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ness of the lower extremities, movable right kidney, pyuria, retroversion of the uterus, and defective circulation of the lower ertremeties. No improvement had resulted from change, travel, rest, and various methods of treatment which she had undergone. The patient was a woman thirty-two years' old, a librarian. The family history was negative. The mental condition was excellent. After she was sent to the writer a thorough examination was made in order to detect, if possible, evidences of organic trouble. It was found that while clear amber urine flowed from the right ureter, a thick whitish fluid came slowly from the left. An x-ray picture of the kidney confirmed the diagnosis of stone. Operation proved this diagnosis to be correct. The patient died on the third day after the operation. The writer suggests that the irritation in the kidneys or pancreas or both caused the socalled referred pain of head, and brought about reflexly a spasm of the vasomotor nerves derived from the lumbar and upper sacral segments. This caused contraction of the blood-vessels of the lower extremities. The ischemia in the nerve endings caused the deep seated pain, and in the muscles the weakness.-Medical Record.

THE CONTAGIOUSNESS OF GUMMA.

Charles Mallory Williams says that if the spirochete is the specific organism of syphilis it must exist in gummata, though in such small numbers that up to the present it has escaped detection. The cases in which exposure to tertiary lesions have been followed by contagion are not sufficiently numerous and carefully reported to bring conviction to even a conservative mind. The experiments which have been conducted in relation to this problem are conclusive that a gumma may be capable of transmitting the disease. This does not mean that a gumma is always contagious. The writer thinks that it is probable that the living growing border is always infectious. He explains the rarity of examples of infection by the fact that the organism is present in such scanty numbers and has so little chance to reach

fertile soil. But this belief is not proven. Whatever may be the explanation of the various questions relating to the contagiousness of gumma, however, the practical lesson is the same. As long as a man shows any sign of syphilis so long must he be considered a source of danger to the community.-Medical Record.

DIAGNOSTIC FEATURES OF SURGICAL DISEASES ATTENDED WITH ACUTE JAUNDICE.

A. A. Berg declares that although it is quite commonly considered that all cases of liver abscess are accompanied by jaundice this view is not borne out in practice. The diagnosis of liver suppuration does not rest upon the presence or absence of icterus. Cases of primary acute infectious cholangitis may be very difficult to diagnose. The pain in the epigastrium and right hypochondrium and the jaundice are most suggestive of gallstone disease to which the cholangitis is secondary. The enlarged tender liver, increased leucocytosis, and fever and chills suggest miliary abscess of the liver. It may be helpful here to remember that in long standing gallstone disease the gall-bladder is most likely to be contracted and not palpable, while in primary acute, infectious cholangitis it is distended and enlarged. In cases in which because the stones do not leave the gall-bladder there is pain, but no jaundice, the diagnosis is often very difficult to make. Syphiloma or gumma of the liver when they break down are sometimes accompanied by acutely developing jaundice. The writer gives the histories of a number of cases illustrating his different statements.-Medical Record.

MEDICAL

CARBOLIC ACID POISONING, VALUE OF ALCOHOL IN.

The authors find that alcohol has a local antidotal effect in carbolic acid burns, due to its solvent action. There is no evidence of chemical antagonism between alcohol and phenol, and there is no effect produced by alcohol in carbolic acid poisoning after the latter has been absorbed into the system. Alcohol and phenol placed in the stomach give no different results from phenol alone, while lavage with alcohol is effected when the phenol is in the stomach, but its superiority over lavage with water is pronounced. From the clinical aspect it appears that alcohol has a local antagonism to carbolic acid. The procedure recommended is immediate, abundant lavage with 10 per cent. alcohol, to be followed by lavage with plain water, and stimulation with strychnine and digitaline, eggs and milk with magnesium phosphate. The point to be borne in mind is that alcohol is not effective after the carbolic acid has been absorbed, and to be of value must be used while the poison is still in the stomach.-T. W. Clark and E. D. Brown, Journal of the American Medical Association.

MANIFESTATIONS OF SYPHILIS ASSOCIATED WITH PUL-
MONARY TUBERCULOSIS.

John H. Pryor, during the last two years, has observed fifteen cases of syphilitic disease associated with pulmonary tuberculosis. He calls attention to a number of conclusions which he has drawn from his observations. Syphilis is a common disease, and physical debility combined with worry and mental distress which may accompany tuberculosis may arouse a latent syphilitic taint. The association of the two conditions may be disguised and the symptoms confused. In such cases the therapeutic test will often be

required for the diagnosis of syphilis. Persistent fever above 99° in incipient tuberculosis when the lesion is slight and when proper treatment does not secure improvement should be viewed with suspicion. Improvement in tuberculosis cases following antisyphilitic treatment is most marked and at times surprising. -Medical Record.

THE TREATMENT OF LATERAL CURVATURE.

R. W. Lovett (Journal A. M. A., June 23) considers the subject of lateral curvature, which probably exists to some extent in 25 per cent of school schildren. Two general types are recognized: the postural or functional and the structural. The first and most common of these is a malposition within the normal range of movement of the spine, and does not necessarily imply any organic change. Its prognosis is good; it is to be corrected by simple gymnastics and a "setting up" drill, thoroughly carried out for a sufficient length of time with conditions rendered favorable. The structural type, of which a characteristic feature is the backward prominence of the chest or loin on the convex side of the curvature, the reverse of that in the postural type, due to the twisting of the vertebræ in addition to the lateral curve, is much more serious and calls for more active measures. Its surgical treatment is considered under two heads: First, treatment to loosen up the spine and to make an improved position possible; second, treatment to secure permanence of the improved position once this is attained. These are discussed separately: The first under the heads of free standing gymnastics, gymnastics given in apparatus, passive stretching of the spine. Stretching by means of plaster-of-Paris jackets (forcible correction), details of all of which are given. Plaster-of-Paris jackets are advised to be employed for short periods (from one to three weeks), and then removed to be replaced by others as long as it seems possible to obtain further correction. The frequent changings are advisable so as to prevent as much as possible the atrophy of the muscles incident to fixation of the trunk. To retain the

improved position, the intelligent use of gymnastics is of great importance, and details of exercises of the groups of muscles are given to a certain extent. Some form of retentive apparatus should also be employed until the muscles are strong enough to permit its being left off. Lovett insists on the importance of thorough measures in these cases.-Memphis Medical Monthly.

THE TREATMENT OF ERYSIPELAS BY WOLFLER'S METHOD.

Bier's recent reports of his method of treating inflammation by means of passive hyperemia, artificially produced, led Payr to review the earlier methods of Wolfler and others which were once much used and with good success. In 1888, Wolfler recommended the use of plaster strips in the treatment of erysipelas. The strips were applied firmly about the affected area with the idea. of preventing the further spread of the disease. The skin thus inclosed often swelled and became markedly edematous, but the rapid disappearance of the redness and the fever and the limitation of the spread were striking. In 1892, Schneider advocated painting a strip of collodion about the diseased area. Kroel used caoutchouc in the same way. Payr now attributes the results not to a mechanical walling off of the process, but to a passive hyperemia. These methods therefore differed from Bier's only in detail. Payr advocates the use of the passive hyperemia method in erysipelas very strongly whether the disease is on the extremities or on the head.-Boston Medical and Surgical Journal.

SALICYLATE OF IRON.

Gray (Edinburgh Medical Journal) says that this salt has been found by the writer to act as a powerful febrifuge without producing diaphoresis. In fifty cases of erysipelas the first or second local application was followed by a fall in temperature and cure in about thirty-six hours. The mixture employed consisted of one drachm of soda salicylate dissolved in two ounces of water. To this was added two drachms of tincture of potash,

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