Influenza, grip, or la grippe, is raging in several cities of the United States, and Canada may soon expect to be invaded by the epidemic. Authorities have not yet definitely settled whether this rancorous enemy of the old and debilitated and rapid vanquisher of the robust is infectious or contagious. It is probably right to the mark to say it is both. It comes like a thief in the night and strikes down alike the strong and the weak, the rich and the poor. It is no respecter of persons. Thousands fear it, especially those who are never strong, and who have before been prostrated by its crushing onslaught. It has been described by one layman as a disease that it took you six weeks to get over after you were well," and by another: "The window was up, and in-flew-enza.” Though only known to the present generation since 1889-90, it is grey-headed and long past the voting age. In Asia, that continent which report and history have assigned as the birthplace of many contagious diseases, it, too, is said to have been born. As early as 1173 A.D. it was known in Italy, Germany and England. Since then epidemics have occurred at varying intervals up to the time of the great pandemic of 1889-90. Now, any practitioner, anywhere, can pick out cases whenever he wants to. But epidemics are different. Pfeiffer demonstrated the bacillus of influenza in 1892 in pus cells from the trachea, and the bacillus of Pfeiffer is pretty generally accepted as the cause. It is doubtful if any organ of the body is exempt from attack. Hearts have been demoralized and brains practically obliterated. The respiratory organs have been especially selected as almost the natural hunting preserves of the fell organism. Add to these three the gastro-intestinal system and the quartette is a formidable one. Per se it is not so deadly; the complications generally kill. Owing to this fact its pathology is practically nil. What has been found post mortem can be attributed to the complications. It is the "open door" to the streptococcus, the staphylococcus, the pneumococcus, etc. Such being the life history of la grippe, there is one particularly salient feature which presents itself most emphatically-prevention. Prevention of what? First, of complications in the person attacked; second, of transference to other persons. We wish to say a word about the second. It is a lamentable thing that in a disease which is either infectious or contagious, or infectious and contagious, that isolation is practically seldom or never carried out in influenza. This does not hitch up well with modern scientific progressive medicine. In some cases, of course, where people persist in walking out and doing business with the "goods" on them, not even under a physician's advice and care, but under "patent-medicinein-their-pocket" treatment, not much can be accomplished in the

way of prevention. But in others; in those cases brought to bed, here much could or might be done in the way of isolation and subsequent disinfection, to prevent further attacks in that household. Public medicine has not as yet grasped this situation; but we opine it is assuredly "up to" the doctor to begin to do something in the way of prevention in this exceedingly diversified and diabolical malady.

An Oligarchy is a form of government in which the supreme power is placed in the hands of a few persons; also, those who form the ruling few. "All oligarchies, wherein a few men domineer, do what they list."-Burton. A clique is a narrow circle of persons associated by common interests or for the accomplishment of a common purpose-generally used in a bad sense. Nepotism is undue attachment to relations; favoritism shown to members of one's family; bestowal of patronage in consideration of relationship, rather than of merit, or of legal claim. A cabal is a number of persons united in some close design, usually to promote their private views and interests in Church or State by intrigue. There are said to be ulcerations in the hearts of many Toronto physicians, and probably surgeons. Some people are not troubled by thoughts of a day of reckoning. Dictators have before found themselves in the position of culprits. Some will use the knife when they cannot confute. One should be careful to be not artfully encouraged in fatal folly. The years of a man's age limit in the Toronto General Hospital are to be two score and fifteen, but peradventure he has great strength, he may attain to three score years. Surely no man could attain to that age without finding out that there are even some people in the world who do what they think to be wrong.

Narath's Modification of Talma's Operation for Hepatic Cirrhosis. In the December, 1907, number of "Annals of Surgery, a most interesting paper appears from the pen of Dr. Eugene R. Corson, of Savannah, Ga., on the above subject; and for those who have not had access to this article, we thing a resume would prove instructive.

Narath's original paper was reviewed in a short excerpt in the "Medical Record," which reported the results of about one dozen cases, with a brief description of the operation itself. The operation seems to be very simple. may be performed under local anaesthesia, and would appear to be followed by very good results. To quote from Dr. Corson's paper: "Through a small incision in the

mid-line below the ensiform cartilage the peritoneum is opened, a bunch of omentum is picked up, drawn out, and tucked under the skin, and stitched in place with a few catgut stitches. The incision in the abdomen is carefully sewed around the base of the omental mass, sufficient to close the abdomen, yet avoiding any constriction. of the omental tissue itself. The abdomen is carefully closed in layers, as is now the custom. The operator, as he sees fit, may do a one-sided operation, or he may pick up a second bunch of the omentum and stitch it in on the opposite side, should he think it necessary to increase the area of transplantation. According to Narath, the sub-cutaneous veins become prominent in a week, and the relief to the obstructed portal circulation is at once apparent. He reports no case of hernia, and writes enthusiastically of his method."

The rationale of the operation, of course, hinges on the estalishment of collateral circulation between the portal and systemic (superficial) veins.

At this point Dr. Corson takes up a discussion of this collateral circulation, quoting largely from a paper by Dr. Rolfe Floyd on "The Anatomy of Portal Anastomosis," a detail into which we need not enter.

Dr. Corson reports but one case of Narath's operation, which, however, shows a most satisfactory result. The patient, a man of 43, has a good family history, but a personal history of having had typhoid, dysentery, malaria, yellow fever, and syphilis. Patient has also had gonorrhoea several times. Has used intoxicating liquors in moderation for part of his life, and also to excess during a later part of his life. On first seeing him, patient had pronounced ascites, face drawn and characteristic; was thin and somewhat jaundiced; the urine showed a trace of albumen. Patient was first tapped and two gallons of fluid withdrawn, but ascites rapidly returned. Patient then operated upon under general anaesthesia. Through a median incision the liver was palpated, and found to be in an advanced stage of cirrhosis. A bunch of omentum was tucked under the skin on right side, spreading it out as much as possible. There was no reaction from the operation. At the end of a week there was a distinct increase in the size of the abdominal veins. The abdomen, however, filled up rapidly again, and about one month after the first operation, a second was performed, when a bunch of omentum was tucked under the skin on the left side, just below the first omental graft. After this second operation the patient almost immediately expressed himself as feeling better. Though there was an evidence of re-accumulation

of fluid, it was neither so rapid nor so extensive. He was not tapped again.

In a letter from the patient, written about two years after operation, the patient reports himself as much better, and holding his own in a very satisfactory manner.

Dr. Corson says: "Considering the condition this man was in at the time of operation, and complicated, too, by syphilis in its secondary stage, the result obtained by this operation seems to me remarkable. In the few cases I have seen reported of successful Talma operations the patients have undergone repeated tappings until the collateral circulation was equal to the emergency. In this case the collateral circulation seemed to have been established quite rapidy . . The success attained in this advanced case would point to a much greater success for the operation if done in the beginning of the cirrhotic process.'

Editorial Notes.

Ophthalmotoxic Tests. The recently discovered fact that the topical application of the toxine of a specific micro-organism will cause a very definite local reaction in a subject suffering with the corresponding infections seems to be opening new fields in the realm of diagnosis. The application of this principle in tuberculous disease by von Pirque was the first step toward its practical employment. His tuberculin "vaccination," or "cuti-reaction," as it is called, has proved to be of considerable assistance in the discovery of tuberculous disease in children. Calmette's suggestion, however, that the tuberculin be applied to the conjunctiva has developed a much more trustworthy method. The preparation is instilled into the eye, and in tuberculous subjects there develops a very distinct reddening, which lasts for from twenty-four to forty-eight hours. In the healthy subject the reaction, if present at all, is very much milder and of shorter duration.

Calmette advises the use of a solution in sterile physiological salt solution of the tuberculous toxines obtained from Koch's "old tuberculin" by precipitating with 95 per cent. alcohol. Dr. Baldwin, of Saranac, prefers to use a weaker solution, and advises a one-third or one-half per cent. strength. The amount used for a single test is one drop, and Dr. Baldwin suggests that enough for one or two tests be put up in sealed glass tubules, which can be easily opened and used as needed.

Continental workers report very favorably on this test, and in this country interest is rapidly growing concerning this very simple diagnostic procedure.

Chantemesse has recently applied this principle to typhoid fever, and, although his work has not been substantiated, his results are very encouraging. The typhotoxines are obtained by cultivating the Bacillus typhosus in bouillon of beef spleen, the medium being contained in large flasks which allow of the exposure of a considerable surface to the air. After incubating for a number of days, these cultures are filtered, sterilized, and treated with absolute alcohol. The precipitated toxine is then dried and dissolved in normal saline solution in a strength of 1 per cent. This is used just like the tuberculin preparation in the ophthalmic test, and the resulting reaction is very similar. It seems not unlikely that this test may be serviceable in an earlier stage of the disease than the agglutination test. The possibility of the further extension of this new test to other infectious diseases is evident.-New York Medical Journal.

The Ablation of the Tonsils.-Until the function of the tonsils has been definitely settled there are likely to be differences of opinion in regard to the treatment of the various pathological conditions to which they are subject. Some authorities regard them as the portals of entry of many different forms of infection; others look on them as valuable protective agencies, while still others consider them as not of very great importance in either direction. It seems not unlikely, however, that both of the first two of these views are correct, for it is perfectly conceivable that like most collections of lymphatic tissue the tonsils have a protective function, while at the same time if the toxic process becomes too severe they may be overwhelmed and themselves be converted into foci of infection. The question of whether or not the hypertrophied tonsils so frequently seen should be removed resolves itself largely into a consideration of their condition. If the hypertrophy is a simple one and the tonsillar tissue itself appears healthy the assumption is physiological process intended to compensate for increased functional demands, but if the hypertrophy gives rise to local disturbances or there is infection of the tissues themselves surgical treatment is indicated. Barth (Deutsche medizinische Wochenschrift, December 5, 1907) is convinced that it is only the diseased tonsil that affords a means of entry for systemic infections while a single hypertrophy does not necessarily demand treatment. He also points out that in removing the pharyngeal tonsil the submucosa