REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

In

Hemophilia. Sahli (Zeitschrift f. klin. Medizin, Bd. 56, Heft 3 and 4, 1905) made a hematologic study of three cases of hemophilia in members of different families. each instance the neutrophile leucocytes were diminished with an increase in the lymphocytes. Spontaneous blood coagulation was considerably diminished, but during a hemorrhage somewhat increased. Therapy is to be a constitutional one. As a local applicaiton Sahli recommends adrenalin.

Premenstrual Temperature Elevation in Pulmonary Tuberculosis.- Kraus (Wiener Med. Wochenschrift, No. 13, 1905) directs attention to an increase in the body temperature (0.5 to 1 deg. C.) in women with tuberculosis just preceding or during menstruation. He considers this symptom as being of diagnostic importance, and further states, that during this temperature elevation the pulmonary auscultatory signs are often more pronounced, resembling a tuberculin reaction.

A New Method for Detection of Acetone in the Urine.-Collo (Revista Famacili, No. 2, 1905) states that this method is not only a delicate test but also serves as a quantitative estimation. The test depends on the splitting of acetone, when oxidized, into acetic acid. Urine containing only a trace of acetone requires distillation, previously adding a few rdops of dilute sulphuric acid. The presence of acetone in larger quantities dispenses the necessity of distillation. The test is performed as follows: To five c. c. of the urine or an equal amount of the distillate add two or three drops of a 5 per cent iron sulphate solution five drops of dilute sulphuric acid, a few c.c. of peroxide of hydrogen and heat gently. Fifteen to twenty drops of concentrated sulphuric acid are then added and the whole again heated. The acetic acid, formed by splitting up of the oxidized acetone, combines with the alcohol produced by heating the sulphuric acid forming ethyl acetate (aether aceticus), the presence of which is detected by its peculiar odor.

A New Test for Detecting Minute Quantities of Albumin in the Urine.-Ravold (Jour. of the Mo. State Med. Asso., April, 1905) modifies the so-called Speigler-Jolles reagent. by increasing its specific gravity with a sulphate of magnesium solution. This does not interfere with the efficiency of the reagent in

any way. The reagent consists of 50 c. c. of a saturated magnesium sulphate solution which are added to a mitxure containing two grams of bichlotde of mercury, four grams of succinic acid, four grams of sodium chloride and fifty c.c. of water. The urine is first to be acidified by adding one c. c. of dilute acetic acid to five c. c. of urine. After filtering, the urine is slowly floated on the surface of the reagent by means of a pipette. If albumin is present the ring formed at the point of contact will not disappear on heating. Further examination should be made for globulin, nucleo-albumin or mucin, and the albumoses. Ravold considers the test exceedingly delicate, is easy of application, simple to prepare and absolutely free from fallacies.

The

The Treatment of Hemoptysis. -Francis Hare (American Medicine, April 1, 1905) says that in any case of hemorrhage there are two essential factors, namely: There must be at the bleeding point a solution of continuity of the wall of the vascular system and an intravascular pressure of the blood exceeding the extravascular pressure of the tissues. It then follows that in order to check a hemorrhage we might attempt to restore the continnity of the vessel wall; to supplement the extravascular pressure of the tissues; to reduce intravascular pressrue of the blood. first of these, in checking pulmonary hemorrhage, is out of the question; the second has been suggested by a deliberate induction of a pneumothorax on the affected side; the third is the only safe method and may be accomplished in one of three ways: (1) By reducing the systolic force of the heart; (2) by increasing the resistance in the bleeding vessel on the cardiac side of the bleeding point; (3) by reducing the general peripheral resistance in the circulation. The fist indication is attained in the use of such drugs as aconite and antimony; the second in compression of the arterial trunk leading to the bleeding point and in vasoconstriction of the bleeding vessel itself through drugs, such as adrenalin and applications of cold; and the third in the use of amyl nitrite. The author strongly advocates the employment of the latter, stating that it possesses obvious advantages. The treatment is absolutely safe, easily and rapidly applied, can be used by the patient in the absence of professional supervision and causes no interference with the cough. He reports sixteen attacks of hemoptysis in nine consecutive cases (eight tuberculosis, one mitral) treated by inhalations of amyl nitrite. In all save one, the bleeding stopped within three minutes; in the exception, cessation was delayed for ten minutes.

The Present Status of Blood Examination in Surgical Diagnosis.-Soudern (Med. Record, March 25, 1905) emphasizes the value of the differential leucocytic count in inflammtory conditions, stating that it offers. a better guide than the absolute leucocytosis. Three distinct blood pictures may occur in inflammatory lesions: (1) A relative percentage of polymorphonuclear cells below 70, with an inflammatory leucocytosis of any degree. excludes the presence of pus at the time the blood examination is made, and usually indicates good body resistance toward infection; (2) an increased relative percentage of polynuclear cells, with little or no inflammatory leucocytosis, is still an absolute indication of the inflammatory process, and the percentage is a direct guide to the severity of the infection; (3) an increased relative percentage of polynuclear cells with a decided inflammatory leucocytosis. Here the percentage of polynuclear cells is an accurate guide to the status of the inflamma. tory lesion. Iodophilia is less reliable as a test of the presence of suppuration than is the differential count.

OBSTETRICS AND GYNECOLOGY

W. H. VOGT, M. D.

Scopolomin-Morphine - Narcosis.- Hugo Zeffer (Monatsschrift fuer Gelwertshilfe and Gynaek., Vol. XXII, No. 1.) Scopolaminmorphine is indicated in all cases where a long continued deep narcosis is wanted, and where chloroform is contraindicated. In operations which last no longer than one-half hour the combination of scopolamin with chloroform is indicated. The half narcosis with scopolamin-morphine is suitable in nervous and excited patients, also during labor when the pains are very strong in both normal and pathologic conditions of the uterus, in eclampsia and in cases where an operative interference is expected. For long continued use as a substitute for morphine, scopolamin-morphine is highly recommended. There are no absolute contraindications to its use, and with the necessary precautions the narcosis is absolutely harmless.

Cholecystitis in Childbed. - (Christiani, Monatsscrhift fuer Geburtshilfe and Gynaek., Vol. XXI, No. I.)-The ease with which cholecystitis may be mistaken for puerperal sepsis is demonstrated by two cases which the author observed. In order to arrive at the diagnosis of puerperal pyemia such conditions as diseases of the appendix and gall-bladder must be excluded. Cholecystitis during the puerperium demands surgical in

terference more so than otherwise since destructive changes of the liver tissue is more to be feared during pregnancy and the puerperium than at other times.

The Histological Diagnosis of the Early Stages of Uterine Tuberculosis. J. Schottlander, Monatschrift fuer Geburtshilfe and Gynaek., Vol. XXI, No. 1.)-With the aid of microscopic preparations the author shows that the changes in the glands and superficial epithelium brought about by the tubercle bacillus, such a polymorphia with and without stratified cells, are not sufficient proof to warrant the diagnosis of tuberculosis. Contrary to Veit he has at times found it impossible to find the tubercle bacilli, and he believes the tubercle bacilli are liable to be destroyed at any stage of the process. In the diagnosis of tuberculosis he places the greatest value on the detection of specific tuberculous products (tubercles and giant cells), which, however, are not always positive proof.

The Diagnosis of Cystadenoma Serosum Papillare Ovarii.-E. Fraenkel, Monatsschrift fuer Geburtshül fe and Gynaek., Vol. XXI, No. 1.)-To differentiate clinically between cystadenoma serosum and adenocarcinoma papillare ovarii is often impossible. Even when the findings seem to speak positively for carcinoma and the suspicious peritoneal metastases exist the operation should, if technically possible, be finished thoroughly in order to save those cases in which there is a doubt about the diagnosis, and possibly only a benign papilloma existing. In the case cited the metastases disappeared entirely after an exploratory laparotomy.

Uterus Rupture. (A. v. Valenta, Zentralblatt fur Gyaek., No. 9).-A complete rupture of the uterus was observed fourteen times in 1350 labors. Of these eight cases were operated, three of these recovered. Those cases not operated, all died. The sooner after the rupture the operation was performed the more favorable was the prognosis. If the child is still in the uterus it should be delivered per vias naturales, if however it has completely entered the abdominal cavity it should be removed by laparotomy. In five of the cases he performed the supravaginal amputation with extraperitoneal stump, twice the uterus was extirpated, and in one case he sewed the tear. The author recommends the supravaginal amputation as offering the quickest and safest means of dealing with a uterus rupture.

Prevention of Puerperal Fever.-(B. Credé, Zentralblatt fuer Gynaek., No. 6). Since we use every precaution to prevent infection of

the new born's eyes, Credé believes it is just as important to sterilize the internal genitalia after childbirth. He regards Zweifel's idea as to the evacuation of blood clots as a very fortunate one and a step farther in the prevention of sepsis. The reason why so little has been done in this respect is that we have had no antiseptic which would stop the stop the growth of bacteria without doing injury to the cells of the living organism. Long experience has convinced him that collargol (soluble silver) serves the purpose admirably. He suggests the following procedure: Just as we clean the patient and sterilize every instrument that is to be used during labor in each and every case, so should we in every case introduce the so-called collargol vaginal ball either into the vagina, or if possible into the cervix or uterus, this to be followed by a loose packing of gauze in the vagina. If necessary this gauze and ball should be renewed. ball should be renewed. Where infection has already taken place he uses irrigations of 1:2000 or 5000 solution of collargol, and then introduces a suppository to act during the interval. He also makes He also makes use of the inunctions of this ointmeut and in severe cases uses the intravenous injections of collargol using at first 8 to 10 c.c. of a 2% solution. The formula for the vaginal balls he gives as follows: R Collargol...

Tale pulv.

Ol. cacao.

Fiant globuli No. x.

0.5-1.0 0.5-1.0 ..19.0

Hand Sterilization with Special Reference to Use of Oil of Cloves.(-J. C. Webster, American Journal Obstetrics, March).-The method as described by Webster is as follows: The hands are scrubbed for five minutes with any good soap and hot water, the latter being frequently changed. The skin is then dried with a sterile towel and rubbed for one minute with alcohol to remove any remaining moisture. When it is dry, unpurified clove oil is rubbed into the skin for four or five minutes and afterwards washed out with alcohol. Clove oil is a powerful solvent of fats and penetrates deeply into the skin. The unpurified oil is less expensive and is probably a better germicide (its impurities being acid in nature) than the purified oil. The hands thus cleansed are thoroughly rubbed with sterilized talc powder and covered with smooth dry rubber gloves which have been boiled for fifteen minutes. The skin of the hand is the same at the end as at the beginning of the operation. The sterile talc having been rubbed into all the irregularities of the skin is therefore very smooth. The operator should wear gloves of medium thickness which are made from a model of his hand thus securing a perfect fit.

Perineum, Perineorrhaphy and Prolapse.(A. Stuemdorf, Medical Record, April 1, 1905). Since it is only possible to unite each of the severed tissues to each other by an immediate operation and oftentimes it is even then difficult or even impossible, Stuemdorf advises the preliminary introduction of guide sutures at some convenient time prior to the descent of the presenting fetal part, three or four silkworm gut sutures are passed into the structures between vagina and rectum, from the cutaneous base of the perineum to its apex. If no tear occurs the stitches are again easily removed and no harm is done.

Hysterectomy for Fibroids of the Uterus with a Report of Two Hundred and Fifty Operations. (John Deaver, American Medicine, April 15).-Regarding fibroids of the uterus and their treatment Deaver expresses the following opinion: Fibroids of the uterus do not require removal unless they are productive of symptoms, but when they do become symptom producing, they should be removed promptly, before the patient has been weakened by toxemia, hemorrhage or sepsis. Abdominal supravaginal hysterectomy is the operation to be preferred in the vast majority of cases. Myomectomy is applicable only to younger women in whom the tumors are few in number and subperitoneal in character. Panhysterectomy is to be employed only when intraligamentary growths, whether uterine or ovarian, render the performance of supravaginal amputation difficult or dangerous. The ovaries or a part of one ovary should be preserved in every woman who has not reached the age of menopause, unless they are distinctly and indisputably diseased, or unless their retention would needlessly prolong and complicate the operation.

DEPARTMENT OF LEGAL MEDICINE..

R. B. H. GRADWOHL, M. D.

The Medico-Legal Questions Arising in the Case of Patrick, Convicted of the Murder of Rice by Alleged Chloroform Inhalations.Clark Bell (The Medico-Legal Journal, March, 1905) describes the case of Patrick, a New York lawyer who was convicted of the murder of Rice, the said conviction being based on evidence of witnesses' as to the congestion of the lungs presenting the appearance of death by poisoning. It appears that the body had been handled before the autopsy by an embalmer who had injected the embalming fluid into the veins and arteries before rigor mortis had intervened, but the lungs were not preserved at the autopsy. It became an important question as to how far

the condition of the lungs, after this embalming process, had been caused by this inspection of the embalming fluid. The Med

ico-Legal Society of New York City had been asked for an opinion on the several points at issue. The matter was given over to a select committee of the society for possible determination. They were informed that an autopsy had been held, that a single lengthwise incision had been made into each lung; that the body had been cremated; that the chemist, Dr. Witthaus, had taken the viscera for examination, but not the lungs which he left in the body and which were cremated with it.

The witnesses for the prosecution contended that the death resulted from the administration of chloroform. A number of A number of questions were submitted to this select committee, as follows:

Q. 1. Would the embalming of a human body by the arterial process with "Falcon" embalming fluid (containing formaldehyde) two hours after death, before rigor mortis set in, as described by witnesses in this case pro. duce a congestion of the lungs, similar in appearance and character to the condition produced by poisoning by chloroform inhalation?

2. Would an embalming process two hours after death by the arterial process as described, before rigor mortis, without removing the blood, as described by witnesses in this case produce any congestion of the lungs, and how far would it resemble the condition of the lungs produced by the administration of chloroform? 3. Would the condition of the lungs, as described in this case, indicate the cause of death, and to what extent, and describe how would the congestion of the lungs after such an embalming process resemble or differ from that condition, which would be conclusive proof of death resulting from poisoning by the inhalation of chloroform?

4. Of the finding of the jury, that the cause of death was due to the administration of chloroform, based on the medical and other expert testimony given in this case, please report what effect the embalming process, as shown herein, would have on the body and lungs, where none of the fact of the embalming was explained or shown to the jury?

5. To what extent would the condition of the body, the viscera and the lungs be affected by the embalming of the body, as described herein, and what would be the condition if the death was not produced by the inhalation of chloroform?

6. If chloroform had been administered, as shown by the accomplice Jones in this case, what in your opinion would have been

the condition of the body, viscera and luugs after the embalming process described had been used?

7. Would the medical witness be able to discriminate from the post mortem examina. tion between the administration of chloroform as a cause of death, or as a result of the embalming process?

8. Please state the cause of death in this case and the reasons for your opinion.

9. If you are unable to state the cause of death, state the reasons.

10. If the cause of death was doubtful, give reasons.

11. State whether from all the evidence, the death of Rice resulted in your opinion from the administration, or inhalation, of chloroform, and the reasons and basis for your conclusions.

The select committee composed of gentlemen in no way interested in the trial of this case, reported that they had entered into general correspondence with bacteriologists, pathologists, embalmers; that they had experimented upon animals and cadavers; that they read the official record of the medical evidences; that they were in possession of the attending physician's report on the case of William M. Rice, to the effect that death was due to old age (84 years), weak heart, diarrhea and mental worry. The answers to the above questions follow:

1. Yes, the condition found would be indistinguishable, whether a true congestion. or condition produced by the embalming fluid.

2. It could not be determined whether the condition found depended on the effects of chloroform inhalation or upon the embalming fluid or both.

3. There was nothing in the lungs per se to indicate the cause of death.

4. The committee failed to see how any jury could arrive at a conclusion regarding the cause of death without fully considering the fact of chloroform inhalation and the presence of the embalming fluid being associated together as important factors in this

case.

5. We are unable to state what the appearance of an embalmed body would be, in any way, different where death resulted from inhalation of chloroform would be found where death resulted from other causes.

The answers to the other questions, summed up, are that the committee agreed in believing that Rice did not die from chloroform poisoning, that he did die from the conditions described by his attending physician.

This report was discussed by the members of the Medico-Legal Society and adopted unanimously.

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SOCIETY PROCEEDINGS

THE GOLDEN BELT MEDICAL SOCIETY.

The annual meeting of the Golden Belt Medical Society was held at Gypsum, Kansas, April 6th, under the presidency of Dr. W. S. Lindsay, of Topeka.

The regular routine business was transacted. The annual reports of secretary and treasurer were read and accepted. The subject in regard to an official journal for the society was discussed and the secretary instructed to correspond with Dr. Howard M. Hoxie, editor of the State Journal, in regard to the matter.

The following physicians made application and were elected to active membership: Dr. M. N. Bremen, Roxbury, Kansas; Dr. F. W. Koons, Chase, Kansas.

The following officers were elected for the ensuing year:

President, E. R Cheney, Gympsum.

First Vice-President, T. R. Conklin, Abilene.

Second Vice-President, F. G. Lagerstrom, Salina.

Secretary, L. Leverich, Solomon. Treasurer, Howard N. Moses, Salina. Librarian, E. E. Hazlett, Abilene. President W.S. Lindsay reported a rare and most interesting case of ataxia-abasia, which was discussed by Drs. Ketchersid, Moses, Riddell, and the discussion closed by Dr. Lindsay.

The following scientific papers were read

and discussed "Professional Sympathy, or How to Foster Medical Fraternalism," by Dr. W. A. Klingburg, Elmo, Kansas. Discussed by Drs. Tobey, Harvey, Moses, Riddell, Lindsay, and closed by Dr. Klingburg.

"Two Parallel Cases of Femoral Aneurism," by Dr. E. R. Cheney, Gypsum, Kansas. Dr. Cheney presented these two cases for examination, and both were very interesting. The doctor's paper was discussed by Drs. Crafford, Ketchersid, Nordstrom, Smith, Brittain, Riddell, Harvey, McBride and Moses. "Skin Grafting," with a report of a case, by Dr. E. O. Smith, Marquette, Kansas.

Discussed by Drs. Ketchersid, Crafford. Lagerstrom, Brittain, Klingburg, Harvey and closed by Dr. Smith.

"Gelsemium," by Dr. J. C. Entz, Hope, Kansas. Discussed by Drs. Winterbotham, Klingburg, Riddell, Harvey, Leverich, Crafford and Cheney.

Dr. W. Neptune being absent, his paper on "Apomorphine Hydrochlorate," was read by Dr. Howard N. Moses of Salina. Discussed by Drs. Lindsay, Leverich, Koons, McBride, Harvey, Riddell, Klingburg, Smith, Hawthorne and Ketchersid.

Foreign Bodies in the Rectum,' by Dr. E. W. Hawthorne, Gypsum. Discussed by Drs. Tobey, Moses, Riddell, Lindsay and Seitz.

Committees were appointed as follows: On Program.-Drs. Harvey, Seitz and Conklin.

Ethics and Election. Drs. Ketchersid, Riddell and E. O. Smith.

Publication. Drs. Axtel, Brittain and Magee.

The following members were present: Crafford, Harvey, Moses, Crafford, Harvey, Moses, Winterbotham, Klingburg, Lindsay, Bremen. Koons, McBride, Entz, Ketchersid, Riddell, Hawthorne, Cheney, Seitz. Tobey, Leverich, Lagerstrom, Brittain, Nordstrom and Smith. Twenty-one in all.

Solomon, Kansas, was selected as the next place of meeting, July 6th, 1905. L. LEVERICH, Secretary.

NEW SCHOOL OF ANATOMY.- The New York Post-Graduate Medical School has just inaugurated a separated and distinct department to be known as a school of anatomy. This most important branch of medical science will henceforth be handled elaborately and with detail in all its braches. The managers of the Post-Graduate School have long believed that insufficient attention is given to anatomy and have waited the psychological hour for this new departure. A separate building has been secured for the work,