'gastralgia,' 'painful digestion,' 'cardialgia, dilated stomach,' and 'gallstones.' They, however, fail to get well or to realize expected relief, and so become thorns in the flesh of their medical attendant until further complications end their career, or until he places them in the surgical category where they belong. And it must be conceded that such a temporizing course with medicines and foods is too frequently warranted by the more or less vague teachings of many text-books on practice, which fail properly to interpret the organic, and, consequently, surgical conditions underlying the symptomatology embraced in histories such as the ensuing : "Mrs. S., aged thirty, was referred to me October 10, 1904, by her physician, Dr. Fred. A. Grossman, of Cleves, Ohio. ravenous "Previous History.-Thirteen years ago she had dyspepsia,' characterized by a appetite, acidity of the stomach, regurgitation of food and occasional water brash. The pain accompanying these conditions was at times intense, of a hot burning cbaracter and usually came about two hours after meals. She was treated with alkalies and digestants, with but little relief. A few years later the pain became heavy and boring in character, and would ordinarily continue until she again took either sodium bicarbonate or some food. She became so tender over the stomach that she was too short in front,' 'could not stand straight,' nor could she tolerate either the weight of her clothing or the pressure of her corset. Five years ago she was given the rest cure and the milk diet, but with an aggravation rather than an amelioration of symptoms. Her hunger increased, but she was afraid to eat because of the pain that remorselessly followed a couple of hours later. She then tried the various patent foods, but without satis. factory results. She then placed herself in the hands of first one and then another gastrologist, in Chicago, who used and taught her to use the stomach-tube. This brought her relief, and she thought at times that she was cured, only, however, to have a recurrence more severe than before. She was constipated; her urine was high colored and irritating, for which she was given laxatives and diuretics until her stomach rebelled. She had attacks of nausea associated with vomiting, but there was no history of blood in the matter thus rejected. She suffered with distention of the stomach, which at times interfered with her breathing and gave her irregularity of the heart, and an almost constant pain that was experienced chiefly at the fundus of the stomach. At this juncture she consulted Dr. Grossman, who advised an exploratory incision. 64 Examination.-Patient looked like a fat anemic, although her weight, 130, is twenty-six pounds under normal. The abdominal wall was tense over the stomach, the resonance of which occupied the whole triangular area between the umbilicus and the ensiform, but disappeared on the introduction of the stomach-tube. No tumefaction could be felt. Inflation of the stomach by air pumped into it redeveloped the distention. Analysis following a test-breakfast revealed marked hyperchlorhydria. The blood showed a leukocytosis of 11,000, with only 65 per cent. of hemoglobin. Diagnosis. The previous history of the case alone justified the presumptive diagnosis of surgical ulcer. This was confirmed by the physical signs presented, the distention of the stomach and the residual food in it, indicating partial occlusion of the pyloric orifice. The time of the worst pain-about two hours after meals-indiAn opinion cated ulceration of the duodenum. was given to this effect, and an exploratory incision advised. Operation at the Good Samaritan Annex, Clifton, October 14, in the presence of Drs. Grossman and McGrath. A large ulcer was found near the pyloric orifice, which was contracted to less than a third of its normal calibre. There were several mottled areas, indicating underlying ulcers in the upper two inches of the duodenum, between which and the pancreas there were extensive and firm adhesions. An opening was made in the meson of the transverse colon, through which a loop of the duodenum was brought up and anastomosed to the posterior wall of the stomach, a supplementary duodenostomy was made three inches below the union to the stomach; the bile current was cut off from the stomach by plicating the proximal segment of the duodenum between the two artificial openings; complete occlusion of the pylorus was also effected by plication; the abdomen was closed and the patient put to bed in excellent condition. "After-Course. The patient vomited a little bloody mucus a few hours after being put to bed. She slept seven and a half hours the first night, and longer each subsequent night without having taken a single dose of morphine or other anodine during her entire convalescence. Her pulse never went above 86, while her temperature, generally normal, touched 100° F. only twice. The bowels moved spontaneously in thirty-eight hours, the first time they had moved without a laxative for over a year. On the second day she took beer with a relish and retained it with comfort, although it had made her vomit whenever she had taken it before the operation. In addition to beer, she took broths and water during the first six days, after which she was given light diet. She was permitted to occupy any position in bed that she found the most comfortable, generally choosing the semi-recumbent until the tenth day, when the abdominal wound having healed by first intention, she was permitted to get up. "Remarks.-The conditions revealed in the case were such as are found with but slight variation in all patients giving a similarly classic history. They are all chronics, and ordinarily as distressing to their physicians as to themselves. The actual condition-gastric ulcer-with which they are afflicted, has been found in from 2.7 per cent. to 13 per cent. of autopsies in long series. That many of them if left alone develop into cancer, seems to be established by the observations of Audisten. London hospital records show that of those not operated upon, 60 per cent. died or were not cured, while no record is given of the remainder. The only rational principles of treatmeut are rest and drainage. The only way absolute rest can be given to an ulcerated pylorus is to close it, while the only way drainage can be effected is to divert the food current. The operation exemplified in the preceding case has a mortality varying from 3 per cent. to 7.5 per cent. at the hands of the most skilled operators, and P. S. CONNER, M.D. J. C. OLIVER, M.D. in all classes of subjects. The death-rate is, naturally enough, higher in old, complicated cases, in patients with run-down constitutions, while it is practically nil in patients yet in fair general health. The post-operative period is almost painless, while the subsequent history of these cases is almost invariably that of a normal appetite, painless digestion, rapid increase in weight and prompt return to the ordinary activities of life. As Max Einhorn, the leading American gastrologist, says: 'They all feel as if new-born.' " Surgery. The Treatment of Inoperable Cancer by Hypodermic Medication. Shaw-Mackenzie (Medical Press and Circular, October 19, 1904) reports encouraging results from the hypodermic injection of chian turpentine administered hypodermically. The method has not received an extended trial, nor has it resulted in cure of the condition, yet the effects reported are a diminution in the growth of the tumor, removal of pain and fetor, followed by some restoration to normal nutrition, as shown in the improvement in the general health of the patient. The hypodermic injection of soap solution, as advocated by Mr. J. H. Webb (Melbourne), is referred to. The technique is given as follows: The injections of chian turpentine are administered deeply into the subcutaneous tissue of the buttock. Given deeply they occasion little or no inconvenience or pain. The muscular tissue itself must be avoided. An " An all-glass" syringe is recommended. The injection should be given under the most careful aseptic precautions. Five minims of a 20 per cent. combination of chian turpentine with olive oil, obtained from Messrs. Southwell Bros. & Barclay (Birmingham), is the quantity to begin with, increasing by five minims on alternate days up to sixty minims. H. J. W. Fractures of the Neck of the Femur. Whitman (Medical Record, March 19, 1904) takes up ia detail fractures of the neck of the femur. He believes this injury CHAS. A. L. REED, M.D. H. J. WHITACRE, M.D. H. A. INGALLS, M. D. If to be much more frequent than is commonly supposed, for the reason that in middle life, as well as in childhood, the fracture is often incomplete. Hospital records show that 37 per cent. of the cases treated are above sixty years of age, so he advises careful examination in all hip injuries, his observations leading him to believe that many cases are classed as simple contusions, thus losing favorable opportunity for treatment in the very cases in which it should be most efficacious. the fracture be at the juncture of the neck with the shaft, union is usually good, owing to the large surface of the fragments and because it is often incomplete. If it be at the small part of the neck the chances for good union are poor unless the primary shortening be overcome. He believes the typical treatment for complete fracture of the neck of the femur is the long lateral T-splint to which the limb and body are bandaged, supplemented by a weight of from five to twenty pounds attached to the limb. H. A. I. A Case of Carcinoma of the Appendix. Cullingworth and Corner (Lancet, November 12, 1904) report a case of carcinoma of the appendix and speak briefly of the frequency and nature of the lesion. They believe that the disease is not nearly so infrequent as at present it seems to be. The early cases thus far have been diagnosticated only in the routine examination of appendices removed for chronic, subacute, or acute appendicitis. The location of a lesion in the operated cases is found to be at the distal end of the appendix in 48 per cent.; at the middle section in 37 per cent.; and at the cecal end in 15 per cent. The lesion presents itself in the following varieties; (1) A hard, small, whitish nodule; (2) a more or less caseous little mass; (3) a nodule breaking down in the centre; (4) an apparently fibrous stricture; (5) an apparent obliteration of the lumen of the tube: and (6) a nodular bulbous tip to the organ. Inasmuch as carcinoma of the intestinal tract causes symptoms solely by reason of anatomic or mechanical evils, it is apparant that such tumors of the appendix will not give rise to symptoms except when the drainage of the appendix becomes obstructed and symptoms of appendicitis develop. These patients are therefore operated upon for appendicitis. The case reported presented a firm, nodular, bulbous tip to the organ. The case is reported two and a half years after the operation, and the patient is still in excellent health, with no evidence of recurrence. H.J.W. Dermatology and Genito-Urinary Diseases. M. L. HEIDINGSFELD, M.D. Internal Treatment of Multiple Hall (British Journal of Dermatology, July, 1904) reports a case of multiple warts of the scalp and forehead in a male, aged twenty-seven, which remained uninfluenced by external therapy (salicylic acid), and which atrophied and entirely disappeared in two weeks from the internal administration of 30.0 daily of mistura alba (magnes. sulph., 31; magnes. carb., gr. xv; choloroform et aq. menth. pip. Corneal Chancre. Salmon (La Syphilis, August, 1904) reports inoculation experiments of syphilis upon the cornea of an ape. The chancre, as in man, implanted itself only on the conjunctiva, and spared the cornea in its entirety. Histologic examination of the excised eye shows characteristic changesproliferation of the epithelium, syphilitic iritis, endarteritis, mononuclear invasion, and pigment proliferation. There was a typical period of incubation. Etiology and Pathology of Tabes. Fritz Lesser (Berlin. Klin. Woch., 1904, No. 4), from post-mortem examinations in ninety-six cases of tabes, found post-mortem evidence of syphilis in 28 per cent. Inasmuch as post-mortem syphilis attains in 9 per cent. of cases of over thirty-five years of age, it is evident that syphilis must have some etiologic bearing on at least some of the cases of tabes. Lesser accounts for this in the fact that he attributes to syphilis a fourth or quartiary stage, characterized by an interstitial inflammation, which is uninfluenced by treatment, and which conforms to the first or early stage of tabes. This paper provoked considerable opposition from Mendel, Hausemann and Benda in the Berlin Academy of Medicine, who maintained that the two affections must be carefully dissociated, and that syphilis could exert at the most merely a predisposing influence. Adiposus Dolorosa. Hammond (British Medical Journal, July, 1904) reports two cases of multiple painful fatty tumors of the body in two sisters, both mothers of large families. The affection began on the anus and the nodes gradually extended and multiplied in numbor. Patients were over thirty when the disease first manifested itself. Absorptive Power of the Skin. Gundrow (Arch. f. Derm. u. Syph., Vol. 71, No. 1, 1904), from physiological experiments conducted on man and animals, found that the skin only absorbed two substances with which he experimented, namely, salicylic acid and amorphous aconitin, as determined by chemical reaction and physiological effect. Lanolin is not absorbed. It does not necessarily follow that because a crystalline substance like salicylic acid readily penetrates the normal skin that others, liquids or even gases, do likewise. Even substances which produce a local reaction in the form of Thinim (Dermatolog. Zeitschr., Vol. xi, No. 8) reports a new emulsion of vaseline which contains 25 per cent. water, which recommends itself as a vehicle for the preparation of ointments, in that it holds many substances otherwise insoluble in intimate relation. Many substances can thus be first dissolved in water and then added in solution. It also recommends itself for injection purposes and as a lubricant for instruments, etc. It can be readily incorporated with metallic mercury, which remains perfectly suspended almost indefinitely. Bubo and Crede's Ointment. Dejurin (Russ. Jour. Skin and Vener. Diseases, 1904) reports that the use of Crede's silver ointment in thirty-five buboes following soft chancre, with duration from four to twenty-one days, with fluctuation well pronounced in ten cases, ill defined in fifteen and absent in the remainder, a favorable result was obtained in fourteen cases, after an average of eight to nine inunctions. The number of inunctions varied in different cases from four to nineteen. He concludes from his own experience and from a careful review of the literature that the treatment is neither as efficacious or inefficacious as an abortive measure for infective lymphangitis as the ardent admirers on one hand and relentless critics on the other would lead us to believe. Paulsen's Syphilis Serum. Ludwig Waelsch (Arch. f. Derm. u. Syph., Vol. 70, No. 3, 1904) reports that Paulsen's syphilis serum was used on animals, with the result that the animals became ill and died. For this reason he cannot see the justice of the claim that it should be given a further trial, the more so since it is not produced from the bacillus of syphilis, and even the discoverer admits that it has thus far not proven itself to be so very efficacious against syphilis. High Frequency in the Urethra. Strebel (Arch. f. Derm. u. Syph., Vol. 70, No. 3) reports a favorable reaction in the urethra from quartz vaccuum tubes introduced while excited by the high frequency. He also maintains that by first localizing the urethral lesions by means of an endoscope and covering all except the corresponding portion of the tube with an impervious shellac he is able to properly circumscribe the action of this form of ultra-violet treatment. Ringworm. Sabouraud (British Journal of Dermatology, No. 7, 1904) reports that since. ringworm has been treated at the Hospital St. Louis, in Paris, by means of the X-ray, the period of time required in effecting a satisfactory result has been reduced from eighteen to three and a half months. All communications for the Editor, and all books for review, should be addressed to the Editor at the above address. All business communications, or those referring to subscriptions or advertising, should be sent to the Managing Editor, Suite 4, Berkshire Building, 628 Elm Street. SUBSCRIPTION TERMS: THREE DOLLARS PER YEAR. NEW SERIES VOL. LIII. Cincinnati, Ohio. THE CHOICE AND USE OF MEDICAL. LITERATURE.* Ladies and Gentlemen: BY HUGH T. PATRICK, M. D., From the beginning, the Mississippi Valley Medical Association has been blessed above other scientific societies with a general friendliness-indeed, a fraternal affection-among its members. Second only to the American Medical Association in size and in geographical extent, second to none in earnest and fruitful work, our Association has retained a sort of family warm-heartedness unique in large bodies. For this we should be thankful. For this your President is peculiarly grateful, for well he knows that to this kindly spirit and to no merit of his own he owes his present honorable position. During his brief incumbency it shall be his great pleasure as well as duty to foster the old friendships and cement the new. And now, since inexorable by-laws require you to undergo something called an address, I am going to inflict a few de sultory remarks about the matter and the manner of our reading. The choice and use of medical literature will depend first of all upon what the physician tries to be; not upon what he would like to be, not upon what his ideal may be, but upon what he thoughtfully, consistently, persistently strives to be. Our day-dreams of attainment are much the same, but the daily walk of doctors varies greatly. Most of us have met a doctor who may be called the family factotum. He hob-nobs with fussy mothers and puttering fathers. He is greatly interested in grandma's cough, knows just how to wash the baby, has his special poultice and can take off warts. Dropping in to ask about Aunt Em's backache, he stays an hour visiting with the folks. He is a gentle and kindly soul, but his mind is occupied with the trivialities of medicine and domestic chit-chat. *President's Address, delivered before the thirtieth annual meeting of the Mississippi |