calculus in the ureter. He said if a localized inflammation gives rise to any symptoms the pain will radiate along the distribution of the renal nerves. He then gave some anatomical points on the blood supply and distribution of nerves of the kidney and ureters. The distribution of these nerves accounts for the manifestation of pain during the renal crises and causes the subjective pains referable to the upper part of the ureter. DR. N. B. CARSON, of St. Louis, read a paper on Intermittent Hydronephrosis. He considered cases of intermittent hydronephrosis very rare, so rare that no one man has a sufficient amount to report, and must depend upon the reports of cases of others. Hydronephrosis is a distension of the kidney with water. May be caused anywhere in the ureteral tract. It may be congenital or acquired, constant or intermittent, unilateral or bilateral. If infection takes place it is usually from below upward, and we then have pyonephrosis Congenital causes do not always give rise to symptoms in infancy. He related several cases of his own and those of other physicians that came under his notice Sometimes the fluid is colloidal in character. There are usually degenerative changes in the parenchyma of the kidney. The treatment is purely surgical-remove the obstacle and establish the flow of urine Massage has been recommended, but relief at best is only temporary. When used by Dr Carson he did not know whether it was the massage or the other remedies that afforded relief The relief experienced after aspiration is only temporary and is usually only of benefit for diagnosis. Incision and drainage have been of use in some cases, but usually will cause a fistulous opening Nephrotomy is the ideal operation in these cases if you are sure the remaining kidney is healthy and can carry on its physiological office. Drainage 18 not recommended unless complete removal is not practical. Discussion of the two papers. DR CORDIER, of Kansas City, sali in response to the paper of Dr. Bryson: "This is a subject very little understood, but we are making advancement both in diagnosis and treatment of these conditions, we are treating them more scientifically. To be able to explore the bladder and catheterize the ureters to ascertain whether there is obstruction in one or both is certainly a long stride forward in the science of medicine. The paper presented b Dr. Bryson shows great skill in arriving at a diagnosis He disagreed with Dr. Car ance. son in regard to it being the better plan in cases of hydronephrosis to remove the kidney if possible, for, he said, "it is remarkable how the kidneys will regain their function He cited a case in which a movable kidney had given rise to a great deal of distrubAfter making an incision into the abdominal cavity with the intention of draining, and before he got to the kidney, he noticed that the enlargement had diminished, and by the time he reached the kidney it had disappeared altogether. He placed the kidney in the normal position and the patient got well. The cause giving rise to this condition was simply a kinking of the ureter, when it became unkinked the fluid passed on into the bladder and the enlargement disappeared. DR. BRANSFORD LEWIS, of St. Louis, said the enlargement of the kidney and then the passage of a large amount of urine is due to the unkinking of the ureter. We sometimes see this same condition during shock, sometimes have the same condition from congestion of the kidney and also from nervous influence. Sometimes the bladder will be filled to overflowing on account of the congestion and increased blood pressure. He further said the points brought out by Dr. Bryson were very practical. DR. HUGO SUMMA, of St. Louis, said that the cases of intermittent hydronephrosis are not so rare as Dr. Carson considers them; that he often finds them, and especially in women, on account of the anatomical arrangement of the organs. The tubes become perforated or absorbed and the contents of the cyst are sometimes taken up and excreted through the vagina. He cited cases of such a condition. DR. JACOBSON, of St. Louis, in dis-. cussing Dr. Carson's paper, said inflammation of the bladder wall will cause a contraction of the ureteral wall, and as a result of this contraction the urine is dammed back and hydronephrosis is the result. The seminal vesicles extend from the base of the bladder to the ureters, these vesicles becoming inflamed, may, by their proximity to the ureters, cause them to contract, thus again causing urine to be held back, and we will have hydronephrosis. (To be continued.) The Society proceeded to the election of President and settlement of the next place of meting. Dr. Geiger of St. Joseph was chosen president and Excelsior Springs selected as the next place of meeting. BRAINARD DISTRICT MEDICAL SOCIETY. Annual Meeting, Springfield, Illinois, April 22, 1897. Society met at 10:30 A. M. The first hour was occupied with routine business, the annual reports of Secretary and Treasurer, payment of dues, etc. The Secretary reported 66 members in good standing, a gain of six during the year. The Treasurer reported all bills met, and a balance on hand of $38.17. Dr. J. D. Whitley, for the Committee on Microscopy, gave a report on Influenza, as owing to a mishap with cultures the material was not ready for the paper on Bacteriology, which he intended giving. (See next issue.) The Committee on Nominations reported the following list of officers for the ensuing year, and on motion the report was accepted, and the Secretary ordered to cast the ballot of the Society for the persons proposed: President, R. M. Wilson, Lincoln; Vice-President, J. A. Glenn, Ashland; Secretary, Katherine Miller, Lincoln; Treasurer, Chas. C. Reed, Lincoln; Board of Censors, J. W. Spears, Geo. N. Kreider, J. C. Fisher. Dr. Wilson having taken the chair, the address of the retiring President was then called for, and Dr. Servoss responded with a business-like paper on "Should the Physician be a Business Man? and why?" The amendment limiting the number of yearly meetings to two was defeated. Society adjourned at 12.30 for dinner, and reconvened at 2 P. M. The applications of membership of Drs. H. C. Hill, of Athens, and H. C. Walters, of Farmingdale, were read and referred to the Censors. (These were favorably reported and acted on later.) It was moved and carried that members desiring to attend the American Medical Association should be supplied with credentials as delegates on applying to the Secretary. On motion, it was decided to discuss Dr. Whitley's paper before hearing any other, and by consent the President was allowed to appoint two to discuss the subject. He appointed Drs. Kreider and Brown. DISCUSSION. DR. KREIDER suggested that some influenza cases resemble typhoid fever. It appears that the new microscopic tests offer sure means of diag. nosis, and should be employed. Doubtless many cases of so-called typhoid fever aborted by the Woodbridge and other treatments are really influenza. Many lives are permanently damaged by the disease, and this happens even in cases mild in onset. The bacteriology as presented by Dr. Whitley is very interesting. DR. BROWN.-Dr. Whitley's researches are very suggestive and interesting. Doctors feel that an atmospheric influence is at work in these Often a whole family is at once affected, and similarly. This influence must be due to an infection. Some cases this year have strongly suggested true croup. The bronchial tubes are often affected. Calomel has proven useful to clear out the excretory canals. Salicylates are rather frequently useful. DR. WILSON had noticed heart trouble following influenza and proving. troublesome, especially in elderly people. DR. WHITLEY.-My intention in the paper was to show especially the bacteriological of seven pulmonary types of the disease; aggravated lobar pneumonias show a mixed infection. The paper of DR. J. B. MURPHY, of Manito, on "Typhoid Fever" was read in his absence by the Secretary. He said, in brief: This is a preventable disease, usually beginning in August or September with chills, suggesting malaria. The temperature is continually elevated, or rising gradually to 103° to 104°. Anorexia, coated tongue, tenderness in iliac region are present. Diarrhea is common; after the first week nearly a constant symptom. In two cases I have seen a morning temperature of 105°, with evening temperature of 104. Such cases almost surely die. Weakness and mild delirium increase with the passage of time. Bed Complications.-The common one is bronchitis, with pneumonia next, but thrombosis of femoral vein may occur and parotid suppuration. sores are inexcusable. Well marked cases present no difficulty of diagnosis. Treatment. The milder the better. In malarial districts give quinine. every two hours during first day, then Hydrarg. chlo. mite... Sodii bicarb.... M. ft. powders No. xx. Sig.: One every two hours, till all are taken. gr. ij gr. xx Follow with mild dose of Seidlitz salts. Quiet, fresh air, clean beď, no visitors, are needed. Sponge with aromatic vinegar and water, as often as need to control temperature. Allow free drinking of boiled water with acid hydrochlor. dil. m. xv-xx every two or three hours. If needed to secure quiet use Dover powders and camphor, or codeine sulph. Food.-Use rich milk sterilized, one to two quarts daily. Have given four quarts with good effect. Warm milk to 100, if patient is very weak. Use no alcoholic stimulants, but sustain the heart with strychnia nit. gr. 6. every six hours. Use antiseptic enemas of boiled water and boracic acid.. Keep up elimination from lungs, skin, bowels and kidneys. Use cold freely if high fever. Avoid coal tar preparations. Disinfect discharges. Use only soft food for weeks. In perforation use opium with strychnia and normal salts solution. hypodermically. Never give up a patient till actually dead. In excessive diarrhea give zinci sulpho-carb. gr. i, codein sulph. gr. 4, hyoscyamine gr. gr., strychnia sulph. gr. 14, as needed when two or more passages. occur in an hour. DISCUSSION. DR. HURST.--While in the main I approve the methods of the writer, I wish to enter a protest against such excessive feeding. No more milk or other food should be given than can be assimilated, as the excess is merely burdensome to the digestive organs. "An Unusual Surgical Case," was reported by Dr. A. L. Brittin. On April 14 was called seven miles from town to see a carpenter who nad been hurt. On arrival found the man in bed, unconscious; breathing stertorous; pulse 38; skin cold and clammy. Right pupil dilated, left pupil contracted. He had been in good health. Age 25 years. While raising the frame of a barn about II A. M. his assistant above let fall a heavy oak beam eleven feet long. The patient was stooping at the moment, and it struck him endwise on the head. He was unconscious for forty-five minutes, then aroused, got on his horse and rode home two and one-half miles. Told his wife he was hurt and his head ached, and to send for the doctor. He then went to bed, and his family thought went to sleep. At 3.30 P. M. they found they could not arouse him. The man wore a thick, quilted cap which probably accounted for the small amount of discoloration visible, the only sign of injury. Consultation was suggested, and at 7.30 P. M. Dr. J. A. Prince visited the patient. No change; and as this condition continued next morning at 9 o'clock, Dr. Prince returned and the patient was prepared for operation. The right parietal bone was exposed, and a fracture three and one-half inches long with depression was exposed. The bone was trephined and raised, and a large clot removed. Great hemorrhage followed, uncontrollable by usual means. The common carotid was promptly ligated. In two hours the man recovered consciousness, and inquired, if the boy sent for the doctor had returned yet. Improvement has been steady. Pulse 66. At first the face was congested, but that has already passed away, DISCUSSION. DR. WILSON.-This case was certainly very unusual and skilfully arranged. In a somewhat similar injury, a compound fracture, however, gauze tamponing was required for several days to control hemorrhage, but proved efficient. DR. HURST.-Tamponing is generally efficient in venous bleeding, but when arteries are spurting ligation is the only safety. DR. CAMPBELL.-Tannic acid and antipyrine rubbed up with water, form a jelly of great value as a hemostatic. In Dr. Stephenson's absence Dr. Shipp presented some thoughts on the "Analgesic Effects of Local Applications.' The advantage of controlling pain by external remedies through their effects on the circulation and nerve endings of the painful region was well presented. Such relief avoids the need of loading the system with drugs which may tax the elimininative powers severely. A paper on "Pleurisy" was given by Dr. A. E. Campbell: Of this common disease the two varieties are, Pleurisy without effusion and pleurisy with effusion. The former may be confounded with pleurodynia and intercostal neuralgia. Of these, the former presents a diffused area of tenderness, painful on pressure and slight movement. The latter has pain along the affected nerve, and usually three points of tenderness. In dry pleurisy the pain is confined to one small spot, and only affected by breathing. This should be treated by rest, strapping of side, and mild anodynes. The cough should be controlled by codeine and hyoscy. In the second variety we have a sero-fibrinous exudation with the fibrin proportioned to the acuteness of the disease. The chronic form is classed with empyema and pyotherox. Many regard this as tubercular or cancerous. Bowditch says, "If the effusion is bloody on aspiration, the pleurisy is cancerous." The physical signs and diagnosis between pneumonia and pleurisy were concisely given. When in doubt the hypodermic needle should be used. Treatment.-Hypodermic morphia is the most efficient for relief of the pain. Hot fomentations are useful. Antikamnia and other coal-tar products often give relief to pain and fever. Strapping the side is wise in the acute stage. When effusion has occurred free catharsis by salines; jaborandi, if not too depressing, is valuable. In robust patients, after fever is gone, potass. ind. gives good results. Tr. of iron, sod. salicyl., potass. acet. with infusion digital. are also useful. Each case must be studied for itself. When delay of absorption occurs, aspiration must be considered. When? and where? are the questions to be answered. If the fluid has formed rapidly and in excessive amount, it should be done at once, withdrawing only half the fluid; after this, in favorable cases, improvement is steady to recovery. Even in cases doing reasonably well, recent authors advise aspiration, regarding it as the essential' treatment for pleurisy. As to the place authorities differ. Accidental plugging of the needle by particles of lymph is more apt to occur at the lower places. Sudden death may follow aspiration, but is very unusual. If empyema occurs free drainage with resection of one or more ribs is indicated. Gade says the opening should be as high as the center of the effusion, usually the center of the sixth rib. Senn resects the fifth rib, so as to ensure against the diaphragm clogging the tube. Irrigation is now rarely done. If tubercle bacilli are present in the fluid, Senn injects a ten per cent iodoform emulsion. Internally ferr. iod., ars., strych. and cod-liver oil should be given in full doses. DISCUSSION. DR. KREIDER.-Formerly operation was so risky, it was a last resort. Now, removal of fluid is clearly indicated. Sudden death might be due to sudden relief of pressure on the heart, hence only moderate amount should be removed at once. Often exsection of rib is desirable, removing enough to allow complete healing, even to the removal of all the ribs, as in Shady's case, where a frame was worn to support the shoulder. Dr. Kreider mentioned illustrative cases. In children aspiration is generally successful. DR. BROWN.-Diagnosis is not always easy. Often a sudden onset occurs in pleurisy. There is a difference in the cough, and in percussion note over solid lung and effusion. The lung is dull; the effusion, flat. Sometimes respiratory sounds may be heard over the dullest part, but will seem remote, evidently transmitted from the good lung. I would first blister in chronic cases. When this is healed, if fluid does not recede rapidly, aspirate. Never draw off all at once-one pint, or even half a pint is enough in an adult. Repeat, if needed. I have had perfect success with |