Patients suffering from the severest forms of chronic constipation who had tried all possible remedies and whose judg ment was unimpeachable preferred Exodin on account of its prompt, painless and efficient action to all other medicaments. I made an extensive series of experiments with Exodin, adding it to the oil enemata, but the administration by mouth. seemed to act better.

Exodin is marketed in the form of 74-grain tablets, which are tasteless and odorless. One tablet is enough for children. Adults take from one to three tablets; two, however, are usually sufficient to produce one or several mushy stools within 8 to 12 hours. The tablets should be allowed to disintegrate in a suitable quantity of water and the mixture drunk under constant stirring with a spoon. Any Exodin remaining in the glass should be rinsed down with additional water. This method insures the introduction of the remedy into the stomach in the finest possible state of subdivision.

Clinical Reports.

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

STATED MEETING HELD JANUARY 4TH, 1904.

The Vice-President, Dr. D. S. Dougherty, in the chair. Primary Endothelioma of the Lung and Pleura.-Doctor Maurice Packard presented this patient, of whom he gave the following history: Male, aged 24 years; cigarmaker by trade. Father died of endocarditis, sister of apoplexy, brother of diabetes. No history of tuberculosis in the family. The patient gave no history of syphilis or of alcoholism, and claims he was never ill until the present time. About five years ago he began to cough, with very litle expectoration, but otherwise was perfectly healthy until fifteen months ago, when the cough became more distressing and was accompanied by profuse expectoration. He became very short of breath, especially on exertion, and suffered from pains localized anteriorly on the

right side. These pains were increased on deep inspiration. There were no night sweats, nor, at that time, any hemoptysis or loss of weight. Although the examination of the sputum was negative, he was sent South with a diagnosis of tuberculosis. As there appeared to be no improvement, he remained but a short time. The symptoms continued about the same, but he noticed that the veins of his chest and abdomen were growing larger, and that when he coughed he brought up considerable blood, sometimes as much as a cupful. His sputum examination was still negative.

Dr. Packard saw him for the first time about two months ago, and his examination developed the following: The man was fairly well nourished, but had peculiar varicosities on the chest and abdomen. His right lung did not expand as well as the left, and there seemed to be a change in the dimension of the thoracic arch. Pectoral fremitus was diminished on the right side, from the second to the fifth intercostal space, and from the sternum to the axillary line. Over this area the percussion note was flat, but over the other portions of the same lung and over the left lung it was almost normal. Vocal fremitus was diminished, and distant bronchial almost tubular breathing could be heard over this affected region. Over the other portions of this lung the sounds were normal. The heart, spleen, liver and abdominal organs were normal. Sputum examination and thoracentesis were negative; the urine was normal. One month ago signs similar to the above were found posteriorly in the lower lobe of the right lung.

Erythromelalgia. Dr. J. C. Lynch presented this case of Wier Mitchell's disease or erythromelalgia, occurring in a man 51 years of age, who was also the victim of tabes. The patient was single, and an officer in the navy. He had had the ordinary diseases of childhood. During adolesence he had pneumonia twice and typhoid fever. While on a cruise to the Far East he had Chinese malaria (?). (From his description one would be warranted in presuming that it was lues). Since he was 20 years old and up to the present time he had been free from sickness, except for three attacks of tripper. After the Spanish-American war he noticed that he had difficulty in holding his water (hurried sphincteric action), which was shortly followed by difficulty in walking (ataxic gait), accompanied by sharp, shooting, stabbing pains in the feet and legs

(lightning pains). On consulting the ship's surgeon about his difficulty in walking he was told he was suffering from beginning gangrene of the left foot. He was put to bed and his condition improved. Six months later the other foot became involved. The first two toes were then amputated. After recovery from this operation he retired from the service.

Acute Thyroidism Following Curettage. This case was reported by Dr. Brooks H. Wells. He said that since the time. when the Roman matron measured with silken ribbon the throat of the bride before and the day after marraige, to determine by its rounded increase that she had been a pure virgin, the sympathetic relation of the thyroid gland to the pelvic organs has been vaguely known; but hardly more than a decade has passed since we began to appreciate the various facts that will in time lead to an accurate knowledge of the functions and physiology of this and the other ductless glands.

Under certain conditions there occurs in those individuals who have been the subjects of a thyroid tachycardia a virulent, acute toxemia, characterized by a well-marked group of symptoms. This toxemia may follow operations upon the thyroid itself, operations upon the pelvic organs, or, more rarely, operations upon the breast or other parts of the body, or any marked nervous strain.

The exact mechanism by which the function of the gland is disturbed or excited is not definitely known. The disturbances after operations on the thyroid itself have been attributed to an outpouring of toxic material into the blood, either as the result of the manipulation to which the gland is subjected or from a leakage and absorption from its cut surfaces. These causative factors can be ruled out when the thyroidism follows operations on other parts of the body. In cases similar to the one recorded below it seems certain that the condition is the result of a reflex disturbance of the central nervous centers and the sympathetic centers that control the activity of the thyroid gland or, as has recently been suggested, of the parathyroids.

The condition is often rapidly fatal, death occurring within the first three or four days from cardiac exhaustion. When recovery ensues the symptoms rapidly or gradually disappear until the individual reaches the status present before the attack.

The following case of acute thyroid poisoning following curettage seemed to possess features of interest which made it worthy of record.

Mrs. X., aged 53 years, had passed the menopause at the usual time, but during the last six months had had repeated small bleedings from the uterus, which was not enlarged, and was freely moveable. She was nervous, thin and poorly nourished. For many years she had had a slight enlargement of the right lobe of the thyroid, an excitable, rapid pulse and slight tremor, but no protrusion of the eyeballs. Auscultation of the chest revealed a few bronchial rales. No other pathological condition was discovered. To exclude the possi bility of beginning cancer of the fundus uteri as a cause for the post-climacteric bleeding, a curettage of the uterus was performed under strict asepsis on November 5, at 10 a. n. The scrapings from the endometrium were examined by Dr. Jeffries, Pathologist at the Polyclinic, who reported that they showed only a moderate grade of endometritis. There were no further symptoms, local or general, that could be referred directly to the curettage.

The anesthetic was given by Dr. Bennett, and was gas fol lowed by ether. After a few breaths of ether her heart became so rapid that Dr. Bennett considered it wise to change to chloroform, under which the heart beats became slower. From the beginning of the anesthesia to the return to consciousness a little less than half an hour elapsed.

Six hours later the patient was flushed, tremulous, nervous, voluble, but not worried and with mind clear. Her pulse had risen to 130 and became more rapid on any little excitement. Temperature 100.5 degrees F. Twenty-four hours after the operation the flush, tremor, nervousness and volubility were increased; the pulse had risen to 178 and at times was uncountable; her temperature was 99.5 degrees F., there was profuse sweating, a watery diarrhoea, marked irritability of the bladder with polyuria, many soft rales all over the chest, and vomiting. The thyroid was perceptibly enlarged, especially on the right side, and presented a quite apparent thrill. There was marked throbbing of the heart and large arteries. Examination of the urine showed a sour odor, reaction neutral, sp. gr. 1012, no albumin, no casts, innumerable colon bacilli, and a few pus cells. These symptoms of an extreme toxemia continued to the end of the first week, when her temperature

reached 101.6 degrees F., and the auscultatory symptoms of bronchitis became more marked, though there was little cough and little expectoration. Blood examination at this time showed no leucocytosis and no typhoid reaction.

From the fifteenth to the twenty-fourth day the patient's condition was such that death was expected to occur at any time. The toxic symptoms continued, the tongue became dry and brown, there was extreme weakness and the usual relation between temperature and pulse was reversed so that the most rapid and weak heart action was when the temperature was lowest. The diarrhoea ceased to be troublesome on the twentyfirst day, and on the twenty-fourth the patient was able to take small amounts of solid food by mouth. From this time on improvement was steady, but slow, until she reached a condition approximating that before the operation.

Treatment. At the beginning it was thought that some of the symptoms might be dependent upon an intestinal toxemia, and the patient was given calomel followed by a saline and repeated high colonic flushings. The bladder for several days was washed out with a boric acid solution at eight-hour intervals, the washing being followed by the injection and retention of two ounces of a 10 per cent. argyrol solution. The diarrhoea was finally controlled by tannigen by mouth, ten grains every three to six hours as needed, and starch and deodorized tincture of opium, ten minims, by rectum, every six to eight hours. The insomnia was relieved by the opium and by trional at night, in doses of from twenty grains at first to five grains at a later period. As it became impossible to make the patient retain food given by mouth, rectal alimentaemployed more or less from the eleventh to the twenty-second day. Solid food in small amounts was given on the twenty-fourth day. The heart action and general condition were not benefited by any drug; colonic flushing, strychnine, digitalis, belladonna, superarenalin, alcohol, all seemed to do more harm than good.

tion was

Dr. Robert C. Myles opened the discussion of this case. He said that one of the peculiar characteristics of exophthalmic goitre is the diminished electrical resistance. If some one would experiment with these cases in order to find out, if possible, what alkaloid was discharged into the system, and its exact relation to the thyroid, the speaker thought these cases could be treated more successfully.