septic dressings were applied, and the patient removed to her bed." There seemed every probability that she would recover, but death occurred three days later from peritonitis. All his cases were for floating-kidney. "Heretofore we have told our floating-kidney patients that they must accept their condition as incurable. Whether we will readily follow the bold example of Dr. Martin, and extirpate floating kidneys hereafter, is a question. 5. Mistura Olei P. osphorati. 6. Dr. Sims refers to a case of kidney disease, complicated with abscess and stone in the pelvis of the kidney, and says: "In such cases as this there is certainly a future for Martin's operation. In 7. such a case as this we might cut down on the kidney, as Martin does, and if we found a stone in the pelvis we could remove it, close up the incision with suture, return the kidney to its place, and leave the case to nature's efforts."-St. Louis Clin. Record. M. Dose, one teaspoonful, diluted, after meals. 2. Mistura Antimonii Composita. M. Dose, one to two teaspoonfuls. Dose, a tablespoonful. 8. Mistura Potassii lodidi co. K Potas Iodidi............ M. Dose, two to four teaspoonsful. grs. ii 3 ii 3j SOURCE OF THE ALARMING HEMORR- The difficulties experienced when we search for the exact point of the origin of the vascular alterations in hemoptyses have been a most serious obstacle to an exact knowledge of its pathof3j logy. This explains why the discovery of aneurisms f3ij of the arteries of the lungs in phthisis is of recent f 3 j date, since, in spite of a few facts previously pubf 3 ij lished, it is principally due to the researches of gr. xv. Rasmussen, made popular in France by Professor f3ij Jaccoud. Having had occasion to observe two cases of hemoptysis in my service at the Liennec Hospital, I have been fortunate enough to discover easily the point of origin of the hemorrhage by the aid of a method of which I wish to explain in a few words. mx 3j The first idea which comes to the mind in making fiv these anatomo-pathological researches is to open f 3 the bronchial tree, in following the branches by which it comes into the trachea. It is impossible in this way to find the ruptured vessel, for the trahea, as well as the large and small bronchial tubes, is filled with a bloody mucus which everywhere appears nearly the same. The mechanism of these terrible hemorrhages is as follows: The blood flowing from the arterial perforation into the cavity flows continually into the corresponding bronchial tube, thence into the trachea, where by the respira f 3 v Tr. Opii Camph.....................aa f 3 iss M. cases. 4. tory movements it is mixed with air. It results, gique, 1878, Nos. 5 and 6, M. Jacquet arrives at therefore, the acts of inspiration draw this bloody the following conclusions: 1. In Addison's disease mucus into the bronchial ramification, so that the the bronzed skin one finds only as a lesion of the subject succumbs not so much by the amount of sympathetic system, and pigmentation, without blood lost as by the obstacle to respiration pro- atrophy, of the nervous cells of the ganglia which duced by the presence of a liquid in the air pass- are in the neighborhood of the diseased suprarenal ages. This was the cause of death in the two glands. 2. The degeneration of a part of the nerpatients mentioned in this communication, and I vous fibres attaching the semilunar ganglia to the am convinced that it is the rule in the majority of nervous centres ought to be regarded as secondary and consecutive to the process of sclerosis which accompanies the tuberculization of the capsules. 3. That lesion is insufficient to serve as the basis of a pathogenic theory of Adison's disease. Hyperpigmentation of the nervous cells of the great sympathetic and of the cerebro-spinal system is a fact of the same order as the hyperpigmentation of the epidermic cells of the Malpighian plexus. 5. This hyperpigmentation renders probable the existence of an alteration of the blood by the substances which a suprarenal gland would, in the normal state, be employed in utilizing by transforming them. 6. The alteration of the blood by functional or organic insufficiency of the suprarenal glands is a pathological phenomenon analogous to that which exists in chronic uremia. 7. Alongside of the melanodermia, by alteration of the suprarenal tissue, there seems to exist cases in which the melanodermia is due to the lesion of other bloodmaking organs. 8. Clinical researches in Addison's disease ought especially to be directed to the chemical analysis of the blood and the urine.London Med. Record, April 15, 1879. To discover the vessel whence the blood had during life proceeded, I placed a canula in the pulmonary artery and injected water. Finding this came out by the right bronchus, I then fixed the canula in the right branch of the pulmonary artery, opened the principal bronchial tubes and again injected. Then finding the liquid issuing from a single lobe, the canula was fixed into the vessel of this lobe, and the corresponding bronchial tubes being cut the injection continued. It was now easy to follow by dissection the bronchial tube from which the water issued, and to come directly upon the cavity, and see the liquid issuing by the perforation of the artery. In this preparation, I show you a branch of the pulmonary artery of the third or fourth order adhering to the wall of the cavity into which it projects. The ulcerative process which has continually enlarged the cavity in the pulmonary tissue has respected the arterial tunics which it has partially isolated from the tissue of the lung surrounding it; but under the influence of the ulceration the artery is altered at a portion of its circumference. The vascular tunics, weakened by disease, yield to the pressure of the blood, and distending form a true aneurism, whose coats are the internal and middle coat of the artery implicated. The walls of these small aneurisms are still further weakened by a caseous degeneration of their ele- The following clinic on Scurvy, by J. M. Daments, and finally burst, producing the hemoptysis. Costa, M.D., is reported in the Hospital Gazette: In the first of my cases a young man of twenty-This disease is not often met with in private pracfive years, had pulmonary symptoms for eleven months. Signs of large cavities existed at the apex tice, but we meet with it very often in the wards of of the left lung. A first hemorrhage, estimated at hospitals. There have been a number of cases resix ounces, stopped easily; three days after it was cently under my charge in this hospital and I have renewed, and the patient died in about a quarter of thought it worth while to bring the most marked of an hour, after losing about two quarts of blood and these cases before you to-day and to devote a short mucus. The post-mortem showed a sacciform aneurism of the size of a large nut projecting into time to a discussion of its symptoms and treatment. the cavity, and developed on an artery of the third Case I.—T. H., æt. 35, a strong, well built, order, which also projected from the wall of the hardy sailor, has been on a two months voyage on cavity. In the sac were two perforations, one-eighth an English ship which sailed from Cardiff, Wales, of an inch in diameter. In my second case, besides to Carthagena, Spain, and thence to this city. the pulmonary aneurism which caused the fatal During this time he subsisted almost entirely on hemorrhage, I found another unbroken in a cavity salt food. Two weeks prior to his admission in the opposite lung.-Gazette des Hospitaux-(yesterday), he began to suffer pain in his bones, Western Lancet. PATHOLOGY OF ADDISON'S DISEASE. ON SCURVY. and particularly in the large joints, i.e., ankle and knee. The left ankle, indeed, became so swollen in the course of this attack that he had not been able to work at all during the eight days prior to There was no ap In the Archiv de Physiologie Normal et Patholo- his entrance into the hospital. pearance of fever during this time, and he always And we might well attribute the rheumatic pains to slept well at night. His bowels were constipated, this specific condition were they not explainable however, and he complained of a moderate amount otherwise. of debility. What he came here for and what was the worst symptom to him, were the peculiar rheumatic pains, (I use this expression in his sense, and not in my own), which he felt, especially round his left ankle and knee. These, indeed, were the predominant features of the disease when he first came. not so. Upon examining him yesterday, I found that these pains were associated with numerous ecchymotic spots most plainly visible on the inner aspect of the left ankle. Joined with this ecchymosis. There was some swelling the skin presenting a glazed appearance as if it had been painted with collodion, but the resident physician assured me that this was There is some slight want of power in this foot (left) and some pain upon motion. There is also general pain in both the knees. But let me turn to the other symptoms. The one which is the most significant is the appearance of the gums. They look spongy and scorbutic, particularly in the upper jaw. The tongue is clean. The breath was at first fetid, but is less so now. The man's bowels are constipated. The urine was examined, and found to be acid, and free from pus albumen. The patient's temperature upon ad mission was normal, i.e., 981⁄2°, and it has remained so since. Having then examined these cases with sufficient accuracy, let us group them together, see in how far they are alike, and close with a few explanatory remarks. And first let me call your attention to the causative element of the disease. The men are both sailors, and have been limited for a long time to the same salt diet, and exposed to the same hardships. This salt diet fails to meet the requirements of the system. You all know that scurvy is produced most commonly by the withdrawal of the vegetable juices from the diet. It is, in other words, as we now understand it, oneness or sameness of diet, for even fresh animal food will produce it if no other diet be allowed. The peculiar elements supplied to the blood by vegetable foods are wanting. Salt provisions are, however, much more likely to bring on the disease than a long continued fresh meat diet. In this respect the cases are alike. This brings us to a consideration of the symptoms, and the question arises, are the symptoms presented by these two men, the symptoms of scurvy, are these typical cases? in fine, what are the peculiar symptoms of scurvy? What I have styled pseudo-rheumatic pains are a very common feature of the disease. These pains have quite frequently been mistaken for those of rheumatism in the lower extremities. A patient with these pains will very often consult you for rheumatism, when his other symptoms will show you very plainly that the case is not one of rheumatism at all. Another point-these pains, like rheumatism, are usually associated with some stiffness of the joint and with the production of pain upon motion. They are almost always limited to the lower extreat-tremities; at all events, it is in the lower extremities that they are most marked. Upon auscultating the chest, and more particularly the heart, I can plainly distinguish a systolic, soft murmur. This murmur is most marked over the body of the left ventricle. The area of the splenic dulness is enlarged so that it extends to the margin of the ribs. The hepatic dulness is normal. There is no cough and has been no hemorrhage from the nose or lungs, and no dropsy. This concludes the clinical record of the case. Before I expatiate upon the character and ment of the disease I will show you this other case. CASE II. This case is less marked, and were it not that the man comes from the same ship, has eaten the same restricted diet, and has been exposed to the same circumstances, his true condition might very easily escape notice. He complains of the same pseudo-rheumatic pains (excuse the expression), and his debility is still more marked than in case number one. This is the history: W. B., æt. 29, a sailor; has had the same shooting pains in his legs. His tongue is clean as in Case I. His gums are spongy.. He has had no fever. There is no albumen in his urine. No marked dyspepsia and no special depression of mind. His bowels are also constipated. There is in this case also the same soft, systolic murmur over the body of the left ventricle, with much greater rapidity of the action of the heart than existed in Case I. This case is not quite so pure a one of scurvy as Case I, as the man has a specific history. These pains are present in both of these cases, and in both of them we find spongy gums, which are, without doubt, the most reliable diagnostic sign of scurvy. In both cases the tongue is clean and there is but slight, if any, gastric derangement. In both cases there is constipation, and in case number one some fetor of the breath. These symptoms, viz: clean tongue, constipation, and fetor of the breath are all common to scurvy. In Case I there are some additional points of interest; one of these is the peculiar ecchymotic eruption on the inside of the left ankle. This is a symptom very peculiar to scorbutic extravasation. There is also in Case 1 some enlargement of the spleen, and this, although the man has never had malarial fever, so that it has a still greater significance as a symptom. So too, we find in both cases what is not generally recognized as an accompaniment of scurvy, namely, a soft, systolic, ventri cular blood murmur, which is unassociated with any symptom of cardiac enlargement. In neither case have there been any febrile phenomena, and in neither case have we been able to discover any albumen in the urine. With this I think that I have exhausted the category of symptoms. Do such cases ever occur in private practice, you will, with great propriety, inquire of me. To this question I will answer both yes and no. Marked cases of the disease are not likely to present themselves in private practice, but less marked instances you will most undoubtedly meet with. If you know what fully developed scurvy is, you will understand these less marked instances. Emotional persons, living in luxury, begin to bring themselves down in diet. They never have very much appetite, and they think the less they eat the less they will suffer from dyspepsia. Such persons drop first one and then another article of food, and are in reality starved, although driving about in handsome carriages. Such instances may not be striking ones, and yet you will find in them spongy gums, lassitude, fetor of the breath, clean tongue, and a more or less strongly marked tendency to constipation. These people, too, have pseudo-rheumatic pains. They have tried electricity, perhaps, and tried limiting their diet, and made a tour of the various baths, and yet their pains are not improved. You may be surprised to hear me say so, but I assure you that these are real cases of scurvy, although they are only half developed. Certainly my diagnosis would not seem to be sustained by the circumstances of the patients, and yet I have cured very many such cases by this key, and by therefore, putting them upon the proper treatment for scurvy. I have even known of the existence of ecchymotic spots on the legs of such people just as is the case here, and this, too, in those living upon the best of the land, and with apparently everything to gratify their tastes. What are we to do for these cases? How are we to treat scurvy? I am now speaking of the proper treatment of Case 1, for in Case II, the scurvy is evidently complicated by specific disease. Of course, the first thing to be done is to vary the diet and particularly to let the patient eat whatever vegetables may happen to be in season. Among vegetables I may mention particularly celery, spinach and onions. Onions, though not impart ing the most pleasant of odors to the breath, is a most excellent anti-scorbutic. Let the patient eat potatoes and a varied vegetable diet. Then the fruits are always of value, such as oranges, lemons, grapes etc. Our object, of course, should always be to introduce the ingredients of vegetable food into the diet in their most inviting form. When the fresh vegetables cannot be easily procured, lemonade, freely partaken of, is a very fair substitute. With it the patient should eat a moderate amount of fresh meat and fish. As regards medicinal agents, irrespective of diet, the mineral acids do most good. These remedies are of especial value in such cases as these now before you, where we have noted the presence of a distinct murmur, not of cardiac, but of anæmic origin. To the mineral acids, we can of course add iron. Case 1 has been taking the tincture of the chloride of iron with muriatic acid-twenty drops of the former with ten drops of the latter (strong muriatic acid) well diluted, thrice daily. With this treatment I look for a decided abatement of the symptoms. In Case II, I will carry out this same treatment to some extent, for as there is a syphilitic eruption present he will require specific treatment in addition. With this in mind, I have given orders that he should have one twenty-fourth of a grain of the bichloride of mercury thrice a day. The rules of diet must be the same for this man as for Case 1. Time will not allow of my engaging in the speculation as to whether scurvy can be prevented by the proper use of lime juice, a supply of which all captains should carry with them when going upon a long voyage. All I can do is to merely hint at the subject, which if properly and fully considered would carry me far beyond my allotted lecture hour. TREATMENT OF EPILEPSY. A. McLane Hamilton, M.D., says in regard to the treatment of epilepsy, (Medical Record.) I am in favor of combining bromide of sodium with bromide of ammonium, equal parts of each, and of administering sixty grains of the combined salts together with thirty grains of hydrate of chloral daily. The doses should be divided so that the largest may be given a short time before the fit is likely to occur; that is if any regularity in the occurrence of the convulsions can be distinguished. Of course this quantity may be increased if occasion requires. In other cases the bromides given in combination with bicarbonate of potash and some simple bitter tonic, as recommended by Brown Séquard, will produce wonderful results. These remedies are especially serviceable in the nocturnal forms of the disease, and, in fact, are to be commended in the treatment of attacks of an irregular character. I will caution you against giving the bromides with the mere idea of exhausting, as it were, or stamping out the disease. It is of the utmost importance to combine with them cod-liver oil or some other fat making material which improves the nutrition of the nervous substance. It has been my good fortune in many instances, where the bromides have been given in excessive doses (even to the point of producing full bromism, and yet without producing any apparent effect upon the disease), not only to diminish the number of seizures by reducing the quantity of gard to city children. We in the city, therefore bromides administered-and giving cod-liver oil, urge a ride on the salt water, or taking the child to cream, extract of malt or linseed oil-but to de- the sea-shore if possible. In all cases, in children cidedly improve the general health of the patient. under a year, if the diarrhoea is severe, keep warm If the disease has appeared in a patient over twenty applications over the abdomen: make a spice bag. years of age, especially when the characteristics of Take a half ounce each of cloves, allspice, cinnamon the disease are such as I have described when and anise seeds pounded, but not powdered, in a speaking of syphilis as a cause, we may use the mortar, put these between two layers of coarse combined iodide and bromide treatment, or, better flannel, about six inches square, and quilt them in. still, the bichloride of mercury. One secret of suc Soak this for a few minutes in hot spirits (brandy, cess in the management of this form of the disease, or whiskey, or alcohol), and water equal parts, and and in fact nervous syphilis in general, is to push apply it to the abdomen warm, renewing it when it the administration of the iodides as far as we can gets cool. In this way we not only get the effects safely go, and this must be done rapidly. What- of a poultice, but we also get the sedative and antiever you do in the treatment of this discouraging septic effects of the spices. Great heat, with inaffection, be consistent and methodical; it is ex- fluences that depress the nervous system, bad hytremely injudicious to make changes and try new gienic surroundings, improper diet, too early weancombinations when the patients are doing appa- ing, bottle food, and dentition, are among the rently well, or even some time when no change causes that predispose to diarrhoea. follows, or to relax your vigilance over the invalid's personal habits. For epilepsy is essentially a disease, I believe, in which there is a habit, if it may be so called. In many cases, in fact in a large proportion of all, there is a regular recurrence EXTIRPATION OF THE UTERUS. of the fit; and every day gained after the time when [Dr. Marion Sims Medical Record, gives the folthe attack usually occurs is to the patient's advan-lowing account of the operation by Prof. Schroeder tage, and helps to break up the tendency to of Berlin.] regularity. DIARRHEA OF CHILDREN. The name of Schroeder is well known amongst us. We are all familiar with his classic work on gynecology and with his great success as an ovariotomist since his adoption of Listerism. He is yet a young man, with a splendid record and an assured follow-brilliant future. I saw in his wards an interesting case of extirpation of the uterus for sarcoma. Dr. A. A. Smith (Med. Record) gives the ing in regard to the treatment of diarrhoea in children. The operation had been performed about ten days before, and the patient was convalescent. She was nearly forty years old, and had a tumor about the size of an egg in the body of the uterus. A bit of it was scraped out with the curette, submitted to the microscope, and found to be malignant. Whatever the cause, all children, whether infants or those older, ought to be kept quiet when suffering from diarrhoea. They should be kept in a partially darkened, quiet room, free from noise, and all talk in the room should be avoided, especially when the child is asleep. The nervous system in childProf. Schroeder then determined to extirpate the hood is so impressible it is easily disturbed, and organ. He made the incision as for ovariotomy; any disturbance of this kind aggravates the diarr- drew the uterus up from the pelvis; transfixed the hoea. Infants under one year ought to be kept cervix with a double ligature antero-posteriorly, just lying down as much as possible. They should not above the vaginal junction; tied one on each side, be jolted up and down, as is the custom of most including the corresponding part of the broad liganures and some mothers, in order to amuse them.ment just as Péan does; and then he amputated the If the child is under one year, let it be placed on body of the uterus from the cervix at the os intera pillow, if the diarrhoea is severe, as it can be num. This left a raw surface about an inch and a kept quiet more easily in this way than when lying half in diameter, which Péan and others have been on the lap. Even in changing the napkin care in the habit of pulling outside through the lower should be taken to move the child as little as pos- angle of the abdominal incision, and fixing it there, sible Don't be afraid to keep the room well as they did the pedicle in ovariotomy. The ventilated in which the child lies. Mothers are clamped pedicle and Listerism are antagonistic, if usually over careful for fear the child may take not incompatible. Prof. Schroeder did not wish to cold, and on this account are apt to keep the room leave a sloughing pedicle outside; nor did he wish *too closely shut up. When the child is awake it to leave a suppurating one inside the peritoneal can be carried carefully into open air, always in cavity. And he hit upon this happy idea. He exthe shade. Salt-air is beneficial to almost all forms sected the cervix conically from the amputation surof diarrhoea in children, and this specially so in re-face down to the surface at which it had been trans |