man's spirals. The spirals were composed of cells of the ureter and bladder and also contained masses and crystals of sulphate of calcium. Besides these bodies, the urine contained epithelium from the ureter and bladder, crystals of triple phosphates and crystals of sulphate of calcium, and numerous amorphous masses of carbonate of calcium. The writer believes this to be a case of renal colic due to stone, the lithiasis having caused a membranous ureteritis, from which the spirals were formed. Case II. Ab. scess of the kidney, masses of fibrin in the urine. A man of 39 was first observed with fever and with pain in the region of the left kidney. Ex. amination of the urine showed albumin, tubecasts, epithelium from the pelvis of the kidney, and hæmatoidin crystals. Besides this were masses of casts 10 centimetres long, 3 to 4 milli metres thick, some white, others of red color, and composed of fibrin coagulated, covered with epithelium of the renal tubules. There were found large masses in the urine six days and then disappeared. The tumor disappeared and the patient remained well six months. After the first examination the urine was normal, and there was no tumor to be found in the region of the left kidney. A HOPEFUL CANDIDATE.-A late applicant before the Texas Examining Board was asked: "What is histology?" Histology is the history of medicine." "What system of medicine do you practice?" "The Vanderbilt and St. Louis systems, and sometimes the homonpath system." and on that ground I deem it worthy of mention to day."-Indian Med. Record. PRURITUS VULVE FROM JEALOUSY.-" Once," says Dr. William Goodell," I was asked by a medical friend to see an exceedingly bad and acute case of pruritus vulvæ-the very worst that ever came under my observation. The lady was tossing about in her bed in a state bordering on frenzy from the intense itching, which could be allayed only by cold-starch poultices applied every few minutes. Very naturally attributing it to uterine disease, my friend had discovered a small but angry-looking tear in the cervix, exuding a viscous discharge, and I was called into I, too, was at first led astray; but the suddenthe case to decide the question of an operation. ness of the seizure, its vehemence, and the lack of consistency in the behavior of the symptoms put me on my guard, and we soon found out the stubborn case to manage, but she ultimately cause to be an attack of jealousy. This was a recovered under isolation, massage, and heroic doses of asafoetida. Twice I treated a highly intellectual lady for attacks of pruritus vulvæ and the sensitiveness of the genitalia so acute as and of vaginismus. The itching was intolerable, to forbid every attempt at sexual intercourse. Each attack was brought on by mental overstrain from exacting literary work, and much domestic unhappiness ensued. Several cases I have personally known of ladies who had for months been treated for supposed uterine or ovarian disease, when their whole and only trouble was remorse at having had illicit inter "What is the homonpath system, as you call course, or at having resorted to criminal aborit?" "Sweatin' the patient." THE EARLY DIAGNOSIS OF PHTHISIS.-In a paper read at the International Congress, M. Bernheim, of Paris, calls attention to the following points which may be advantageously made use of in addition to the usual clinical symptoms of beginning pulmonary tuberculosis: "(1) the examination of the secretions (urine, excess of phosphates and diminution of urea; blood, changes in configuration of the corpuscles; expectoration, presence [rare] of bacilli, urine ditto); (2) the inoculation of the patient's blood into an animal; (3) the examination of the lymphatic system (in many cases of commencing phthisis the glands are enlarged); (4) the constant hypertrophy of the spleen; (5) the improvement induced by the inoculation of these debutants in phthisis with immunized serum, the condition of other patients not being amelorated by serotherapy. Of course, the association of several of the above signs is necessary before the diagnosis can be affirmed; but the early and constant enlargement of the spleen is a sign to which attention has not been called sufficiently, tion."-Medical Record. THE APPEARANCE OF CARBAMIC ACID IN THE URINE AFTER The Continued ADMINISTRATION Of Lime-Water.- Dr. John J. Abel says: "The urine of dogs fed on meat becomes strongly alkaline when slacked lime is mixed with the food, and gives off ammonia and carbon dioxide spontaneously. It contains absolutely less ammonia in the twenty-four hours than normal urine. It always contains a calcium salt in solution which is not bicarbonate of calcium, and which decomposes with precipitation of calcium carbonate if the urine be allowed to stand. The lime urine exhibits all the characteristics of a weak aqueous solution of calcium carbamate, and a white powder may be isolated from it which behaves in every way like synthetically prepared calcium carbamate, except that it gives less accurate results on being subjected to quantitative analysis. Human urine behaves exactly like that of the dog when large quantities of lime have been taken, and it likewise contains calcium carbamate. "Why carbamic acid should appear in such noticeable quantities after the administration of lime we can only surmise. It seems plausible to argue that the body avails itself of its readily soluble calcium salt to get rid of the excess of calcium that has been absorbed. That calcium is absorbed in not inconsiderable quantities has been repeatedly demonstrated, and that there are in the urine but few acids that can form soluble calcium compounds is apparent, but in the present state of our knowledge we can furnish no adequate explanation for the appearance of this acid under the circumstances described in this paper. "The fact that carbamic acid is an important intermediate product of the metabolism of the body gives to its appearance in the urine a more than merely clinical or pharmacological impor. tance. Recent researches have made it more than probable that it is the chief immediate precursor of urea, and that it therefore plays a great part in the complicated chemical processes to which the proteids of our food are subjected before their nitrogen is eliminated in the urine." -American Lancet. HEMIPLEGIA AFTER DIPHTHERIA.-Edgren, after alluding to the rarity of the records of such cases, refers to Auerbach's case. This was one Oxford, and Cambridge were not-the Univer. sity of Fez had French, Spanish, and English, as well as Tunisian and Egyptian students on its benches. At the present day it is the Western centre of Mussulman theology. THE Sixty-sixth Congress of German Scientists and Medical Men will take place this year at Vienna, toward the end of September. It is said that the Beaumont Hospital Medical College will unite with the St. Louis College of Physicians and Surgeons. BOOK REVIEWS. Materia Medica, Pharmacology, and Therapeu tics. Inorganic Substances. By CHARLES D. F. PHILLIPS, M.D., LL.D., F.R.S. (Edin.). Late Lecturer on Materia Medica and Therapeutics at the Westminster Hospital Medical School, etc. Second edition. London: J. & A. Churchill, 1894. The works of Dr. Phillips upon materia medica and therapeutics are favorably known on both sides of the Atlantic for their pracin which an apoplectic attack left a typical hemi- tical character and their comprehensiveness. plegia in a patient with acute nephritis following They embody the personal experience of the diphtheria. Apart from this the symptoms of author, together with constant reference to the ordinary diphtherial paralysis developed. The progress of investigation and literature. The hemiplegia was looked on as the result of a best testimony to their worth is the exhaustion hæmorrhage into the anterior two thirds of the of the editions. The present volume has been posterior arm of the capsule. The persistence out of print for several years, and the companion of the motor paralysis made it almost certain volume, on "Vegetable, Animal, and Organic that it was not the result of uræmia, and the Compounds," is nearly out of print, but is well mode of commencement excluded embolism. advanced toward a revised edition. Dr. PhilThe hæmorrhage may be explained by the lips pays much, though not disproportionate, alteration in the vessel-walls which results in all attention to pharmacology and physiological infectious diseases, or by the elevation of blood-action, as well as to therapeutics. We like the pressure consequent on the severe nephritis. clear arrangement by which the physiological Edgren records a similar case of his own. He and therapeutical action of the various drugs is is of opinion that the paralysis is of cerebral displayed. The author devotes a liberal space origin, and that the internal capsule of the oppo-to the therapeutical value of water, and gives a site hemisphere is the seat of the lesion. Most probably it is a hemorrhage which is so far related to the diphtheria that the vessels become degenerated and rupture through the infectious disease. As in the multiple neuritis of the ordinary post diphtherial paralysis, so also in the rare hemiplegic form changes occur in the blood vessel walls from the effects of the toxina circulating in the blood.-Indian Med. Record. THE OLDEST UNIVERSITY IN THE WORLD.According to the Revue Scientifique the oldest University in the world is that of Fez, the holy city of Morocco. This seat of learning was founded in the eleventh century by Fatma the Holy. In its early days-while as yet Paris, compendious account of the various European mineral springs, their chemical composition and uses. The discussion of the chief metals is thorough, and the author has succeeded in indicating their most valuable applications. As regards classification, the author has, in the main, followed an alphabetical order. He has, however, treated of the gases and non-metallic elements first, next of the halogens, then water, acids, and metals, the last named bodies being placed in the order of their Latin names. This work is one which the reader may consult with profit and satisfaction. Its usefulness is enhanced by a good general and clinical index. The style in which it is brought out is excellent. Manual of Practical Anatomy. By D. J. CUN- land's Students' Manuals. The distinguished Professor of Anatomy of Trinity College has given us a work which is extremely well adapted to the necessities of the medical student, being full enough, on the one hand, and, on the other, not overburdened with detail. The student is guided in the work in precisely the same manner as he must carry it out in the dissecting-room,-from without inward. The order of dissection is substantially that which has long been taught in the University of Edinburgh and the many schools whose anatomical professors were educated at the Scottish capital. This fact is of local interest to Philadelphians, moreover, as the founders of our oldest medical school received much of their training at Edinburgh. The author calls attention to the most recent and important step forward as regards gross anatomy, -the study, that is, of the true relation of parts as exhibited by frozen sections. The art of exposing different structures by the scalpel consists in the manipulation of connective tissue. When that is properly dealt with the parts, so to speak, expose themselves. This is not, however, the exact relationship of parts within the living human body. Therefore it is that the study of frozen sections supplements, extends, and renders exact the knowledge derived from dissection. As Professor Cunningham says, "sectional anatomy is the true anatomy, but it can only be appreciated and understood by the key which is supplied by dissection." The uniformity of anatomical nomenclature is a desideratum, and the author has, therefore, where the terms adopted by the committee appointed by the German Anatomical Society differ from those usually employed in Great Britain, introduced into the text, within parentheses, the names recommended by the committee. The plates illustrating the text are good, the typography is of the best, and the volumes constitute an excellent guide for the undergraduate and a good book for the practitioner who desires to look up references prior to an operation. A Manual of Instruction in the Principles of Prompt Aid to the Injured. Including a chapter on "Hygiene and the Drill Regulations for the Hospital Corps, U.S.A." Designed for Military and Civil Use. By ALVAH H. DoTY, M.D., Major and Surgeon, Ninth Regiment, N.G.S.N.Y., late attending surgeon to Bellevue Hospital Dispensary, New York. Second edition, revised and enlarged. New York: D. Appleton & Co., 1894. The author treats of an extremely important subject. How many lives have been sacrificed for the lack of such instruction as is contained in this book! The first seven chapters give, in popular language, the cardinal facts of anatomy and physiology, after which the author describes the art of bandaging, antiseptic applications, what are the first things necessary to do in cases of wounds and contusions, and how hemorrhage is to be arrested. Such accidents as broken limbs, sun-stroke, epileptic fits, poisons, etc., often occur under circumstances where much time must elapse before a physician can arrive upon the scene. An intelligent by-stander can do much, during this dreary time of waiting, to relieve the pain and danger of the injured person and prepare the way for the services of the physician. Every person ought to read carefully such a book. The illustrations are very good. The illustrated section on transportation of the wounded adds interest to the general plan of the work. The Care and Feeding of Children. A Catechism for the Use of Mothers and Children's Nurses. By L. EMMETT HOLT, M.D., Professor of Diseases of Children in the New York Polyclinic. New York: D. Appleton & Co. This little work is arranged in the form of questions and answers, the latter in brief sentences and small words, such that any one can understand. The questions are those which women are continually asking physicians. A Clinical Manual. A Guide to the Practical Examination of the Excretions, Secretions, and the Blood, for the Use of Physicians and Students. By ANDREW MACFARLANE, A.B., M.D., Instructor in Neurology and Diseases of the Chest in the Albany Medical College, New York and London: G. P. Putnam's Sons, 1894. etc. This book concisely states the results of the many great advances in physiological chemistry and clinical microscopy,-results which the physician must use in his every-day work. The procedures explained are adapted to the needs of the general practitioner, and are of such a nature that he can perform them in his office. The second part of the work relates to the new and more exact methods of examining the contents of the stomach. In the third part special attention is devoted to the pathogenetic microorganisms. COMMERCIAL NEWS. LIQUOR SEDANS. A correspondent of the Medical Age writes as follows: "This I find to be a utero-ovarian sedative and anodyne of exceptional value, as in my hands it has produced the most brilliant and flattering results, far exceeding my most sanguine expectations. "Mrs. W., aged 44 years, and approaching the menopause; very anæmic, thin, and of a nervous temperament; much anorexia at times; habitually constipated; complains often of headache and palpitation, with frequent but scanty micturition; menstruation very irregu: lar, returning every three to five weeks and lasting from two to four days; flow small in amount and nearly colorless; attended with violent pains in the lumbar region, groins, with general tenderness over the hypogastric region; no organic lesion of the heart, simply functional, as a result of other lesions. "Upon examination, I detected retroversion of the uterus of the second degree, and a profuse leucorrhoea. Had previously almost exhausted the materia medica in seeking a remedy for her relief. Had given Hayden's viburnum comp., aletris cordial, fluid extract viburnum prunifolium, cannabis Indicæ, etc. As a dernier ressort, I ordered Liquor Sedans, I drachm four times a day, to be continued during menstrual period; Fowler's solution with bromides; and an injection for the leu corrhoea; also placed a Thomas retroversion pessary; saw her four days later; met me with a smile, and remarked the new medicine' was going to 'cure' her. Her improvement has been steady and rapid; appetite good; menstrual epoch unattended with pain; discharge higher colored and more profuse, last ing from five to six days, and more regular than before for years. Leucorrhoeal discharge disappeared; does not suffer with palpitation or headaches. Such is my happy success with that grand therapeutic agent, Liquor Sedans." BLOOD-IRON. medica, under claims that it is a natural proteid compound of iron, perfectly soluble, pleasant to the taste, odorless, permanent, with a neutral reaction, non styptic, nonirritating, non-constipating, and furnishing a blood-like color in aqueous solution, which proves that it is in the condition of "oxygenation" characterizing oxyhemoglobin. They claim spectroscopic analysis of this article shows it to be oxyhemoglobin in an almost pure condition. In fact, it seems to be the purest form of hæmoglobin yet offered to the profession. The slight impurity present can hardly be called an impurity, as it is a form of hæmoglobin known as methæmoglobin. Practically speaking, therefore, Hæmoferrum (Stearns) is pure hæmoglobin. years chemists have been at work in an attempt to obtain some method whereby hemoglobin could be isolated and made into a permanent, marketable commodity. At last this desirable result seems to have been obtained, and Messrs. Stearns & Co. are now ready to supply a demand which, judging from past history, is an enormous one. They offer to supply samples and literature free to all inquirers, and request that their preparation be given a thorough trial by the medical profession. For many Dr. Angelo de Bellomi, of Città di Amandola, Italy, July 22, 1893, says: pleased to inform you of the successful results by the use of your Bromidia as hypnotic and sedative. I prescribed it for a lady suffering from severe vomiting due to pregnancy, and which threatened to cause abortion from denutrition. I had previously tried opium, chloroform, creasote, and oxalate of cerium, all without effect. I gave 10 drops in a little sweet wine three times a day before meals. The vomiting ceased the first day; four days later I was able to discontinue the use of Bromidia, and now, after a month, there has been no return of the vomiting, and the patient is perfectly well. "I have found Bromidia excellent in de-. lirium tremens accompanied by insomnia, also in the delirium of typhoid, and in bronchitis Hæmoferrum, or Blood-Iron is the name with neurasthenia following influenza. given by Messrs. F. Stearns & Co., Detroit, "In a case of chronic nephritis, where all Mich., to a new preparation of hæmoglobin kinds of hypnotics, antineuralgics, and analgerecently introduced by them to the materia | sirs had failed to give relief, Bromidia, in doses (Continued on advertising page 18.) THE MEDICAL BULLETIN A MONTHLY JOURNAL OF MEDICINE AND SURGERY VOL. XVI. THE PHILADELPHIA, SEPTEMBER, 1894. ADDRESSES. SUCCESS IN PRACTICE.* By W. BLAIR STEWART, A.M., M.D., BRYN MAWR. HE receipt of your diploma as a graduate in medicine is but the presentation of your passport from the unenlightened world of the laity to the comparatively unexplored field of active practice. Entering upon this new territory as you do, full of enthusiasm and youthful vigor, you meet with your first surprise when you stand upon the threshold, confronted with many roads leading toward infinity. On a closer inspection you will notice shining lights on each path, gradually fading in the distance, and followed at long intervals by many satellites of varying magnitudes. You next view the horizon through the eyes of returning pilgrims, and soon learn that you are about to launch upon an undertaking which seems to have no end nor any definite beginning. You find yourself in the position of a man who sails skyward in a balloon, not knowing what his destination will be nor what fate awaits him. If you have been a close student and have a true sense of cultivation, you are filled with awe at the sight before you. If you have wasted many of your opportunities, you tremble. If you have been indifferent, you are either filled with abject terror or rush madly along the alluring road of quackery, full of pleasures at first, but which finally leads to disgrace, dishonor, loss of principle, sacrifice of your good name and often your morals. We are only beginning to live when we die. * An address delivered before the Medico-Chirurgical College, No. 9. We enter the profession with a sense of knowledge and power, and leave it with a feeling of our utter weakness and inability to cope with disease. Coming to a realization of our soliloquizing, the questions naturally asked are: Which road shall I choose? and how shall I succeed in it? Like the typical Yankee, let me answer the first question by asking another in return. What has been your motive in entering the selfish, through idle curiosity, or the mere deprofession of medicine? Is it pecuniary or sire to have a profession? If so, you have mistaken your calling and had better turn back. Is it with a determination to help others? to give your life to the attention of the sick? to do your duty to the poor as well as the rich? to preserve the honor and dignity of your profession, and to conduct yourself in a charitable, moral, and conscientious manner? If you are of this class, God bless you and prosper you! The profession needs more men of this stamp and type, and will welcome you with open arms. When you have carefully selected a location for your life's work, attend strictly to business. Improve your idle moments, for you will have many hours, weeks, and months at your command in which to review your weak points and fortify yourself for many heretofore-unthought-of emergencies. though you are doing nothing, but never sacKeep up the appearance of a busy man even rifice your word or honor in so doing. This is a time when pluck, patience, and endurance are brought to a test; a time when life seems dark; when the fates seem to be against you; when you become dissatisfied and contemplate changes. |