phine, strychnine, digitalin or hypodermics of ether or whiskey Hastings think the use of the colpeurynter and the Champetier de Ribes bag are only useful in hospital practice; the same he hold for Caesarean section, either vaginal or abdominal. In spite of the good results which de Paoli has recorded, Hastings warns against the use of the Bossi dilator or any other metal dilator in placentae praeviae. He agrees with Spiegelberg in saying that almost all post partum hemorrhages are the fault of the medical attendant, and therefore the treatment is largely preventive. If hemorrhage should occur the placenta should be expelled, if the uterus is empty when the hemorrhage occurs, at hot douche at 120 deg, or the same with acetic acid3 %, or packing the uterus with sterilized gauze are the only methods worth considering. The Effect of Gonorrhea on the Female Generative Organs.-Joseph Taber Johnson (J.A. M.A., March 11, 1905) knows of no statistics of the mortality arising from gonorrheal infection of the female organs of generation, but he says we can obtain an approximate idea when we consider the great number of major surgical operations performed on its account; the number of abortions caused by it, and the untold number of conceptions prevented by the disastrous results of such infections. Johnson believes that the race suicide arising directly and indirectly, from this disease would equal the mortality of tuberculosis, pneumonia or typhoid fever, and he is not quite sure, but what it might exceed them all combined, if we take into consideration the one-child sterility, and the absolute sterility produced by gonorrheal inflammation of the uterus and its appendages. Remarks and the Results of X-Ray Treatment in Several Cases of Carcinoma of the Uterus. (Sinclair Tousey, N. Y. Med. Jour., March 11, 1905.)- In this paper a case is reported of a woman of 50 years who was suffering with a fibroid of the uterus which had undergone carcinomatous degeneration. The patient at the beginning of the X-ray treatments was so weak that she had to be brought to his office in a coach with her doctor and and nurse. The first results of the treatment was the very prompt disappearance of pain. Next to go were the discharge and odor. After the first few treatments she gained wonderfully in health. The treatment consisted in allowing the X-ray to shine through the uncovered abdomen, and also through Nott's speculum and in the application of high frequency currents. The current used was the 110 volt direct current, with, a liquid interrupter of the Simon's type. The Wappler 8-inch coil was used and the tube was a 40 cm. Gundelach tube, a rheostat, to cut the current down to about four and a half amperes was made use of. With the tube disconnected this strength of current gave about a six-inch spark. The vacuum in the tube was adjusted for each treatment to correspond with an internal resistance of about 2 inches; and a penetration of two or three layers in the author's radiometer. The distance was nine inches from the anode of the tube to the nearest surface of the patient and the time of exposure was about five minutes over the abdomen, and five minutes in the vagina. The high frequency currents, as used in this particular case were taken directly from one pole of the X-ray coil by means of an insulated cord passing from the coil to an insulated handle by which the operplaced in contact with the skin. ator held a glass vacuum electrode, which was. When in operation this tube is filled with ten thousand waves a minute of ultra violet and violet light passing into the patient's tissue and disappearing. A certain amount of ozone is produced and some of this is carried in by the current. Four and a half months after be ginnig treatment the fibroid had diminished one-half in size. The discharge odor, pain and weakness were a thing of the past. About one year afterwards she developed a serious gastric disturbance, which, however, did not seem to be carcinoma, and of which she finally died. In other cases cited the results were similar. The author recommends the treatment highly at any stage before the recurrent cancer has too far sapped the patient's vitality. INTERNAL MEDICINE. O. E. LADEMANN, M. D. 2. Clinical Examination of the Urine.-Richard Cabot (J.A.M.A., March 8 and 25, 1905). The essayist's paper, which covers over 13 pages is chiefly devoted to the investigation of two questions, namely: 1. When an anatomic lesion is found post-mortem, how often is that lesion evident from urine in life? When an anatomic lesion is found post-mortem, how often is the urine normal? He classifies his investigated cases according to the views of Councilman. 1. Acute degeneration of the kidneys, the lesions being confined to the epithelium without involvement of the glomeruli vessels or connective tissue. 2. Acute glomerular nephritis, applies to cases in which, besides a varying amount of degenerative lesions, well marked exudative or proliferative changes are found in the glomeruli. 3. Subacute glomerular nephritis refers to proliferative glomerular lesions of a greater duration. 4. Chronic glomerular nephritis is conceived as the terminal stage of the acute or subacute cases. 5. Chronic intersttitial nephritis are those cases in which the lesions appear to originate not in the glomeruli, but in the connective tissue and blood vessels. The arterio-sclerotic changes usually found in the vessels are not the predominating lesion. 6. Amyloid nephritis is a form of chronic glomerular nephritis in which the capillaries are infiltrated with amyloid bodies. 7. Senile atrophy inoludes those cases presenting the histologic structure with that defined as a chronic interstitial nephritis, but only involving a relatively small portion. 8. Arterio-sclerotic atrophy is a condition very similar to the above, bnt with the chief lesions in the blood vessels. 9. Fatty degeneration refers to only those cases with a marked fatty metamorphosis. Cabot tabulates a number of cases in each group, giving the anatomic and clinical diagnosis, specific gravity and 24 hour amount of urine, percentage of albumin and urea, the sediment findings, and other clinical signs of a nephritis. He next discusses the most valuable methods of examining the urine in the diagnosis of nephritis, finally summarizing his investigations as follows: 1. There are many cases of acute glomerular nephritis which cannot be recognized by any of the methods of examination known to us. 2. In some cases of subacute and chronic K glomerular nephritis, qur diagnostic resources are likewise at fault, but in the great majority of cases here studied, the condition of the urine in taken connection with other features of the clinical picture, enabled us to anticipate the autopsy findings. Our success in the diagnosis of chronic glomerular nephritis was almost as constant as our failure in the acute cases. 3. When we face the group of chronic interstitial cases, our diagnostic resources appear to be neither as sufficient as in chronic glomerular nephritis, nor as inadequate as they were shown to be in the acute cases. In about one-third of the cases the diagnosis was correctly made before death. 4. Among other conditions mistaken for nephritis, owing to the implicit reliance in the urinary findings, we find that the senile and arterio-sclerotic degenerations are not infrequently the cause of mistaken diagnosis of chronic nephritis, while in conditions involving passive congestion or acute degeneration of the kidney, the urine occasionally simulates that of acute nephritis. Even in cases where no lesions are to be found at autopsy, the urine is occasionally highly albuminous and full of casts. 5. In our ordinary urinary examinations, common errors are: (a) The attempt to estimate urea without an accurate knowledge of the patient's metabolism. (b) The statement that renal cells are present when all that we know is that we have seen small mononuclear cells, perhaps belonging to the renal tubules, perhaps not. 6. Cryoscopy and other attempts to test more directly the renal permeability are not as yet capable of supplementing in the clinical work the older methods of examination in the diag. nosis of nephritis. The vast majority of estimations of urinary solids, including urea, are in the author's opinion waste of time, since they are not, and in most cases cannot be made, part of a general metabolisin experiment. The attempt to estimate the anatomic condition of the kidney by the measure ment of albumin and the search for casts is fallacious in the extreme. The most reliable data about the urine are those most simple and quickly obtained, the twenty-four hour quantity, the specific gravity and the color. Veronal Poisoning.- Kuhn (Hospitalstid, No. 2, 1905) reports an instance of intoxicattion from the internal administration of several successive evening doses of 0.5 each. The symptoms were those of an intense itching eruption mainly distributed to the face and upper extremities, considerable swelling of the oral mucous membrane associated with a vesicular formation, fever, headache and general depression. It required nine days to bring about a complete evanescence of the symptoms. A Position for Clinical Examination.Cooper (American Medicine, March 25, 1905) directs attention to a position of which he gives a diagramatical illustration. The posi tion consists in placing the patient on the back with the thighs flexed at right angles, the legs resting on a chair or low table at right angles to the thighs. The chair is to be of such a width as to allow the feet to project beyond it a short distance. In this position the rotation of the pelvis on the spine at the sacroiliac synchondrosis shortens the distance between the origin and insertion of the anterior abdominal muscles; the flexion of the thigh at the hip joint shortens the distance between the origin and insertion of the iliopsoas muscles, and as the legs are perfectly supported their relaxation is complete; the abdominal vertebral column is unarched, thus aiding in the relaxation, and the spines of the lumbar vertebras are brought into direct contact with an X-ray plate; the perfect support of the legs insures spontaneous relaxation of the thigh and leg muscles. Cooper strongly recommends this position in the following procedure: 1. In palpating the abdomen its use will often dispense with the necessity for administering an anesthetic and affords a better relaxtion than immersion in the kind of hot baths usually found in the patient's home. 2. In radiography of the abdomen it is a simple way of bringing the posterior abdominal wall in contact with the X-ray plate. 3. To elicit a doubtful knee jerk, the movement of the foot and contraction of the extensor cruris both come into evidence. 4. To elicit a doubtful Babinski reflex. On the Latency of Tuberculosis.-Weichselbaum and Bartel (Wiener klin. Wochenschrift, No. 10, 1905) publish an interesting article on the subject of tubercular latency. Their investigations cover numerous and exhaustive microscopic examinations of tonsils and other lymphatic glandular structures of children who had never shown any signs of tuberculosis during life and a careful postmortem inspection of the different organs failed to reveal any traces of a tubercular infection. In not one instance was the tubercle bacillus demonstrable, although quite a number of animals inocculated with the previously examined glandular substance developed a tuberculosis. These results warrant them in concluding that it is not possible to accurately determine, from either the site of the lesion or extent of the disease, the point of bacillary invasion, as their investigation prove conclusively that the inocculated material must have been impregnated with the tubercle bacillus without the production of any specific reactive manifestations. were unable to determine just how long this They period of latency may exist. An Early Symptom of Pulmonary Tuberculosis. Kuhn (Deut. militärärztl Ztschr., Heft 2, 1905). In 1899 Burghart pointed cut the importance of fine crepitant rales, located at the anterior lower margin of the lungs between nipple and anterior axillary line, as an early symptom of pulmonary phthisis, and not infrequently one of the first objective signs. Kuhn has given this symptom careful attention in suspicious cases of pulmonary tuberculosis, and found it the only physical diagnostic evidence in 13 out of 47 cases. Water Drinking in Typhoid Fever.-Cushing and Clarke (Am. Jour. of the Med. Sc., Feb., 1905) made a study of a series of typhoid fever cases in which large quantities of drinking water were given. The summary of the results of their observations is as follows: 1. Large quantities of water internally, a gallon or more in twenty-four hours, may 229 easily be taken by typhoid fever patients, if administered in small quantities at frequent ation of watery urine at once follows, the and definite intervals. 2. A copious elimindegree of polyuria, day by day, closely corresponding to the quantity of fluid ingested. 3. Patients are more comfortable by this mode of treatment and toxic, nervous symptoms are lessened. 4. The mortality, as well as the severity, of typhoid fever, seems to be hydrotherapy employed as an accessory to still further diminished by this method of the cold bath treatment of the disease. The Influence of Food Temperatures on the Function of the Stomach.-Müller (Zeitschrift f.diätetische und physikalische Therapie, Bd. VIIII, Heft 10 1905). The salient points of the author's publication may be briefly stated degree, of equalizing the temperature of ailas follows: The stomach is capable, to a high Fluids with a temperature of 50 deg,. and 5 ments to that of the body temperature. deg. C. when taken into the stomach leave that organ before the temperature equalizes being less with low than with high temperathat of the body, the degree of equalization tured drinks. The stomach empties itself perature. Both warm and cold drinks retard most rapidly with ingesta at the body temgastric motility, which is a sort of an intestinal protection insuring a temperature before entering the duodenum. more uniform The temperature of fluids had apparently no influence on the secretory function of the considerable increase in hydrochloric acid. stomach. The ingestion of alcohol caused a Acute Bacterial Aortitis in Pyemia with Perforation of the Aorta.-Witte (Ziegler's Beitrage zur pathologischen Anatomie, Bd. XXXVII, Heft 1) reports an extremely rare 25 years of age who had died suddenly from and unique case of occult pyemia in a man hemorrhage. At the necropsy an abscess was found located between aorta and left bronchus involving and causing a perforation of both. structures with an ensuing fatal hemorrhage purative focus there was a thoracic empyema, into the bronchus. In addition to this supabscess of the kidneys and heart, the latter perforating into the pericardial sac with a consequent pyopericarditis. Witte believes that these suppurations were all of a secondary nature, the primary focus remaining obscure. Is Banti's Disease an Independent Affection? cine, Dec., 1904) have made this question a -Gilbert and Lereboullet (Revue de Médeinvestigations tend all the more to substanrepeated and extensive study. Their recent tiate their former views in that the so-called "Banti's disease" is not an independent affec tion. In most all instances the liver is an altered state and in all probabilities the primary seat, resulting from a disturbance in either the bile or portal systems. It is only in very exceptional cases that changes are limited to the spleen alone. The hepatic manifestations may be very pronounced or quite inconspicuous, but the existence of these changes should never be lost sight of in the therapy of this symptom complex rather than directing therapeusis to the enlarged spleen. Syphilitic Heart Affections. Cecikas (Revue de Médicine, Dec., 1904.)-The essayist's paper embraces an elaborate discourse on leutic heart diseases. He gives a brief He gives a brief epitome of eleven cases, stating that the usual period, before cardiac involvement evidences itself, ranges from 3 to 10 years after the initial infection. Cardiac complications do occur at the beginning of the infection, but are exceptions. After twenty years they are quite rare, although instances have been recorded as late as forty years after the syph ilitic infection. Cardiac luetic after effects are quite as frequent occurrences as brain complications. The lesions are principally sclerotic and gummatous infiltrations, aortitis, inflammation of the coronary arteries and rarely a diffuse gummatous myocarditis. The symptoms are mainly those of attacks of angina pectorus and cardiac asthma, muffled and indistinct heart tones with or without murmurs, irregular and unequal pulse, and eventually signs of an involvement of the semilunary valves of the aorta with accompanying hypertrophy and dilation of the left ventricle. When these symptoms are encountered in young and middle aged individuals (30 to 50 years) without any evidence of sclerosis of the peripheral vessels and an absence of some other etiologic factor, the probability of an underlying syphilis must be entertained and a careful inquiry into the previous history must follow. The results of an antileutic treatment, although not an absolute proof that the condition is of a specific nature, will in doubtful cases often clear the diagnosis. The prognosis is favorable. if the proper treatment is instituted sufficiently early, as complete absorption of the gummatous infiltrations is the rule. Cardiac lesions on a syphilitic basis, even in advanced stages, offer a better prognosis than when the changes are due to some other cause, as an antisyphilitic treatment always produces beneficent effects. With reference to the treatment, Cecikas advocates subcutaneous injections of the soluble mercurio salts in preference to intravenous injections, or the use of insoluble mercuric salts. A proper treatment is to extend over a period of years, and of course, the iodides have their respective place. By preference the writer uses Gilbert's syrup or the ferruginous iodide preparations. Cardiac medicaments are to be reserved until the last stages when cardiac muscular incompetency takes place. By this routine of treatment the majority of the author's cases made a complete recov ery. Aneurism of the Descending Thoracic Aorta. -Barton (Washington Medical Annals, March, 1905.)-The author's cases is instructive inasmuch as it points out the difficulties sometimes entailed in arriving at correct diagnosis. The actual condition was not diag nosed until few hours before death which was caused by a rupture of the sac into the left pleural cavity. The only symptom was that of pain which apparently seemed in connection with the digestive function. The radioscopic examination revealed a tumor extending from the seventh to the eleventh dorsal vertebra, but in view of the persistent epigastric pain, together with increased patellar reflexes and spinal rigidity a tentative diag nosis of Pott's disease was made and the patient treated accordingly. Somewhat later an exploratory laporotomy was made on the supposition that the tumor was a gastric neo plasm whereupon the real condition was diagnosed with the result mentioned. The aneurism which contained two perforations was almost cylindrical in shape, measuring seven inches in length and causing an erosion of the seventh, eighth, ninth and tenth dorsal vertebrae. A Functional Test of the Heart. Herz (Deutsche medezincische Wochenschrift, No. 6, 1905) understands by this expression a variation in the pulse rate on slight muscular exercise with mental concentration. The procedure consists of ordering the patient to slowly flex and again extend the forearm with undivided concentration of attention on the movements. The patient's elbow rests on the examiner's left hand and the latter holds the wrist tightly on the other without exerting any pressure to make the movement passive. The pulse is to be counted before and after the test. The self-motional inhibition (Selbsthemmungsbewegungen) does not influence, or only slightly accelerates the pulse when the heart is sound. In diseased condition of the cardiac musculature, particularly atheroma, the pulse becomes retarded. In nervous individuals and neurasthenics there is a considerable pulse acceleration, and unpleasant sensations are experienced by the patient. It is also a means of differentiation between bronchial and cardiac asthma. In affections of the semilunar valves of the aorta The this reaction is especially marked. mental concentration acts indirectly on the heart through the central nervous system, and like digitalis it has no action on the sound heart. Microscopic Examination of the Fasting Stomach Contents and Its Diagnostic Value.Ackermann and Gompertz (Medical Record, April 8, 1905) emphasize the importance of microscopic examination in gastric disease, asserting that it is equal if not superior to chemic analysis of the stomach contents in furnishing diagnostic information. They enumerate the various structures likely to be encountered in health and disease, concluding their paper as follows: 1. The presence or absence of hydrochloric acid can be determined by a microscopic examination of the fasting stomach contents. 2. The origin of mucus can be determined only by a microscopic examination. 3. By the microscopic examination mild cases of pyloric stenosis can be differentiated from simple gastrosuccorrhea. 4. The constant presence of pus, blood and possibly infusoria in the fasting stomach contents is an absolute evidence of extrapyloric carcinoma. 5. Benign obstruction can be diagnosed early by the finding of sarcinas, yeast cells in chains, or food remnants. 6. The early diagnosis of malignant obstruction of the pylorus can be made by the finding of the Oppler-Boas bacilli. The Prolonged Use of Digitalis.-Thomayer (Casoplek. cerk., No. 9, 1905) says that the universal fear of accumulative effects from the continued use of digitalis is overestimated. He illustrates this fact in a woman 52 years old, who took a daily amount of 0.15 g. (2.5 grains) of the powdered leaves for a period of eight years and three months without the slightest evidence of an intoxication. The patient died of cardiac incompetency with the discontinuation of the drug. Pulmonary Complications in Typhoid Fever. -Hrivna (Časop. tek. cesk., Nos. 12 and 13, 1905).-The essence of Hrivna's paper may be briefly stated as follows: Pulmonary complications in typhoid fever are partly croupous and partly bronchopneumonias, resulting from either a secondary monoinfection of the strepto, staphylo or pneumococci, or a mixed infection of these cocci with the typhoid bacillus. Monoinfections with the typhoid bacillus are rare. Out of thirteen autopsied cases of typhoid with pulmonary complications, the typhoid bacillus was found alone in only one instance. SUBSCRIBE for The Medical Fortnightly. THERAPEUTICS. W. T. HIRSCHI, M.D. Diagnosis and Treatment of Gastric Cancer. -(G. Klemperer, Therapie der Gegenwart, No. 1, 1905). The diagnosis is relatively easily made after the tumor is palpable, and the patient is cachectic, but in the first three to six months a positive diagnosis is almost impossible. If a patient past middle age suddenly has dyspeptic disturbances which do not improve with suitable diet and rest, the case becomes suspicious as being cancer. If to this the HCl decreases and lactic acid increases in the stomach contents, it is a farther indication of cancer. After this period a tumor may be palpable, but as such tumors occur with perigastric infiltration, and infiltrations around ulcers of stomach they must be borne in mind. Hydrochloric acid may be diminished in anemic individuals afflicted with gasttric ulcers, or increased if a cancer develops in an individual suffering from gastric ucler who is not anemic, consequently this test must be used with caution. A hypertrophic pylorus due to an ulcer or nervous hyperacidity must also be thought of. Exploratory laparotomy is justifiable in very obscure cases. The treatment is first of all surigcal, i.e., removal of the tumors, or where this is not possible and a pyloric stenosis exists, gastro-enterostomy should be performed to improve digestion and prevent the gradual starvation of the patient. high degree of cachexia and diffuse metastasis contraindicate surgical interference. A The writer gives the following rule as a guide to an early diagnosis and treatment. If an elderly individual, with healthy internal organs, who has previously has a healthy stomach, complains of dyspeptic disturbances and loss of weight, and if after eight weeks of treatment the loss of weight and dyspepsia continues, the motility of stomach is decidedly reduce with absence of HCl an exploratory operation is justifiable, even if no tumor is palpable. By following this rule, operations will be performed earlier and with better results. In inoperable cases a suitable diet consisting of light soups, meat, vegetables, and starchy substances is indicated. Drugs are useful to alleviate the symptoms as they arise. Bitter tonics to increase the appetite. Morphine, codein and dionin to relieve pain and trional, sulfonal and veronal to induce sleep. Gastric washing with warm water containing an antiferment (pot. permanganate, resorcin) often give great relief. The Use of Thiosinamin to Relax Cicatricial Tissue. (Honig, Budapesti Orvosi Ujsag, |