ulcus ventriculi or perforating ulcers in consequence upon typhoid, typhus abdominalis, dysentery, and perforating ulcers due to tuberculosis of the intestines, could then be rescued. from an early death. PULMONARY LITHIASIS.* BY JAMES S. RAWLINS, M.D. I CALL your attention to this case of pulmonary lithiasis on account of its rarity, the large number and diffuse deposit of the concretions, the slow process of breaking down of the encapsulating tissues and extrusion of the calculi, its close resemblance to phthisis, with complete recovery of patient. I have gone over the accessible literature upon this subject for fifty years or more past, and have been unable to find either report of case or article upon this subject, hence I regard it as an exceedingly rare condition and worthy of report as one of the curiosities of medicine. Dunglison, the only authority I have that mentions the term lithiasis pulmonorum, defines it as the formation of concretions in the lungs, occasioning at times litho-phthisis. I was called to see Luther Farris, male, aged 40, farmer, previous history good, family history good. The patient was confined to bed and stated that he had been troubled for some two months or longer with cough, hurried breathing, easy fatigue, and gradual emaciation. Physical examination of his lungs revealed feeble, prolonged expiratory murmur, with scattered, dry bronchial râles. Not sufficient dullness for tubercular deposit, although all symptoms indicated incipient tuberculosis, and he was treated accordingly. It is useless to follow the minute history of the patient from day to day, but I will state his general condition and the course of the disease. From a stout, active farmer of 165 lbs. weight, he became bedridden and reduced to 125 lbs. He had hurried and difficult respiration, with a very violent, annoying cough of paroxysmal character. About the third month of his sickness he expelled during a violent paroxysm of coughing the first calcareous concretion, which was expelled with such force as to fly across the room. This was followed by others during similar spells of coughing, sometimes several a day, for Read before Tri-State Med. Assn. (Miss. Ark. & Tenn.) Memphis, Nov. 20, 1901 two months or longer-several ounces having been expelled in the meantime. These calculi varied in size from a coffee bean to a grain of wheat or smaller, and were very hard and generally rough, some being complete casts of portions of the bronchus and air cells. After coughing up these concretions for several months they became less frequent, with a gradual subsidence of the cough, until twelve months after his acute attack he appears to be in his usual health. Now, two years since his attack, he is free from cough and in fine health. My son, Dr. J. S. Rawlins, who treated the case with me, took great interest in it and kept a minute report of the case as well as a large number of the concretions, which were misplaced or lost during my son's illness. I have one or two of the concretions left, which can be examined by any one who desires. Discussion. Dr. Alfred Moore, Memphis: This is a condition I have never found in a living patient, but in the dissecting room I have found a good many cases, and have no doubt but that they exist more often than we discover. Dr. Rawlins, closing; I have no further remarks to make, other than to state that this patient prior to the onset of his condition was strong, robust and weighed 175 pounds. He was reduced to 125 pounds. No other trouble followed, and the patient went on to complete recovery. PROGRESS OF MEDICINE. MEDICINE. UNDER CHARGE OF B. F. TURNER, M.D. Visiting Physician St. Joseph's Hospital, Memphis. Erythema Bullosum et Gyratum. At the "Vienna Gesellschaft" Neumann (Cor. Med. Press & Cir., vol. 72, no. 3264) exhibited casts of a rare case of erythema bullosum et gyratum occurring on the dorsum of the foot and the palms of the hands of a patient who had been treated for some time with arsenic for chronic furunculosis. The patient was given three minims of Fowler's solution at first, which was gradually increased. When admitted three months later under Neumann, the patient's face was swollen and puffed, the eyelids red and par tially covered with a crust. On the inner surface of the legs were small groups of bullæ, extending to the anus, while the scrotum had a red weeping eczema. On the dorsum of the left foot and in the palm of the left hand were large pustules, with red circumferences. In the urine there was found a moderate quantity of arsenic. This is a case of peculiar idiosyncrasy, as the patient during the whole of the treatment did not take more than ten, or fifteen at the outside, of the Asiatic pills commonly used in the Vienna clinics, and composed of-acidi arseniosi 0.5 gramme, piper nigr. 5 grammes, gum arabic 1 gramme, aqua q.8., fiat. pil. 100; this is equal to 6 milligrammes of arsenious acid in each pill. Therefore the total amount of arsenic taken would not exceed 0.15 gramme or 2.215 grains, which is a very small quantity to produce such extensive morbid changes. Lang said that he had drawn attention to this subject before, which had brought him into conflict with his colleagues. In one case some time ago, he said hyperkeratosis cutis was produced by a very small quantity of arsenic given for psoriasis; in another the results were somewhat similar to those obtained in Neumann's case, where large patches of exfoliation in both hands and feet occurred. Neumann replied that the doubt was justified in the case of arsenic given for psoriasis, as frequently such cases developed hyperkeratosis when no arsenic was administered. SURGERY. UNDER CHARGE OF W. B. ROGERS, M.D. Professor of the Principles and Practice of Surgery and Clinical Surgery, A New Procedure for the Radical Cure of Hernia. H. B. Delatour (Brooklyn Med. Jour., vol. 15, no. 12) thus describes an operative procedure devised by him : An elliptical incision is made about the base of the tumor through the skin and subcutaneous tissues down to the sac, the sac is then freed to the ring, an incision is now made through the abdominal wall in the median line about an inch or an inch and a half below the edge of the ring and the peritoneum opened. The finger is then introduced and swept around the ring, within the abdomen, to be sure that there are no adhesions and then with a pair of scissors the incision is carried on either side of the fibrous ring to a point in the median line an inch or so above the upper limit of the ring. This removes the sac with its fibrous neck or rings, and its contents unopened. We have now to deal with these; the ring of hardened tissue forming the neck of the sac may now be incised so as to allow the examination of its contents. The omentum should be separated as far as possible and then ligatured and cut away; the intestine is to be treated according to its condition, if healthy returned and if gangrenous resected, an anastomosis made and the bowel then returned. The closure of the abdominal wall should be done as follows: First the peritoneum and the posterior sheath of the rectus should be sewn with a continuous suture, next the edges of the rectus, which were exposed when removing the sac, and its anterior sheath should be united with chromicized catgut and the skin edges by a subcuticular suture of silk. The advantages claimed by the author for this operation are: 1. There is a considerable saving of time and much less handling of tissues. 2. It takes away from the abdominal cavity the contents of the sac until they have been inspected so that gangrenous intestine or omentum is not necessarily handled. If the intestine is gangrenous it can be resected without being withdrawn from the sac. The same is true of omentum. 3. It gives a firm closure of the wound with the tissues approximated in proper layers. Cholecystectomy for Gall Stones. C. L. Gibson (N. Y. Med. Jour., vol. 79, no. 22) sums up his position in regard to cholecystectomy for cholecystitis and cholelithiasis as follows: In properly selected cases it is an extremely simple and safe operation. It is a curative operation, doing away with subsequent attacks of cholecystitis, and, more remotely, of renewed stone formation. It eliminates the disagreeable possibilities of long-continued biliary and mucous fistulæ. It is indicated in certain technical conditions, such as atrophic or (for drainage) inaccessible bladder, obliteration of the cystic duct, or impacted stone in the cystic duct, and in hemorrhagic conditions of the gall-bladder. It is a prophylactic measure against the development of carcinoma on the site of long-standing irritation. It offers the prospect of a shorter and easier wound-healing and convalescence. It is not to be employed indiscriminately, but has its proper limitations and contraindications. Dissecting Abscess of the Abdominal Wall Producing Deformity Simulating Pott's Disease. J. B. Bullitt (Jour. Amer. Med. Assn., vol. 37, no. 22) says: 1. Abscesses of the abdominal wall without any connection with the abdominal cavity occur most frequently as a result of typhoid fever and readily heal after incision and drainage. 2. The larger dissecting abscesses of the abdominal wall communicate at their inception with some portion of the intestinal tract, occur most frequently as a sequela of typhoid fever or appendicitis, and result from an adhesion between the parietal peritoneum and a viscus, with perforation of the latter. After rupture such abscesses follow the course of fecal fistula, healing sometimes spontaneously or as a result of incision with drainage only after the communication with the intestine has become obliterated. The obliteration sometimes occurs spontaneously, sometimes must be brought about by operative procedure. 3. A dissecting abscess may produce symptoms and deformity simulating Pott's disease; on the other hand, Pott's disease with abscess appearing after an attack of typhoid fever may be confounded with abscess resulting from the typhoidal process. It indicates good luck to find a horseshoe in the road, nails upward—that is, if you see it before you run over it. |