be coapted). The dura was further sutured independently with fine chromic gut. A temporary drain of strips of oiled silk was carefully placed and the skin closed about them. The wound healed kindly. A careful neuralogic report is appended. The author refers to the Stewart-Harte case reported at the Albany meeting in 1902 and to the opinion prevalent prior to this case, that regeneration of the cord in man did not occur after being severed. "In comparing the result in the case reported by Dr. Stewart, with the conditions herewith reported the following points are worthy of note: Sixteen months after the injury, in Dr. Stewart's case, the patient was able to flex the toes, flex and extend the legs and thighs, and rotate the lower extremities. While in the sitting position she could raise the extended leg from the floor, and she was able to stand by supporting herself with her hands on the back of a chair. The bowels were under control except when diarrhoea was present, and moved every second day. The urine passed voluntarily amounted to about sixteen ounces in twenty-four hours; incontinence occurred during sleep. She had the sensations of touch, temperature, pain and locality; the difference between heat and cold, however, was not always distinguished. Rigidity of the muscles was present in a moderate degree; both ankle clonus and patellar clonus were present on each side. Reaction of degeneration absent. No bed-sores had ever developed, and the skin and nails showed no trophic changes.

In the case herewith reported, the following is to be noted in comparison: Twenty-six months after the injury voluntary motion is practically lost in the affected area. He is able to stand when supporting himself by the hands resting upon an apparatus, and to make some locomotion by swinging movements in a special frame on wheels. The bladder and rectal control is doubt

ful, to say the least, the former acting automatically. He has the sensation that the bladder and rectum are about to empty themselves, and if the urinal or bedpan is brought to him promptly soiling is prevented. The amount of urine passed in this manner would probably average more than a pint in the twenty-four hours. Urine is sometimes voided during sleep. Sensation is practically abolished in the entire affected region, with the exception of an area about five inches in length extending down the outer side of the right thigh, where some sensation is present. He is not able to correctly distinguish between heat and cold. Tactile sensations are recognized, but are usually referred to a point two or three inches distant from the point touched. Marked rigidity and spasticity of both legs are present. Patellar reflex exaggerated; Achilles reflex marked. Ankle clonus present on one side and absent on the other. The reaction of degeneration is absent."

The Stewart-Harte case was operated on three hours after the injury, while in the present case upward of ten days had elapsed before consent to interfere operatively was obtained. The prolonged separation of the divided end of the cord and the presence of the foreign body had, in all probability, an influence in preventing a complete regeneration of the cord.

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A SALUTATION FROM THE SOUTHERN CALIFORNIA PRACTITIONER ON THE ATTAINMENT OF ITS MAJORITY.

It is not only the pleasure of the SOUTHERN CALIFORNIA PRACTITIONER to present to its subscribers in this issue, the usual greetings of the Season, but it is its privilege, in virtue of the fact that it enters upon the twenty-first year of its existence, to make a formal bow to the professional world, and to renew at the same time its pledge to have the PRACTITIONER'S pages continue to stand for the best interests of the medical profession in the Great Southwest.

Twenty years ago, when the PRACTITIONER was founded by its present editor, "El Pueblo de Nuestra Senora Reina de Los Angeles" "The Town of Our Lady, the Queen of the Angels"had a population of little more than 15,000 souls and there was not a single

paved street within its confines, nor were sky-scraper structures even dreamed of.

To-day, by way of contrast, there is a municipality of more than 200,000 people, growing with tremendous strides and there are miles and miles of paved and graded streets, and handsome and ornate business and residence structures without end.

Commensurate with this material growth of the city, has been an increase in the number of medical practitioners, so that at the present time there are more than 750 legally licensed physicians in the county of Los Angeles, whose lives and work, are, however, cast along much easier lines and in a far less harsh environment, than that which met our professional brethren who were among the pioneers of a quarter and a half century ago. It is not the purpose of these lines to

go into details concerning the work done by the PRACTITIONER during the last two decades. Suffice it to say, that founded at almost the same time with the College of Medicine of the University of Southern California, this publication has endeavored from its inception, to be a faithful exponent of the activity and work of the physicians of the Great Southwest, and its printed pages of a score of years not only present the only permanent historical record of the local medical profession during that time, but they also bear witness to its efforts to promote the scientific, social and material interests of our guild.

The PRACTITIONER thanks its friends for their cordial interest and co-operation in the past and hopes that its future course may be such as to continue to merit their good will and esteem.

On our twenty-first birthday and on the threshhold of what we trust may prove even a better future than a very kind

past, the PRACTITIONER salutes its friends and the world.

EDITORIAL CHANGES.

Our readers will notice the changes in the editorial staff of this magazine. Dr. George H. Kress who with this issue joins Dr. F. M. Pottenger as assistant editor received the degrees of B. S. and M. D. from the University of Cincinnati. During his student days he was editor of his college paper and since entering professional life his pen has not been idle. He has a love for the work that the readers of the SOUTHERN CALIFORNIA PRACTITIONER will soon realize.

Dr. W. Jarvis Barlow now becomes one of the associate editors. Several of the best editorials that have appeared in the SOUTHERN CALIFORNIA PRACTITIONER during the past year were written by Doctor Barlow and we are glad to have him regularly associated with us in this work. Drs. W. A. Edwards, F. M. Pottenger, Andrew Stewart Lobinger and Dudley Fulton will continue their departmental work. There is not a medical journal in America but would be glad to have their contributions.

Our aim, our earnest aim, is to have in the SOUTHERN CALIFORNIA PRACTITIONER a medical journal that will command the respect of the profession of the Pacific Southwest and with these able collaborators the outlook is certainly hopeful.

BERI-BERI.

With the increased responsibilities of the United States in the Eastern countries, the Philippine Islands, etc., and the greater communication of our people with China and Japan, it is of interest and importance that the life and customs of the people in these countries be made known to us.

Here, on the Pacific Coast, this knowledge will soon be essential, and in the development, the physicians must be alive to play their part and be prepared to recognize among these foreign people the diseases which in the past have been more or less strange to us. I refer here especially to that disease known to the yellow race as "Kak-Ke" (diseased leg) or "Beriberi" (debility). This is possibly the oldest disease in medical literature, certainly described

by the Japanese 2,500 years ago. Its exact etiology is as yet unknown, and sporadic cases occurring in our communities give sufficient reason to arrest our attention. Furthermore, a case of Beriberi has recently appeared in the fever ward of the Los Angeles County Hospital, having been admitted on account of the continuous temperature, of which case I will speak later.

The disease is generously and generally found in tropical climates. Those countries especially of interest to us, on account of the increasing communication, are China, Japan, the Phillippine Islands, and Central America. The diagnosis is easily and early made in these countries as the disease occurs in epidemic and endemic forms, but is difficult in isolated cases, which may occur in any place. Although the etiology is not definitely settled the disease to all appearances is an infectious one -an infectious neuritis caused by a micro-organism or organisms, whose morphological character is not yet demonstrated. Many observers have described different forms, and hold as many views. Others find various bacteria in the blood postmortem, so we know the specific germ is yet undemonstrated. The best Japanese authorities to which I have had access, claim the poison is introduced with food— rice or flour-and the toxine is produced in the stomach and intestines (always the food most blamed is rice), or that some chemical change has taken place in stale or poorly stored rice. The cause advanced by Manson, and recently published by Cohen of Baltimore is that "Beriberi is due to a germ which resides in the soil or in the houses and

surroundings of beriberi places, that it there distils a poison which on being absorbed produces a neuritis." In support of this change of location, hvgiene, treatment, etc., cured the cases, but along with this treatment the diet was changed. It would seem that some credit should be given to the diet, as the Japanese would claim, that is, the staple article rice was stopped and nitrogenous foods added. The mortality from Beriberi in India is from 14 to 30 per cent. In the Japanese army in 1875 it was 17 per cent. Two years later it ran to 30 per cent. In recent years the diet of the Japanese soldiers has been changed to more varied articles with the addition of albuminous food and the epidemic among soldiers and sailors has ceased, as illustrated in the late Russo-Japanese war. The credit of this change it is stated, is due to Dr. Takagi.

It seems only necessary to remember the two distinct classes in which this disease appears, the "wet" and "dry," or the "oedema" and "atrophy." Either or both of these may be found in varying degree, so that other classes are sometimes made, such as the "incomplete," the "mixed." After all, each case shows more or less of each of these classes. Cohen, who has had service in the Philippine Islands, divides each case into three periods-stage of oedema, stage of paralysis, stage of convalescence, or death. He has found that every case earlier or later, develops some oedema and that the greater the degree of paralysis and atrophy, the less oedema. The principle symptoms are, oedema, pain, atrophy, and impaired locomotion. In the atrophic form pains