vaded in its whole girth by a soft, yielding, easily bleeding tumor, whose summit was reached with difficulty 10 to 11 ctm. above the anus. Operation February 24, 1895. Left lateral position, thighs strongly flexed and pelvis raised. The incision ran from two fingers' breadth below the posterior superior iliac spine along the groove between the gluteus maximus and sacrum toward the median line as far as the summit of the coccyx, then surrounding the anus. The musculature of the buttock was detached, the insertions of the great and small sacro-sciatic ligaments cut, and the coccyx extirpated. A part of the left side of the sacrum was removed, the abundant bleeding controlled, and the rectum isolated, commencing with the anal aperture. The peritoneum was opened after isolation of the anterior rectal wall. The bowel was cut transversely 2 ctm. above the growth, and its end, slightly twisted on its axis, was sutured to the borders of the skin wound. The operation lasted an hour and three-quarters, much blood being lost. A large quantity of NaCl solution was therefore injected, and, except for two days' fever, the patient did well, and at the date of report was convalescent.-British Medical Journal.

The Microbiology of Acute Peritonitis.-CourtoisSuffit, in his recent monograph on "Diseases of the Peritoneum," classes first in order among the pathogenic microbes in peritoneal inflammations the bacillus coli communis (The Boston Medical and Surgical Journal). This micro-organism is a facultative anaerobic, a normal inhabitant of the intestines, but pathogenic under morbid conditions such as occur in all kinds of peritonitis of intestinal origin. Its presence has long been recognized in peritoneal exudations, while it is constantly found in septic peritonitis following intestinal wounds, perforating (gastric, typhoid, enteric, appendicular) ulcers, ischio-rectal abscess, cancer of the colon, hernia, thrombosis of the mesenteric vessels, etc. It has been affirmed that under certain circumstances, as when disordered circulation, strangulation, extreme fecal distention, undue pressure, or mechanical injury has impaired the integrity of the bowel and lowered tissue-resistance, this bacterium may become migratory, gain the peritoneum, and excite inflammation. Cornil found such bacteria actually in the substance of the wall of a partly necrosed intestine. The possibility of such migration may explain many cases of so-called idiopathic peritonitis attending stercoral impaction, severe bowel inflammations, etc.; the germs passed through the intestinal walls and provoked peritonitis. It is doubtful if peritonitis has ever followed cystitis, yet Achard and Renaut have proved the identity of the colon-bacillus with the bacterium pyogenes of the bladder. The pneumococcus has very rarely any causal relation to acute peritonitis, whether the infection occur as a sequel to pneumonia or independently of that disease. The streptococcus pyogenes has been found in the pus of a great many cases of peritonitis, where it existed to the exclusion of every other microorganism (post-operative and puerperal peritonitis). Cases of streptococcus-peritonitis following erysipelas of the face have been reported by Cheurlin and others, and in rare instances this disease has succeeded scarlet fever, a malady in which the streptococcus seems to have a predominant part. Penetration, by the microbes, of the abdominal wall is said in rare instances to have taken place in cases of erysipelas of the abdominal integument; and puerperal peritonitis from extension of a streptococcus-inflammation from the pelvic peritoneum and uterine cavity is of very common occurrence. Acute peritonitis has been in numerous instances ascribed to the staphylococcus (aureus and albus) found apart from other micro-organisms in the pus. In other cases, the staphylococcus was associated with the streptococcus, or with the rod-shaped or round micro-organisms of putrefaction. The saprogenous microbes seem to have been influential in cer

tain cases.

The colon-bacillus is probably a bacterium of saprogenous character, with possibilities of greatly exalted virulence. Suppurative salpingitis is a recognized cause of acute peritonitis. When the salpingitis has developed under the influence of the true pyogenic organisms (streptococci and staphylococci), a generalized peritonitis which is almost always fatal follows the rupture of the tube. The case is not so serious, according to Bumm, when the salpingitis succeeds gonorrhoeal infection, and in which the exudates contain only the diplococcus of Neisser. The latter microorganism, Bumm says, can exert its action only on mucous membranes, being inoffensive to the serosa and cellular tissue. Naturally, then, the rupture of such a pus tube, or the leakage of pus from the fimbriated end into the peritoneum, would not be followed by a general septic peritonitis, but the exudate would be resorbed like any aseptic fluid. With regard to the effect on the peritoneum of rupture of one of the hollow organs of the abdomen, the result, as Courtois-Suffit remarks, is variable, depending on the presence or absence of microbes in the extravasated fluid. bursting of the healthy bladder with effusion of normal urine into the peritoneal cavity is not followed by acute peritonitis. This has been proved by the experiments of Gosselin, Robin, Albarran, and others. The case is altogether different when the urinary passages are infected and the urine contains the streptococcus pyogenes, the septic bacterium of Clado, or other pyogenic organisms.

The

What is true for the urine is equally exact for the bile, as abundant experiments on animals have shown. This is made plain by Dupré in his now classic work on "The Biliary Infections." But the biliary passages and the bile may become infected from various causes, and rupture of the gall-bladder would then be followed by a fatal peritonitis. A case of this kind has been reported by Fränkel, who found in the peritoneal exudate streptococci and staphylococci.

Penetrating wounds of the stomach, allowing small. quantities of gastric juice and other contents to escape into the peritoneal cavity, are not necessarily fatal if the wound be not large and the leakage not great. The stomach is not a good culture-field for pathogenic microbes, the gastric juice being aseptic and antiseptic. The result of a penetrating wound of the stomach or a perforating ulcer will, of course, be far graver if the stomach or its secretions has become pathologically altered, and if there be considerable escape of its contents into the peritoneum.

When the intestine is the source of the peritoneal lesion, whether by traumatism or profound ulceration, the peritonitis is likely to be spreading and fatal, especially if there be a massive infection. The microbes which are chiefly concerned are those which are found in a normal state in the intestine: the coli communis, the bacillus albuminis, the bacillus mesentericus vulgatus, the septic vibrio of Pasteur. There is a law laid down by Malvoz, which, as far as it is accurate, may be of help from a medico-legal point of view. peritonitis be of intestinal origin, the bacterium coli will show it; if it be of uterine origin (as when consecutive to abortion), the presence of the streptococcus will prove this, even though there should be no visible inflammatory lesions of the genital organs.

If the

The Pathology of the Pancreas. It is only within comparatively recent years that any notable additions. have been made to our knowledge of the pathology of diseases of the pancreas. A decided impetus was given to the subject by the researches of Fitz, who practically established upon a firm clinical basis the symptomatology and diagnosis of acute pancreatitis and allied conditions. Of the etiology of these we practically know nothing, and this line of reseach affords a field for investigation that promises to yield important and ' interesting results (Medical News). Recent clinical

and experimental observations have shown that some lesions of the pancreas are attended with glycosuria, but an even more obscure association is that with the peculiar condition known as fat-necrosis. While this has been observed most commonly in connection with pancreatic disease, it has also been found in some cases in which such disease could not be demonstrated. An interesting contribution to this subject has recently been made by Hildebrand, who, in a series of experimental observations on cats, succeeded in inducing fatnecrosis by ligation of the pancreas or its vessels, and by transplantation of the organ in whole or in part. In two animals the pancreas alone was ligated; in six others ligatures were also applied to all of the veins. Sugar was found in the urine of one of these. In one instance a bit of pancreas, two by three centimetres, was excised from the continuity of the organ and fixed with a suture in the omentum of another animal; and, again, an entire pancreas was treated in the same way. In another experiment a whole pancreas was scarified and made to surround a portion of the small intestine. The animals withstood the operations well, but in all the characteristic white areas of fat-necrosis appeared in the peritoneum comparable to that observed in man. Growing Pains.-Growing pains, defined as pains in the limbs caused by and during rapid growth, and sometimes so severe as to give rise to growing fever, have been diagnosed by the author less and less frequently as the years rolled by, until the vanishing point was reached. Cases which have been classed together under this name are the following:

Myalgia from Fatigue. This is the commonest variety, usually about the knees and ankles after unusual exertion. They are probably due to autoinfection brought about by excessive production of effete materials in the blood and their inefficient elimination. Elevating the limbs and rubbing with the palm of the hand in a direction toward the heart, relieving venous stasis and facilitating a supply of healthy blood to the exhausted muscles, promptly relieves the pain.

Rheumatism.-This is second, if not first, in frequency. There is slight pain in the joints, little or no swelling, and very mild fever, and hence the true cause is not recognized; but rheumatic endocarditis frequently develops in these cases.

Diseases of Joints and Bones of the Lower Extremities.-Cases of hip-joint disease and suppurative epiphysitis of the upper end of the fibula, diagnosed by the laity and allowed to go on untreated, are related under this heading.

Fevers, accompanied by pains in the limbs, in one instance proving to be inception of typhoid fever, constitute this class.

Adenitis. Here, again, the mother still supposes that the lad of sixteen years suffered from "growing pains," but he was treated for gonorrhoea and a sympathetic bubo. The malady "growing pains," with its frequent concomitant growing fever, like its congener disorders of dentition, as a separate morbid entity exists principally as an article of faith. The complaint still maintains, however, a strong hold of the lay mind, and forms an extremely common lay diagnosis which is often the cause of much suffering, and even death, by leading to

and cholesterine. Leptothrix filaments and various other micro-organisms are also found in abundance. The functional troubles bear relation to the nervous irritability of the individual. Pain is a common symptom. This often radiates toward the ears, and is apt to be felt more especially when swallowing saliva, and less when swallowing food. Troublesome coughing fits may be present, especially in the morning. The breath has a slightly fetid odor, and the cheesy masses at times attract the attention of the patient. On examining the throat, the tonsils are usually found enlarged; often there are adhesions between the tonsil and the anterior pillar concealing the tonsil from view. In some cases it may be necessary to retract the pillar or to examine the posterior or upper part of the tonsil with the rhinoscopic mirror. Sometimes a careful search will fail to discover any concretion in the lacunar orifices. In this case pressure with the tongue-depressor, or the introduction of a probe into a lacuna, may bring to view one of these chessy masses. When the tonsils are small, there are two points which should be particularly explored-namely, a large crypt, the orifice of which is covered by the anterior pillar, and the upper extremity of the tonsil between the pillars, the region of the epitonsillar fossa. The cheesy plugs will be found to be easily removed by means of a probe or spud passed into the crypt. Subacute exacerbations of the symptoms occur from time to time, lasting two or three days throat-pains, otalgia, and pain on eating and speaking. or longer, and causing general malaise, more marked

The author holds that the most rational and effective treatment is opening up the crypts by free division of the crypt-walls. This is best accomplished by a hookshaped blade fixed at right angles to the handle. The point of the knife is blunt, but sufficiently fine to allow of its insertion into the smallest cryptic orifice. The method of procedure is as follows: The operator sits. in front of the patient and throws a good light into the throat by means of the ordinary forehead reflector. The tonsil to be operated upon is anesthetized by the application of a ten or twenty per cent. solution of cocaine. This, however, is by no means necessary, as the operation is not really painful. The tongue being depressed with a spatula, the point of the instrument is inserted into one of the cryptic orifices and is brought out at a neighboring orifice, or, if necessary, it tissue is then cut through, and this can usually be is forced through the tissue. The intervening tonsil effected by simple rotation of the handle of the instrument. In this way several crypts can be opened up at a sitting and any cheesy masses that may be present are evacuated. The bleeding is never considerable. Sometimes, especially if the tonsil operated on is large, there will be left some loose tags of tissue, which should be trimmed off with a pair of curved scissors. Adhesions between the tonsils and faucial pillars can

be divided in the same manner as the crypt-walls. From two to three sittings, or even more, may be required for each tonsil, and a week may be allowed to elapse between each sitting. To diminish the tendency of the cut surfaces to unite, a strong solution of iodine (iodine, 90 grains; iodide of potassium, 90 grains; water, 1 ounce) should be applied at the termination of each sitting. In any case this is a good antiseptic ap

are most effective.-Archives of Pediatrics.

are

Chronic Lacunar Tonsillitis.-Dr. Ball holds that the essential cause of this disease is some narrowing of the lacunar tract or orifice impeding the free egress of the contents, together with an abnormally free desquamation of the epithelial cells. The cheesy masses mainly composed of these elements more or less altered. The epithelial cells are arranged in layers, those on the outer surface, and therefore most recently shed, being the least altered. A certain proportion of leucocytes present, but rarely in any number. Toward the cen

art of the plug especially are found fatty particles

ness may be felt after the operation, but this never continues more than a day. A boric-acid gargle may be used during the intervals between the sittings.The Practitioner.

An Early Instance of the Bath Treatment of Typhoid Fever.-Pope Leo XIII., when a young man residing in Benevento, suffered from typhoid fever, and was treated by Dr. Vulpe by means of cold baths. That was fifty

years ago.

There is a Duty of Fifty Per Cent. ad Valorem on diphtheritic antitoxin imported into Canada.

MEDICAL RECORD:

A Weekly Journal of Medicine and Surgery,

GEORGE F. SHRADY, A.M., M.D., EDITOR.

PUBLISHERS

WM. WOOD & CO., 43, 45, & 47 East Tenth Street.

New York, July 6, 1895.

larger and more widely circulated metropolitan weeklies. Each journal has its place, and each, to do its work faithfully, supplements and amplifies that of the other. We believe in local journals as well as cosmopolitan ones. They have a common interest, only the

lines of usefulness stretch in different directions.

Thus we can help each other on the broad principle of a generous rivalry in the common cause, and in the ultimately laudable aim of advancing the interests of the profession and promoting that active dissemination. of scientific truths which makes medicine the most progressive of all the sciences.

THE ENLARGEMENT OF THE MEDICAL RECORD.

We are again called to do a pleasant duty to our readers and contributors. The MEDICAL RECORD has grown so steadily in the capacity and worth of its material that it has been deemed advisable to increase still further the number of its pages and to enlarge correspondingly its capacity for usefulness to its subscribers, contributors, and advertisers. With the commencement of the present volume there will be an increase of four extra pages to each issue, making an aggregate addition for the year of over four hundred double columns, an equivalent in their turn to an ordinary-sized octavo of nearly eight hundred pages, with no increase of cost to its subscribers.

In view of this fact the conviction must continue to force itself upon every one that such a course is war ranted by a success unprecedented not only in American medical journalism, but, we believe, in the world. It must also be evident, judging from these tangible and uncontrovertible evidences of success, that the end has been gained by a wide-spread appreciation of our policy of independence, fairness, and enterprise.

It will be our aim, with the increased facilities at our command and the liberal and expansive purpose of compassing a still larger field, to make the MEDICAL RECORD more than ever a thoroughly cosmopolitan journal, in which not only the interests of the great medical centre are represented but those of the entire country are duly and impartially considered.

Numerous changes will be made in the course of the year to realize this policy, and no pains nor expense will be spared to make it still more representative of the practical needs of the profession of the entire country. We will thus strive to give a metropolitan journal a thoroughly cosmopolitan scope, being only systematized in its efforts by the convenience and necessity of an actively working focal centre. In following such a course there is no intention of interfering with or militating against the interests of local journalism in near or faroff districts; such periodicals have functions of their own, and their proper fulfilment is as necessary and as important as those that apply to the larger publications. The wide-awake practitioner must be informed of the doings of his local societies and of all matters within the direct touch of his individual work, and must necessarily leave the consideration of wider interests to the

THE PRESENT MEDICAL LAW OF NEW YORK.

ELSEWHERE We publish a full text of the medical law of the State. Some day, perhaps, the few familiar with the struggle involved in securing these legislative enactments, now compiled in one law, will relate the history of the conquest. In the near future we propose to call attention to some of the more important features of the law's requirements. Of course the general theory of the law is that the State should be the final adjudicator of the credentials presented by those who desire to practise medicine within its borders. The M.D. degree has thus ceased to be anything more than an honorary title conferred by a private corporation. Although it is true that no one without it can be admitted to the State licensing examination, the supreme test of ability to practise is now vested in the State, which in turn delegates its power to twenty-one examiners (seven from each of the incorporated State Medical Societies) who are sworn to do their duty as State officials.

Under paragraph 148 of the law licenses conferred by other State examining boards may be indorsed by our State regents, but the standards of these other State boards must not be "lower than those provided by this article." Because of these quoted lines no license from a sister State has yet been indorsed, as no other State meets the standard of our preliminary requirements. It would be manifestly unfair to our own State medical colleges, and would constitute an unjust discrimination against our own students, were we to enforce No. 5 of paragraph 145, and in turn permit licentiates of other boards, no matter how severe the medical tests, to register in our State without having submitted to the same or to similar preliminary academic tests. Our New York medical colleges may for a time lose students because of the prohibitive features of paragraph 145; but in the long run this advance of standard will redound to their financial status, as it now advertises their determination to build up medical colleges of which the citizens may be proud and their graduates boastful. The effect of the recent medical laws thus far has been to drive incompetent doctors from our doors, to prolong courses of medical study, to add new studies to the curriculum, and to elevate the tone of the profession as well as to improve its personnel. Thus it will be seen that much has been accomplished, but until the average longevity is increased, and the average mortality of the community is decreased, the

the winter and spring of 1893 and 1894 he was under treatment by Dr. Bramwell with some improvement. In March, 1895, he was placed upon thyroid extract. After three weeks his attending physician stated that the improvement was something phenomenal, and five weeks later he writes that the case continued to improve in every way.

THE PLETHORA OF MEDICAL SOCIETIES. BOTH Paris and London are suffering from a plethora of medical societies. This is the statement made by Dr. Morris in The Practitioner, and it is confirmed by the comments of Parisian and London contemporaries. The remedy suggested, of course, is that some of the societies amalgamate. We have no doubt that the advice is excellent. It has often been tendered to the medical men of New York, where societies are also extremely numerous, but the advice does not seem to be taken. Societies go on multiplying in New York and everywhere else; and we take it that it must be because there is some actual need for them. In this city the problem has been pretty well solved by the success of our Academy of Medicine. In this organization there are so many and such excellent opportunities for societies of specialists to organize under the fostering wing of the Academy that we do not recall any new organization since the sections of the Academy were fairly started. New societies continue to spring up, but they are general in character and have for their excuse social and local causes rather than scientific. They fulfil their purpose in enabling the medical men in certain parts of the town to get together and become acquainted with each other, and in this way they do very good work.

REFORM IN INTERNATIONAL CONGRESSES. Now that the majority of the annual meetings of our State and International Medical Associations are over, a criticism upon these meetings by Dr. Pistor, in the Quarterly Journal of Public Health, may seem very timely. Dr. Pistor thinks that there are too many formal dinners, too many evening parties, and too many invitations to visit industrial establishments, hospitals, factories, orphan asylums, and so on. He asserts that all these interesting functions should be entirely done away with, and that visitors who desire to live sumptuously should do it at their own expense. Many cities in Europe, he says, are unwilling to receive international congresses on account of the heavy expense connected with them. This is not the case, we may say, parenthetically, in the United States, but then we have not the thrifty habits of the older countries. Another trouble with these congresses is that there are too many papers announced to be read, and the discussions, he thinks, are on this account usually very unsatisfactory. The number of sections also should be limited. In fact, Dr. Pistor enumerates all the well-known and wellworn criticisms upon the conduct of the medical congresses of the present day. The defect in Dr. Pistor's position is that he expects too much of this imperfect world. Medical congresses are not meant solely for the production, or even the exploitation of great

scientific truths, but rather for the personal benefit that is produced by the contact of men from different parts of the world with each other. It is at dinners and at the various other reunions and festivities that visitors. to congresses really learn the most. Dr. Pistor, when he gets older and has had more experience with congresses, will probably acknowledge the truth of this

statement.

THE STATE AND LOCAL CHARITIES. THE State of Pennsylvania has always been peculiar in its relations to medical charities. Unlike most other States, it has often and generously appropriated the funds of the taxpayers from all over the State to the promotion of local medical interests. The Medical and Surgical Reporter furnishes a list of the appropriations as reported by the Appropriation Committee at the present session of the Pennsylvania State Legislature. These include sums of $150,000 to the Medico-Chirurgical Hospital, $200,000 to the University of Pennsylvania, $55,000 more to the hospital of that university, $112,000 to Jefferson Medical College, $8,000 to the Woman's Hospital, $3,000 to the Samaritan Hospital, $4,000 to the Children's Hospital, and $25,000 to the Gynecean Hospital. Of course, if the hospitals of Philadelphia get State appropriations the hospitals of the smaller cities must also have their share, and we find a list of forty different hospitals scattered throughout the State, to each of which an appropriation is given. If the general principle of State help to local institutions is considered by Pennsylvania economists to be a sound one, no objection can be raised against any such widely extended generosity as that which the Pennsylvania Legislature shows; but it seems to us that the State will find itself eventually in a very embarrassing situation if it continues the policy which it has adopted of helping along almost any private medical institution just because it has a medical charity annex.

News of the Week.

The Brain of Buchanan, the murderer, executed July 1st, is said to have weighed only thirty-one ounces. . He was a small man.

The Heaviest Woman in America died at Millersburg, O., on July 1st. Her weight was 675 pounds.

The Woman's Medical College of Cincinnati, O., has united itself with the Laura Memorial Medical College. There did not seem to be room enough in Cincinnati for two medical colleges for women.

Doctors and Athletics.-The medical profession has its full share of athletic honors. Dr. Grace has proved himself the champion cricket-player of England, and therefore of the world, and Dr. Pym, of Ireland, having beaten all the tennis experts of Great Britain, has come over to this country and done the same to the American tennis-players. We have in this city Dr. Hammond, who is the champion at foils and broadswords of the United States, and doubtless there is rich material for a bicycle champion among the numerous medical men who have taken up that pastime.