and enzymes through heating at high temperatures.

4. In the over-richness or poorness of the milk itself.

The treatment, therefore, depends upon an intelligent understanding of the cause, of food constituents, of the proper modification of milk, of the addition of peas and of cereals, as well as of fruit juices, raw and cooked, to the diet. Fresh vegetables raw and cooked are antiscorbutic. Baumann and . Howard found that the loss of the various food constituents through the feces was less when fruit juices were added to the diet. For instance, there was a marked retention of chlorine and sodium as well as potassium, calcium, and magnesium, but that the sulphur elimination was greater than that ingested.

The prognosis is favorable, always, if the disease is taken in time. The duration, anywhere from three to eight months, for although it takes from three to eight months of faulty feeding to produce the disease, the cure is not affected until the bones and bone marrow are normal. Therefore, the clinical healing is not identical with the anatomical. The microscope in the future will aid us materially.

MEDICAL TREATMENT OF CHOLELITHIASIS.

H. B. Anderson believes the following statements to be warranted by our present knowledge: 1. While surgical procedure is frequently the best, and often the only means offering a chance of relief, its advocacy, based on certainty of cure and assurance of nonrecurrence, is not borne out by results. 2. The main object of treatment is the relief of the infection and inflammatory changes, and not merely the removal of the gallstones. So long as there is no recurrence of the inflammatory attacks, there will be no attacks of gallstones. 3. Recovery not infrequently occurs under nonoperative treatment, especially in early and mild cases, and particularly after first attacks, before serious local damage has been produced by the infection. 4. Medical

treatment should be given a fair trial in all cases where the patient's physical condition does not warrant operation, and with the numerous patients who refuse operation. In many such cases he has seen complete and permanent recovery from all symptoms of the disease. 5. Medical treatment is indicated in many cases as a preliminary to operation, and in order to allow the acute infection to subside as far as possible. 6. Medical treatment is indicated in all cases after operation to allow of complete subsidence of the infection and, if possible, to prevent reinfection and recurrence.

The Periosteum-W. E. Gallie and D. E. Robertson report a number of experiments made in confirmation of Macewen's view that the periosteum is not osteogenetic, as it has been believed to be since Duhamel reported the results of his experiments in 1739. Their results seem to show that the periosteum is merely a fibrous membrane with no power to produce bone, and that osteogenesis is a property of the endosteum alone, which is as energetic in the absence, as in the presence, of the periosteum. Even as a source of blood supply the periosteum does not seem to be of great importance, for large areas of bone may be denuded without any apparent effect upon it. They have found no difficulty in getting small bone grafts to take after they had been completely denuded of periosteum.

From the New York Medical Journal, abstracted from the Canadian Medical Journal of January, 1914. The item as to the osteogenesis from the endosteum rather than the periosteum is from the same sources.-Editor.

THE ANATOMY OF THE HYMEN. By E. S. McKee, M. D., Cincinnati. The hymen femininus is a thin fold of mucous membrane of varying degrees of thinness attached to the posterior and lateral borders of the vaginal orifice which it partially occludes, usually semilunar in shape, its convex border inferior and looking towards the perineum, its concave edge superior or anterior, point

ing in the direction of the meatus urinarius. The word hymen is derived from a Greek word, meaning a membrane or pellicle, not from the Latin God of marriage. The hymen may be so thin as to be likened to a spider's web, or quite thick and fleshy, hymen carnosus, or even fibrous in its nature. Blood vessels usually ramify through the hymen, which lead to the hemorrhage which usually follows defloration and which is given so great significance by some peoples. The hymen comprises a mucous fold containing between its lamellae a layer of cellular tissue inclosing numerous elastic fibres and some muscular bundles. The epithelium is lamellated, tessellated an about the thickness of that covering the vestibule. The mucous membrane is de!icate and covered with closely set, concal, divided and undivided papillae which penetrate into its epithelium, measuring from two to three m. m. in length. Investigators have found that the nerve supply of the hymen is demonstrated with difficulty, many of them denying the presence of nerves in this organ. The pain on defloration is considered due to the dilatation of the introitus vaginae. Congenital absence of this palladium virginitatis, though extremely rare and never seen by observers of very extended experience, nevertheless has been reported by very few. There is one specimen in the Anatomical Museum at Prague, the genitals of a young woman with a double vagina, where the hymen was absent congenitally on both vaginae.

Some hymens are so tough and others so elastic or have such a large opening that they persist even through sexual intercourse, pregnancy and even delivery. Others are so dense as to necessitate surgical interference to permit copulation, while one variety, hymen imperforatus, closes entirely the vaginal trance, daming up the menstrual flow and also necessitating operative interfer

ence.

en

Anomalies of the hymen, of rare interest, are hymen denticulatus, frequently taken for a ruptured hymen, but which can be differentiated by noting the soft

ness of the borders and the absence of cicatrization. The infundibuliformis is firmly attached at its base to the neighboring parts, but its free borders are cone shaped. This form often escapes rupture on sexual intercourse by being pushed up and stretched by the male organ. Fristo has reported a case where four hymens existed one above another, each having a central opening. Duplex hymens have been reported several times.

Leucart, in 1852, demonstrated that the vesicula prostatica represents not only the uterus, but also the vagina of the female. Shattock became imbued with the idea that an analogue to the hymen might be found in the adult male at the spot where the prostatic vesicle opens into the urethra. Dissections revealed to him that the termination of the male vesicula as viewed on opening the prostatic urethra on its anterior wall, consists of two projecting opposed longitudinal lips, forming a minature hymen. It is in fact this male hymen which constitutes the eminence of the verumontanum. This

homology is quite interesting. The carunculae hymenales seu myrtiformes were formerly considered to be due simply to contraction of the torn remains of the hymen. It was left to Schroeder to demonstrate that they were caused by the effects of child birth upon the remains of the ruptured hymen. Immediately after the first coition, bloody lips present themselves, usually three in number. Sometimes on account of irritation they become hypertrophied so as to require removal on account of size or pain. The elastic tissue is found more freely supplied to the base of the hymen, and it probably plays a part in the formation of these caruncles, as when the hymen is torn they tend to contract it into two or three small bulbs at the base.

CANCER TREATED WITH RADIUM.

Sparmann gives a further account of cases already reported under treatment with radium in von Eiselberg's clinic. The table shows that even died during

treatment. In six the tumor had disappeared, five had improved, one showed scarcely any improvement, and seven had grown worse.

RHEUMATISM A BACTERIAL DIS-
EASE.

From time immemorial the term rheumatism has been used by the laity to describe any pain in the limbs or joints, especially when definite information was not sought of a physician as to the actual process being undergone by the patient. Lately, as a result of careful observation on human beings and controlled experiments on lower animals, it has been proved that many of these cases are instances of infection by definite organisms. In the October, 1913, number of the Journal of Medical Research, Schloss and Foster report the experimental production of arthritis. They were able, by inoculation of cultures of streptococcus pyogenes into the blood stream of four monkeys, to induce a polyarthritis, suggestive in certain respects of rheumatic fever in man. In two instances a chronic arthritis with limitation of motion and contracture resulted from repeated inoculations of streptococci. The bacteria found in this type of infection belong to the streptococcic group, but it has not as yet been proved that the organism found is a special variety, the general opinion being that it is an ordinary streptococcus. That these organisms do cause the disease has been proved by a number of investigators, who have recovered the streptococci from the blood and joints of patients, and have reproduced the lesions in lower animals. These findings explain in a satisfactory manner the heart lesions that are so frequently present and the symptoms of acute infection that occur in acute rheumatism. Once more accurate information separates a definite disease from an indefinite group.

In a recent issue of a popular magazine, a physician, probably a very young one, makes the statement that "rheumatism is, was, has been, and possibly always will be a convenient dumping ground for medical ignorance." Pos

sibly the writer means medical ignorance on the part of the laity, although the average reader will not so interpret the statement. If he really believes his accusation of the profession, the writer is to be condoled with for the extremely slovenly teaching he has received from his faculty; no physician of any standing offers a diagnosis of rheumatic fever unless the signs are pathognomonic, while it is simply incredible that "rheumatism" is ever at this date advanced professionally as a reason for chronic pain due to infections or autotoxemia. The entire article under discussion reads as if the pathology had been acquired exclusively from patent medicine "literature," and is one of a class of articles which, under the plea of taking the public into the doctor's confidence, serve only to intensify ignorance and prejudice. New York Medical Journal.

ABBOTT'S METHOD IN THE TREATMENT OF SCOLIOSIS.

L. Ombredanne lays emphasis on the spirometer as a valuable means of controlling the results of treatment by Abbott's method and as a useful instrument for training the subject in adequate reslength the theory of Abbott's procedure. piratory efficiency. He discusses at Concluding from his experience with the method in a considerable number of cases, in twenty-eight of which the treatment has now been nearly or quite completed, he states that the procedure should be employed only in cases where, upon flexion of the trunk anteriorly, a hump in the back appears. The method is contraindicated in spinal inflexions or static scoliosis and in patients less than six or seven years of age. In cases of scoliosis in which the spinal malposition is completely corrected upon suspension, the method is without superiority over carefully conducted exercises. In patients in whom respiratory exercises are impracticable or dangerous by reason of lack of intelligence of the patient or parents, or on account of adenoid growths, large tonsils, septal deviations, or pulmonary tuberculosis, the proce

dure is also considered inadvisable by the author, unless the interfering factors can first be removed. In other types of cases, on the other hand, correction of the rotation of the trunk and of the lateral curvature will often be obtained regularly in some forms of scoliosis. Observations of twenty-six cases suggest that the results of treatment are permanent, though special exercises are required to insure a fixed position of the spinal column. No method previously known yielded the desired results so constantly and precisely, or could be regulated SO satisfactorily.-Abstract from the New York Medical Journal of Feb. 7, from the Presse Medicale, Jan. 3, 1914.

DIAGNOSTIC ERRORS IN GALL

BLADDER DISEASE.

J. H. Gibbon has searched his operation records for the cases in which he expected to find gallstones and did not, or in which he had made some other diagnosis only to find that gallstones were the cause of the patient's suffering. The latter mistakes are much less frequent than the former. The errors may, in the light of what is found at operation, be clear and it is evident when and how one went astray, but there will still remain cases which cannot be cleared up quite so easily. A history of indigestion which manifests itself soon after eating by a sense of fullness and the eructation of gas; by attacks of pain of sudden origin in the upper right quadrant passing across the abdomen and around to the back and perhaps to the right shouler-blade, and which are relieved by vomiting; and the finding of marked localized tenderness on palpation when the patient takes a deep breath; certainly suggest gallgladder trouble. If we have added to these severe colic requiring morphine for its relief and followed by a transient jaundice, one is quite justified in making a diagnosis of gall-stones. Surgeons have learned, however, that a patient can have all of these symptoms and still not have gall-stones.-Gibbon in Med. & Surg. Journal Med. Rec.

THE EUGENICS OF WAR.

Dr. David Starr Jordan, Chancellor of Leland Stanford Jr. University, said in a recent address on the eugenics of war that the effect of war on nations was to spoil the race by the very simple process of the reversion of selection. This was first noticed, he said, by Benjamin Franklin. The wars that have the most justification on patriotic grounds are generally the most harmful to the race, according to Dr. Jordan.

"Better men," said Dr. Jordan, "go to war for principle than for plunder. Better men go to war as willing soldiers than those who are forced as conscripts. The term 'white slave' was, I understand, first used by Napoleon III in reference to his unwilling conscripts who were brought into his army."

Dr. Jordan quoted a German authority who maintained that the Thirty Years' War, which destroyed about ten millions of people out of sixteen millions alive in Germany when the war began, did not harm the race, because massacre more kindly than war-takes the weak as well as the strong.

"But we would not say," continued Dr. Jordan, "that massacre was to be commended on account of this fact, because in all these matters there are not only eugenic values, but also moral values; although, from the standpoint of eugenics, if you must have killing, it is best to have general massacres, taking all grades of people alike.

"We have discovered within the past thirty years-what we knew before, but we can now prove it-that the laws which govern the breeding of men are precisely the same as those which govern the breeding of the higher animals. Man is a higher animal; man's place is in Nature. And among these laws we have a few very simple ones. 'Like the seed is the harvest.' That is, an individual is not descended from the great herd; a man is not descended from his town or his nation; he is descended from that part of the nation, an individual from that part of the herd which formed his real ancestry.