MEDICAL SOCIETIES ble from the fact that the renal trouble had been of very long duration, the diagnosis of renal calculus not having been suspected for some time. At the time of commencing treatment, there was well-marked pyelo nephritis, with passage of much pus and blood in the urine. Uric acid, urates, and calcium oxalate were also indebted to the Journal of the Americon Medical Assopresent. In this case, too, the use of piperazin proved ciation for the following interesting report of the Secsuccessful in removing nearly all symptoms, and this tion on Practice of Medicine, at the meeting, held on improvement was maintained after discontinuance of June 8 and 9, 1893, at Milwaukee, Wis. the drug. American Medical Association.-We are Dr. H. D. Didama, of Syracuse, N. Y., reported some BRIEF CLINICAL MEMORANDA. a. He stated that saliva is an excellent substitute for olive oil, glycerin, cosmolin, or other substance, as a lubricant for catheters. Although containing bacteria, saliva is not septic, and is always at hand. b. In preparing hemorrhoids for injection he anesthetizes by means of ether or the A. C. E. mixture, and follows by digital dilatation of the anus. He then brings down the hemorrhoids, ligates those with small pedicles, tying with a bow knot, and then injects the material to be used. person. The Radical Treatment of Congenital Inguinal Hernia in Females.-According to Dr. Lucas Championniére (Annals of Surgery) the palliative treatment by means of trusses is becoming some what restricted. Increased frequency of operating has extended our knowledge of the pathological anatomy of the less frequent kinds of hernia, and our views con cerning the stative frequency of the same are changed. Thus congenital inguinal hernia in females appears to be by far more freguent than was heretofore generally supposed. Among fourteen radically operated inguinal herniæ in women, he found in ten instances conditions c. He recommends the following facile reduction pointing to a congenital origin of the disease. Among of prolapsed hemorrhoids: The patient is placed on his the symptoms to be so interpreted in this connection he back, with his knees drawn up. Cocaine is applied to mentions the existence of the round ligament in the the hemorrhoids, if tender. These are then thoroughly wall of the hernial sac, which is hollowed out as by a lubricated with vaselin, and with the tips of two or furrow; the solid attachment of the serous covering three fingers pressed up while the patient at the same with this ligament; the occurrence of small cysts on time is directed to bear down. The hemorrhoids the base of the hernial sac. In the radical operation readily slip up into the bowel. The patient himself can Dr. Championnière recommends that the incision be perform this operation without the aid of a second made as high as possible, in order to remove the latter as great a distance from the vulva as possible. The d. For the ready relief of lumbago, Dr. Didama has operator invades the inguinal canal, seeks the hernial for ten years or more employed large dry cups over the sac from above downward, rather than vice versa. The entire lumbar region. Four cups are applied at once serous cover of the round ligament is so intimately ad and the application is repeated. In fifteen minutes the herent to the sac that the removal of the sac, without pain is entirely gone. The relief is usually not only taking along the ligament, is impossible. Therefore he prompt, but also lasting. The blood is drawn from the separates, as a rule, the ligament together with the sac, painful muscles to the surface, and relief is afforded. as high up as possible; and after ligating, removes it. The cups should be three inches in diameter and six He found no disadvantages arising from this resection inches deep. A tonic and alkaline diuretic may be of round ligament, the stump of resection again attachgiven. ing itself to the abdominal wall. The author recom mends, after separating the hernial sac and before tying of the same, examination of the uterine annexa through the incision; if found to be diseased, these are to be extirpated at ouce. He believes this examination to be necessary, as these organs, in case of inguinal hernia, are frequently dislocated to the affected side and are often diseased. The author provides against recurren ces by splitting, in every instance, the inguinal canal in its whole length, separating and removing the perito neum as high up as possible, and then uniting solidly and accurately the extensive denuded surfaces with each other by means of numerous deep sutures. A truss is but rarely prescribed. The author's results are very favorable; the operation in each instance was invariably followed by recovery. A number of patients examined afterward were found to be free from recurrence; in the majority of the cases operated upon, the time which has elapsed since the operation is too short to base a conclusion upon. Dr. Billings, of Chicago, said that in the use of saliva as a lubricant the patient is in constant danger of infection. While always containing non pathogenic bac teria, the saliva frequently contains pathogenic and Pyogenic bacteria also. Dr. Denison, of Denver, called attention to the danger of transmitting tuberculosis by the saliva used as a lubricant, as the saliva frequently contains tuberclebacilli. Dr. Aulde, of Philadelphia, emphasized the rheumatic origin of lumbago, and suggested the use of potassium iodid, and the salicyiates, as well as the faradic cnrrent. He said that rhux toxicodendron is also of value in the affection. Dr. MacLean, of Detroit, reported a case of supposed appendicitis that had ruptured througe the lung. Dr. Joseph Price said that appendicitis is one of the most troublesome conditions met with by gynecologists the exudate of acute pleuritis as an inflammatory one, and abdominal surgeons. He believes the condition and only operates during the stage of febrile reaction purely a surgical one and advises operation in every when urgent symptoms appear, and then promptly. instance. The removal of the appendix in the intervals If, after the fever and pain are controlled the effusion between the attacks is followed by a mortality of does not become absorbed, he does not wait longer almost nil. The application of poultices and the ad than a week or ten days, but removes the exudate by ministration of opiates are objectionable. In almost aspiration, withdrawing small amounts at a time, in every case the adhesions are extensive, though in some order to avoid dangerous sequelae. This is repeated very exceptional cases there are none. every couple of days, until the tendency to recurrence is overcome. Sudden syncope may follow the removal of a large amount of fluid. Dr. Whittaker, of Cincinnati, said that he prefers the word typhlitis to appendicitis, and asserted that no physician would object to operation in cases in which ulceration is present. As some cases of typhlitis never have a relapse, it would be improper to operate whenever the patient complained of pain in the region of the appendix. The continually recurring cases should pass into the hands of surgeons. Dr. J. Hoffman, of Philadelphia, said that of 18,000 cases with disease in the right iliac region in the German hospitals there was disease of the appendix in 91 per cent., and only 9 per cent. could be classed as typhlitis. He admitted the possibility of a case getting well without treatment, either medical or surgical, but under such circumstances the convalescence is prolonged. Dr. McMurtry, of Louisville, stated that many cases of appendicitis are reported in the mortality lists as peritonitis, especially those occurring in males. Peritonitis is only a symptom, and usually of appendicitis. Dr. J. B. Murfree, of Murfreesboro, Tenn., read a paper on DIPHTHERIA. Dr. Charles W. Purdy, of Chicago, read a paper on THE DETECTION AND SIGNIFICANCE OF CARBOHYDRATES IN THE URINE. He confined his remarks mainly to the consideration of glycosuria, for the quantitative determination of which. he proposed a new test. The test solution consists of copper sulphate, 48 grains; pure potassic hydrate, 144 grains; strong ammonia, U. S. P., 9 ounces; glycerin, 6 drams; distilled water to 20 ounces. It was said to be stable and reliable. Some of the blue solution is placed in a vessel and the urine is dropped in from a buret, until the blue collor dispappears, when the amount of sugar present may be estimated. In the discussion of the Brand method of treating typhoid fever, Dr. Chr. Sihler, of Cleveland, insisted that the cold water treatment of typhoid fever can, should, and will be carried out in private practice. Over five thousand baths have been given under his supervision without difficulty. The objections are: 1. That it is not pleasant to the patient; still patients are usually willing to undergo the discomfort in order to increase their chances for life. He said that the greatest number of cases occur between the ages of three and twelve, and but very few in infants. The disease may be transmitted by cows. The 2. Four out of five of our patients will get well withperiod of incubation is from two to five days. The out it. The bath can readily be given by a member of severity of the disease is the greatest at the height of the family, although it is better given by a trained. the epidemic, but the intensity of the fever bears no nurse. Dr. Sihler has a tub five and three-fourths feet relation to the degree of the toxemia. The pulse is long, two feet wide, and sixteen inches deep. The tem usually feeble and small. The prognosis is always un-perature of the first bath is 88°, cold being applied to favorable. In treatment, few remedies are of much the head and friction being employed. The second avail and none is specific. Isolation and disinfection bath is given at a temperature of 84°, and successive must be absolute. Antiseptic mouth washes; astringent baths at 80°, 76°, and down to 68°. The temperature gargles; the swallowing of ice, pepsin, trypsin, etc., to should be taken every half-hour after the bath. If the destroy the membranes; tincture of ferric chlorid for patient is chilled, he should be wrapped in a blanket the blood; mercuric or mercurous chlorid; alcoholic and have hot bottles applied to the feet. Dr. Sihler stimulants, especially large and frequent doses of regards the chill as beneficial rather than otherwise. He whiskey, constitute a useful method of treatment. uses less alcohol as his experience with the bath grows. Dr. Jenkins, of Iowa, stated that he applies topically, with absorbent cotton, a solution of ferric sulphate. Dr. E. J. C. Minard, of Brooklyn, N. Y., read a paper on EARLY ASPIRATION IN ACUTE PLEURITIS. In Dr. W. G. Thompson, of New York City, reported that he had treated 95 patients in three years by the Brand method, with a mortality of 7 per cent. 1305 cases treated by the expectant method, the mortality was from 20 to 30 per cent. In the French and German hospitals the mortality has, under the Brand It was stated that the diagnosis of the condition is not method, been reduced to below 2 per cent. A patient always easy. Early aspiration was advised, with thorough with a temperature of 102° F. is given half an ounce of asepsis. whiskey, and is put into the bath for fifteen minutes, Dr. Anders, of Philadelphia, stated that he regards being rubbed at the same time. He is then lifted into his bed, rubbed dry, and given a glass of milk. For a cause of death. A lowering of individual vitality as a young child or weak adult a bath of ten minutes is result of famine, overwork, and intemperance is one of better. Often three or four baths per diem will suffice, the main predisposing causes of various morbid conbut in bad cases a bath should be given every three ditions. A widespread disobedience of sanitary laws hours, day and night. For a nervous patient the initial is the common origin of most of our epidemic diseases. bath may have a temperature of 90°. The temperature In all acute infectious diseases there is a great tendency often continues falling after the bath. The occurrence to involvement of the respiratory organs, and esepcially of menstruation need not contra-indicate the treatment, to croupous and catarrhal pneumonia. Cardiac disease and in one instance a patient was five months pregnant, is usually indicated by symptoms referable to other and yet was given forty baths. A characteristic organs, as dyspnea, digestive disturbance, intestinal or result of the treatment is the absence of nervous renal derangement, etc. Derangement of the function symptoms. The patient should void urine before en of one organ will give rise to modification of associated tering the tub; otherwise he will be likely to urinate functions elsewhere. If the liver be primarily involved during the bath. there occurs stasis of the entire portal system, with Dr. Herrick, of Chicago, said that within the past five gastric and intestinal catarrh, constipation or diarrhea, years he had seen nearly one thousand cases of typhoid jaundice, etc. Inherited diatheses, as for example, fever in hospital and private practice. He has observed syphilis, predispose to the development of tuberculosis. that the pulse is invariably slow, notwithstanding the Scrofulous and gouty individuals are subject to tuberhigh temperature, and the average is from five to fif- culosis and lithemia respectively. An inherited neuroteen beats higher per minute in women than in men. pathic constitution predisposes to various mental and A pulse over 106 in a male will require careful watch- nervous disorders. Especial attention was directed to ing, and one of great irregularity is of bad omen. A the relationship between arterio sclerosis and cardiac slow pulse in typhoid fever is as characteristic as a rapid pulse in scarlet fever. Bradycardia is common in convalescence. and renal disease, and cerebral hemorrhage. The general increase in arterial tension puts an extra strain upon the sclerotic arteries, and rupture, with hemorrhage, readily occurs, with a resultant hemiplegia or even with a fatal result. In Dr. Herrick's experience sweating is usually not present until late in the disease. In one case the erup tion appeared on the face and over the entire body. In Dr. Denison, of Colorado, called attention to the 20 per cent of the cases severe epistaxis was an early association of fibrosis with tuberculosis. He expressed symptom. The temperature in the early days of the the belief that the so-called tubercles are the vaults in disease is very intractable. Pain in the abdomen is not which nature imprisons the tubercle-bacilli to prevent a rare occurrence, and may suggest peritonitis. Albu- their multiplication. Under the influence of tuberculin minuria is common, as is Ehrlich's reaction, but the the process that results is not one of softening, but diagnostic significance of the latter is doubtful. Less rather one of contraction, as indicated by a shrinkage mental disturbance follows intestinal antisepsis than in the size of the cervical glands revealed by actual other methods of treatment. Absolute rest in the re- measurement. cumbent posture is insisted upon, with liquid diet, sponging with cold, tepid, or warm water, antipyretics in small doses; opium for hemorrhage; surgery for per foration. The mortality in hospital practice was 17 or 18 per cent. Dr. Scott, of Cleveland, contended that disease is not inherited. A certain state or condition that favors the contraction or development of certain diseases may, however, be transmitted from parent to child. As long as the general system is in a good condition the individual possesses a certain degree of immunity. Dr. Webster, of Chicago, pointed out that disease may be transmitted by heredity, as, for instance, syphilis. Dr. J. H. Kellogg, of Battle Creek, Mich., pre Dr. Anders, of Philadelphia, stated that he is a thorough advocate of the Brand method. He thinks that the chilly sensation produced by the cold bath is not beneficial. Such patients should at once be removed from the tub. Very weak patients should be held in one position while in the bath, to avoid exhaustion. In-sented a communication on ternal antipyretics are to be avoided in these cases, on THE NEW CHEMISTRY OF THE STOMACH AS A Means account of the cardiac weakness as a result of degener. OF DIAGNOSIS AND A GUIDE TO THERAPEUTICS, ation of the heart-muscle. The chief value of the cold BASED UPON THE RESULTS OF ONE THOUSAND bath resides in its stimulating effect upon the nerveANALYSES OF STOMACH-FLUIDS. centers. Dr. H. A. West, of Galveston, Texas, presented a He described a new method of analyzying the stomachcommunication on THE ASSOCIATION OF DISEASES AND MORBID He spoke of the difficulty of ascertaining after death fluids, and proposed a new classification of gastric disease of functional character. The therapeutic indications of these conditions were outlined, together with the means by which these indications are to be met. Dr. Charles Denison, of Denver, presented a new syringe for the injection of tuberculin, which he claimed was thoroughly aseptic and much better than the one usually employed. On one side the syringe is marked in minims, and on the other side in milligrams. Dr. Denison is in the habit of using a 1 per cent solu tion for doses under 20 milligrams and a 10 per cent solution for doses over 20 milligrams. Pan-American Medical Congress-Section on Gynecology and Abdominal Surgery. All members of the medical profession are cordially in vited to attend the meetings of this section to be held in Washington, September 5, 6, 7, and 8. The sessions promise to be exceptionally interesting, many valuable papers having been contributed. Those who may wish to read papers before this section and who have not yet sent in their titles and skeleton abstracts are requested to do so at once, NOTES: AND ITEMS Herpes Zoster as an Infectious Disease, -Th. von Wasielewski (Corresp.-Biat. des allgem. aerztl. Ver. f. Thuringen, Jahrgang xxi, No. 5), states that in herpes zoster appearances are to be found in epithelial cells of the papillary layer which can only be consid ered as protozoa. When the epithelial covering of a herpes vesicle is raised, and the affected skin scraped with a small scalpel, the tissue elements that are thus removed, examined under the microscope, show dis tinctly protozoa with independent movements. Tamponing the Bladder to Arrest Hemorrhage after Suprapubic Prostatectomy, Etc.-Keyes (Boston Med. and Surg. Jour.) describes an original device for checking hemorrhage under these conditions, by means of a gauze pad to which a thread is attached and led through a perineal wound. Traction upon the the thread brings the pad firmly against the bleeding surfaces in the lower part of the bladder and about the vesical orifice. The pad can be removed when desired by means of a second thread which is led through the suprapubic wound. Cabot has modified this device in such a way that the gauze pad can be drawn out into a thin band, and so be removed more readily. Papers have already been contributed by the following distinguished gentlemen from the United States and Canada: Drs. T. Johnson Alloway, Montreal, Can.; A. W. Abbott, Minneapolis, Minn.; J. M. Baldy, Philadelphia, Pa.; H. J. Boldt, New York City; Augustus P. Clarke, Cambridge, Mass.; Ernest W. Cushing, Boston, Mass; Andrew F. Currier, New York City; L. H. Dunning, Indianapolis, Ind; Geo. R. Deane, Spartansburg, S. C.; W. E. B. Davis, Birmingham, Ala.; Joseph Eastman, Indianapolis, Ind.; Geo. M. Edebohls, New York City; De Saussure Ford, Augusta, Ga.; William Gardner, Montreal, Can.; T. H. Hawkins, Denver, Col.; John R. Haynes, Los. Angeles, Cal.; Edw. W. Jenks, Detroit, Mich.; Jos. Taber Johnson, Washington, D. C.; Howard A. Kelly, Baltimore, Md.; Florian Krug, New York City; G. Betton Massey, Philadelphia, Pa.; Lewis S. McMurtry, Louisville, Ky,; R. B, Maury, Memphis, Tenn.; Wm. F. Myers, Ft. Wayne, Ind.; E. E. Montgomery, Phila delphia, Pa.; Robert T. Morris, New York City; Chas. P. Noble, Philadelphia, Pa.; Jos. Price, Philadelphia, Pa.; Geo. H. Rohe, Baltimore, Md; Jas. F. W. Ross, Toronto, Can; Chas. A. L Reed, Cincinnati, O.; I. S. Stone, Washington, D. C.; R. Stansbury Sutton, Pitts-preciable detriment to appetite or weight. The sweet. burg, Pa; T. Algernon Temple, Toronto, Can.; A. Vander Veer, Albany, N. Y.; W. B. Ward, Topeka, Kan. W. W. POTTER, Executive President. BROOKS H. WELLS, 71 West 45th St., N. Y, City: English-Speaking Secretary. New Teachers at the Beaumont Hospital Medical College.-At a Faculty meeting of the Beaumont Hospital Medical College, held recently, the following gentlemen were elected professors and lec. turers: Hugo Toeppen, M.B., Ph.D., Professor of Histology. J. E. Alvord, M.D., Professor of Materia Medica and Therapeutics. J. A. James James, M.D., Lecturer on Osteology. Sebastian Joseph, M.D., Lecturer on Electro-Therapeutics. Dulcin, A New Synthetic Sugar for Diabetics.-The last number of Notes on New Remedies states that a new synthetic sugar, called "dulcin," or paraphenetol carbamide, is engaging the attention of Du Bois Raymond and other physiologists of Berlin. Kossel has been carrying on experiments on rabbits showing that the drug may be taken in doses of thirty. grains daily without any disturbance of the general well-being Dogs also have been fed with this substance for three weeks continuously, without any ap ening potency of this drug is as 200 to 1 of cane sugar. Dr. Ewald has tried this substance clinically and upon persons in health. He reports that it is readily taken, the taste being acceptable to all. It proved to be especially suitable to diabetic persons, given to them in "the mannite combination, one to nine." Tablets containing two fifths of a grain of dulcin-equiva· lent to eighty grains of lump sugar-and one or two of these can be used by patients as the sweetening agent for coffee and other beverages. Ewald regards dulcin as free from toxic property in the quantity that is liable to be taken. Removal of the Seminal Vesicles.-Since Ullman (Boston Med. and Surg. Jour.) removed both seminal vesicles for tuberculous disease, by Zuckerkandl's method-which consists in exposing the prostate and base of the bladder, by dividing the anterior at rectum. tachments of the rectum and then freeing it from the used to think it a disgrace if she wore a larger shoè or prostate and lower part of the bladder, Roux has report boot than a No. 2; if she wore fours, she managed ed two cases in which for tuberculous disease he has them; if she wore fives, she hid her foot. Now she unremoved one seminal vesicle, together with the sper- derstands that is is a law of statuesque beauty that a matic cord and testicle of the same side-through a body should have an extremity apparently equal to its lateral perineal incision, reaching the vesicle by a dis-support-a woman a foot big enough to stand on, and section carried upward between the prostate and the bien chaussee, bien gantee, she never dreams of lengthen ing her skirt because her shoe is a six or seven, or of keeping her hands out of sight because they did not stop growing when she was ten years old. Owing to this last act of wisdom she can walk with freedom where she will, without pinched feet or any of the discomfort. that urges her to sit still; and thus she takes with delight the exercise which does so much for her, which fills her lungs with fresh air and oxygenates her blood, and gives it all its life and sparkle wherever its effects are visible. After all, it is common-sense, the apprecia tion that nature says how much to eat and what to wear, that has reformed an ailing and early withered woman into a beauty of the old Greek type.-Harper's Dr. George W. Gay, of Boston, in May, 1891, removed the right seminal vesicle, through a lateral perineal incision (similar to that practiced by Roux), for cancerous disease thought to be primary in the vesicle. Six months later the wound, which had healed well, reopened; and examination revealed a hard mass, about the size and shape of the forefinger, in the site of the seminal vesicle which had been removed. Villeneuve reports a case in which he removed one seminal vesicle by exposing the spermatic cord outside the inguinal canal, and by freeing and pulling on the cord until the seminal vesicle was sufficiently brought down to be reached and excised. American Surgical Association.-At the meeting of this Association, held at Buffalo, N. Y., May 30 to June 1, 1893, the following officers were elected for the ensuing year. Bazar. The Conduct of A Medical Life.-Mitchell, in the University Medical Magazine, publishes two lectures in which he says among others: "Character is the true and sure object of a rational existence. Back of President-Dr. J. Ewing Mears, of Philadelphia. this character must be a creed. The practice of medi First Vice-President-Dr. Roswell Park, of Buffalo. cine is a profession, not merely a business. He who Second Vice-President-Dr. Lewis S. Pilcher, of looks upon it commercially, and only thus, is apt to Brooklyn. fail of even the mere financial form of success, because it is the peculiarity of our mode of earning a livelihood that it is not and cannot be regarded as a mere business. The more we study the lives of exceptionally successful physicians in all ages, the more clearly will we come to see that the brilliant triumphs have fallen most often to Secretary-Dr. J. R. Weist, of Richmond, Ind. ton. Chairman of Committee of Arrangements-Dr. L. those who had the highest ideals as to what they were M'Lane Tiffany, of Baltimore. The following were elected to membership: Drs. H. S. Burrell, of Boston; Perry H. Millard, of St. Paul; Albert B. Miles, of New Orleans; Samuel J. Mixter, of Boston; John W. Elliott, of Boston; John Parmenter, of Buffalo; J. McF. Gaston, of Atlanta. To Honorary Membership-Prof. Carl Gussenbauer, of Prague. dutifully bound to give, rather than what they were in return to get. I am fond of saying that in our work we sell what neither we who sell nor those who buy can weigh or measure. We have no public to which we hend with abject submission, as does the lower newspaper man, most timid of the reptilea; no judge or jury listens to us; no press or public looks on to applaud or condemn. What we do, neither patient or his friends The next meeting of this Association will be held at can fully understand. One silent auditor makes up our Washington the first Tuesday of May, 1894. The American Girl as She Sometimes Is. -This young compatriot of ours no longer laces herself to breathlessness and a red nose and a pimpled forehead, pushing what flesh there is into regions where it makes deformity; she wears corsets, but only to outline and partially support, never to press or pinch, and thus her digestive organs are kept free to do their work and assist in preparing the rounded and velvety surface, the glow in the eye, the blush upon the cheek, the dye of the soft lips; for, unpoetical as it appears, the laboratory of beauty is in the stomach. In addition to all this, the American girl is no longer ashamed of her foot. She moral accounts. That we live and are to live very largely a life of isolated self judgment, that neither scale nor measure approves the amount and integrity of what we sell-this, I think, should make us doubly careful. I want you to go hence with unattainable ideas of what you mean to make your lives; the higher the better. At all events, have and hold distinct conceptions as to the qualities which make men great in the higher manhood of medicine, and acquire them now. The world may make strange havoc with your views when, as years go on, you are to be guided by them in the every day work of life. But he is to be pitied who, when young, having no ideals of duty, waits for oppor tunity to generate a code of conduct." |