floor, and is so swung that it may be moved in any direction, while the patient remains quiet in a chair or lies down upon the operating-table. While it is portable it is very heavy, and it is not practical to carry it about. I therefore keep it attached to the direct current in my operating room at my office. It is so powerful that it will lift 400 pounds when connected with the 500volt current. Pieces of iron and steel therefore held at some distance from the magnet will be rapidly drawn to the point. The power is perfectly regulated by a foot rheostat.

CASE 1. This case was referred by Dr. Spring, who had taken an r-ray picture, which he has shown to-night, showing the location of the foreign body, and he had endeavored, with the use of instruments, to find it. The foreign body was embedded in the muscular tissues of the forearm, and was a flat piece less than one-quarter of an inch in diameter at its largest part. Dr. Spring was unable to find it with the knife or other instrument. The application of the magnet to the wound at once caused pain (due to the movement of the foreign body toward the magnet, thus proving the fact that a piece of iron or steel was buried in the tissues), and whenever the current was turned on this pain was pronounced. An application of cocaine was made completely anesthetising the parts, and the foreign body evidently worked its way out toward the magnet, and when the arm was drawn slowly away from the point of the magnet the tissues remained in contact with the magnet, being held there by the piece of steel which was attracted toward the point of the magnet. By the use of a knife the soft tissues separating the magnet point from the foreign body were severed, and the steel readily made its way through this path, and was found upon the magnet point.

CASE 2. This case was also referred by Dr. Spring, and was another patient with a foreign body embedded in the tissues of the wrist. Dr. Spring has seen the piece of metal with the fluroscope, but it was still smaller than the piece removed in the other case, being sharply pointed like a needle, one-quarter of an inch long and about one-sixteenth of an inch in its largest diameter. It was removed in the same manner, but it was found best to direct the magnet so that the lines of force would bring it out point first in order to secure it without much cutting. This foreign body was so small that it would have been impossible to remove it without considerable dissection and much searching.

ST. BARNABAS HOSPITAL

MINNEAPOLIS

A FIBROID IN THE ABDOMINAL WALL IN THE SERVICE OF DR. G. G. EITEL

Mrs. J, aged 26, first noticed a mass in the lower abdomen ten months before she entered the hospital. At that time the tumor was small and but slightly painful. It increased

gradually in size, until the time she presented herself for operation when it was about the size of a man's fist. With the increasing size it grew more painful, the pain being especially severe at night. On examination the mass was found to be situated immediately above and to the left of the symphysis pubis. It was hard, and apparently incapsulated and imbedded deeply in the abdominal parietes.

On operation the tumor was found imme

diately below the external oblique muscle.

It

For weeks she had been unable to retain on

both recti muscles. It was so closely adherent to the peritoneum that that membrane was opened up in the effort to dissect it free. It appeared to have sprung from the transversalis fascia.

The external oblique muscle and fascia were free, and were used to make the new wall and to close the wound. Owing to the destruction of the recti muscles some uncertainty was felt as to the result. The patient, however, has suffered no discomfort whatever, and is entirely well.

On section the tumor presented a striped, "silk-ribbon" appearance, macroscopically. Microscopically it proved to be a very cellular fibroma, i. e., a desmoid.

A UTERINE FIBROID, WITH SYMPTOMS OF MALIGNANT DISEASE

IN THE SERVICE OF DR. G. C. BARTON Mrs. D, colored, aged 40, entered the hospital as a medical case, which had been diagnosed “inflammation of the bowels." She was complaining of great pain and tenderness over the abdomen, vomiting, and progressive emaciation. Her family and past history was unimportant. She had menstruated first at 14. The periods have always been regular and painless. PRESENT ILLNESS.-One month ago while doing chamber work, she was suddenly seized with severe pain in the abdomen. The pain was first dull in character, but soon became sharp and shooting. The abdomen was tense and tender. She went to bed, and did not get up again until she came to the hospital. She remained in the medical ward for three weeks, during which there was little or no change. At the end of that time I first saw her. She was then markedly emaciated and anemic with the facies of one suffering from cancer. The abdomen, which was very sensitive, was occupied in its lower half by a tumor, which reached as far up as the umbilicus. The abdominal wall was extremely thin, and the peristaltic action of the intestines was plainly visible through it. The tumor, which entirely filled the pelvic cavity, apparently sprang from the uterus, which, however, was fully movable. There was a foul, bloody discharge from the cervix.

was, moreover, much distressed by gas. She was very constipated. For a week rectal feedings were resorted to, during which time systematic gavage was employed. The stomach contents gave no indication of carcinoma. At the end of a week her condition had not improved, and as a last resort she was advised to have an operation for the removal of the tumor, which was thought to be malignant.

At operation the tumor was found to be a large nodular fibroma, which sprang from the fundus of the uterus. The right ovary contained another fibroma. One small tumor attached to the main growth by a narrow pedicle was adherent to the fundus of the bladder. The left ovary was cystic. There were no adhesions, and it seemed impossible that the tumor could have caused any obstruction to the bowel.

A complete myohysterectomy was performed. There was very little vomiting following the anesthetic, and when the effects of the ether had completely worn off the vomiting ceased entirely, and no further difficulty was experienced. Her recovery was complete.

Microscopic sections of the tumor, which were made in the clinical laboratory at the hospital and by Dr. Frank Corbett, showed the tumor to be a simple fibroma.

The interesting points of this case are:

I. The cachectic state to which the patient was reduced.

Miss E. H, aged 26 years, a dressmaker, with a good family history; has always been of fairly good, although not robust, health. Consulted me for the first time on December 23, 1902. Complained of painful and frequent urination. No appetite. Menstruation regular, somewhat painful. Her temperature was 99.2° in the forenoon. Slightly tender over the bladder and in the lumbar region (on which side my notes do not state). Urine was turbid, slightly acid, and formed a sediment on standing, which by microscopical examination proved to be pus. The filtered urine contained a small amount of albumen.

Patient was sent to bed on a milk diet, and given successively urotropin, decoct. foliorum uvæ ursi and ichthyol (the latter from 3 to 15 drops, 3 times a day). I attended her a couple of weeks, during which she improved somewhat. After this she went to visit relatives in the country, and I did not see her until October 24, 1903, when she came to my office telling me that she had improved a great deal after leaving Minneapolis, giving the ichthyol, which she continued to take for some time, the credit for this improvement. However, in the summer she grew worse again, consulted the nearest physician, and was treated with bladder washings and urotropin, but without much relief.

I advised her to go the hospital for a thorough examination and observation, and this she did on October 25. The condition was about the same as when I first examined her, or probably worse. She had to pass the urine six to eight times during the night, and had a colicky pain in her right side and over the bladder towards the end of urination. Lungs were normal; temperature 98.5°-99.5°. Urine as before. Sediment was examined for tubercle bacilli, with negative result. Daily bladder washings with 2 per cent boric acid solution followed by injection of about half an ounce of 2 per cent nitrate of silver sol., which again was neutralized with normal salt solution, were carried on for some time, and ichthyol was taken internally. Her condition improved somewhat under this treatment, so that on November 17 my record states that she only passes the urine 3 times from 8 p. m. to 6 a. m., and that she was feeling good.

On November 23 her urine was clear and contained no albumen. (This is an interesting incident, probably caused by clogging of the right

ureter on that day, because on November 25 it was about as before, containing albumen and pus in the usual amount.)

On December 4 she left the hospital and tried to work, her condition being about as on November 17th. ·

On January 3, 1904, she came to my office again, insisting that something radical be done. for her, "as she, would rather die than live this way," and the next day she went to the Norwegian Deaconess' Hospital. Her general condition was about as on Oct. 25, 1903. Urine sediment was again examined for tubercle bacilli with negative result. By palpation over the ab'domen some tenderness was felt below right costal arch in the mamillary line and in the right lumbar region.

On January 9 a cystoscopical examination was performed by Dr. H. B. Sweetser and myself, and in the knee-chest position, the bladder expanded by air, we succeeded in locating both the ureter openings quite plainly. Around the orifice of the right ureter an area of about half an inch in diameter showed an inflamed condition

lacking on the other side, the mucosa being of a deep-red velvety color. An attempt at segregation of the urine was not successful, and was given up.

January 11 a nephrectomy was performed, Dr. H. B. Sweetser assisting. The kidney was found and delivered out of the incision without much difficulty. It was considerably enlarged, of a dark-red color, the surface studded with greyish, semitransparent nodules (tubercles). An incision was made on the convex side of the kidney into the pelvis. No abscesses were found in the kidney tissue, and no calculus in the pelvis. The appearance of the kidney seemed to justify no other course than complete nephrectomy, although some anxiety was felt as to the condition of the other kidney. The stump was ligated with catgut, and the wound sutured after introduction of a rubber-tissue gauze drain.

Amount of urine passed after operation: First 24 hours, 13-14 ounces. Second 24 hours, 18 ounces. Third 24 hours, 20 ounces. Fourth 24 hours, 26 ounces. Patient recovered without interruption, and was up in less than three weeks.

Urine continued to contain albumen after the operation, although decreasing from day to day (very likely from the ureter on the sick side).

February 5, urine almost clear, only trace of albumen. I saw her on March 15. She looked a picture of health, and had no pain at urination.

Pesci, in an article from the Reforma Medica, Palermo, which is abstracted in the Journal of the A. M. A., calls attention to the therapeutic value of this drug. It has been used successfully in pleurisy, myocarditis, valvular defects, and typhoid. It increases blood pressure, and is an efficient diuretic, hence it is distinctly contraindicated when blood pressure is excessively high, and the heart is weak.

In some of the cases in which Pesci used the drug, particularly during an active pleurisy, the results were marvelous, the amount of urine excreted increasing from 1,000 to 4,000 c. c.

Barium chlorid stimulates the walls of the arteries, and suspends infiltration into the tissues. It is also indicated in the first stage of disturbance of compensation in valvular affections, which so frequently occur in typhoid or other infectious diseases. Barium is slowly absorbed from the intestine, and is speedily neutralized by potassium salts. The dose of chlorid of barium is from 1-20 gr. to 1-10 gr. It is the most poisonous of the three common alkaline earths, but if used cautiously is as safe as any of the drugs which are given for arterial stimulation.

Many years ago barium was used in chronic and degenerative diseases, but without a very accurate knowledge of its properties. It was supposed to be similar to the action of the heavy metal series, but the investigations of Schedel,

of this salt, and have demonstrated the diuretic possibilities.

A drug that will strengthen the walls of the heart and the muscular coats of the arteries, as well as act as a powerful diuretic, is one that will promise improvement in a variety of diseases. Anything that will encourage elimination by natural methods, that is, by toning the circulatory apparatus, will be a valuable adjunct to the therapist.

BACTERIAL INFECTIONS

To solve the problem of the effect and result of bacterial infections is the ultimate aim of the clinician and laboratory investigator. It is comparatively easy to say that a patient is suffering from an infectious disorder, but it is extremely difficult to ascertain the origin and extent of the process. Repeated examinations of the blood, even though the result is negative, are imperative if we are to arrive at a working basis. A highly suggestive and encouraging line of work has been done by Martzinovsky of Moscow, who believes that endocarditis may result from the action of one or more of several bacteria. He found acute endocarditis in about one-half of his cases of rheumatism, but the bacteria differed in the various cases, so that the assumption is clear that acute rheumatism from a single causal germ is highly improbable. The writer was able to discover a connection between the endocarditis and erysipelas, with streptococci in one case, and a diplococcus endocarditis and croupous pneumonia in another.

Acute endocarditis is frequently followed by progressive, anemia and icterus, with urobilin, albumin, and casts in the urine.

The fact that an acute endocarditis is overlooked and the evidences of an acute nephritic inflammation only are found, leads to confusion and doubt as to the origin of the disease. To examine the blood in all acute cases is wise, yet the time required in making cultures is so great that the majority of physicians will neglect what may be the most important event in the investigation. This is an argument for the clinician. and laboratory man to discuss with the best of the argument on the laboratory side.

The number of microbes in the blood is not necessarily large, and repeated cultures may be required to determine the presence of the special bacteria. Due consideration must be given to the possibilities of infection of other organs by the blood stream.

An acute nephritis suddenly appearing may be due to the infected current and not to an organic kidney lesion. The limitation of the disease process, the clearing of what seemed a serious situation, and the speedy or satisfactory recovery of a patient from an acute endocardial state is strong evidence of a bacterial invasion. Some of these cases recover with little or no treatment; the serious cases die because the disease was unrecognized and therefore unscientifically treated.

Under the conditions described the remedy is that which will attack and destroy the specific bacteria, an antiserum. The time is coming when the blood must carry the serum directly into the diseased or involved organs. The roundabout method is too slow and uncertain. If the patient recovers under the old methods of treatment it is because the power to resist the force of the bacteria is present. With the antiserum methods the results should be more prompt and specific.

THE GULLIBLE PUBLIC

In order to advertise a new remedy successfully to the public through the daily press, the claims for such remedy must be set forth in stronger language than has previously been used for like purposes, and as adjectives have only three degrees of comparison one might think the end of extravagance in language had long ago been reached. If any one thinks the end has been reached, let him read the advertisements of "Liquozone" now occupying large space in the leading dailies. It is claimed to be liquid ozone, and to cure "all diseases that begin with fever-all inflammation, all catarrh in any part of the body, all contagious diseases, all the results of impure or poisoned blood." A score of chemists, including the chemist of the Governmental Agricultural Experiment Station of North Dakota, have analyzed the so-called "liquid air," and have found it to be composed of water, sulphuric and sulphurous acid, and inert

FILTRATION BONDS

The Hennepin County Medical Society at its last meeting passed a resolution urging the Hennepin County delegation in the legislature to vote for the issuance of bonds to the amount of one million dollars to construct a sand filter for the water supply of Minneapolis.

The city has been widely advertised in many ways, but the most flagrant form of advertising for any city is an admission that its water supply is impure. To remedy this, and to place the city before the country as a city adapted to maintain a record of good health, Minneapolis must have pure water at any cost. To postpone a remedy for the purification of Mississippi water for two years is to invite the multiplication of disease germs. To be unprepared means a high death-rate to Minneapolis. No man is truly conservative who advises delay. Other cities have passed through experiences that should not be repeated here. The Mississippi river is becoming a channel for extensive sewage deposits, and some day the accumulation will reach Minneapolis and infect the city.

The investigations by the State Board of Health have shown conclusively the bad effects of water-borne epidemics, and no risks should be accepted when a remedy is at hand.

Minneapolis can even stand a higher taxation to cover the bonds asked for.

It is to be hoped the legislature will promptly grant the prayer of the Hennepin County Medical Society.