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INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Serum Diagnosis of Typhoid Fever by Means of Fischer's Diagnosticum.-J. von Tiling (Medical News, Feb. 4, 1905) speaks most favorably in behalf of this test for the general practitioner. The test is reliable and dispenses with the necessity for live cultures and the use of the microscope. The fluid and apparatus is manufactured by Merck & Co., of Darmstadt, the total cost of which is but $1.85. The serum is first diluted with 9 parts of water and then mixed with the diagnostic fluid in two separate test tubes, in the proportions of 1:5 and 1:10 respectively. A third tube is filled with the diagnostic fluid which serves as a control. The turbidity of these fluids, due to the bacilli in suspension, appears about equal. The test is positive if the fluid clears in test tubes one and two after ten to twelve hours. The clearing is due to a clumping together of the bacilli which sink to the bottom. The reaction sometimes occurs in a very much shorter time, but if no clearing shows itself within the specified time, the test may be considered negative. The writer pricks the finger with a needle instead of obtaining the blood by means of a cupping glass, catches a few drops, either on a glass slide or filter paper, permits it to dry, dissolves it in a normal salt solution in the proportion of 1:10 and mixes it with the diagnostic fluid in the required manner. This slight modification has yielded very satisfactory results. The author is having a paratyphoid diagnosticum prepared.

Trauma and Chronic Compression of the Epigastrium as Etiologic Factors of Gastric Ulcers.-Wm. Ackermann (Medical News, Jan. 14, 1905) discusses the relation of trauma and prolonged epigastric compression in the causation of gastric ulcer. He states that it is reasonable to suppose that ulcers may be caused by compression of the gastric walls, if we consider the formation of decubital ulcers elsewhere. Men, owing to their occupation, are more subject to epigastric compression than women, and for this reason it is plain why ulcers are more frequent in men than women during the latter years of life. It is also probable that many cases of gastric dilation thought to be the result of a perigastritis are really due to cicatrices following traumatic ulcers. Artificially produced ulcer in animals rendered anemic show a slower tendency to heal than otherwise. The decreased alkalinity of anemic blood may explain the hyperacidity usually present. Injuries to the stomach may cause an extensive lesion limited to the mucosa, or a hematoma

between the muscularis and the mucosa, the pressure of which may produce a necrosis. It is natural that gastric juice should act detriAckermann mentally on injured surface. cites 16 cases in which constant pressure on the epigastrium was followed by gastric ulcer. Both the occupation of the patient and the situation of the ulcers seemed to tally with the author's views, the ulcers usually being found near the pyloric end, this part of the stomach being more exposed to pressure.

A Clinical Study of Myoidema, with especial Reference to Its Occurrence in Pulmonary Tuberculosis. Henry Shively (New York Med. Jour., Jan. 4, 1905.)-By this term is understood a peculiar muscular contraction elicited by sharp percussion with the forefinger. The contraction occurs in the group of fibers near the point of impact, appearing as a well defined whip-cord-like ridge, tetanic in character, running in a direction at right angles to the course of the muscle fibers, and subsiding in a few seconds. The author has made a careful clinical study of this symptom. He found it present, not only in pulmonary tuberculosis, but also in typhoid, lobar pneumonia, acute and chronic bronchitis, carcinoma of the breast, aneurism of the aorta, syphilis, and he also observed it in perfectly normal person. In a series of 750 cases of pulmonary tuberculosis sign was present in 703 individuals. this number 196 were incipient, 475 moderately advanced and 79 advanced cases. Although this symptom is found in such widely widely different conditions and apparently of little diagnostic significance, Shively regards it of some importance as an addition to the syndrome of signs and symptoms in arriving at an early diagnosis of pulmonary tuberculosis. He says, myoedema is one of the indications of a departure from health

which should receive some consideration.

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complicating a grip-pneumonia. Of the 8 cases in which this sign was absent, 3 were tubercular meningitis, 3 a meningitis of otogenous origin, 1 as a premortal complication of typhoid fever, and 1 consecutive to a scarlatinous nephritis with a suppurative otitis media Lewin emphasizes the practical value of Kernig's sign as an early symptom, especially in the epidemic form of meningitis, occurring as early as the first or second day. The author further studied this phenomena in a series of other diseases, and in many normal individuals. He found an evidence of the sign in perfectly healthy persons, especially those with a nervous temperament, but a pronounced Kernig was never present in any of his cases, not even in those presenting an apparent meningeal involvement. He, therefore, regards an outspoken Kernig as a strong testimony in favor of an existing meningitis, particularly when other meningeal symptoms are not typical. The absence of the sign does not, however, exclude a meningitis, but its presence is most valuable in the so-called formis frustes, meningitis fulminans and meningitis siderans. The symptom is of equal value as a diagnostic criterion of a meningitis complicating an acute infectious disease.

On the Retention of Chlorides in Diseases and the Significance of this Retention in the Production of Edema in Heart and Kidney Disease.-S. Barsky (Wratscheburg Westnik, Nos. 21-25, 1904) bases the following conclusions with reference to a retention of chlorides, on a thorough study of five cases:

1. In the course of many infectious diseases there is a diminution of chlorides in the urine due to a retention in the economy.

2. An increase of the chlorides in the urine during the course of febrile diseases, either sudden or gradually, is an expression of a favorable turn.

3. There is absolutely no relation between fluctuations in the amount of chlorides excreted by the urine and variations in the bodily temperature, fluctuations of the former, in febrile diseases, are often of greater signi.

ficance than of the latter.

4. Sodium chloride can not be considered as an entirely harmless substance and is not to be used without some discrimination in certain conditions.

5. The dangers in the administration of sodium chloride consist in the production of edema and anasarca, the appearance or increase of albumen in the urine, and the development of uremic symptoms.

6. Sodium chloride is always to be eliminated from the diet of individuals with disturbances in compensation, resulting from

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8. In using saline transfusions, the solu tion must be isotonic. A 0.9 per cent solu. tion is the nearest correspondent to the freezing point of blood, and is the proper percentage in rendering the solution isotonic.

A Case of Acute Syphilitic Nephritis.-H. Thiemann (Muenchner Med. Wochenschrift, No. 5, 1905) says, although a number of unobjectional cases of acute syphilitic nephritis have been recorded in the past few years, they are, however, of comparatively infrequent occurrence. The writer's case meets with the requirements suggested by Welander, Justus and Karvomen, who assert that the diagnosis of a leutic nephritis is only justified under the following conditions: 1 The kidneys, previous to the syphilitic infection, must be in a healthy condition. 2. The renal changes to be on a parallel with other syphilitic manifestations. 3. An improvement or disappearance of the albuminuria under a mercurial treatment. In the anamnesis of the patient, a woman 24 years old, there was nothing which would indicate any previous renal involvement. Two weeks before her admission into the hospital she noticed an eruption on her body and at the some time her limbs begun to swell. She denied absolutely of having any knowledge of an initial sclerosis. On entering the hospital a typical syphilitic exanthemata presented itself, together with an indolent swelling of the lymph glands, a generalized edema, and a slight enlargement of the liver and spleen. The left side of the vulva was considerably swollen, presenting on its inner surface a large indurated ulcer. The urine contained an abundance of albumin (10 prom. Esbach), a specific gravity of 1020, the 24 hour amount 500 cc., with numerous hyaline granulated and epithelial casts in the sediment. After the seventeenth infection of bichloride of mercury the nephritis and syphilitic manifestations had entirely disappeared. During this period the 24 hour amount of urine increased from 400 cc. to 2200 cc. A total of 50 injections constituted the treatment.

Some Observations on the Diagnosis of Renal Calculus with Special Reference to Diagnosis by Means of the Roentgen Rays.Alexander Johnson (New York Med. Jour., Feb. 4, 1905) discusses the clinical history of nephrolithiasis with special reference to diag nosis by means of the X-ray. He gives in detail his observations in 125 cases with the Röntgen rays used as a diagnostic agent.

He says that the positive diagnosis of renal stone by the X-ray is reliable and of great practical value. A negative diagnosis is also reliable and valuable up to a certain limit. If pictures of the proper quality are obtained, calculi of oxalate of lime and phosphates can be excluded. Pure uric acid calculi cannot. Failures of detection are due to: 1. The great thickness of the body of the patient; 2, imperfect working of the electrical apparatus: 3, improper handling of the photographic plate in the dark room; 4, imperfect photographic plates. Pictures of a proper quality can easily be obtained in children and slender adults of both sexes. Satisfactory photographic plates can also usually be obtained in well nourished adults by repeated trials. In unusually stout patients with a thick abdomen and the buttocks are large, the conditions are extremely unfavorable and only occasionally will the results, obtainable with the present form of apparatus, be satisfactory. The writer's best pictures have been taken with the Wehnelt electrolytic interrupter. The exposures for large, stout individuals have varied from 10 to 15 min. utes, with the anticathode about 30 inches from the photographic plate. For thin persons the exposures were about one-half this

time.

The Practical Value of Litten's Diaphragmatic Phenomena in Diagnosis.-Wm. Berkeley (New York Med. Jour., Feb. 4., 1905) suggests the term of "phrenic wave" for this phenomena, which consists of a visible descending and ascending shadow associated with the respiratory movements of the diaphragm in the lower zone of the chest. The excursion, which varies from 2 to 5 inches in normal adults is of the following practical importance: 1. To students of physiology the phrenic wave is useful as a demonstration of the respiratory movements of the diaphragm. 2. When unbroken and over three inches in extent on both sides, it is a good indication of healthy lungs, and should be incorporated as such in life insurance examinations. 3. As an easy and practical substitute in many cases for the expensive and laborious Röntgen ray examination of the movements of the diaphragm, when such an examination is desired. 4. When diminished markedly on both sides, low down in the thorax and more marked behind than in front, it is an excellent sign of asthma and emphysema. 5. When absent or nearly absent on one side only it is a useful confirmatory sign of a variety of conditions which may be suspected from other signs, particularly pleurisy and early tuberculosis. 6. When absent on both sides no conclusion of any kind is really jus

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The Significance of the Swelling of the Glands of the Neck in Middle Suppurations.Stenger (Archiv fuer Ohrenheilkunde.) lays great stress on the swelling of the lymph glands in the superior triangle of the neck close under and behind the mastoid process, between the sterno-cleido mastoid and the trapezius muscles. They are of diagnostic value to judge as to the involvement of the mastoid process in acute suppuration, especially in those cases when other symptoms of mastoid complications are absent.

Acute Anilin Poisoning after Use of Local Anesthetic in the Ear.-(Sugar, Archiv fuer Ohren hielkunde).-Girl nine years old became severely ill after use of Gray's anilincocain solution as an anesthetic in the ear. She complained of headache, vertigo, nausea and intense cyanosis. The urine was dark brown and the spectral analysis of the blood showed the methaemoglobin band. Author declares the intoxication due to the direct ab

sorption of the anilin into the blood from the granulations in the ear, or by means of the tube in eventual idiosyncrasy. The anilin is an exquisite blood poison which leads to methaemoglobinemia and for that reason the cyanosis. Gray's solution, therefore, is not indifferent and least of all for children. The anilin derivatives as orthoform and anesthesin are not without danger, especially in oily solutions.

Treatment of Otitic Septicemia. Alex. Randall (Jour. of A. M. A.)-believes that all cases of middle ear inflammation should be treated as though the outlook were serious. Several cases in his practice in which the tympanic symptoms were slight, meningitis and intracranial complications developed with fatal results. Besides local treatment general measures should be used to control such a condition. In speaking of the treatment author recommends rest in bed, purgatives,

bloodletting, heat or cold, restricted diet. In spite of paraentesis or the internal Wilde's incision, that is incising the posterior wall of the canal, we may still have symptoms of pain, fever, headache and nausea. If no local symptoms calling for operative interference are present, author believes great benefit may be derived from hypodermoclysis or enteroolysis. He thinks it feasible to sterilize a fountain syringe by boiling and the needles by alcohol, which some authors object to because they claim strict asepsis cannot be employed. Enteroclysis while the result is slower and its value less, it can be so easily performed that patients will not object to its use. Oftentimes the trouble may be only mere toxemia and high enema will often cause a drop in the temperature and disappearance of the troublesome symptoms. Lumbar puncture may not only be of diagnostic but also of therapeutic value, and is harmless if done with proper precaution. It will relieve the tension, stupor and convulsion may cease. In closing author again urges the frequent use of enteroclysis, the amount varying in from 2 to 3 oz. for children to a pint in adults. Elevation of resorvoir about one foot, then supporting peritoneum for several minutes. While very simple it may forestall serious complications, especially where indications for surgical interference are vague.

Acute Otitis Media as a Cause of Enteritis. -(T. J. Etbrich, Med. Jour., Pa). Child of thirteen months with acute pharyngitis. An acute otitis media catarrhalis developed followed by an enteritis which improved immediately after paracentesis. Later on intestinal disturbances always improved when ear was treated.

FOR SANATORIUM.-The county and district medical societies of Illinois are doing their best to interest the representatives in the bill providing for the establishment of a state sanatorium for consumptives.

DEATH OF THE IMPROVER OF THE MICROSCOPE.-E. Abbe died recently at Jena, aged 64.

He was the inventor of numerous improvements in instrumental optics, and to him bacteriology owes its marvellous strides in late years. He has been connected with the Zeiss factory, since 1860, and at the same time was honorary professor of astronomy and meteorology at Jena. His successful reorganization of the Zeiss establishment was on a basis which tends to solve some of the more pressing social problems of the day.

SOCIETY PROCEEDINGS

OMAHA-DOUGLAS COUNTY MEDICAL SOCIETY.

REPORT OF THE MEETING OF FEBRUARY 14.

The society has been quite active active in the prosecution of the State Electro-Medical Institute in order to establish the principle that an institution, or a corporation, could not be legally chartered, or licensed, to practice medicine. The matter has been carried to the District Court, at an expense of $100 to the society, and won. The institute took an appeal to the Supreme Court which is now ready for action. It involves an expense of about $130 to perfect the appeal and the matter of the society assuming this ob ligation was postponed for two weeks in order to secure a larger attendance. Many of the members are extremely anxious to test the question because they think that there is a very vital principle involved. Others hesitate on account of the expense, and also because it seems to be a matter for the State society, rather than that for a local society.

President Peabody read a paper upon the use of

TURPENTINE IN TRAUMATIC HEMORRHAGES.

He had not heard of its use by others; had used it in twelve or fifteen cases, in abortions at all stages, with most excellent resul's. Its use had been preceded, in many cases, by the use of ergot, by the curette, hot water, position, and such other measures, without relief. This was promptly had when the uterus was packed with guaze lightly dipped in tur pentine.

Dr. Lord spoke of the use of turpentine as an antiseptic; said that the Mayo brothers used it in the place of alcohol which they disliked very much for a local application, and were greatly pleased with it.

turpentine does not coagulate albumen and cannot form a lot. It had been used in pulmonary hemorrhages. He thought that the gauze used by Dr. Peabody was the real factor of benefit. He felt that there was too much danger of irritating the kdneys with such a quantity as would get into a strip of gauze three yards long as used. He had seen a cystitis caused by 10 drops of the drug. Turpentine is an antiseptic, but a dilator, not a contractor.

Dr. Muirhead called attention to the fact that

Dr. Mary Strong said that she had seen evil effects from the use of turpentine, and she would not dare to use it unless it was the only thing available. She had seen anuria from the use of a few drops.

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Dr. Leander said that the use of turpentine for intrauterine hemorrhage was first advocated in 1880 in the Dublin Rotunda Hospital. It was customary for all the internes to carry it as a matter of routine. was soon found that disastrous results followed its use and vinegar was substituted.

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Dr. Peabody said that he had used turpentine all his medical life of forty-six years in hundreds of ways, and had yet to have any ill results from its use in any way

Dr. Ewing Brown read a paper upon

MAŁPOSITIONS OF THE UTERUS.

"Any position is abnormal in which the uterus is fixed. Omitting downward displacement, there are two main divisions, forward and backward displacement. Anteversions do not give rise to pelvic disorders. The dysmenorrhea of anteflexion cases is a result of incomplete development of the pelvic organs. Retrolocations are practically all retroflexions. Posterior displacement is practically the most frequent gynecological condition. Various authorities give from 10 to 20 per cent as the percentage of retroflexion cases seen. The prevention of this trouble lies with the general practitioner in his obstetrical work, for this malposition follows confinement. Each woman should be examined at the end of the second, and also at the end of the sixth or seventh week after labor, to make sure that involution was complete. If it is not retrodisplacements will often be found, and yet, at this stage, are easily relieved by appropriate treatment. The difficulty will lie in securing these examinations after labor. What proportion of these cases require treatment or operative interference? Hemorrhoids, neuralgic pains in the legs, painful defecation, and such symptoms require treatment. Too much stress has been laid upon reflex pains and neuroses, yet we do find headache, hysteria and nervous disorders with these conditions, but they point to an engorged uterus and endometrium, or other local conditions. Pessaries have been decried and abused, but they have not been used with skill; when so used, they are very valuable. The operation of vaginal fixation has been abandoned. Tait sutured the fundus to the anterior abdominal wall prior to 1880. This was no doubt the first ventral suspension, or fixation. About 1885, others sutured the cornua, but not the fundus, to the wall. In 1890, Kelly placed his sutures through the posterior portion of the fundus, near the ovarian ligament, thus securing the uterus in an anteflexed position. In 1895. he began to place the sutures through the superior and anterior portion of the fundus. Beyea reports 85 per cent of

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469 ventral suspensions as improved. Holden reports 60 per cent as cured entirely, or much relieved, and that 20 per cent received no benefit. Gilliam's operation, that of drawing a loop of the round ligaments through a stab puncture in the rectus muscle, appears to be a valubale operation. No adhesions are formed; the strongest portion of the round. ligament is used, and the fundus remains movable. The various round ligament operations in which these are looped or folded upon themselves intraperitoneally are open to several objections. It must not be forgotten that the relief of an engorged uterus by means of a dilation and curettage is often of very great value."

Dr. W. O. Henry.-I am pleased to see that Dr. Kelly has given up his operation and is now doing what I have always advocated, anterior suspension. Ventral fixation, and suspension are not alike. The former should never be done in the child-bearing period. In my judgment, anteflexion does need treatment at times and the pessary is useful. Dr. Lucy Waite takes the position that retroflexion, of itself, does not deserve treatment at all. I am of the opinion that all retroflexions should be treated and cured. They develop trouble in their later history, interfere with the circulation, cause passive congestion and, still later, adhesions. Pessaries are very useful, and operations later, if necessary.

Dr. Morison.-I should like to know what is the record of the autopsy room as to the conditions found there after ventral fixation or ventral suspension, had been done during life.

Dr. Hamilton.-I am of the opinion that benefit is derived from ventral suspension. The operation acts as a pessary, holds the uterus in place and secures the return of the uterus to normal position, holding it there until its becomes permanent. When uterine fixation is done, it is permanent, if suspension is done, that is temporary; it merely holds the uterus in position till better conditions prevail.

Dr. Berry.-Bandages are the cause of retroflexion. I condemn them. I teach the genupectoral position if there is a tendency to retroflexion.

Dr. Lord.-When in general practice, I always tried to look after the question of involution. I made subsequent visits and examinations for the purpose of securing better involution and preventing retroflexion. Too much attention to operations, and too little to the prevention of these conditions. I have never been able to see the philosophy of suturing the posterior uterine surface to the abdominal wall. I always use

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