PHARMACOLOGY. OFFICIAL REPORT ON ACETANILID MIXTURES. The following report has been approved by the To the Council on Pharmacy and Chemistry of the In response to the request of your chairman we have Specimens of the articles were bought in different cities in the open market, and in original, sealed pack- Soda and ammonia, combined with carbonic acid, are calculated and reported as sodium bicarbonate and as ammonium carbonate (U. S. P.), respectively. Salicylic acid is calculated and reported as sodium salicylate. According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients 43. 21. 20. Internal measurements of the pelvis: Inches. ADVANTAGES OF A LOCAL MEDICAL CLUB Gentlemen-I have been asked to give a few of Personally I am extremely gratified to have so many of the profession here to-night. I think that the social spirit manifested by coming out to the little repast which has been furnished is a pretty good indication of the attitude of the mem- bers of the profession toward this question of or- It may seem to some that with the number of county and State medical bodies in existence Read at the inauguration of the Medical Club of Middletown, present in other cities than our own to find that there does exist a very evident need of such local union among men working in the same profession. Of course, cities of any considerable size have their academies of medicine, physicians' clubs, etc., but there are smaller cities which have some sort of local combination for mutual protection and scientific advancement. Our sister city of Newburgh has long maintained a very excellent society of this kind, even in the presence of two county medical bodies. It is an evident fact that no movement of this kind arises unless there exists an actual need for organization. It has seemed apparent to some of us that the time is now ripe for some sort of a medical club or society in Middletown and vicinity. I believe that the first mention of this matter was made while Dr. Stivers, Dr. Shelley and.myself were en route to the annual meeting of the State Society on February 1, 1905. We all agreed that it would be an excellent plan for Middletown to have a local society. Dr. Shelley especially suggested "something to eat" as a means of promotion of good fellowship. Since that time we have talked to a number of men, and all seemed to agree that some plan of organization would be a good thing. Only recently the clergy of this city formed a ministerial association, and hold meetings at which a dinner is usually served, and personally I do not see any reason why the medical fraternity of this city cannot do likewise. It remains for me to give you as briefly as I can a few ideas of the possible advantages which would be enjoyed if we had such an organization in this city, to suggest and elicit points for discussion, and, after all have expressed their opinions upon the subject, whether of a favorable or unfavorable character, to possibly obtain an expression as to whether we can organize the profession along the lines laid down in the discussion, and possibly to elect officers and a committee to draft a set of by-laws. The evident advantages of a local society such as I have in mind are these: First. The advancement of scientific knowledge by frequent meetings, papers, cases, discussions, post-graduate instruction by members of other societies in other cities, either by clinics or papers, or demonstrations. Second. The promotion of good-fellowship, confidence and social spirit among the local members of the profession, and also among the families of those represented. Third. The education of the profession and laity in regard to what are the requirements of professional ethics by a more careful observance of its provisions among ourselves and proper instruction of the public by furnishing them with copies of the Principles of Ethics of the American Medical Association, as well as fre quent and pertinent articles in the daily press or by personal explanation of these requirements. Fourth. Prevention of the abuse of our hospital privileges by those perfectly able to pay for services. Fifth. Possible maintenance of a circulating library of medical books and magazines for the benefit of our members. Sixth. Prevention of counter-prescribing by the druggists of this city and the possible establishment of a stock company drug store by the physicians where prescriptions will not be substituted and strictly ethical drugs dispensed, patent and proprietary medicines to be excluded. Seventh. The establishment of a chemical and bacteriological laboratory for the rapid diagnosis of disease either at the hospital or elsewhere, to which all members of the profession could bring specimens for examination. Eighth.-Education of the public as to all matters affecting the health of the city and cooperation with the local health authorities in these matters. Ninth.-Supervision of the local press by a press committee as to the character of the advertising matter appearing therein, which, as is well understood, is often of very questionable nature; and also to suppress medical advertising through its pages. Tenth.-Aiding in securing the passage of proper legislation for the medical profession in city, county and State affairs. Eleventh.-Protection of the profession against the growing evil of contract practice, which has ruined the profession in many of the European countries, as well as the proper regulation of life insurance fee. Twelfth.-Protection of members from delinquent debtors by keeping a list of "dead beats" such list to be so collected as not to expose the physician who contributes the name of a debtor, and the publishing of a uniform fee-bill, containing in detail the proper charges for every branch of practice. I have thus tried to give you an outline of some of the possible advantages of a local medical club, and trust that you will not hesitate to criticize and discuss the various points offered. The topic of fee-bill and delinquent debtor list I wish to elaborate more fully and I cannot do better than read a few articles which I have collected from various sources which may give some idea as to what some local associations are doing along this line. In closing, I wish to thank you for your presence and in giving attention to these suggestions. I trust that you will all feel free to express your views in this matter, and if we can succeed in making the burdens of our profession easier by any of the means suggested I shall feel amply repaid for any effort I may have made in this direction. Book Reviews. PROGRESSIVE MEDICINE, VOL. 11, JUNE, 1905. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. 8vo., 346 pages, 48 illustrations. Per annum, in four cloth-bound volumes, $9; in paper binding, $6; carriage paid to any address. Philadelphia and New York: Lea Bros. & Co. The second volume for 1905 of this most excellent review of the advances in medicine and surgery contains the following articles: Hernia, by Wm. B. Coley, M.D.; Abdominal Surgery, by E. M. Foote, M.D.,; The Year's New Work in Gynecology, by John G. Clark, of Philadelphia; hematology and the diseases of the ductless glands have been supervised by Alfred Stengel, M.D., of the University of Pennsylvania; the compilation of the more recent studies in ophthalmology has been done by Edward Jackson, M.D., of Philadelphia. The same method of presenting the material has been followed in this volume which have made the previous ones of such value to the busy practitioner who has not the time to spend hours of library research. The subject matter has been presented in a most clear and concise manner, giving in a few words the gist of the leading articles both in American and foreign literature. A TREATISE ON HYGIENE AND SANITATION. For Students, Practitioners, Health Officers, etc. By Charles Harrington, M.D., Assistant Professor of Hygiene in Harvard University Medical School, Boston. New (third) edition, thoroughly revised. In one 8vo volume of 793 pages, with 118 engravings and 12 plates. Cloth, $4.25 net. Philadelphia and New York: Lea Bros. & Co., 1905. The third edition of Dr. Harrington's Practical Hygiene has been revised and enlarged, thus making this most popular text-book thoroughly up to date. The sections on malarial and yellow fever infections have been entirely rewritten. New statistics in regard to the prevalence of tetanus in toy-pistol wounds are given. A new section on uncinariasis disease in the Southern States has been added. A review of the epidemic of typhoid fever from polluted water supply in Butler, Pa., and Ithaca, N. Y., is of great value to health officers and others in charge of the water supply of cities. The epidemic of typhoid fever at Ogdensburg, N. Y., from polluted ice is accurately traced. A new section on the destruction of algæ in reservoirs used as a public water supply has been written. The value of copper sulphate is impartially discussed. The sections on disinfectants has been rewritten and revised, especially in regard to surgical disinfection. An entire new chapter on immunity has been added. This chapter discusses in detail Ehrlich's theory and Metschnikoff's theory. But most valuable of all is the section on the "Practical Application of Studies in Immunity," in which the various infectious diseases and the antitoxins so far produced are admirably explained, as well as the present limitations of antitoxins in general. As a complete authoritative manual on all questions TEXT-BOOK OF MATERIA MEDICA: INCLUDING LABORATORY 273 ment of the Western Reserve University, of Cleveland. 12mo volume of about 400 pages, illustrated. Flexible leather, $2 net. Philadelphia, New York, London: W. B. Saunders & Co., 1905. unusually interesting manner, making it easier for the Dr. Hatcher has treated this very dry subject in an student to retain the subject matter. In this he has departed from the older methods. The laboratory procedures in the study and classificascopic description of most of the more common drugs. tion of drugs is set forth in the macroscopic and microWe can heartily recommend this volume as a working text-book for students. THE OPHTHALMIC YEAR-BOOK. A Digest of the Literature of Ophthalmology, with Index of Publications for the Year 1903. By Edward Jackson, A.M., M.D., Emeritus Professor of Diseases of the Eye in the Philadelphia Polyclinic; President of the American Academy of Ophthalmology and Oto-Laryngology; Ophthalmologist to the Denver County Hospital, St. Anthony's Hospital and Mercy Hospital, Denver, etc. With 45 illustrations. The Herrick Book and Stationery Company, Denver, Col., 1904. This book is an excellent, systematic arrangement of the literature on ophthalmology for the year. The author has furnished a digest of the literature that is important; second, of the publications for 1903 the title of each book is given and date of publication. The Journal articles are arranged alphabetically, according to the authors' names. CLINICAL FEATURES OF THE PATHOLOGY AND THERAPY OF DISORDERS OF METABOLISM AND NUTRITION. By Prof. D. Carl von Noorden, Physician-in-Chief to the City Hospital, Frankfort a/M. Part VI, Drink Restriction (Thirst Cures), Particularly in Obesity, by Prof. Carl von Noorden and Dr. Hugo Salomon. Price, 75 cents. New York: E. B. Treat & Co., 1905. practical review of the therapeutic application in reAn excellent monograph on thirst cures, giving a striction of liquors. The evil effects of ingested liquids, due to the labor of the heart and kidneys, is forcibly put, and adds to our knowledge of how our patients are victims of dilated heart and dilated stomach. "In cases of nephritis the restriction of liquids is an important postulate of rational treatment, particularly in contracted kidney." For the benefit of obesity, we commend the reading of this work. THE INTERNATIONAL MEDICAL ANNUAL. A Year-Book of Treatment and Practitioner's Index. 1905, twentythird year. A résumé of the year's medical literature, by thirty-six department editors, with added articles by noted specialists. Price, $3. New York: E. B. Treat & Co. In this volume the publishers have improved the appearance and added greatly to the usefulness of this reference-book. The larger-size page gives better opportunity for illustrations and display text. As a reference-book it is the best for rapid work ever published. Many subjects are here treated which are not in the text-books. tionary of Materia Medica and Therapeutics; second, The contents are divided into three parts: First, the Dicthe Dictionary of Medicine and Surgery; third, Sanitation. The popularity of the work is ever growing, and it stands high as a ready book of reference to the general practicer of medicine and surgery. THE AMERICAN YEAR-BOOK OF MEDICINE AND SURGERY. Being a Yearly Digest of Scientific Progress and Authoritative Opinion in All Branches of Medicine and Surgery Drawn from Journals, Monographs and TextBooks of the Leading American and Foreign Authors and Investigators. Collected and arranged with critical editorial comments. Under the general editorial charge of George M. Gould, M.D. Surgery and Medicine. Philadelphia and London: W. B. Saunders & Co., 1905. This work, under the authorship of Dr. Gould, maintains the high position for conscientious thoroughness 1 274 which it has held so long. It is undoubtedly preeminent, the best of the published literature during the past year, and in a form to be readily accessible to the busy practicer of medicine and surgery and of invaluable assistance in keeping in touch with the advances in the subjects treated. There are many excellent illustrations; also nine insert plates of practical value. A REFERENCE HAND-BOOK FOR NURSES. By Amanda K. Beck, Graduate of the Illinois Training School for Nurses. Philadelphia and London: W. B. Saunders & Co., 1905. This little book is designed for the beginner and the graduate as well. It contains a list of the more common drugs, with their doses and therapeutic uses. Many of the more common formulas are given, and a list of the receipts for the preparation of enemata and poultices is included. We have also placed before us the methods of preparing all sorts of food for the sickroom and for infants. All the various diseases with which the nurse has to do come in for their share of discussion and suggestion. There is nothing in the book that can distinguish it from the raft of others of its kind that are now being offered to the student nurse. MOSQUITOES OR CULICIDE OF THE STATE OF NEW YORK. New York State Museum, Ephraim Felt, State Entomologist, Bulletin 79, Entomology 22. New York State Education Department, Albany, 1904. This monograph gives a complete list of all the known species of mosquitoes found in this State. Over fifty varieties are described in the text, and the drawings and illustrations of these are of the highest order. The volume will prove to be a most desirable and useful reference hand-book in the library of any physician possessing a copy of it. NOTHNAGEL'S ENCYCLOPEDIA OF PRACTICAL MEDICINE. American Edition. Malaria, Influenza, Dengue. By Drs. Julius Mannaberg, O. Leichtenstern. Edited, with additions by Maj. Ronald Ross, F.R.C.S., C.B.; J. W. W. Stephens, M.D., D.P.H., and Albert S. Grunbaum. M.D., F.R.C.P. Authorized translation from the German, under the editorial supervision of Alfred S. Stengel, M.D., Professor of Clinical Medicine in the University of Pennsylvania. Philadelphia and London: W. B. Saunders & Co., 1905. The The general excellence of this system of medicine has been kept up in this volume, and it seems safe to say that all of them are just as good as this one. chapter on malarial diseases is compiled by Dr. Mannaberg, while the other two are the work of Dr. Leichtenstern. On all subjects of a hematologic nature, the former is an authority of note and worth, and anything written by him is always of the best kind, showing deep study and discernment. The association of these two writers is a most happy one, and shows the keen insight of the editor. The various old and new ideas of the methods of infection by the malarial organism are given in detail, and the means by which our present thoughts on these ideas were arrived at are exploited in the text. The work of Manson, Grazzi and their contemporaries is taken up and most intelligently analyzed, and the best of each tabulated. The chapter devoted to influenza is the most comprehensive of any so far published on the subject. Not only are the etiology, symptomatology and prognosis discussed at length, but the pathology and complications of the most common disease are dealt with. There are but twenty pages devoted to the subject of dengue, and it would seem that the matter were thoroughly gone over. The micro-parasitic origin of the disease is insisted upon and direct contact is the method of transmission of the contagion herein held. As in the other volumes of this encyclopedia, the work of the publisher has been most carefully and satisfactorily done. NOTHNAGEL'S PRACTICE. DISEASES OF THE BLOOD. By Prof. Dr. P. Ehrlich, Prof. D. C. von Noorden, Dr. N. Y. STATE JOUR, OF MEDICINE. A. Lazarus, Dr. F. Pinkus. Edited with illustrations by Alfred Stengel, M.D., Professor of Clinical Medicine in the University of Pennsylvania. Authorized translation from the German, under the editorial supervision of Alfred Stengel, M.D., Professor of Clinical Medicine in the University of Pennsylvania. Philadelphia and London: W. B. Saunders & Co., 1905. In this day, when the science of hematology is really in its infancy, it is not an easy task to get together a volume on this subject which could in any manner be "up to date." Of course, many of the theories brought out in this book are already discarded as either erroneous or not proven, but on the whole, its text is such that we can say that we can accept the contents without more than the usual reservations of any new science. Dr. Stengel, the editor, is keenly alive to all the most modern work on this subject, and has made corrections wherever the text is at fault or at variance with the newer thoughts. Although the book contains 680 pages, the subjects under discussion are but those of anemia and its clínical features, chlorosis and the leukemias. By far the best of these chapters is that on chlorosis, which has been written by Dr. von Noorden. Here the etiology, general and special symptomatology and prognosis are most interestingly dealt with. At the end of each chapter the literature of the subject treated is appended, and it is of the full German kind. The theories of the morphology of the blood are those of Dr. Ehrlich, and are generally accepted by the medical profession to-day. Throughout the whole book the work and theories of the writer are most evident. In every respect this is the best text-book on this subject that has so far been published. BOOKS RECEIVED. REPORT OF THE COMMISSIONER OF EDUCATION FOR THE YEAR 1903. Vol. I. Washington Government Printing Office, 1905. A MANUAL OF ACUTE POISONING, giving classification, varieties and individual substances usually met with in emergency poisoning, with special symptoms, simple tests, chemical antidotes, physiologic antagonists and treatment. Together with methods for use in first aid to the injured. By John W. Wainwright, M.D., member of the American and New York State Medical Associations, the American Chemical Society, etc. New York: E. R. Pelton, 1905. THE SURGICAL ASSISTANT, A Manual for Students, Practitioners, Hospital Internes and Nurses. By Walter M. Brickner, B.S., M.D., Assistant Surgeon Mt. Sinai Hospital, Out-Patient Department, etc. 360 pages, 123 original illustrations, and 116 illustrations of surgical instruments. New York: The International Journal of Surgery Co., 1905. Price, $2 net. THE PHARMACOPEIA OF THE UNITED STATES OF AMERICA, EIGHTH DECENNIAL REVISION. By the Authority of the United States Pharmacopœial Convention held at Washington, A.D., 1900. Revised by the Committee of Revision, and published by the Board of Trustees. Official from September 1, 1905. Philadelphia agents, P. Blakiston's Son & Co.; subagents, New York, E. R. Pelton, 19 East 16th street; Chicago, E. H. Colgrove Co., 65 Randolph street; St. Louis, C. V. Mosby, 2313 Washington avenue; San Francisco, Payot, Upham & Co., 100 Battery street. GRAY'S ANATOMY. Messrs. Lea Bros. & Co. have pleasure in announcing a new edition of "Gray's Anatomy," to be published about midsummer, and embodying nearly two years of labor on the part of the editor, J. Chalmers DaCosta, M.D., of Philadelphia, and a corps of special assistants. Original Articles. THERAPEUTIC VALUE OF ANTITOXIC SERA.1 BY HARRY T. MARSHALL, M.D., IN The antitoxin treatment of diphtheria is, of course, the best-known and most successful example of serum treatment which we have. The mathematical precision with which the serum acts if used properly; the importance of using the antitoxin at the earliest possible moment after infection; the advantages of employing even extremely large doses of the serum, especially if its use is begun after the disease is well established; the greater rapidity with which immunization can be effected by intravenous injection, and the consequent advantages of this method over subcutaneous injection; the harmlessness of the serum; the local use of antitoxin as a spray, both to neutralize the unabsorbed toxin and, as William R. Stokes pointed out, as a means of hastening the disappearance of the diphtheria bacilli from the throats of convalescent patients; these are matters which have been discussed fully in the recent literature. lation, and even if the toxin is lightly bound to a cell, it may be dislodged if a great excess of antitoxin is brought to bear. Whether this phenomenon is due to dissociation is now a contested question, which is closely connected with the question of the complexity of the diphtheria virus. It is certain, however, that the toxin-cell, or toxin-antitoxin union cannot be disrupted after it has existed for some hours, and when once union between toxin and cell is firmly established, no amount of antitoxin will influence the action of the toxin on the cell. In the case of diphtheria we have a soluble toxin conveyed in the circulation or in the tissues by the antitoxin. In the case of tetanus we are confronted with a different set of conditions. Since the work of Behring and Kitasata in 1890 we have known that animals can be made to produce an extremely potent serum against tetanus toxin, and in some experiments the value of this serum has been proven. However, neither in experiment nor in therapeutic use have the results been so clear and satisfactory as with diphtheria serum, although it appears that the serum has some protective value. We have now an explanation of some of the difficulties that are met with in the use of this serum. In 1903 (Archiv. für exp. Pathologie, und Pharmakologie, Bd. 49, p. 369), and in 1904 (Proc. Royal Society. Vol. 72, p. 26), Meyer and Ransom published the results of their work upon the action of tetanus toxin and antitoxin. They could demonstrate the toxin in the motor axis cylinders after a subcutaneous injection of toxin; and they could prevent the toxin from reaching the cord by making an intraneural injection of antitoxin. A dose of tetanus toxin which was sublethal if injected subcutaneously, was fatal if injected into a motor nerve. After toxin was in a nerve tetanic symptoms could be prevented by cutting the nerve or cutting the cord. The intraneural injection of toxin was followed by tetanus, even though the blood contained a large amount of antitoxin. Most of these actions of serum and diphtheria toxin can be clearly understood from our knowledge of the properties of the toxins and antitoxins. The diphtheria bacilli produce unstable poisonous bodies of complex but unknown chemical structure, called toxins. The toxins are readily soluble in the blood plasma, and are carried to the body cells for which they chance to have a chemical affinity. The toxin unites with the cells by means of the corresponding haptophorous, or binding, groups in the toxin and cell, and then, period between the injection of toxin and the according to the virulence of the toxin and the vitality of the cell, either the cell is killed by the toxin or the cell reacts, throws off the toxin and a number of free haptophore groups i. e., side chains, or receptors of the kind which have chemical affinity for the toxin. These free receptors are the antitoxins. The antitoxins will unite with any free toxins that may be present in the circu Read before the Medical Association of the Greater City of New York, April 10, 1905. Not only did they find that the tetanus toxin is carried to the central nervous system along the motor nerves, but they found also that the toxin gains entrance to the nerve through the motor end plates; that the toxin does not reach the central nervous system by any other route except along the nerves; that tetanic rigidity is altogether a result of central irritation, the peripheral nerves not being concerned, and that the latent onset of tetanic symptoms is almost altogether due to the time required for the toxin to pass along the motor nerves to the cord or brain. They produced a local tetanus, and a general tetanus, in which toxin injected into the circulation was picked up by many motor end plates. They also produced a form of sensory tetanus, which they called "tetanus dolorosus," by injecting toxin into the posterior root or cord. They found that the tetanus antitoxin is not |