not be used, as pigment may be absent from the internal muscular injections in the gluteal region caused no dis

organs in such cases, and ordinary cirrhosis without diabetes this accumulation of pigment may also be pres ent. Br. Med. Journ.

comfort, and for a week the patient received three or four ounces in this manner, experiencing appreciable benefit; so that gastrotomy was undertaken under the local ansethetic influence of cocaine. The operation was unattended with shock of pain. The stomach was opened with a tenotome, and a catheter was introduced for feeding purposes. The patient's temperature rose a couple of degrees after the operation, but he did not improve as had been anticipated, and in six days he suddenly collapsed and died. Upon post mortem examination an annular epitheliomatous stricture at the cardiac extremity of the esophagus was found. There was also some thickening and ulceration about the pylorus, one of the ulcers having given way into the peritoneum.— Med. News.

The Passage of Fat into the Urine.-The conclusions drawn by Chabrie from the facts which he has gathered are, that the passage of fatty substances into the urine may be due to a variety of causes which he tabulates under four heads.

The Pathogenesis of Hepatic Abscess.-In the course of experimental observations, Zancarol (Revue de Chir.) found that the injection of dysenteric stools of a cat, containing emedæ, into the intestine of twelve other cats, was followed in six cases by the presence of streptococci; in 11 of the cats dysentery developed, in 7 with amebæ in the evacautions and in 4 without emebæ. In the intestines of these animals was found the ulceration characteristic of dysentery. In none of the animals were amebe found in sections of the bowel, while in 11 of the 12 streptococci were found in the depths of the intestinal mocous membrane. The injection of hepatic pus, sterile by culture, into the rec tum in 7 cats was followed by the development of abscess of the liver in 2, purulent infiltration in 3, and dysentery in 4. The injection of pure cultures of strep tococci from these inoculated animals into the intestine in two cats caused dysentery in one, with recovery after 1. The presence in the blood of a parasite, the filaria the lapes of forty-four days, and dysentery in the other, sanguinis hominis. Investigation has shown here that with death after the lapse of sixty-seven days. Upon post mortem examination ulceration of the large intestine was found, together with cicatrices and streptococci in lungs and liver. Injection of a pure culture of strep tococci into the ischio-rectal fossa of a cat was followed by the development of dysentery. Upon post mortem examination a peritoneal effusion was found, with ulceration and edema of the walls of the small intestine. A pure culture of streptococci was obtained from the blood of the liver, as well as from the blood of the heart, the pericardium, the gall-bladder, and the peritoneum. In jection into the intestine of dysenteric stools from man, containing ameba, was followed by the presence of amebæ in the intestine, but after death by the presence of streptococci in the spleen. The large intestine was in a state of exfoliation and congestion.- Med. News.

the function of the kidney relative to the secretion of its normal constituents is not modified.

2. Certain pathological states, and in particular that of a form of Bright's disease. The lipuria is always very light.

3. The ingestion of quantities of fat.

4. Intestinal retention. In this case it is necessary to distinguish between the effects produced by an experimental or pathological ligature in man or in the dog. In the first, a retention of twenty four hours is sufficient to produce the passage of fat into the urine; in the latter forty eight are required. The author's theory is that this form of lipuria is produced by the resorption of bile, and he has produced it by injection of bile into the abdominal cavity of animals. Chyluria may be, therefore, a disease of the liver.-Journ. of Cuta. and Gen. Urin. Dis.

Hypodermatic Alimentation.-Caird (Edin. Med. Journ.) has reported the case of a man who for Therapeutic Effects of Altitude.-Dr. de la three years had suffered from gastric catarrh and had Harpe divides altitudes into three principal zones: 1. received great relief from washing out his stomach. For The sub-Alpine zone, between 700 and 1,300 metres; 2, five months there had been increasing difficulty in the Alpine zone, up to 1,900 meters; and 3, the hypertaking solid food and in passing the stomach tube. Alpine zone, above that height. The first of these is Finally, only fluids could be taken; and on examina considered most suitable for invalids suffering from cartion a stricture was found at the cardiac extremity of diac affections, atheromatous changes, those advanced the esophagus. Gastrostomy was proposed, but declined in years, and excitable subjects, while a higher altitude on account of the great weakness and emaciation. Near- gives excellent results in tuberculous, amemic, and neuly twenty-five pounds had been lost in two months. rasthentic cases. With regard to the properties of the The temperature was rather subnormal. But little of mountain air, the chief factors of the climate mentioned the fluid taken by the mouth was retained, the greater are: 1. The lowering of the temperature, at the rate of part being rejected. Some nourishment was adminis 1° for every 170 meters in the Alps; 2, the energy of tered by the rectum. In the hope of increasing the insolation; 3, the dryness, and 4, the purity of the air; strength and securing sufficient improvement to warrant 5, diminished atmospheric pressure. Those unaccusthe performance of gastrostomy, the subcutaneous ad- tomed to the climate of these altitude must becom acministration of sterilized olive oil was begun. Intra- climatized; the process takes some days, perhaps a week,

MEDICAL SOCIETIES

[We are indebted to the New York Med. Journ. for the following abstract of papers read before the Mississippi Valley Medical Association, October 4-6, 1893.

during which the appetite increases, thirst is intense, respiration more frequent, the number of cardiac pulsations augmemted, and the blood-pressure diminished. The quantity of air inspired increases, as also the amount of carbonic acid expired. Insomnia is at times very troublesome. Frequent palpitations and dyspnea occur, especially in cardiac, anemic, and fatty subject. Once acclimatization is complete the sleep becomes natFibroid Tumors of the Uterus. - This was ural, but the quantity of inspired air as slightly increased, the subject of the President's address. After giving a while the blood is found to contain more corpuscles. definition of these tumors, the author dwelt upon their This diminished atmospheric pressure exerts an influence etiology, which he said was still a mystery. They were on the circulation, accelerating it and raising the blood- more frequent in the black than in the white race. pressure and tension of the pulse; the blood-vessels are both races they were more frequent in the body than in fuller and nutrition is improved, thus affording excellent the neck of the uterus, and more frequently situated in conitions for the treatment of anemia and feeble cardiac the posterior than in the anterior wall. After the menoinnervation. The action of the dry and pure (free from pause was established these tumors generally disapmicrobes) air makes itself especially felt in certain peared, unless they had undergone cystic degeneration. pathological conditions; for example, the pus of suppurating, tuberculous, or pleural cavities undergose dimin ution, the favorable process of sclerosis of the tissues surrounding the cavities is accelerated, and the cold of high altitude rendered more supportable.-Brit. Med

Journ.

Gall-Stone in the Intestines.-There are large numbers of cases on record in which obscure cases of in

In

Bearing on this point the President reported an anoma lous case. The patient was forty three years of age; she had never menstruated in her life, had never shown any physiological evidence of ovulation, had been twice married, and was then a widow and childless. She had for ten years had a large fibromyoma of the uterus, which thus far had given no evidence of atrophy.

With regard to the pathology, the tumor always had its origin in the substance of the uterine wall or in the subperitoneal connective tissue.

The symptoms accompanying the presence of these tumors in various localities and stages of growth were widely different. However, there were vague pain in the pelvic region; pain referred to the front or back of the leg; irritability of the bladder or rectum; uterine tenesmus; menorrhagia or metrorrhagia; dysmenorrhea; profuse leucorrhea; and a serous discharge from the uterus. The diagnosis of very small fibromyomata, when many of the leading symptoms were absent, was considered extremely difficult.

testinal obstruction have proved to be due to the impaction of gall stones at some part of the intestinal tract. These cases are interesting from several points of view, and especially on account of the difficulty in diagnosis which many of them present. Of course when one has to do with a patient who is known to have suffered from jaundice or from occasional attacks of biliary colic, the possibility of the obstruction being caused by the impaction of such calculi must occur at once to the surgeon; but except in cases where the obstruction is due to the agglomeration of several freshly formed calculi, there is often a curious absence of previous symptoms pointing to calculous formation. Yet in these very cases the stones are frequently of considerable size, so large in fact that they could not possibly have passed through the common bile duct by any conceivable degree of dilatation. They have indeed ulcerated through the gut by a slow necrotic process devoid of painful manifestations. Under these ciscumstances an exact diagnosis must be difficulty not to say impossible. The matter is, however, of some importance, because one is, of course, anxious to spare the patient the danger attending so serious an operation as laparotomy with incision of the gut, the more so seeing that a very large proportion of such cases are emenable to medicinal and general measures. It is probable that the failure to elicit the Forensic Medicine.-This paper was read by Dr. history of previous symptoms of hepatic colic is some- C. G. Comegys, of Cincinnati. The author had come to times due to the inquiry being restricted within too the conclusion, from his experience, that there were but narrow limits. It is indeed necessary to go far back in few lawyers sufficiently informed in medical science to the patient's history to obtain the desired date, which conduct a case in the interests of truth and justice, espemay have been forgotten or overlooked. Fortunately cially the most important cases in medical jurisprudence. the effect of surgical intervention in the more urgent Every physician, as an expert witness, must have ob cases is very satisfactory, provided it be had recourse to served the embarrassment of lawyers in trying medical in good time.-Med. Press. cases. They asked questions enough, but, from their

So far as the medical treatment was concerned, but little could be done for the relief of patients suffering from fibromyomata, and nothing for those suffering from tumors that had undergone cystic degeneration. Surgically, there were but two routes by which solid uterine tumors could be removed-the vagina and the abdominal wall. With the exception of small tumors with a well-defined pedicle, all subperitoneal fibromyomata could be reached only by section of the abdominal wall. The President had in one case divided the posterior wall of the vagina and through this opening removed the tumor.

lack of medical experience, they were incapable of thor- incident to childhood. The author reported a case of oughly understanding the answers of a witness, so that chorea occurring in his practice with a marked history the proper interpretation of them bearing upon the his of rheumatism, one of ten cases illustrative of this tory of a case at the bar might be reached, and, when class observed by him. The cases had not occurred endeavoring to give the court and jury clear views of successively. Between them other cases had presented the subject by additional questions, they often confused themselves lacking the rheumatic history, but four of the whole investigation. This disagreeable state of the number had occurred in rapid succession, with a affairs was usually brought about by certain lawyers pronounced rheumatic history. Seven of the patients who had armed themselves by a superficial study of had been girls. medical works for the occasion. Dr. Comegys believed that the high order of legal men would welcome welltrained men in medicine as coadjutors in the lofty work of establishing justice.

Problems of Public Interest Concerning the Insane.-In a paper thus entitled Dr. Orpheus Everts, of College Hill, Ohio, said there were several problems of public interest involved in the present re lations of society to the insane. Among the more im portant of them were questions of dependency and curability of the insane and the preventability of insanity. The author summarized his conclusions as follows:

1. Intelligent provision for the insane implies provis ion for various classes, according to the capabilities of enjoyment and the exercise of variously impaired fac ulties.

2. Public provision for whatever class of insane per sons implies housing, clothing, food, sanitary and moral discipline, amusement and employment for such as are capable of being amused and employed, and medical treatment for the sick. The essential features of such provision are adaptability to the needs of each dis

tinctive class.

3. Great, expensive, architecturally imposing palaces, providing alike for all classes, however serviceable they may have been, esthetically considered, in times past, as they unquestionably were, are no longer necessary or appropriate to the needs indicated. So long as the insane are comfortably housed, each class according to its condition, it is comparatively unimportant whether it be in large or small houses, cottages, or palaces, con nected or detached, in high or low buildings.

4. It is important that the insane of all classes be well fed under careful supervision; but whether in small or large dining rooms, by groups or congregations, is of little consequence; it should be a matter of convenience rather than of number.

Among the exciting causes of the disease were irri tation in the nostrils and adenoid growths in the vault of the pharynx. Inasmuch as Kirkes, Tuckwell, Hughlings Jackson, and Bastian had supported the embolic theory of the disease, and in consideration of the fact that chorea was so frequently associated with endocarditis, we should be on the alert to interrogate the heart when called to a case of chorea. As matters now stood, we had numerous exciting causes resulting in chorea.

Chorea, its Pathology and Treatment.This paper was contributed by Dr. H. M. Lash, of Indianapolis. So much uncertainty had existed regarding the pathology of chorea that its treatment had been varied and widely different in its character and aims, amounting even to empiricism. The author then gave the causes of chorea as laid down in the recent work on nervous diseases by Dr. Landon Carter Gray. He referred to the repeated experiments of Dr. H. C. Wood, who had announced his conviction that the choreic movements had their origin in the spinal cord and were directly due to paralysis or depression of the inhibitory function of the cells. Acting on the strength of this conviction, Dr. Wood had sought for a remedy that would strengthen the proper function of these cells, and he had it in quinine.

Dr. Lash then reported a case of acute chorea in a boy thirteen years of age. The choreic movements had been constant, general, and pronounced. It was agreed to try Dr. Wood's suggestion, and so the patient was put on full doses of quinine. Twenty grains a day, in four doses, were given him for three days, when he showed considerable improvement. The quinine was increased to twenty-five grains a day and given in that amount for three days more, when the patient again reported. There were no remaining symptoms of the chorea, and the quinine was gradually withdrawn. The

5. It is important that public institutions for the in patient had remained entirely free from the trouble sane be well organized and administered.

6. It is wise to retain in office capable men, who have demonstrated their fitness by successful management of affairs, so long as their capabilities continue to be elastic.

ever since, and without any subsequent treatment of any kind. Another similar case with a successful result was reported.

Diphtheria; its Specific Diagnosis. - This was the title of a paper read by Dr. J. C. Culbertson, of Chorea in its Relation to Rheumatism.- Cincinnati. The author said that this disease was of This paper was contributed by Dr. I. N. Love, of St. peculiar interest because of its treacherous and insidious Louis. The author said that recently the pathology of character. The uncertainty of diagnosis had caused this disease had been cleared up to a very considerable some excellent practitioners to adopt the pernicious degree. It was a definite affection and one especially habit of diagnosticating and treating all cases of sore

quarantining of the family, to be followed by the May Rew, of New York, whose bogus medical college

Now is the time to subscribe for the MEDICAL none too precious to be sacrificed, if need be, in relieving REVIEW. humanity's physical suffering, and surely "greater love

hath no man than this, that a man lay down his life for attention, while the drugs most in use in the treatment his friend.