tegration. I think it really means disintegration in material in which there is no replacing the integral part. In neurasthenia we can replace the parts or very nearly so. A man might not be himself, might not be the same man he was before he had neurasthenia but he can probably be very nearly restored to that condition. One of the most perplexing things in treatment is to find occupation for the patient during the time that is necessary to be spent in recovering from such a condition. Perhaps it took years to get into this condition and it must of necessity take a considerable length of time for the patient to recover from it. And the occupation, whether it should be a physical occupation or a mental one, is perhaps as perplexing a feature as there is in the whole subject, and the necessity of studying the individuality of the person almost from childhood up comes into play. To keep their minds off this, that and the other is going to keep the physician pretty busy and he knows best what things are valuable to the patient, and sometimes the most diverse things are called for, according as there are diversities in character.

Dr. Hall :-Concerning "Treatment away from home" it might be said that the systematized night care of an institution offers a distinct advantage. To meet early and promptly and allay the distressing symptom of phobias incident to the characteristic insomnia is to gain a decided advantage in the therapeutic care of the person afflicted with neurasthenia.

Dr. Kingman :-Some of these cases are so peculiar the physician has to look after the whole environment, the whole world almost, and then the appetite, that would be the flesh, and then you come to the patient himself. It is a large contract to have to look after the world, the flesh, and the devil. Dr. McDonald :-About the pronunciation of the word neurasthenia. I heard a man read a paper on the subject one evening and he pronounced it neurasthénia. After the meeting some of the fellows joked with him about it telling him he had better come down to Boston and get a little culture. He was a New Yorker, like myself, which probably accounted for his slip. But he said: "I knew Beard well; he named the disease and called it neurasthénia, and if it was good enough for him it is good enough for me."

Dr. Chesebro :-The chair wishes to thank the gentlemen for their very excellent papers which were interesting and instructive in every sense of the word. Also to thank Dr. Kingman for the material assistance rendered in arranging this program.

Dr. Chapin :-You have all read recently that the deaths due to diarrheal diseases of children have not decreased in Providence and it has been noted that the cause is impure milk. It has been noted too in other cities and I think efforts have been made to remove the condition. You all know that Strauss started the pure milk supply in New York five years ago and sterilized milk was furnished. A few years later they furnished pasteurized milk instead of sterilized milk and it sold for the comparatively low price of store milk Other cities since have taken it up abroad and in this country, in Liverpool

and in Rochester in this country. Some of them distribute pasteurized milk but I think the best plan is followed in Rochester. The Health Department there started this work by furnishing pasteurized milk but later decided that it was better to give pure milk. They obtain their milk and bottle it without any pasteurization at all and sell it at several stations in the city for one cent a bottle, one bottle containing four or five ounces, and two cents for a large size. They have five stations and a trained nurse present from eight to one every day and the milk is sent in from the country in bottles properly modified for certain of the children and sold at the price above mentioned. An important feature is the trained nurse and physician who have supervision over the station. It has seemed to a number that such a plan would be a good thing in Providence and the other evening a dozen or more physicians were talking it over and they were of the opinion that something of the kind ought to be done here and it was suggested that the matter be brought up before this Association. In order to bring it before the Association I would like to offer the following resolution: "That the President appoint a committee of nine including himself, to consider the advisability of distributing pure milk for the infants of the poor during the hot weather, and if they deem it advisable the expense of the same is not to be charged up to this Association; and the said com. mittee has authority to associate with itself other interested persons either members of the Association or otherwise."

The following Committee was appointed: Drs. Chapin, Swarts, Partridge, Millar, Ellen A. Stone, Gray, DeWolf, P. E. Fisher and Chesebro.

Dr. Noyes read the following resolutions in regard to the death of Dr. J. C. Pegram, Jr., which were placed on file and copy ordered to be sent to Mrs. Pegram and to John C. Pegram, Esq. :

We the undersigned, a committee appointed by the President of the Providence Medical Association to present appropriate resolutions upon the death of John C. Pegram, Jr., M.D., beg leave to report as follows:

WHEREAS in accordance with Divine Providence John C. Pegram, Jr., M.D., an honored member of this Association has been removed by death;

RESOLVED that we as an Association do hereby express our deep sorrow and great loss in the untimely taking off of one who had already achieved eminence as a surgeon and one whose manly qualities, genial disposition, gentlemanly demeanor and honesty of purpose endeared him to all.

Dr. Chesebro spoke of the meeting of the American Medical Association this week in Boston, and urged that each and all should attend if possible.

Book Reviews.

OPERATIVE OTOLOGY. SURGICAL PATHOLOGY AND TREATMENT OF DISEASES OF THE EAR. BY CLARENCE JOHN BLAKE, M.D., Professor of Otology in Harvard University, and HENRY OTTRIDGE REIK, M.D., Associate in Ophthalmology and Otology, Johns Hopkins University. New York and London. D. Appleton and Company. 1906. $3.50.

The work begins with a well illustrated chapter on surgical anatomy of the temporal bone and adnexia, which is followed by a chapter on aseptic technique; Chapter III, diseases of the auricle and external auditory canal ; Chapter IV, diseases of the tympanic membranes and tympanum; Chapter V, the possible complications and consequences of suppurative otitis media; Chapter VI, middle ear operations; Chapter VII, mastoid operations; Chapter VIII, adventitious aural surgery. This chapter treats of a considerable number of operations, which, though not strictly a part of otology, are, however, necessarily connected with this work, as adenoidectomy. In addition there is an appendix containing eight notes concerning some points referred to in the body of the book and including an article on the localizing symptoms of brain abscess by Dr. George Arthur Waterman, of Boston. The work has eight full-page plates and forty illustrations in the text. It is of exceptional value to the medical student and hospital interne and to the general practitioner who occasionally encounters aural cases.

A COMPEND OF MEDICAL CHEMISTRY, INORGANIC AND ORGANIC, INCLUDING URINARY ANALYSIS. BY HENRY LEFFMAN, A.M., M.D., Professor of Chem. istry in the Woman's Medical College of Pennsylvania and in the Wagner Free Institute of Science. Fifth Edition-Revised. Philadelphia: P. Blakiston's Son & Co.

This compact epitome of medical chemistry, though designed for a quiz compend, is more than a student's abstract and will be found a convenient reference book for the physician and pharmacist. The chapters on Organic Chemistry and Urinary Analysis fill half the book and are especially valuable because presenting up-to-date information on a branch of science now in active development.

THE PRACTICAL MEDICINE SERIES, comprising ten volumes on the Year's Progress in Medicine and Surgery. Under the general editorial charge of GUSTAVUS P. HEAD, M.D., Professor of Laryngology and Rhinology, Chicago Post-Graduate Medical School.

Vol. I. General Medicine. Edited by Frank Billings, M.S., M.D.

Head of Medical Department and Dean of the Faculty of Rush Medical College, Chicago, and J. H. Salisbury, A.M., M.D., Professor of Medicine, Chicago Clinical School. Series 1906. Chicago. The Year Book Publishers. 40 Dearborn Street. Price, $1.50.

Vol. II. General Surgery. Edited by John B. Murphy, A.M., M.D., LL.D. Professor of Surgery in Rush Medical College. Chicago. 1906. Price, $2.00.

These volumes are two of a series of ten to be issued at about monthly periods and covering the entire field of medicine and surgery. Price of the series of ten volumes, $10.00. The topical arrangement enables those interested in special subjects to buy only the parts they desire.

HEALTH OF PROVIDENCE, JUNE AND JULY, 1906.

There were 269 deaths reported for the month of June. The 269 deaths represent an annual rate of 16.12 per thousand in an estimated population of 203,000. The rate for June, 1905, was 15.56.

In July 332 deaths were reported. This represents an annual rate of 19.24 per thousand. The rate for July, 1905, was 16.88.

The annual death rate for 1905 was 17.48.

There

There were 18 deaths from pneumonia in June and 19 in July. were 29 deaths from diarrheal diseases in June and 82 in July. In July, 1905 there were 66 deaths from diarrheal diseases and excepting that. year the number in 1906 is the smallest for July since 1898. There were reported during the two months, to the Superintendent of Health 29 cases of scarlet fever, with 1 death; 28 cases of diphtheria, with 3 deaths; 25 cases of typhoid fever, with 4 deaths, and there were 4 deaths from cerebro-spinal meningitis.

On the twenty-eighth of July a report was brought to the Health Department that two people had been bitten by a dog on Christian Hill; that the dog had shown strange symptoms, that he had been killed by the police, and that the body was then in the custody of the dog officer.

On account of the prevalence of rabies in eastern Massachusetts for the past two or three years it had been expected that the disease would show itself in Providence, and as this was the first case that was reported to the health officer of a bite from a suspected mad dog, the body of the dog was immedi

ately taken to the bacteriological laboratory of the Boston City Board of Health, and on the thirty-first of July report was received that the dog. showed the Negri bodies, and was, therefore, undoubtedly rabid. Subsequently the animals inoculated from this dog developed typical rabies paralysis and died, one fourteen, and the other sixteen days after inoculation. Although there was a history of at least two persons having been bitten, only one of these was located. He was a boy sixteen years old who had been bitten on the hand. On investigation it was found that the wound had received no surgical treatment. The boy's parents were notified of the diagnosis in the dog's case, and of the danger to the boy. There was found to be no provision by which either the city, or the state could assume the responsibility of the boy's treatment at any hospital, or Pasteur institute, but the Mayor, Hon. Elisha Dyer, on August 1st, offered to send the boy to the New York Pasteur Institute, at his personal expense. This offer was gratefully accepted by the parents, and on the second of August he went to New York and received his first treatment. At the next meeting of the Board of Aldermen an ordinance was passed, directing that all dogs running at large should be muzzled until the sixth of October, which would cover a period of about seventy days from this known case of rabies. This is the first time that the department has been able to make use of the discovery made by Negri, at Padua, in 1903, by which the diagnosis of rabies can be made in a much shorter time than by the inoculation test, which requires at least some fifteen or sixteen days. The so called Negri bodies are found especially in the gaglion cells in the region of the Ammonshorn (hippocampus major) and in the Purkinje cells of the cerebellum. A smear from one of these portions of the brain can be stained and examined in a few hours. A section of the brain substance can be examined in a few days. The smear may be fixed for one or two minutes in wood alcohol, then stained with a mixture of 10 c.c. distilled water, two drops fifty per cent. solution methylene blue in water, two drops saturated alcholic solution rose aniline violet. The fixed specimen is flooded with the stain and gently heated until steam comes off, then washed in water and dried in the air. With this process the Negri bodies are seen as cell inclusions, stained deep red, while the rest of the cell takes the blue stain. The intracellular substance is reddish purple and the blood cells yellowish red.

At this writing the boy has fulfilled at the Pasteur Institute the eighteen days of treatment given there for bites on the hand; and is at home waiting for the end of the two weeks probation which follows the treatment at the institute.

One other case has been sent from this neighborhood to the New York Pasteur Institute, a nine year old girl who was bitten on the face and hand, at Lakewood, by a dog that was destroyed before it was known whether it had