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quick and anti-gold brick laws and tackle this problem so important and so much neglected. The American love of fair play should suffice to see to it that each man gets his dues and that each man be not unjustly accused and convicted. False accusations and miscarriage of justice can best be prevented if we have in the fundamental officials who lay the basis for every murder case, i.e., the medical examiners, men of the right caliber and training, men of merit and men of acumen. Until this is done, it is hopeless to suppose that justice can ever be obtained. We want justice and truth to prevail not by accident, but by design. We want the coroner system abolished. We want medical examiners selected on merit. We want them held to account for the proper performance of their duties by the enactment of regulations governing their work. R.B.H.G.

THE election of Dr. William J. Mayo, of Rochester, Minnesota, to the presidency of the American Medical Association, is a tribute

William J. Mayo not only to his achieve

President-elect

of the American Medical Association.

ments in painstaking research in clinical surgery, which in itself has won for him interna. tional distinction, but

also to the art of American surgery, which he represents by his classical and authoritative work. Again, it is a triumph of individual worthiness and esteem; of natural selection and good citizenship. The great Northwest is honored, in having within its borders, such a genius for hard and good work, and who is contented to win his laurels under his own

fig tree, rather than seek the greater plaudits of urban opportunities. Will Mayo, by which name he is generally known in the Northwest, reminds us, in his characteristics, of that great surgeon in biographical history, Benjamin Bell, of Edinburgh-a man "devoid of every kind of ostentation," kindly in disposition, plain and accurate in speech, always a student and though stored with information, he is, in conversation, and discussion, a learner, even when communicating information.

Another worthy characteristic is his marvellous industry so conscientiously followed; he in fact, is a genius in industry and system always finding a way to accomplish, and knowing the reason for so doing. He is a man who compares what he observes, and his faculty of observation is comparable to that displayed by the great genius Bell.

As to his work in clinical surgery, it can be

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fuls of castor oil, and stop milk. Give barley water or rice-water until further advised by the physician. The further treatment is simple. The child should be kept as quiet as possible and in the coolest room in the house, and the quarters as spacious as are to be had. Boiled water is given as a drink, and frequent spongings during the very hot days are advised. The cereal water, plain or dextrinized, is to be continued until the acute symptoms have subsided in large measure, regardless of the age of the patient. Barley-water or rice-water is given in the strength of one-half ounce of the cereal to the pint of water. When milk is resumed it is given skimmed, in small quantities, in cereal water; never more than a half ounce in the feeding. Condensed milk given in amounts of one-half to one drachm in a feeding of cereal water is often well digested when fresh milk would not be. The author's experience is that just four drugs may be relied on in diarrhea, and these are calomel, castor oil, bismuth, and opium. Bismuth

must be given in large doses to be of service, and opium, which must be used with care, is best given in the form of Dover's powder. The technique of and indications for irrigation of the colon are then described, and it is stated that the measure should not be used indiscriminately. Kerley never washes out the colon oftener than once in twelve hours, and usually once in twenty-four hours suffices. In conclusion it is urged that the matter of prophylaxis be taken up by the municipal government.

THE eighteenth annual meeting of this association will be held in Council Bluffs, Iowa,

Medical Society of the Missouri Valley.

on Thursday and Friday, August 24 and 25, under the presidency of Dr. S. Grover Burnett, of Kansas City. The Grand Hotel has been selected as headquarters, while the sessions will be held in the auditorium at Lake Manawa, a beautiful resort near the city. This will afford a cool and comfortable place to enjoy the scientific program, which will be much appreciated. The evenings will be devoted to the various forms of amusement found at this park. Following is a list of the papers already promised:

Discussion on Diabetes, led by Dr. LeRoy Crummer, Omaha.

Discussion on Pulmonary Tuberculosis, led by Dr. J. W. Kime, Fort Dodge, Iowa. Carelessness in the Use of the Curette, Herman E. Pearse, Kansas City.

Treatment of Patients after Intra-Abdominal Operations, Daniel Morton, St. Joseph. Practical Facts About Hernia, L. A. Todd, St. Joseph.

Four Cases of Essential Anemia and Their Differentiation, W. O. Bridges, Omaha.

Some Observations on Carcinoma of the Large Intestine, A. P. Condon, Omaha.

Clinical Importance of the Diplo-bacillus of Morax-Oxenfeld, Harold Gifford, Omaha. The Prevention of Deformity, J. P. Lord, Omaha.

Bodily Weight as a Factor in Prognosis in Nervous and Mental Disease, Frank Parsons Norbury, Jacksonville, Ill.

Some Non-Septic Causes of Fever after Labor, Mary Strong, Omaha.

The Pharmacology of Antipyretics, A. L. Muirhead, Omaha.

Ectopic Gestation, with Report of Cases, O. Beverly Campbell, St. Joseph. Paper, W. O. Henry, Omaha.

A cordial invitation is extended to the profession.

If you are not already a member send to the secretary for application blank, and join the best working society in the West. Initiation fee, $1.00, annual dues, $1.00. Wood Fassett, Secretary, St. Joseph, Mo.

Chas.

TOOTH AND NAIL CORRUGATIONS Excepting Hutchinson's notches, the corrugations of the teeth and nails are not much mentioned in medical literature, and G. Lenox Curtis, New York (J.A.M.A., August 5), remarks that this neglect is a mistake and that they have a decided pathological significance. From the study of many cases he is satisfied that the transverse lines on nails and teeth are caused by autointoxication resulting in rheumatism, and that the severer the attack the more prominent are they. Children whose mothers suffered from rheumatism during pregnancy and those that have rheumatism themselves during the period in which the enamel of the permanent teeth is developing show these corrugations. The longitudinal indentations on teeth and nails, Curtis thinks due to autointoxication from intestinal indigestion, and that white spots on the nails also indicate autointoxications. When these markings are absent, a corresponding absence of the diseases may be assumed. The nail markings have importance owing to the fact that they are temporary, being obliterated in a month or two by the natural growth of the nail. They are, therefore, indications of recent disease.

'THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

A

THE DIAGNOSIS OF DISEASES OF WOMEN. Treatise for Students and Practitioners. By Palmer Findley, B.S., M.D., Assistant Professor of Gynecology and Obstetrics, Rush Medical College, Chicago, etc. Second edition. Revised and enlarged. 588 pages. Illustrated with 222 engravings in the text and 59 plates in colors and monochrome Philadelphia and New York: Lea Brothers & Co., 1905. (Cloth, $4.75 net; leather, $5.75 net.)

The second edition of this book, which has appeared after a comparatively short period following the first, represents a thorough revision of the entire field of gynecological diagnosis. It is encyclopedic in its character, no more comprehensive treatise on the subject being extant. The text has been increased 100 pages and contains a large number of new and original illustrations and colored plates. New chapters on examination of the blood and bacteriologic examinations, which has a most important bearing in gynecological diagnosis have been added. Such subjects as chorio-epithelioma malignum and cystic degeneration of the ovaries have been presented up to their latest developments. A large chapter is devoted to diseases of the kidneys as far as they have any relation to gynecology. The whole work bears the impress of individual ity, and is to be regarded as a representative product of American gynecology.

GYNECOLOGY, MEDICAL AND SURGICAL. Outlines for Students and Practitioners, By Henry J. Garrigues, A.M., MD., Gynecologist to St Mark's Hospital in New York City, etc. With 343 Illustrations. 1905. Philadelphia and London: J. B. Lippincott Company.

This edition of Dr. Garrigues' book must be regarded as a very valuable guide, both for students and practitioners. Although written particularly for students in medical colleges it is a handy reference book for the general practitioner. It outlines the whole It outlines the whole system of gynecology and minor operations are described in detail. The chapter of "Examination in General" is especially valuable for those beginning gynecological work. The chapter on "Treatment in General" gives a clear outline of the usual office treatments, and does not leave the student in doubt as to how to proceed in a given case. The author does not pretend to take up the whole field of gynecology in this book, but for rare diseases, anatomy and embryology refers the reader to his larger work, "A Text-Book of Diseases of Women." The book is worthy of a high place in medical literature.

W.H.V.

INSOMNIA from overtire was relieved by nux enough to bring the patient up to being simply tired.-Brunton.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

The Carbon Factor in Gout: Hyperpyremia. -Francis Hare (Medical Record, June 17, 1905) advances the view that the retention in the economy of carbonaceous material is largely responsible in the causation of gout period, Normally, there must be a systematic equili brium between the carbonization of the blood from the body's carbon intake and its decarbonization, but Hare believes that this balance is at times disturbed and carbonaceous material accumulate in the blood to an

ultra-physiologic or pathologic degree. He applies the term hyperpyremia to this hypothetic state in contrast to the term pyremia to the normal state. The means by which hyperpyremia may be dispersed are numerous, and include bilious attacks, migraine, gastralgia with anorexia, asthma, major epilepsy and acute articular gout. Some of these operate through increased expenditure, others through restricting the intake, and their action is called by the author carbonization. In order to support the proof that acute articular gout is dependent upon hyperpyremia, Hare deducts the evidence obtained by a consideration of the action in gout of such factors as the diabetic treatment, exercise, temperature, fat formation, etc., showing that the paroxysms represent an acarbonizing processes. The mechanism of acute articular gout involves an interdependence between hyperpyremia and uricemia, through which the kidneys at times become more active in excreting uric acid; that is, the renal disability depending on hyperpyremia is terminated by acarbonization of the blood. His view of the steps in acute gout are summarized as follows: 1. Hyperpyremia from excess of carbonaceous income or deficiency of carbonaceous expenditure. 2. Progressive accumulation of uric acid in the blood; uricemia. 3. Deposition of a portion of the uric acid in a joint. 4. Acute arthritis. 5. Pyrexia involving increased combustion. 6. A carbonization of the blood. 7. Free elimination of uric acid retained in the blood. 8.

Recovery by the blood of its solvent power for uric acid. 9. Reabsorption of the extravascular articular deposits of uric acid. Thus the acute gouty paroxysms may be regarded as "a pathologic function"-as a conservative reinforcement of inadequate physiologic function; and uric acid may be regarded as an essental instrument therein.

Enterogenic Cyanosis.- (Hijmans v. d. Bergh. Deutsches Archiv f. klinische Medizin, Vol. LXXXIII, Nos. 1-2, 1905). This entity, first described by Stokvis and Talma

"autotoxic, enterogenic cyanosis, who have reported four cases within the last three years, consists in a cyanosis of the skin, supposedly due to the formation of methemaglobin resulting from the absorption of toxic substances in the intestinal tract. Bergh reports two additional cases cf this rare condition. The first case was that of a boy 9 years old presenting a urethrorectal fistula as a result of an anal stenosis. The urine, by its decomposition, set up an enteritis. A pronounced cyanosis of the skin and mucous membranes developed, which was found to be due to a darkened state of the blood without an increase in the erythrocytes (polycythemia). It was at first supposed that the dark discoloration was due to methemaglobin, but the spectroscopic examination showed bands of sulpho-hemaglobinemia. The patients stools were found to have the same effect on blood outside of the body. In the second case the spectroscopic bands ex. hibited true autotoxic methemoglobinemia. In this instance the actual cause of the condition could not be determined. The intesThe intes tinal disturbances were slight. The cyanosis in this case was also intense, but as in the first, varied in intensity at times. A complete subsidence of the cyanosis occurred on an absolutely milk diet, while a nitrogenous diet caused its reappearance.

A New Indicator.-Fuld (Muenchener med. Wochenschrift, No. 25, 1905) suggests that either a watery or alcoholic extract of red cabbage is an efficient indicator, particularly adapted for titrating acid solutions, and in estimating the percentage of total acidity of the gastric contents. The indicator is prepared as follows: The leaves of the head of cabbage are torn apart, boiled with water and allowed to stand at ordinary room temperature for twenty-four hours. The solu tions is then decanted or strained through a sieve and reduced to a small volume over a water bath when it is ready for use. It is well to add a small quantity of alcohol. Acid solutions are colored red and alkaline green by the indicator. Titration is made with a deci normal solution of potassium hydrate in the ordinary manner, the fluid to be titrated containing a moderate amount of the indicator. Fuld says the indicator possesses the following advantages. The simplicity of the preparation, it can be used with artificial light and in solutions not entirely colorless, the stability of the indicator in hot and cold weather. It is to be remarked that

extracts of various other red plants do not possess the same property as that of red cabbage.

Diacetic Acid in the Cerebro-Spinal Fluid in Diabetic Coma.-Grüberger (Zentralblatt f. innere Medizin, No. 25, 1905) reports a girl 16 years old who died in a diabetic coma. The cerebro-spinal fluid gave a positive diacetic acid reaction with both Gerhardt's and Legal's test. The author is unable to find a similar recorded instance.

A Contribution to the Study of Ankylostomiasis.-Liefmann (Zeitschrift f. Hygiene und Infections-kraukheiten, Bd. 50, Heft 3, 1905). The investigators experiments substantiate the views of Loos, who is of the opinion that the ankylostoma parasites are capable of entering the body through the unabraised skin. Parasites of the ankylostoma caninum placed on the intact skin of six dogs were found, in almost corresponding numbers, in the intestinal tract of four of the animals. Liefmann was unable to determine as to whether the anemia in ankylostomaisis is dependent on the continuous loss of small quantities of blood, or by the absorption of toxic material elaborated by the parasites. As a matter of fact, hemalytic substances apparently seem to play no role. It is probable that a local intestinal anemia is followed by a general blood impoverishment.

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Formic Acid in Rheumatic Conditions.Couch (Medical Record, June 24,1905) bases the following assertions on an extensive study and chemical analysis of the excretions in rheumatism. All rheumatism, acute chronic, muscular or arthritic, is due to selfgenerated systemic poison. This poison is chemical and not bacterial. It is an acid and a product of suboxidation, but it is not uric acid. Uric acid is a product of, and not the cause of rheumatic conditions. Rheumatism is produced by fermentation of ingested starchy foods. It is caused by carbon dioxide gas generated in the bowels, and is due to drinking at meals and washing the food into the stomach without proper mastication and mixing with the proper ferments designed to digest such foods. He was led to study the action of formic acid as a remedial agent in rheumatic conditions by the remarkable experience of a farmer, who after being stung by bees was cured of the disease. Couch found the remedy to be of the greatest value, illustrating this fact by detailing the histories of a number of effected cures. He recommends the following directions in using formic acid: 1. Always cleanse the parts thoroughly before injecting formic acid solution.

2. Never use a stronger solution than a 3 per cent; a 2.5 per cent solution is better. 3. Never use it without injecting from 5 to 8 drops of a 1 per cent solution of cocain or other local anesthetic as a preliminary to the formic acid treatment. 4. Always choose exterior or outer parts of a limb for injecting the remedy and inject it just beneath the skin, though deep injections may be used when occasion demands. 5. Never use any more than eight drops in one place of either cocain, 1 per cent solution or of the formic

acid solution. Use a similar amount of the cocain and the formic acid solution. 6. If large doses of formic acid solution are used, hard, painful lumps are formed which are slow of absorption and painful; whereas if smaller doses are used no destruction of tissue

results and no painful growths supervene. 7. Inject the most painful points and make the injections not less than two inches apart. 8. The author has never used more than thirty injections at a time, and it is far better to use only from twelve to fifteen, and to repeat the following day in another place. Avoid all nerve trunks, if possible, since injections involving nerves are apt to be followed by severe pains lasting twenty-four hours. Injections may be given every day, or every other day, till the pain has ceased. It will not be apt to return unless gross carelessness or willful disregard of plain directions exist.

Chronic Acetanilid Poisoning.-Alfred Stengel (J.A.M.A., July 22, 1905) says that by reason of the comparative obscurity of symptoms, chronic acetanilid poisoning is probably of a more frequent occurrence than the medical profession appréciates. He reports in detail two instances which had recently come under his observation. The cases were of special interest from a diagnostic standpoint. The first case had been regarded as an obscure vascular disease simulating the symptom complex of chronic polycythemia. Stengel is of the opinion that some of the cases reported as instances of a chronic polycythemia might have been case of chronic acetanilid poisoning. Both patients denied the use of the drug. Another point of interest was the promptness with which the neuralgic symptoms were controlled after a withdrawal of the acetanilid. This would seem that the continued use of the drug so lowers the patient's resistance that instead of having a normal controlling effect on the neuralgic manifestation it acts as a general depressant and the neuralgic symptoms occur with even more frequency while it is being used than would otherwise be the case. Both patients recovered with a discontinua

tion of the drug and the adoption of a general tonic treatment.

GENITO-URINARY.

T. A. HOPKINS, M. D.

Active Treatment of Early Gonorrhea.-According to Cotton (Boston Med. and Surg. Jour., Feb. 9, 1905) acute gonorrhea in its early stages where uncomplicated is most effectively treated by active irrigation. Where there are such complications as phimosis or folliculitis these must of necessity have attention before an effective treatment by irrigation can be instituted. He employs a combination treatment which reduces the

severity and shortens the course of the disease. He finds that the "organic" silver preparations used, not alone, but in combination with copious bland irrigations (potassium permanganate), accomplish definite results by germicidal action. By following out a routine based on this, varied to suit vary. ing cases, we can effect a very rapid cure in a certain proportion of cases, a very considerable diminution of time of treatment required in other cases, a very comfortable condition as to symptoms during the course of treatment, and, by no means least, the most efficient limitation as yet possible of the area involved as well as of the duration, and hence the best chance for avoidance of complications and chronic processes.

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Nephroptosis; Operation. In cases of slight dislocation Harlan (Lancet-Clinic) finds a five-inch elastic bandage applied from the pubes to the iliac crests with a loose kidney pad over the cecum, superior to full ab dominal bandage, because, being anchored below the crests it remains better in place and fulfills the theory of general abdominal support. The viscera are made the main support of the kidney, equal pressure from below upward is imparted. In cases requiring surgical intervention his technique is as follows: Cut down upon the organ in the line of dislocation from the front; press aside the abdominal viscera over the track of the dislocation and carefully reattach the peritoneum to the back, following up the track until the kidney rests in its original location, imbricate the peritoneum in front of and over the lower end of the kidney if there be enough elongation (and there usually is) of the peritoneum in front of the kidney to allow of sufficient dislocation forward to give rise to pressure symptoms upon the descending portion of the duodenum and the colon. Attach the meson of the ascending and transverse colon (if necessary) to the wall of the

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