CALIFORNIA STATE BOARD OF HEALTH.

SACRAMENTO, CAL., Feb. 5th, 1904.

EDITORS OF THE PACIFIC MEDICAL JOURNAL:

Dear Sirs: Last September the State Board of Health held a Sanitary Conference with the local Health Officers of the State at San Francisco. A permanent organization was effected and it was decided to hold the next meeting at Paso Robles at 10 A. M. April 18th, 1904, the day before the meeting of the State Medical Society.

This Conference is purely of a sanitary nature, having nothing to do with the practice of medicine or its different schools. It is called at the time of the State Medical Society on account of the number of doctors who will be there making it possible to get a greater attendance. Every physician, no matter of what school, and every health officer or other person interested in the sanitary condition of the State is urged to be present. Papers will be presented on different sanitary subjects and free discussion held. There will also be a report on needed sanitary legislation.

This Board would greatly appreciate any effort on the part of the medical journals of the State to call attention to the Conference and secure a large attendance.

Respectfully,

N. K. FOSTER, Secretary State Board of Health.

Hotel Stockton.

The Hotel Stockton, 232 Stockton St., opposite Union Square Park. Most convenient location in the city to all theaters and restaurants.

Rooms suitable for doctors or dentists. Rates: From $5.00 to $12.00 a week, and $30.00 to $50.00 a month. MRS. L. E. ADAMS.

Tongaline.

An elegant lithograph in eleven colors of a Medicine Man of the Sioux Indians has been sent to every physician in the United States by the proprietors of the Tongaline Preparations and Ponca Compound. Any physician who has not received this handsome and artistic reproduction of a famous Indian Chief can easily obtain such by writing for it to the Mellier Drug Company, St. Louis.

Proceedings of Societies.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

Meeting held December 7. 1903. The President, DR. JAMES HAWLEY BURTENSHAW, in the chair.

ERYTHROMELALGIA.

DR. J. C. LYNCH presented a patient suffering from red, painful extremities. About four years ago the patient had severe burning pains, first in the right and then in the left foot. The pain was intensified by standing or walking, and several months later he noticed that the painful areas were red and swollen and that the ball of the great toe was violet after exertion. Two years ago the middle toe of the left foot was amputated because of the great pain. The toes of both feet are red; over the metatarsophalangeal articulation the skin is of a violet hue; the superficial veins are prominent and the parts are painful to pressure, but do not pit. When the feet are elevated the congestions disappear, to return when the feet are dependent. Sensibility and thermal sensation are not disturbed. The patient's condition improves during the cold weather.

The speaker said that the pathology of this condition is not well understood. Wier Mitchell considers it a vasomotor disturbance. It is probably due to a peripheral neuritis of the branches of the plantar nerves associated with diseased blood vessels. Most of the cases so far recorded have occurred in men during middle life. Long hours of standing, associated with hard work, worry and exposure to various temperatures are important causative factors. Various infective diseases, such as gonorrhea, malaria, syphilis, may also be important factors. It also occurs as a symptom in certain organic diseases of the central nervous system.

Erythromelalgia may be confounded with Pick's erythromelia and the stage of local asphyxia of Raynaud's disease. In erythromelia there is a circumscribed reddening of the skin, followed by venous dilatation, confined to the extensor surface of the extremity. There is absence of pain and increased surface temperature and no change on altering the position of the extremities. In Raynaud's

disease, 80 per cent of those afflicted are women. It begins with local ischemia; pain may be absent or acuţe; it has no relation to position; it is unaffected by season. In many cases the symptoms are brought on by cold. It is anesthetic to touch, surface temperature is much lowered and there is symmetrical gangrene.

GENERAL PARALYSIS OF THE INSANE.

This patient, also presented by DR. LYNCH, illustrated the promptness with which the luetic poison attacks the central nervous system. The patient, 27 years of age, had a sore on the penis, which was cauterized, and he was given "pink tablets." This treatment made him much worse and he consulted another physician, who gave him black ointment to rub in every night. He continued this for about three weeks, when his eye became sore and painful and he consulted an oculist, under whose care his eye improved, but his throat became affected. The oculist sent him to another physician, under whose care he remained for about three months, when he lost his voice. He then consulted a specialist on the throat, and continued under his care until he became demented. The essential features of his disease are that it began with a series of epileptic seizures, on recovering from which he was affected by temporary aphasia and paralysis, which disappeared in a few days and was replaced by marked mental impairment. The mental condition gradually improved, until he was prostrated by another seizure. He cries continually, wants to go to school, and is unable to answer any questions intelligently.

DR. W. B PRITCHARD opened the discussion, saying that, in his opinion, the difference between Raynaud's disease and erythromelalgia is one of degree and sometimes symptomatic, but that the essentials of the conditions are identical.

DR. M. PACKARD said that these cases are much more common than is ordinarily supposed. He had seen seven of them in the Polyclinic Dispensary during the preceding summer. The pathology of erythromelalgia and Raynaud's disease is practically the same, being an obliterating endarteritis. They are all due to contraction, as Mitchell showed in 1870. Two cases of this nature in Dr. Sach's clinic developed into gangrene. In Raynaud's disease the

pain is stabbing, while in erythromelalgia it is constant. Several cases of erythromelalgia were sent from the Hospital for Ruptured and Crippled with a diagnosis of flatfoot, owing to the character of the pains, and while these patients may have had flat feet, treatment by the Whitman brace only irritated the condition, due to the pressure it exerted. Cold water and potassium iodide proved effective, but the most successful agent in dilating the arteries was nitroglycerin.

DR. PRITCHARD, in referring to the second patient presented by DR. LYNCH, said that he would like to call attention to a point of much interest to neurologists in the development of general paresis. Twenty years ago, if a diagnosis of general paresis was made, it was safe to assume that the patient could not live more than two years, but to-day it is reasonably certain that he would be alive ten years from the date of the diagnosis. For this transformation the speaker knew of no explanation. Another point of interest is that some years ago, before it was safe to make a diagnosis of general paresis, the patient must have shown some symptoms of grandiose delusions, but to-day nearly 50 per cent of the patients suffering from this disease are without any delusions of grandeur whatever, and the condition is gradually tending toward a type that will be relatively free from such delusions.

EPILEPSIA LOQUAX.

DR. PRITCHARD presented a patient suffering from this condition, aged 45 years. He said this was the only case of the kind he had ever seen. About nine years ago the patient began to suffer from attacks of vertigo and sudden pallor, the first of which was brought about by a shock. These attacks continued at irregular intervals for five years, when, at the onset of an attack, a spasm of the face was added to his other symptoms. He has continued to have these attacks with increasing severity and frequency up to the present time, when they assumed the type he proceeded to describe. The patient's face becomes very pale, twitching begins over the left eye (a few years ago the twitching had been over the right eye and it had been transferred to the other side of the face); then the muscles of the whole face began to twitch, the hands become fixed, and a most profuse diarrhea of speech follows, with per

fectly distinct articulation, continuing for a minute and a half. This is followed by characteristic semi-coma lasting for an hour or two, when the man's condition becomes normal. There is absolute loss of memory from the occurrence of some incident preceding the pallor until the awakening. The center of explosion in such cases, it is assumed, is in the region of the center of speech (Brocas convolution). Usually epileptics do not talk, yet this patient's only evidence of epilepsy is in his talking.

DR. D. S. DOUGHERTY said that while he had charge of the Epileptic Wards of the New York City Insane Asylum, Ward's Island, one patient would have seizures in a corner, remain rigid for a moment, and then talk incessantly for two or three minutes, have a slight twitching, fall, and the attendants would put him to bed and he would sink into natural slumber.

ANEURISM WITH VERY UNUSUAL COLLATERAL VENOUS

CIRCULATION.

DR. MORRIS MANGES presented a patient for DR. LYNCH. The man was 48 years old, with the following history: He complains of pain through the chest and backbone, which is intensified on pressure. He first noticed this symptom six months ago, and it was followed, three months later, by pain over the heart and dry, brassy cough. Ten years ago he had a typical chancre. Physical examination reveals a large mass occupying the upper right part of the chest, which on palpation is seen to have some expansile pulsation. On either side of the mid line of the abdomen there is a double set of enormously dilated and tortuous veins representing a caput Medusa. Nor is this the only evidence of pressure; some of the upper veins are enlarged, also the veins of the back, especially on the left side. There is also a marked enlargement of the veins of the upper extremity, less marked on the left side. Examination of the heart shows the apex beat to be in the sixth space. Over the tumor nothing would lead one to suppose it was an aneurism except the slight expansile pulsation. One hears nothing except the heart sounds sharply accentuated. Deep palpation behind the episternal notch is negative and Oliver's sign is absent. In a case of this kind one would naturally think of an aneurism, of a gumma or other neoplasm. A new growth can be eliminated on