry Street, Philadelphia.

This book has been written for the student and general practitioner. All the specialties should be covered in the same way. Something intermediate between the quiz manuals and the encyclopedias are what the general practitioner wants, and Dr. Bishop has met the requirements well. This edition is improved by the addition of chapters on the "Related Diseases of the Eye and Nose," and Life Insurance Affected by Diseases of the Ear, Nose, and Throat." Illustrated articles on autoscopy and pachydermia laryngis have been added. Many new half-tones and colored drawings have been made specially for this edition. The book only claims to be "a key, or introduction to the exhaustive treatises already in the field." The first chapter discusses the question whether occupation, age or sex have any great influence in etiology; the conclusions seems to be that they do not. "Dust and cold damp air are largely responsible for the wide-spread existence of naso-pharyngeal catarrh among Americans." He does not believe that "baldness" has any predisposing influence. "Our climate is rugged, but the people born and reared in it do not seem to partake of its robust character." He prefers the Politzer to the Valsavian method of inflation, and denies the probability of there being any real danger of tympanic rupt

ure in employing it. He does not hesitate to recommend proprietary remedies, resinol and bromidia being specially referred to. After trial of silver nitrate, zinc sulfate, salicylic acid, europhen, dermatol, alumnol, iodol, yellow pyoktanin, nosophen and aristol in chronic suppuration of the middle ear, he prefers the two last named, as a general rule. In mastoid disease he advises palliative measures first; ice bag, counter irritation and leeches. These failing, "any wellinformed surgeon, after sufficient practice on the cadaver, can perform the operation with safety and success if he follow closely the rules laid down." Of all devices to assist the hearing only two have proven of actual practical value in my experience; the conical conversation tube and the London horn." In laryngeal examinations he suggests coating the mirror with liquid soap and then polishing dry, to prevent the breath of the patient from interfering with the image. This plan is better than heating mirror. "Cocain has no place in my practice except as an anesthetic in surgical procedures." Heredity and nervous temperamentts are declared the predisposing causes of hay fever, and dry hot air or cold damp air, infusoria, dust, gas, electric and sunlight reflected from snow the exciting causes. He has "broken it up" by directing treatment towards the uric acid diathesis. His nasal support, for use when the bones have been destroyed, is unique. He does not use a local anesthetic in tonsillotomy. The book closes with a number of prescriptions and methods of recording cases. The first edition was good; this one is better.-A. L. R.

No one interested in dermatology should be without the "Atlas of Diseases of the Skin" translated from the German of Franz Mracek of Vienna and edited by Prof. Henry Stelwagon of this city. Instead of the usual clinical and etiologic methods of diagnosis, the plan of the book seems for the most part based on histologic appearances, a most excellent plan of differentiation when we consider the difficulties of diagnosing skin affections closely resembling each other in gross appearance but requiring different methods of treatment. The directions for treatment are concise and up-to-date and a large number of well selected formulas are given. Too much praise cannot be accorded to the illustrations which comprise sixty-three colored plates and thirty-nine full page half-tones. B. Saunders of this city, the publisher, is to be congratulated on producing a volumn unexcelled for merit, and unequaled for cheapness.

W.

same price. A lofty view of the creative power, and resulting parenthood, is here presented.

Our Monthly Talk.

"We don't want theories; we want facts." How often we hear this, yet somebody must proceed on theory alone, else we would never make any progress. Theory must be proved or disproved by trial. Doctors have reason to know this better than any other class. They know that theories must be tested by trial, and this theorizing and trial make medical science a progressive science.

Concerning new ideas in government, people ask, "has it ever been tried ?" and they usually say, "it won't work ;" "it is a visionary dream;" "it is impractical nonsense," etc.; and doctors are just as ready as other people to make these remarks, well knowing that many things in medicin that may have seemed "visionary" when first proposed have proven to be of incalculable value in practice.

Perhaps you think, when you have read thus far, that I am about to propose some new political theory. No, I am not. There are plenty of facts to present.

A short time ago, in this city, Hon. Jno. A. Cockburn, formerly Premier of South Australia, spoke before the American Academy of Social and Political Science on "Recent Extensions of the Sphere of State Activity.* The audience was large, and its intelligence may be judged by the fact that it consisted of the members of the Academy and their specially invited friends.

The speaker began by stating that he did not intend to bother his hearers with theories. He would confine his remarks to a plain statement of facts.

The Home is the Basis.

He then told how they had come to realize that the establishment of homes is the best way to build a nation. Every man must be given an opportunity to establish a home, which should be permanent. We all know how, under the system of unlimited ownership of land, the land of a country gradually accumulates into the hands of a few. They have adopted the lease system, by which the government leases land to settlers, the lease being permanent, or for a long term of years. In this way the purchase money remains in the hands of the settler as his working capital, with which to buy horses, cattle, tools, etc. How much better this is than for a settler to spend his all for his land, and then perhaps have to mortgage his land in order to get the stock and tools necessary to farm the land. His title is equally as good as tho he had purchast the land, and the yearly rental is but little more than taxes would be. The State is the landlord, and this fact makes the farmer a more intensely interested citizen than he would be under our individualistic system, and the State cares more for him and his prosperity than is the case under our system. He can't sell or mortgage his land, as he could if he owned it out-right, but he has

*By the way, Mr. Cockburn is an M. D., and he spoke to me in the highest terms of some American medical books extant fifteen years ago, before he went into politics.

the perpetual use of it, hence he stays on it, and the ownership of the land does not gravitate into the hands of a few. Sagacious statesmanship seeks to make it easy for every citizen to establish and occupy a home, and to secure that home to him and his family perpetually. The South Australian System seems to do that very successfully. Out of a total of 578,192,000 acres, only 19,508,178 acres have been "alienated," or sold. Under our system practically all of our vast domain has become "alienated," and the number of tenants (with private parties or corporations, not the State, as landlord) is increasing every year. The home is the foundation of a nation; the land is the foundation of homes. Few landlords (generally non-resident) and many tenants make a poor and discontented nation. With the land so controlled that it may be occupied in small tracts as permanent homes for actual settlers, under perpetual or long term lease from the State, prosperity is sure to result if it can possibly be dug out of the ground-and that is where all prosperity must originate.

Even this liberal land policy will not give homes to the destitute. Then what must be done with this class? In Europe, and also in most other parts of the world, in the pre-national period, people lived in village settlements. Each family was allotted a certain plot of ground, which it tilled year after year, not wishing to "buy" more ground from neighbors, and never dreaming of "selling" their home plot. Hundreds of millions of people have lived happy, contented lives in this way in the early history of the world. It occurred to the statesmen of South Australia that if idle hands and idle lands could be put together, something better than pauperism must result. In 1894 the government began the establishment of village settlements, aiding the people to get a start at first, and aiding in the government when necessary. In March, 1899, it was reported that seven of these villages were prospering, having under successful cultivation 6,585 acres, including 290 acres of orchard and 119 acres of vines. The members of these settlements hold their instruments of production-land and machinery-in common, and divide equally the proceeds of the cultivating of the soil. This is a suggestive plan for the disposition of our "army of the unemployed” during hard times.

Government Railroads, Banks, etc.

He spoke of State ownership of railroads, telegraphs and telephones as a matter of course. Their great distances, and the interest of all in the prosperity of all, has rendered it a necessity that these public utilities should be conducted impartially for the service of all. I suppose that he regarded our system of private ownership of these things, and their management for private profit, as fifty years behind the times. These important public agencies, particularly the telegraph, are government owned and operated nearly all over the civilized world. The telegraph is left in private hands only in Cyprus, Bolivia, Honduras, Cuba and the United States. This is the company we are in, in this respect. Our large metropolitan newspapers are served with news by the Associated Press. The As

sociated Press depends upon the Western Union Telegraph Co. for its telegraphic service. I am told that no paper can get this service unless it agrees to not advocate Government ownership of the telegraph. A metropolitan newspaper without the Associated Press dispatches cannot present the news; so with this light it is easy to understand why Government ownership of the telegraph has been a smothered issue.

He said that he supposed he would have to speak of his next point "with bated breath." I suppose he had read in some of our capitalcontrolled newspapers that our Government should "get out of the banking business." He said, "and we have a Government bank." This, like the other extensions of state activity, bad resulted from necessity. Farmers were charged exorbitant interest rates, and the rates varied greatly in different parts of the province. The statesmen there seek to serve the interests of the industrial classes. They saw that their farmers could not retain their homes and prosper while paying exorbitant interest rates. The Government bank was establisht, offering loans on good security at low rates, and this not only brought down the rates charged by private capitalists, but it equalized the rates all over the province. Only good has resulted. The losses of the Government from bad loans and non-payment of interest have been so trifling, that no one considers them an argument against the system. The idea that it is the duty of the Government to serve the interests of producers--the most useful class in any community-is deservedly gaining ground. Our statesmen seek to serve the interests of speculators and capitalists (witness the bond sales in 1894-1895) and let the individual producer take care of himself-if he can. This makes a nation of renters and capitalists. It is much better to have a nation of home owners, the Government being the capitalist.

This principle, the protection of the interest of the individual producer in his home, capital under the management of the Government serving him at the lowest rates, is till further illustrated in the following:

"With the view of assisting the producer to find a profitable market, a state export department was in 1895 organized by the Government. Thru its agency the world's markets for fruit, frozen meat, and dairy produce have been made accessible to the farmer. The little rivulets of produce from the farm and garden are collected in a receiving depot at Port Adelaide; there they are subjected to inspection by experts. All inferior articles are rejected; but produce which comes up to the standard of quality receives a stamp of approval and is prepared for shipment. Insurance, freight, and sale are, if so desired, arranged by the department at lowest wholesale rates; so that all the farmer has to do is to forward his produce and await the receipt of his check, secure in the knowledge that his interests in the distant markets are closely watcht and guarded by responsible officers, and that the highest possible profit is secured to him. By means of the facilities afforded at the depot an export trade in early lambs has been created, and it is gratifying to note that the quality of the consignments this year has been reported by exports to be equal to anything that reaches the London market. The export department has proved especially useful in bringing South Australian wines under the notice of the British public. All wines exported thru the depot are inspected and analyzed, and, if, found suitable, are certified as sound and pure. On arrival in London they are stored, and. if necessary, blended and treated at the Government bonded store. They are placed on the market under the name of the "Orion" brand. Australian wine is rapidly finding favor in the eye of the public, and is especially valued by physicians on account of its purity and, in the case of the red wine, on account of its health-restoring qualities, due to a high percentage of iron in its composition. I cannot pass from this subject without alluding to the ability with which Mr. E. B.