CASE 2. Marasmus. Female, age eighty-seven; patient almost pulseless; skin cold; mind clear. After the use of one quart of the solution by enema the pulse at once filled out and the skin became warm. These symptoms recurred at intervals of every three or four days, and treatment repeated with same effect for four weeks. The patient died.

CASE 3. Cirrhotic liver. Male, age thirty-nine; pulse 160 and weak; skin cold. After using one quart of solution by enema pulse quickly filled out and slowed down to 120 beats, and skin became flushed. The patient relapsed every two or three days for twelve days, and enema repeated each time with good effect. Patient died.

CASE 4. Placenta previa. Multipara, age thirty-six. In thirty minutes after termination of third stage of labor patient pulseless and apparently moribund. One quart of solution was used by enema, and in fifteen minutes the pulse filled out and color returned to face, and patient was soon out of danger.

CASE 5. Acute dysentery. Female, age twenty-seven. Pulse 160 and weak; skin cold and cyanotic. One quart of solution used by enema, and in thirty minutes pulse 120 and skin warm. Enema repeated every four to eight hours, and patient safely convalescent in thirty-six hours.

CASE 6. Typhoid fever. Male, age thirty. On twentieth day profound intestinal hemorrhage; pulse rapid and hardly perceptible; skin cold and blanched. One quart of solution used subcutaneously, and in a few minutes pulse filled out and color returned. In twelve hours the hemorrhage returned, but not so severe; pulse 140 and weak; skin cold; subcutaneous injection of solution repeated, and promptly pulse slowed down to 115 beats; color returned and patient convalesced.

CASE 7. Puerperal septicemia. Multipara, age thirty-four. On the eighteenth day, morning temperature 97° and evening 105°; pulse 145 and very weak; skin cold. This condition had existed for three or four days. One quart of solution was used by enema, and continued every four to eight hours for two days. Morning of first day, temperature 100°, and evening 102°; morning of second day, temperature 99° and evening 100°; pulse 85; skin warm. Patient convalesced. Having observed in my own practice and read in medical literature how quickly the normal saline solution thrown into the rectum. will bring about a reaction, the mind naturally seeks to discover how this reaction is brought about in so brief a time. It is not reasonable to believe that such a volume of fluid could have been absorbed so

hurriedly, therefore we seek for an answer elsewhere, and it is to be found in the chemical affinity of the blood and nervous system and cell-life itself for an alkali, which brings about this explosion, termed molecular action.

The use of the normal saline solution is attracting universal attention over the world, and at present certain infectious diseases are being treated by this method in France, and the profession are anxiously awaiting a report of these investigations.

The human organism is like a palace with electric bulbs in every room, and all connected by one wire with the dynamo; touch the button at the front door, there is an explosion, and the little bulbs light up the whole palace! Thus it is when the normal saline solution is injected, there is an explosion, and instantly every cell in the body is aroused, revived.

OWENSBORO, Ky.

ACUTE ORCHITIS.*

BY W. H. HARDESTY, M. D.

No doubt you gentlemen present have often observed a failure on the part of the physician to differentiate between acute orchitis, acute periorchitis, and acute epididymitis.

Acute orchitis may be defined as an inflammation of the testicle proper. The testicle may be attacked primarily, or it may be secondarily affected by invasion from some remote or neighboring organ. The disease may be either local or diffused.

Etiology. Orchitis may be traumatic, idiopathic, or due to the extension of some specific or non-specific disease along the cord, propagated from disease of the bladder, urethra, or seminal tubules. It may be found in ectopia testis, where the gland is placed in the perineum or cruro-scrotal fold. Contraction of the cremaster muscle, thereby causing the organ to be pressed against the external abdominal ring, may give rise to this trouble. There may be anomalous distribution of the cremaster loops, which could thoroughly basket or encircle the testicle, and any irritation capable of causing contraction of sufficient frequency and strength would inflame the organ. Metastatic, or, to use the term of Ziegler, hematogenetic causes, such as mumps, syphilis,

*Read before the Ohio Valley Medical Association, at Henderson, Ky., November 12, 1901.

typhus abdominalis, and allied troubles are to be included among the etiological factors. Rheumatism and gout are factors worthy of consideration, though their causative influence is denied by some authorities. However, atrophy of the testicle sometimes occurs during and after an attack of rheumatism or gout, which, to my mind, goes far to maintain the truth of this statement. There are attacks of orchitis which come on without any apparent cause.

Fleming reports a case in a child fourteen days old, otherwise perfectly healthy, in whom an acute and painful swelling of the testes about the size of a hen's egg occurred. There was a protrusion from the scrotum and loss of a mass about the size of a walnut, which ended in restoration of the normal function.

Cases of the latter class are reported as accompanied by sudden abscess formation, with or without fungous testes. Of the hematogenetic causes, mumps heads the list as the most frequent. Gonorrhea may cause orchitis, but not frequently, as the latter usually is a sequel to gonorrheal epididymitis.

Under the head of traumatic influence in the production of orchitis may be included operations upon the urinary tract, as for fistulæ, evacuation of hydrocele or hematocele, the use of the catheter, particularly in the aged; and lastly, as not an infrequent cause, may be mentioned repeated and prolonged sexual excitement, especially if ungratified.

Gross Changes. The skin of the scrotum is tense, smooth, and slightly reddened; the superficial veins are distended, and sometimes in severe cases become tortuous. The organ is smooth and regular in outline, and in size varies from that of a walnut to a goose egg; in almost all cases the increase in size is manifest by inspection. There is no change in the shape of the organ, and the increase is slow and steady; in some instances there is a sense of fluctuation, but fluid is seldom found in the vaginal cavity.

Symptoms. The disease is generally ushered in by a feeling of weight, uneasiness, and extreme sensitiveness about the parts. This increases and grows into very acute pain as the inflammation progresses, and at this time is more especially referred to the suprapubic region when the bladder is distended. Infection of the lumbar retroperitoneal glands is marked by a tender point in the loin or by pain extending the full length of the lumbar region on the affected side. The pain continues from two days to a week, or longer, after which it becomes gradually less, until nothing is left except a little soreness

upon touch. Generally there is a slight rise in temperature, though in severe cases the pyrexia may go as high as 104° F. There is commonly loss of appetite; nausea, vomiting, hiccough, and constipation are not uncommon. The reflex symptoms, which are variable, may simulate strangulated hernia, especially if associated with ectopia testis.

If suppuration takes place, softening ensues, the skin breaks down, and pus is discharged externally. The abscess cavity usually heals quickly. If the process has destroyed a great deal of the intertubular structure the seminal tubules prolapse and may be observed at the opening of the cavity, bathed with discharging pus.

The disease varies greatly in intensity. A mild case may be the result of extensive injury or even virulent gonorrhea, while the worst cases reported may follow a slight injury or non-specific urethritis. Cases which attack the center of the gland and suppurate cause most pain and an exaggeration of other symptoms out of all proportion to the amount of inflammation present. This is due to the greater amount of peripheral tissue resistance offered by the uninvolved gland itself, and its serous and fibrous tunics.

Differential Diagnosis. To differentiate between acute orchitis and periorchitis serosa is sometimes difficult. Transparency is suggestive in the latter but is not always a feature, though when present it is more or less conclusive proof. The appearance and consistency of the skin are more determinate. The skin over an inflamed testicle is stretched; it may be reddened and the veins distended.

In periorchitis fluctuation with inflammatory changes in the skin are observed, and the tumor is not so hard and heavy. When evidence points in the direction of fluctuation an aseptic puncture with a hypodermic syringe will determine whether or not the tumor is hydrocele, hematocele, or abscess. Pain in the groin and loin of the affected side may be felt, both in orchitis and epididymitis.

Pain in the groin is a prominent prodromal symptom of epididymitis, but is not so constant and severe in orchitis. It is relieved by the recumbent posture in both. Pain in the loin is constant in orchitis, and is not relieved by the dorsal decubitus. Pain referred to the testicle in orchitis is not relieved by rest on the back and elevation of the testicle, while in epididymitis great relief is obtained.

In orchitis the shape of the tumor is uniform and smooth, while in epididymitis it is larger, more angular, and irregular in outline. Pain

produced by palpation in either orchitis or epididymitis is felt only in the part of the organ inflamed. This is a reliable sign. The character of pain is a distinguishing feature. In orchitis the pain is of a stretching character, while in epididymitis it is as if produced by pressure.

Treatment. Rest in bed, with the testicle supported and elevated by means of a suspensory, pillow, diaper, or four-tailed bandage. Morphine should be given in sufficient quantity to relieve pain; all kinds of poultices, so long as heat is maintained, are more or less serviceable. Cold applications are often effective in the early stage, but they should be employed with great caution in the old. Oldfashioned tobacco poultice, or Scotch snuff, glycerine, and hot alcohol act well. The bowels should be cleared by a full dose of calomel, followed by some saline.

If absorption of the inflammatory deposit is slow, it may be hastened by stimulating application to the scrotum, massage, strapping, and a suspensory. When temperature is high, aconite veratrum viride or a coal-tar product may be given with good result.

WAVERLY, KY.

Reports of Societies.

OHIO VALLEY MEDICAL ASSOCIATION.

Stated Semi-Annual Meeting, Held at Henderson, Ky., November
II and 12, 1901.

The meeting was called to order by the President, C. B. Graham, at II A. M. November 11th. The reports of the committees were called for. Dr. J. W. Stone made a report for the Committee on Arrangements, which was received and filed.

Dr. M. F. Coomes, of Louisville, read a paper on "Plastic Surgery of the Face," which was discussed by Drs. A. M. Hayden, Horace Whitacre, C. H. Johnson, Ben. L. H. Floyd, D. S. Reynolds, S. Lambert, J. N. McCormack, and R. L. Moss.

Dr. W. H. Hardesty read a paper on "Acute Orchitis," which was discused by Drs. S. Lambert, J. W. Stone, A. J. Leiber, Arch Dixon, Ben. Floyd, T. J. Townsend, W. L. Dixon, S. L. Henry, and C. B. Graham.