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patient in bed when the morning temperature is above 9.4°and the evening temperature above 99.4°F. If one only ofthese temperatures is above the normal more attention mustbe paid to the elevation of the morning reading. He rightlyurges that this rule should not be made too rigid, and thatthe temperature for several days should be taken intoaccount as well as the general condition of the patient, hisbody weight, and pulse-rate. He recognises various differenttypes of the diurnal variations of temperature, and he givesdetails of the influence of menstruation upon the temperaturein women suffering from this disease. He also gives generalhints as to the ordering of exercise to patients. All these

points should be of interest to practitioners who have thecharge of patients suffering from this disease, and althoughit is difficult to watch the manifestations so closely in privatepractice as in a sanatorium, it is highly desirable that thegeneral principles of this form of treatment should be carriedout for patients in their homes; and, indeed, patients whohave been to sanatoriums are often anxious that this should

be done. Dr. Pearson’s paper, which is obviously the outcomeof practical experience of the points he deals with, shouldtherefore be valuable.

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OLIVER WENDELL HOLMES AND THE DOCTRINEOF SEMMELWEIS.

IN a leading article last week we reviewed the work cSemmelweis as set forth in Sir William J. Sinclair’s book

the life and doctrine of the Hungarian master. In a yeawhich has seen the centenary of another medical teache

who was amongst the first to recognise and proclaim thinfectious origin of puerperal fever, it is fitting that somereference should be made to his claims in this respect. Thl

memory of Oliver Wendell Holmes will necessarily live in thlworld of letters longer than in the world of medicine, forthe charm and kindly humour of his ’’ breakfast-table’

causeries and the rare poetic quality of many of his gracefulverses have, of course, delighted a far larger audience thanwere wont to attend his anatomical lectures at Harvard.But his early announcement and persistent teaching of theinfective nature of child-bed fever are worthy of wide

respect, even though we accept Sir William Sinclair’s viewthat the late Dr. CuIlingworth in his warm admiration for theman spread abroad too liberal a report of the share played byHolmes in the solution of the darkest of obstetrical mysteries.At the same time, all credit must be given to the Autocrat" for his early and persistent preaching of the doctrine ofchild-bed cleanliness in America and for the use of his

literary gifts to attract attention to the subject and to

attack the practices which brought puerperal fever in theirtrain. There seems no doubt but that Holmes’s concep-tion of the causation of puerperal fever was in realitythat of the theory of contagion as it was held in

England at that time, and that this was very far from thedoctrine of Semmelweis in which in reality contagion,in the sense it was understood by the contagionists, playedno part. We must confess, however, that we are some-

what inclined to agree with Sir William Sinclair when he

points out that the eulogists of Holmes have allowed their.zeal to carry them a little too far. There could be no possiblequestion of any comparison of his contribution on the subjectwith the work of Semmelweis. All that Holmes wrote was

true, but in it there was nothing that was new or original.At the same time, it is interesting to find that in

America there were not wanting prejudiced and un-

believing opponents such as Meigs and Hodge, whoattacked Holmes with much virulence. Dr. Meigs’s posi-tion may be illustrated by a quotation from a lecture.

Referring to outbreaks such as those described by Holmeshe says : "I prefer to attribute them to accident or to

) Providence, of which I can form a. conception, rather thanE to a contagion, as to which I cannot form any clear idea, att least as to this particular malady." That Holmes recognisedr that contagion could be carried from the cadaver of a patientj dying from puerperal fever is clearly shown in the first rulet he gives at the end of his essay, which, it must be remem-: bered, was published in 1843, or four years before Semmelweisbbegan the use of chlorinated lime as a disinfectant. It is

! that a physician holding himself in readiness to attend casesof midwifery should never take any active part in the post-mortem examination of cases of puerperal fever. It was also

laid down by him that a physician attending the necropsies ofcases of simple peritonitis or of erysipelas should not attendany case of midwifery without changing all his articles of

dress, allowing 24 hours to elapse, and using thoroughablution. At the same time, it must be remembered, as SirWilliam Sinclair points out, that these rules might well havebeen copied from those of Lee, Copland, or Storrs, prominentupholders in England of the theory of contagion. After all,questions of priority are of little importance in this matter atthe present day. There have been few, if any, greatdiscoveries made in the history of the world which have notbeen suggested or foreshadowed by some thinker or writeryears before coming to fruition ; and all honour is due toHolmes for the part he played in endeavouring to lessen theshameful mortality from puerperal septicaemia which wasprevalent in his day. As Dr. Cullingworth rightly said, wemay give abundant honour to Semmelweis without forgettingthe earlier and beneficent contribution to our knowledgewhich we owe to Oliver Wendell Holmes.

GLANDULAR FEVER.

THE term glandular fever was applied by Pfeiffer in 1889r to an infectious disease occurring usually in children between2the ages of.five and eight years, and associated with pyrexia,slight redness of the throat, and swelling of the cervical

t lymph glands. Since that time various epidemics of this

disease have been observed, and in this country the con-: dition has been studied by Dr. Dawson Williams who has: described abdominal pain and tenderness as early symptoms.An interesting paper is published by Dr. J. Edward Burns ofBaltimore in the Archives of Internal Medicine of August 15th,describing an epidemic of this disease which occurred in

the children’s ward of the Union Protestant Infirmary ofBaltimore. There were nine cases in all, six occurring in hos-pital in children from two and a half to five years of age, theother three in the family of one of these cases after her returnhome-all three being adults. The first case in this familywas the mother who developed the disease 24 hours afterthe return home of her daughter. No member of the

family had seen the child for two and a half months

previously. It would therefore appear that the incuba-tion period may be as short as 24 hours, although it is

usually stated to be from seven to nine days. There wassome leucocytosis in all of the cases, the counts varyingfrom 18,800 to 26,400. Differential counts showed a rela-

tively greater increase in the small mononuclear elementsthan in the others, but the coexistence of other infections insome of the cases complicated the picture. Even after con-valescence there seemed to be a relative increase in the

small mononuclear forms, although the total leucocytes wereonly between 5000 and 8000. There was injection of the

throat and tonsils in all of the patients, but no exudate.

Cultures showed the staphylococcus aureus. In all of thecases except one there was enlargement of the glands onboth sides of the neck, and the swelling appeared to extendon both sides at the same rate. Both the swelling and thetenderness appeared to reach a maximum on the third day.The upper glands of the chains anterior and posterior to the