men and hardened. Cutting the bandage relieved pressure, and the blood disappeared. Sea Air for Tubercular and Rickety Patients. Dr. Taylor, in his review of the treatment at Berck, said that Calot was an enthusiastic advocate of sea-air for patients affected with external or peripheral tubercular lesions, those of the skin, glands, bones, and joints. He rejected phosphorus in the treatment of rickets, prescribing intestinal antiseptics and a diet mainly of milk and eggs. Many of his patients were kept recumbent. He affirmed that rickety deformities would disappear during a sojourn at the seaside. Dr. Sayre had listened to Calot as he described the advantages of seaside treatment. His interest in the subject was shared by others of his countrymen, whose native enthusiasm perhaps lent a too rosecolored light to their views. Dr. Taylor had been impressed with the picturesque quality of Calot's writings. His zeal often broke through the conventional boundaries of scientific composition. The reader was entertained and delighted, but not necessarily convinced. Treatment of Pott's Disease. Dr. Ely said that Lorenz used a corset composed of perforated strips of celluloid, metal bands, and canvas. It laced in front, and was probably sufficiently comfortable, but could not be said to "splint the spine." Dr. Taylor said that although Calot declared that neither braces, plaster jackets, nor corsets could prevent or arrest the deformity, all of his patients wore the plaster jacket after subjection to manual pressure directed against the kyphos. In certain cases, ablation of spinous processes without invasion of the tubercular territory was recommended in order to facilitate correction and avoid sores from pressure of the jacket. The use of suspension, the amount of manual pressure, and the degree of lordosis to be enforced were points to be settled for each Severe pressure and all traumatisms were to be carefully avoided, in marked contrast with the violent proceedings which called attention to the name of Calot in 1896, when he was claiming uniformly brilliant results from the outlay of all his strength on the kyphos, supplemented with cuneiform resections in obstinate cases. Dr. Sayre said that Calot's recent methods, as he had heard him describe them, varied but little from those of Dr. L. A. Sayre when he introduced suspension and plaster of Paris jackets. Calot had, however, secured a distinct advantage in extending the jacket up to the chin, instead of stopping at the top of the sternum, thus promoting lordosis even of the lumbar spine, and gaining a leverage over the entire spine, which was impossible when the upper part of the vertebral column was free. Treatment of Joint Diseases. Dr. Ely said that at the Lorenz clinic joint diseases generally were treated by retention in plaster of Paris. The spica for hip disease usually had an iron stirrup running down from the bottom to take up the weight of the body. Dr. Jaeger said that Lorenz taught that traction per se did no good in hip disease except as it caused fixation, and that fixation alone was necessary, as the inflamed joint could well bear the weight of the body so long as there was no rubbing of the joint surfaces. Dr. Taylor said that Calot very justly believed that a stiff joint in a good position was better than a movable joint in a bad position. It was his practice to reduce the deformity by force, and retain the improvement with a plaster spica. Complete anchylosis in a bad position required subcutaneous orteotomy of the femoral neck. Treatment of Abscesses. Dr. Jaeger had noticed fewer abscesses in patients affected with hip disease at Vienna than in patients of the same kind in America, which was not easy to explain except by climatic differences, as the poor there were poorer, and their nourishment probably worse, than in this country. Dr. Taylor said that Calot forbade incision, curetting, and excision in Pott's and hip disease, unless the joint or abscess was infected or a sequestrum was found. He took the ground that patients affected with these diseases practically always got well under closed treatment, and always died under the open treatment. Abscesses were to be treated by roborant drugs, a full diet, correct hygiene, and rest. A cold abscess might be aspirated through healthy tissue and medicated by injections. By repeated aspirations and the application of compresses and bandages, openings which seemed inevitable might be averted, and in from four to eight weeks the abscess would disappear without a scar, and with healing of the bone in most cases. It was interesting to note that we had (1) in Calot a surgeon of ten years' active experience, formerly an advocate of scraping, incisions, and excisions, with the reputation of having done eighty excisions of the hip, who was now aggressively opposed to the operative treatment of diseases of the joints, and (2) in Lorenz, a surgeon of great experience in the cutting treatment of congenital dislocation of the hip, who had given it up in favor of a bloodless method. The co-incidence and the contrast between the recent past and the present were quite impressive. Lateral Curvature from Division of the Spinal Accessory Nerve. Dr. R. A. Hibbs related a case as follows: A girl, fourteen years old, had had glands removed from the left side of the neck six months before she was first seen a few days ago. There was spinal curvature toward the right, with drooping of the left shoulder, paralysis and atrophy of the trapezius, and marked disability of the left arm. The patient declined an operation for uniting the ends of the spinal accessory nerve, which had evidently been severed at the point where it pierced the sterno-cleido-mastoid muscle. Dr. Myers recalled the case of a similar patient, fifteen years of age, whom he had been observing for three or four years. He saw her eighteen months after the paralysis, and considerable permanent atrophy of the muscles of the shoulder had set in. There was spinal curvature toward the opposite side, which did not go on to be extreme, and was easily controlled. Fracture of Cervical Vertebra. Dr. Sayre related the case of a man who was carried home unconscious after a fall on the head and neck about two months ago. On regaining consciousness there was paralysis of the extremities, bladder, and rectum, in which there was slow improvement after two days. As every attempt to walk increased his symptoms, he was kept in bed several weeks. A diagnosis of fracture and dislocation of the fifth and sixth cervical vertebræ was made on his history, the flexion of the head, the absence of motion of the head and neck, difficulty in swallowing, and the disability of the left upper extremity. The diagnosis was confirmed by skiagraphs, of which it had been necessary to take several from different points of view. One of the negatives was taken after fastening a bandage tightly over one shoulder and under the opposite arm-pit, so as to make a gulch in which one edge of the plate had been forced so far as it would go. The skiagraphs and a brace were exhibited. The latter consisted of a leather and a steel collar attached to posterior steel rods and a pelvis belt. The head and neck would be thus fixed until consolidation was assured, the brace being capable of easy modification from time to time as the patient improved. He recalled an almost exact counterpart in a case which occurred several years ago, in which the application of a jacket and jury-mast had been followed by disappearance of the paralysis. Pneumatic Perineal Straps. Dr. Myers exhibited rubber tubes ten inches long and one and a quarter inches in diameter, designed to take the place of the ordinary perineal straps. Smaller sizes were also made. Each tube was provided with a removable cover of Canton flannel and a valve for inflation by a bicycle pump. The straps were not elastic. They were expensive but very durable. The pressure made by them was equalized automatically, and that made them especially comfortable for older children and adults whose weight made perineal support difficult. THE EFFECT OF NUTRITIVE ENEMATA ON THE GASTRIC SECRETION.-Metzger's object was to determine whether the administration of nutritive enemata caused any secretion of hydrochloric acid. The experiments were made on dogs and human beings. Gastric fistulæ, according to Pavlow's method, were formed on the dogs. The technique of the experiments is as follows: The rectum is cleared out by an enema of water, and then, if after an hour the stomach is empty or gives no congo-reaction, the nutritive enema was administered. Neither water nor water and common salt cause any secretion of HCl. An enema composed of 125 grms. milk, 2 grms. yolk of egg, and 2 grms. NaCl, caused either no secretion at all or only a very slight one. An enema composed of 100 grms. bouillon, 50 grms. red wine, and 2 grms. NaCl acted differently. In four out of five experiments there was within an hour a secretion of 4 c.c. of a strongly acid character. The secretion followed much quicker than with the egg and milk enema. Further investigation proved that the action depended not on the bouillon but on the wine. Thus wine without bouillon caused in two hours the secretion of 6 c.c. of fluid of a total acidity of 120, and HCl acidity of 110. Experiments carried out on patients gave substantially the same results. The stomach must be empty or contain no hydrochloric acid. The rectum is cleared out by an enema of water, and if after an hour the stomach is still empty, the nutritive enema is administered, and the gastric secretion is tested every half hour. In eight cases egg and milk caused a slimy fluid containing no free HCl. In some cases a little HCl developed after one and a half hours. Bouillon-wine enema, however, gave after half an hour a strongly acid secretion containing free HCl, which usually disappeared in an hour. The active portion is the wine.-München. med. wchnschr., 1900, No. 45. VOL. 31. "NEC TENUI PENNÂ." FEBRUARY 15, 1901. No. 4. H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors. Books for reviews, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER AND NEWS, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. MODERN DIAGNOSIS OF BLADDER DISEASES. Since the invention of the cystoscope by Dr. Max Nitze, of Berlin, about twenty years ago, we have made great progress in diagnosis of the various diseases of the bladder. Associated with Nitze are the names of Casper, Albarran, Fenwick, Pawlik, Kelly, Harris, Koch, and many others who have greatly aided in the mechanical appliances, and whose clinical work has been of great advantage along the line of treatment as well as diagnosis. The catheterization of the ureters is now easily accomplished by many instruments and methods, and thus we are able to go beyond the bladder and diagnosticate calculi in the ureter and pelvis of the kidney, tuberculosis, and many other diseases of this organ. Our conception of cystitis has undergone great changes now that more careful study of the actual pathology has been made under direct observation, aided by bacteriological experiments. Catheterization of the ureters is of great value in determining which kidney is involved, and thus aids the urinary analysis for the surgeon. Many operators now curette the mucous membrane of the bladder, and report excellent results in ulceration of this organ. Cumston, in this country, and Fenwick, in London, report good results from such radical treatment. The real credit for the progress made should be given to Nitze and Pawlik, and not to the many who have made mod |