back and shorten them, if need be, to bring the bowel into position, as also the hepatic flexure of the colon. Care should be exercised during the operation not to wound the colica sinistra or colica media arteries, as the case may be, and the kidney must not be placed too high. Remove the appendix. A prolapsed duodenum should be normally replaced and its fixation secured if necessary. Use either silk or cat-gut ligature. If there be much fat about the kidney it is best to incise the peritoneum and remove it. If the kidney be adherent to the peritoneum enucleate from its bed of adhesions and then replace and attach it in the manner described above. A continuous superficial catgut suture may also be used to secure the anterior surface of the kidney to the peritoneum. You thus obliterate the path in which the dislocated kidney wanders, and re-establish the normal relations and positions of both the kidney and abdominal viscera, and in so doing re-establish the equilibrium of the sympathetic and general nervous systems reason of the congestion of the peritoneum prompt and efficient union of the latter to the back is secured. Rest in bed with proper diet should bring about perfect recovery in a couple of weeks. No danger of pyonephrosis can result from this operation, as there are deep sutures through the kidney, and the danger of abdominal troubles is practically nil, an aseptic operation being done. produced the painful crisis. If it was by occcluding the ureters, it seems strange that there was not an enlarged kidney, or at least a condition of hydronephrosis. It is difficult to explain why there was such a large quantity of urine passed after each attack, unless it was of reflex origin. Suprapubic Cystotomy.-Hoffmann (Zentralblatt f. Chirurgie) attaches great importance to careful preliminary treatment of the bladder before suprapbuic cystotomy in order o facilitate healing of the incision by relieving the inflamed or irritated state of the mucous membrane usually present in cases requiring operation. Rest in bed for some time and the internal administration of antiseptics and the application of moist compresses to the abdomen, bladder irrigations, etc., are the measures to be employed. Two other features of the author's technique are the omission of drainage from the wound, and of the permanent catheter. He does not By consider the presence of either of these necessary for healing, and thinks that their absence tends to favor union of the incision. Papilloma of the Kidney; Nephrectomy. Boucher (N. Y. Med. Jour.) reports an interesting case of a woman of 40 years, with attacks of colicky pains in the region of the left kidney, extending down the course of the ureter to the groin, and at first associated with menstruation. Finally they occurred as often as three times a week, and she rarely went ten days without one. Before and during the attack no urine was passed, but after the attack she passed large quantities (often two quarts) of clear urine. Ocasionally it was dark, but contained no stones or blood. Examination of the abdomen was indefinite, and exploratory incision was decided on. The right kidney was in good condition. The left was found in almost normal position, but hard and small. A nephrectomy was done, and the patient made a good recovery. Incision of the organ removed showed the cortical substance to be somewhat contracted and harder than normal. Extending into the ureter from pelvis of kidney two small papillary tumors were found, so attached that when the kidney was in position the tumors passed by each other in such a way that they apparently occluded the entrance of the ureter. It is not clear just how these tumors The Hypodermic Use of the Salicylate of Mercury in the Treatment of Syphilis.-E. F. Kilbane (Med. Record, July 29, 1905) says that taking for granted that mercury in some form is indicated, we have, in the intramuscular injection of the salicylate of mercury a mode of administration that is free from most, if not all, of the difficulties encountered in the use the drug when administered in the ordinary ways (mouth, inunction, vaporization, etc.), in that it is cleanly, safe, efficient, entirely practical for office or dispensary use, easy of administration, and capable of accurate dosage. It is entitled to consideration and trial as the routine treatment or foundation of treatment, to which may be added, or for which may be substituted, other treatment when required by special indications or conditions. It is equally well adapted to the modified expectant, the interrupted, or the continuous method of treatment. The objections usually made to the method are shown to be groundless by describing the plan followed in the Roosevelt dispensary, where sixty-four cases have been treated in this way during the past year. No untoward results have ever been noted, and only in one case did the patient complain of discomfort after any but the first few injections. The author recommends this treatment for trial in every case of syphilis in which the administration of mercury is indicated for a period of time. Its advantages are many, and its disadvantages few and slight. THE MEDICAL FORTNIGHTLY A Cosmopolitan Biweekly for the General Practitioner The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature, and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited. Advertising forms close on the first and fifteenth of each month. Time should be allowed to submit proof for correction Advertising rates on application. Remittances and business communications should be addressed to the Fortnightly Press Co. Subscription, $2.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. 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Contributions and books for review should be addressed to the editors, 319 and 320 Century Building, St. Louis, Mo. THE DELAY OF OLD AGE.-We are, in our enhanced appreciation of youth and vigor in these times, according to C. G. Stockton, Buffalo, N. Y. (J.A.M.A.), neglecting too much the consideration due to old age. We should give more attention to the matter of mitigating its disabilities and of delaying their onset. We lack data, however, for positive conclusions as to the best methods to be employed for this purpose. Stockton would have a study of pedigrees, as is done in the breeding of domestic animals adopted in the case of man for the rooting out of the qualities that tend to degeneration and to early individual decay. Marriage should be a matter of scientific selection more than it is at present; the breeding of bad stock should be prevented. He deprecates the modern tendency to individualism which would not prevail in a rightly adapted social system. Coming down, however, to the more detailed possibilities of improving the poor material we have to deal with, he finds certain things that med or ical science can do or is doing to delay to alleviate old age. One of these is the improvement of the nutrition of the aged as the result of good teeth. It is doubtful, he says, whether we fully appreciate what we owe to the dentists. Another debt is owed to the oculists who, by bettering the eyesight, have added interest to life in the aged. Still another way in which we can work to postpone senility is in warding off arterial disease. The earlier symptoms of arteriosclerosis are too often neglected, and even advanced conditions also. Autointoxications of one sort or another are for the most part responsible for advanced arterial degenerations and the prophylactic and curative measures are well understood. He says that there is a good reason for believing that the toxic state that underlies senility originates in the colon. Hence the need of keeping up proper elimination in addition to the usual measures for improving the general circulation. By more attention to the pathology of old age we will render it more physiologic and less repulsive. FRACTURE OF THE PATELLA.-J. B. Cutter, Albuquerque, N. Mex. (J.A.M.A., August 5), reports a case of fracture of the patella in which the patient refused treatment and precipitately left the hospital as soon as he learned the time and confinement it would require. About three weeks later he returned to obtain a certificate of discharge, having used his leg constantly during the interim, no attempt at treatment or immobilization having been made. There was ligamentous union apparently, the separation of the fragments being three-quarters of an inch. The functional result was remarkably good, there being almost complete extension and no inconvenience in walking. The separation case suggests to Cutter the question how much or how little advantage is gained by the conventional periods of rest in the the patella? recumbent position in cases of fracture of FACIAL ACNE.-Shoemaker (Med. Bulletin) recommends the following: B Ferri pyrophosphatis... Calcii sulphidi.... gr. j gr. ss gr. go gr. J Sig. One such pill three times a day. Locally: B Ung. hydrargyri nitratis. 3i 3ss gr. xx gr. xv 3ss MEDICAL MEMORANDA. For Sale.-First-class surgical chair and fine improved nebulizer. Both will be sold cheap if taken at once. Address" Removed," care Medical Fortnightly, St. Louis, Mo. For Sale. Will sell my eye and ear practice to registered physician or optician and guarantee $250 a month profit on refraction alone. $1,000 cash necessary. Dr. J. T. S., 302—517 S. Bdwy., Los Angeles, Cal. An Ideal Laxative and Cathartic. Abbott's saline laxative is an ideal laxative and cathartic as well as a sure relief for most forms of diarrhea; in fact, it is indicated in all conditions due to derangement of the digestive functions. The general usefulness of this preparation cannot be overestimated. It is pleasant, promptly effervescent, perfectly soluble, and more efficient than any similar preparation with which I am familiar, for by a happy combination of its well-known ingredients the manufacturers are enabled to introduce an extra large amount of the active agent. The attention of the medical profession is being directed to the use of sal hepatica in typhoid fever and inflammatory conditions of the bowels. It appears to be a very safe saline laxative in such affections, being less obnoxious to the organism than sodium phosphate alone or other salines, and is more readily eliminated. By commingling lithium and sodium phosphates in proper proportions with certain of the "bitter water" salts, the manufacturers of sal hepatica claim a compound is secured that is superlatively more active than either the lithium or sodium salt alone, or, indeed, than any of the natural purgative mineral waters. Recognizing this, the most eminent practitioners latterly have taken to prescribing sal hepatica in preference to the natural waters, with the result that the remedial action of the latter is enhanced, the untoward manifestations accruing reduced to a minimum, and their palatability materially increased. Sal hepatica is very effective in limiting and reducing the amount of uric acid formed within the circulation and excreted by the kidneys, and is freely absorbed and taken into the blood and as rapidly (along with the chemical products formed) eliminated by the excretory ducts or organs as is readily demonstrated by its presence, after a brief course thereof, in perspiration and urine, the latter more particularly being doubled and trebled as to quantity and rendered decidedly alkaline. Sal Hepatica is the original cffervescent saline laxative, hepatic stimulant, uric acid solvent and eliminant of irritating toxins in the alimentary tract. It is manufactured under the direct supervision of J. LeRoy Webber, Ph.G., its originator, and only at the laboratories of Bristol-Myers Co., manu. facturing chemists, 277-279 Greene avenue, Borough of Brooklyn, New York City. Hell and the Humboldt.-In the early days of our great mining camps the famous little burro (better known as the Rocky Mountain canary), has played a very important part, and he has been pictured in story and in song in glowing colors; but you will immediately ask what has that to do with the strikingly expressive word Hell" that heads this little story. Well it has all to do with it, for in the early 10's when the railroad was a thing hardly to be hoped for and wagon roads were as scarce as the oases in the desert, Julius Hell and his ever faithful little burro played the all important part in their search for glittering gold in the early history of the Humboldt mine, for it was by this man discovered, and it was here he planted his staff, and from that time to the present day he has lived in true western style in his typical one roomed mountain cabin within a stone's throw of the original discovery of this promising mine. The Humboldt mine is located on the Ute Creek in Clear Creek county, Colo., about six miles from Idaho Springs, and within three-fourth of a mile of the famous Lamartine group which has produced to date upward of $8,000,000, and is still apparently in its infancy. The Humboldt has produced according to the records of the sampling works and smelters who took the ore from the leasers, over $200,000, or rather that amount of value has been reported as royalties paid thereon. This was mostly done from the surface down to the 150 foot level. A tunnel enters the mountain 150 feet from the apex, and has been run 750 or 800 feet on the vein to the joint shaft at the end lines of the Mary Foster claim. One hundred and fifty feet below this tunnel a second tunnel has been run 800 feet also on the vein. This exceedingly promising ground has been secured by tunnel interests, and it is understood that Kansas and Chicago people are associated with them. Oliver Matthews, the Cripple Creek expert, and L. S. Judd, mining expert and manager of the Remington Mining and Power Co., of Hydraulic, Colo., have examined the property and report very favorably upon it as a safe proposition, there being large bodies of high grade ore practically blocked out, and according to Mr. Matthews there is mill-dirt on the dump and left standing that will amount to not less than 10,000 tons worth $6.50 per ton fire assay which can be milled at a good profit. The company owns its own mill which it now proposes to enlarge and newly equip, making it possible to treat this low grade production on the ground, and we understand other arrangements are being made for the further extended development of the property. With the prescription all is obscurity; the pharmacist may mistake, the doctor order and wait; meanwhile the patient dies.-Bourdieu. No more healthful, stimulating and generally beneficial application can be made to a diseased mucous membrane than Kennedy's pinus canadensis. A New Preparation of Iodine.-Iodine has not only retained its position in the front rank of therapeutic agents, but the more its physiological action is studied, and the better it is understood, the greater becomes the field of its usefulness; the indications for its administration therefore are fixed more scientifically and with more precision. The best organic compound of iodine is the iodotannic compound. It is in this form that iodine is found in many vegetables. Therefore for many years chemists have been seeking a process which would allow them to add to the tannin of plants a larger quantity of iodine than is normally found therein. It would have been easy for us to prepare an elixir, a syrup or an iodotannic wine, but we put aside these forms. The alcohol in elixirs and wines is frequently contra-indicated in numerous cases in which iodine would be of inestimable service, and even the syrup is not exempt from criticism on account of the repugnance patients have to its sweetness and its possible deterioration through fermentation. We, therefore, gave preference to the saccharated form, to which we have given the special name of "Iodalia. This new method of presentation offers, however, serious technical difficulties. The combination of iodine and tannin is very hygroscopic, and, for that reason, is difficult to dessicate with any uniformity. After repeated experiments, however, we succeeded in overcoming this difficulty, and are now able to guarantee the absolute preservation and inalterability of Our saccharated "Iodalia" Numerous tests made in typical cases have proven that “Iodalia” is perfectly tolerated. Even in very large doses, no symptoms of iodism have been noticed, whereas corresponding doses of iodine, pure or in mineral combinations, could certainly not have been tolerated. Elimination proceeds naturally, and one hour after the absorption of a teaspoonful of the saccharate, the urine contains manifest traces of iodine. There is a gradual increase up to the third hour, only to disappear at the end of twenty-four. Tests made on patients who were susceptible to ordinary iodine medication showed that they were not affected by this preparation. Dosage. In iodine strength, Iodalia corresponds to 6 centigrames (1 gram) of iodine in each teaspoonful. Dispensed by leading pharmacists. Prepared by M. Pelville, Paris. Send for literature and sample. Geo. J. Wallau, U. S. Agent, 2 Stone St., New York City. The Most Satisfactory Method of Treating Hay Fever. It is now regarded as a pretty well established fact that hay fever is a neurosis with the peculiar local manifestation of hypersensitiveness of the respiratory mucous membrane Excessively humid air, dust, the pollen of certain plants, attenuated particles of matter, and certain volatile emanations cause a pronounced irritation of the mucous membrane. This is indicated by violent fits of sneezing, copious discharge of mucus; sensation of burning in the pharynx and post nasal vault and sometimes in the region of the forehead, the eyes, and the cheeks; more or less headache and difficulty of breathing, due to nasal stenosis produced by turgescence of the mucous membrane; and in a few cases, cough and bronchial asthma. These phenomena are undoubtedly the direct result of the vasomotor paralysis that follows the primary irritation. They are caused by an engorgment of the tissues resulting from excessive dilatation of the capillaries. So much for the etiology and pathology of the distressing condition that annually incapacitates thousands of the most valued citizens of the country every year, and for which no method of treatment heretofore has proved more than palliative. With the discovery of the remarkable therapeutic properties of the suprarenal gland and the isolation of its active principle, adrenalin, a new day dawned for the hay-fever patient. As our experience with adrenalin Increases we are more than ever convinced of its efficacy. Its very satisfactory and exceedingly prompt action in controlling the paroxysm is simply charming to physician and patient. It affords the sufferer the grateful relief from physical torment and mental anguish that he once learned to expect from cocaine; but the dangers and inconveniences of cocaine are entirely wanting after the use of adrenalín. The latter powerfully contracts the capillaries, reduces the turbinal turgescence, thus relieving nasal stenosis, and checks the profuse flow of mucus. It also overcomes the sense of mental and physical depression that is so common in many chronic cases. Adrenalin is used either in the form of the 1-1000 solution, or the more recent adrenalin inhalant. The latter is a permanent oily solution 1-1000 strength. Either solution may be sprayed into the nares and pharynx, during deep inspiration when it is desired to reach the lower air passages, or the nasal tissues may be treated by means of topical applications or cotton mops. It is unnecessary to use cocaine, as the adrenalin solutions are not at all or very slightly irritating. Adrenalin is kept in the leading pharmacies of the country, and the physician should have no difficulty in procuring it at any time. Messrs. Parke, Davis & Co., who market the adrenalin preparations, have published a brochure on the treatment of hay fever that should be in the hands of every medical practitioner. It can be obtained by application to the Detroit office, or any of the branch houses. Vol. XXVIII (Absorbed the Morgan County (Ill.) Medical Journal. January 1, 1903.) ST. LOUIS, AUGUST 25, 1905. Papers for the original department must be contributed exclusively to th s magazine, and should be in hand at least one month in advance. French and German articles will be translated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the proof. Engravings from photographs or pen drawings will be furnished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R EDWARDS, M. D., Chicago, Ill. Mr. REGINALD HARRISON, London, England. HOBART A. HARE, M. D., Philadelphia. THOMAS LINN, M. D., Nice, France. LEADING ARTICLES THE DELAY OF OLD AGE AND THE ALLEVIATION OF SENILITY.* CHARLES G. STOCKTON. M. D. BUFFALO, N. Y. Professor of Medicine in the University of Buffalo. IN 1805, Lewis and Clark, typical and celebrated among American explorers, turned their faces toward the farthest west and dis close in a single expedition the possibilities of the continent and the mysteries of the great undiscovered. Their feat is in principle but a repetition of the undertakings of Columbus, De Soto, and La Salle, of Daniel Boone and the numberless pioneers who so quickly, almost suddenly, transformed America from a desolate wilderness into the puissant commonwealth of today. In each we may discern a discontent with the established order and environment of his heritage; an inspiration to find in newness a satisfaction which the settled regions, settled habits of thought, settled manners of life failed to provide him at home. The word settled" is significant. Our race is without rest until it *The oration on Medicine at the fifty-sixth annual meeting of the American Medical Association, held at Portland, Ore., July 11-14, 1905. No. 4 settles things; and with this there stalks a poignant impatience with the things that are settled. The new, the undiscovered, the unattained, the unprecedented-this it is which charms American manhood. The muezzin calling his prayers from a minaret in far away Cairo, the yellow haze in the circumambint air, the camels with jingling bells, the palms turned always eastward by the hot breeze from the monotonous sands-these possess for the western man no attraction greater than that of poetic interest. In these scenes he could never make his life. The European finds in America everywhere that which impresses him with our youth; in the Orient, he sees the indisputable evidence of age and a settled order of things. This exploitation of new lands, the cry of "Westward Ho!" which for the past few centuries has stirred mankind, is rapidly, inevitably dying out; but during the long period of its continuance it has wrought important changes in our point of view, it has stimulated a luxuriant growth of thought, it has modified considerably our nature. As our common interest has been fixed upon the untried, we have gradually come to exaggerate the importance of new truths and to ignore the meritorious which the slow moving caravan of thought has brought us from the ages. MIDDLE AND LATE AGE HAVE USEFULNESS. Now, it may seem a non sequitur, but reflection leads one to inquire if the great appreciation which we feel for the vigorous youth-spirit of recent times, has not educated us to prize-perhaps to overvalue-youth to the disparagment, if not to the absolute neglect of old age. element of truth in the right interpreted utIn saying this we are not unmindful of the terance on this subject of one of our most distinguished colleagues. From the standpoint of the original investigator, as from that of the soldier, or the adventurer, there is nothing to replace the effort of the man under forty; but if for no other reason than to obstruct impetuosity and to provide such handicap that youth shall not too soon outrun the limitations which a wise Providence has provided, middle and late old age have their uses. At any rate the old man is with us and there appears to be no acceptable method of obliterating him, even if it would add to the welfare of the race to do so. |