OF PURPURA HEMORRHAGICA. (See page 139.) Dr. W. J. Craigen read a paper entitled ELECTRICITY IN GYNECOLOGY, in which he reported several cases treated by electricity, spoke of the use of high currents and their dangers, and referred to the possibility of resuscitation after a severe electrical shock, as was suggested in New York. Dr. Randolph Winslow reported Two CASES OF GASTROSTOMY FOR CICATRICIAL STENOSIS OF THE PHARYNX AND ESOPHAGUS, in which he showed that the operation had saved life so far, and gave some promise in one case of ultimate recovery. Dr. George J. Preston then read a paper entitled HYSTERICAL PYREXIA. (See page 133.) Dr. William H. Welch said that the question of fever of central nervous origin was an important one with reference to the general theory of the origin of fever. He had noticed that in the cases of so-called hysterical fever there had often been reported remarkable variations in the distribution of heat, differences of several degrees having been observed between the temperatures taken at different parts of the body, particularly of surface temperature. He would ask Dr. Preston whether he had noted similar fluctuations and irregularities. Dr. George J. Preston had noticed many of the points above alluded to. There may be the greatest differences between the temperature of the two sides of the body. The fever may be out of all proportion to the organic lesions and may be caused by hysteria. Dr. William Osler then made some remarks on CHILLS AS A CAUSE OF ERROR IN DIAGNOSIS. Chills differ very much in their etiology, but they may be divided into two main groups: 1, from some sudden shock to the nervous system; 2, from absorption of the toxic material formed by organisms. In the so-called nervous chill, fever is absent. In the second group, there is always fever. The first group need not detain us. The nervous chill is that met with in gall-stone colic or in the passage of a catheter. This in itial chill is without fever, but subsequently there may be chills with fever due to infection. The disease most often associated with chills is malarial fever and here the chill is of a characteristic kind so that the name, "chills and fever," is synonymous with malaria. The two great diagnostic points in malaria are the invariable association of the plasmodium of Laveran and the invariable curative effects of quinine. These are the two special features of the malarial chill. It may be said that within forty-eight hours the chill will cease in genuine malaria if quinine be used. On the other hand, the paroxysms continue and under its use malaria may be excluded, except in a few cases of the autumnal malarial fevers, which may resist quinine for a few days, but these have not the same character of ordinary intermittents. He had not met a single instance of genuine malarial fever which quinine had not stopped. He had Chills cause errors in diagnosis in various affections. In tuberculosis, the error may be made early or late in the disease, for it is at the two extremes of pulmonary tuberculosis that we have chills. These are a special feature of the early stages of tuberculosis. had many cases of early phthisis brought to him as malarial fever. Errors occur frequently in regions where paludism is common. Then there is the large group of septic processes with fever, such as abscess of the liver, which is a common cause of chills and fever in this latitude. There are very few cases of abscess of the liver which are not at first regarded as malarial fever and thus much valuable time is lost in the treatment. Malignant endocarditis is another disease which is ushered in by chills and which is often treated for malaria. A not frequent source of error is the chill following and associated with pleurisy of a tuberculous form and from empyema following the infectious diseases, as scarlet fever, etc., and following the formation of pus. The chills in typhoid fever are of the greatest importance and have attracted attention for years. They occur in 2 and 3 per cent. of all cases. Very often the chill is due to the doctor's giving powerful antipyretics. I have seen a case is which chills and fever had followed a large dose of antifebrin. In certain affections of the urinary passages, and more especially pyelitis, chills occur which are often obscure. In chronic obstruction of the common duct by gallstones there is the condition called by Charcot hepatic intermittent fever, due to catarrhal cholangitis. In new growths of various kinds, as in cancer of the stomach, in Hodgkin's disease and lastly in syphilis, errors in the fever may be made. The important points in the diagnosis are in the use of quinine and in the examination of the blood. Dr. John Neff reported a case of fever, in the course of typhoid fever, in which there was kidney complication with albumen and casts. The use of nitro-glycerine caused much improvement. Dr. Harry Friedenwald referred to a case of otorrhea which had high fever, and which turned out to be due to a thrombosis of the lateral sinuses. Dr. John Morris made some interesting references to the fevers of former days and the manner of treatment. He Dr. G. H. Carpenter spoke of having seen cases of tuberculosis with fever which he thought was malarial because it occurred in a malarial district. also said he had seen a certain number of cases of fever in the course of typhoid fever which he called typho-malarial fever. Dr. I. E. Atkinson referred to some obscure cases with fever, and said milk fever was a thing of the past as we now know it and was not due to the condition of the milk or the breasts. Septic fever occurred in the course of typhoid fever. Dr. J. J. Wilson referred to a case of typhoid fever in his practice in which there were several chills and finally an abscess of the parotid gland developed. Dr. William Osler was glad to hear Dr. Carpenter's remarks about typhomalarial fever. Many physicians treat ordinary cases of typhoid fever as malaria from beginning to end. There is no such disease as typho-malarial fever. The two diseases may exist concurrently. Quinine will cure malarial fever but it will not influence typhoid fever at all. Cases of so-called typho-malarial fever are typhoid and should be treated as such. Too many lives have been lost by neglect of this caution. In nearly four hundred cases of typhoid fever which have been treated at the Johns Hopkins Hospital, in no case had malaria co-existed. Dr. I. E. Atkinson then read a paper entitled BLOOD-LETTING FOR THE RELIEF OF OVER - DISTENSION OF THE RIGHT CAVITIES OF THE HEART. SECOND DAY. Dr. Thomas A. Ashby read a paper entitled TREATMENT OF RETRO-DISPLACEMENTS OF THE UTERUS, in which he reported several cases with the results of his treatment. He considered the subject under four heads: The congenital; the acquired forms without adhesions; the acquired varieties associated with inflammatory conditions of the tubes and ovaries; and those cases in which the tubes and ovaries are not involved to any extent but where the uterus is firmly attached to the pelvic peritoneum by firm bands of adhesions. Dr. W. J. Craigen asked if he had ever had trouble with a hemorrhage after breaking up adhesions. It is not good to leave the uterus with a partially diseased stump after removal of the tubes and ovaries. Dr. E. M. Schaeffer was glad to hear him speak of the use of massage and endorsed his reference to the corset as a potent disease-factor by preventing the proper exercise and development of the abdominal region. Dr. Ashby had never had any trouble with hemorrhage after the operation if the blood-vessels are looked for and tied. He does not believe in removing the uterus unless it is diseased; then tie off the stump and disinfect it and do not remove more tissue than is absolutely necessary. This is a principle of surgery which should be followed in gynecology. Massage should always be tried first. He had seen return of the uterus to its normal position by manipulation. He believes the corset is a cause of trouble, but can Dr. Schaeffer tell us how to avoid it? Dr. R. W. Johnson then read a paper entitled WANDERING KIDNEY WITH REPORT OF A CASE OF NEPHRORRHAPHY. (See page 169.) Dr. Ohr referred to cases in his practice, and spoke of the difficulty of making a diagnosis of floating kidney in stout persons. Dr. R. W. Johnson would not advise removal of the kidney unless there was some good reason for it. He is in favor of conservative surgery and referred to removals of the vermiform appendix. He did not advise operation for hernia as long as the truss will retain the hernia and as long as the case is in a civilized region where trusses can be found and operations done in an emergency. Dr. E. M. Schaeffer then made some OBSERVATIONS ON THE USE OF FOOD AS MEDICINE. (See page 151.) Dr. E. N. Brush said that persons should be taught not only what good food is, but how to purchase it and how to cook it. Dr. S. J. Fort said that he treated epilepsy and imbecility by giving the proper food. Dr. W. B. Canfield said that while it was eminently proper to insist on nourishing food, many persons preferred to eat what they liked rather than what was good for them and in making a diet list, palatability should be considered. Many a person, sick or well, preferred a savory dish even if not so nourishing or digestible, and often its palatability made it more digestible in spite of chemistry and physiology to the contrary. The diet of rice as pointed out by Dr. Schaeffer may be very nourishing, but it was also constipating and not to be borne by many. He noticed that little reference was made to the use of sugar in food. He thought that the craving of children and some adults for candy was a natural one, and he did not think that good candy in moderate amount was injurious. Dr. G. H. Carpenter said he knew more about cattle raising than he did about bringing up a healthy race and the former was much easier. He agreed with Dr. Canfield in what he said about palatability. It is important to gratify the appetite when no actual harm is done. Dr. T. A. Ashby said that disease in woman was divided into two classes : that in the married and that in the unmarried. In the sterile woman the disease is generally from some defect formed in childhood. Then hygienic measures are important. About ninety per cent. of the diseases in child-bearing women are due to child-birth. Sexual selection is ideal and so are the charts which were here shown. Dr. Schaeffer said in conclusion that rice constipated because it was so thoroughly digested that there was little residue. There is no waste as in other foods. Rice properly cooked formed a very palatable dish. The Chinese recognized the value of rice when they ate rice and butter. Dr. E. N. Brush then read a paper on the TREATMENT OF INSOMNIA, in which he deplored the multiplication of hypnotics which had been encouraged by physicians so much of late, and spoke of natural methods as inducing sleep. He referred to baths, proper clothing and attention to general hygiene. Dr. Schaeffer agreed with Dr. Brush and thinks that attention to food and drink will often take the place of drugs, as he had already shown in his paper. Dr. S. J. Fort then read a paper entitled PSEUDARTHRITIS, in which he related cases of hysterical joint trouble simulating rheumatism. Dr. William B. Canfield then read a paper on the THE TREATMENT OF PULMONARY CONSUMPTION IN LARGE CITIES, in which he referred to the great advances in the pathology of that disease and the failure to find a specific remedy. He said that cod-liver oil and tonics were still relied on in most cities. Outdoor life, equable climate, good food, comfortable clothing, slight occupation. in some cases do more than drugs. With our present light the proper treatment of consumption in large cities, especially the incipient cases, was in small hospitals where each case could be studied. Dr. H. Friedenwald then read a paper entitled SPRING CATARRH OF THE CONJUNCTIVA. Dr. E. M. Schaeffer then read a paper on DIRTY AIR IN PUBLIC PLACES, in which he spoke of the necessity of good ventilation. The papers by Dr. George Thomas, ILLUMINATION OF THE ACCESSORY NASAL CAVITIES, and by Dr. J. T. Smith on ACUTE PERICARDITIS, were read by title. The profession of Cumberland and vicinity were very cordial to the visiting physicians. MEDICAL PROGRESS. OPACITY AND LUXATION OF THE LENS. -Dr. L. L. Thompson of Indianapolis, in writing on some phases of opacity and on luxation of the crystalline lens, in the Ophthalmic Review, offers the following résumé: 1. Segmental opacities of the lower inner portions of the lens usually remain stationary for many years; rarely do they cause blindness. 2. Annular opacity, or "arcus senilis lentis," is often met with in persons under thirty years of age. Women seem to be more subject to it than men ; it rarely passes beyond the periphery until after middle life, when it sometimes extends in the form of a minute speckled opacity of the whole anterior surface of the lens again becomes stationary, and seldom causes blindness. 3. Cataract is occasionally cured spontaneously by liquid degeneration within the capsule. It 4. Congenital ectopia lentis is by no means a harmless anomaly. Its subjects are usually highly myopic, and have greatly reduced acuity of vision. may cause loss of vision by glaucoma, and ultimately destroy the sight by luxation of the lens downward, thereby starting inflammatory action. 5. Spontaneous luxation downward of the cataractous lens of an elderly person often takes place. It gives temporary sight to the patient, but the end is usually suffering and loss of vision. 6. "Second sight" is a danger signal. It is not always caused by increase in the conjugate axis of the lens incident to incipient cataract. It is frequently present long before the faintest sign or symptom of cataract. It is often brought on by long continued congestion of the fundus (as seen by numerous minute floating particles in the vitreous humor) by a relaxed suspensory ligament, and by luxation of the lens forward. * * * STAPHYLOCOCCI AND ACUTE RHEUMATISM.-Sacaze (British Medical Journal) points out that in many cases of acute articular rheumatism it is possible to find, or obtain a history of, some lesion which may allow these organisms to pass into the circulation. This lesion may be some injury or an acute tonsillitis of marked severity. He brings forward several cases in support of his theory, and also quotes the researches of SaintGermain, who found joint effusion as the result of the intravenous injection of cultures of staphylococci of feeble virulence. In the fluid in these cases no organisms were found, as is frequently the case in acute rheumatism. On the other hand, Bouchard and Charrin are quoted as having found large numbers of staphylococci in the serous effusion from the joints of patients suffering from rheumatism. CAUSE OF DEATH IN SKIN BURNS.Kianicine (International Medical Magazine) has made some experiments to determine the presence of a ptomaine in the blood of animals affected with burns of large extent. In thirty-five experiments the ptomaines were found both in the blood and in the organs, while the blood of healthy animals, prepared in identically the same manner, did not contain this ptomaine. The method of StasOtto was employed in the same manner as is done by Brieger for preparing the peptotoxine. Extraction is accomplished at a temperature of 80° C. (176° F.), with alcohol, evaporation, and the digestion of the remainder with amyl alcohol. Next, evaporation to dryness, dissolving the product in water, and purification by means of the subacetate of lead, by the use of sulphurretted hydrogen; and finally a purification by means of ether. PRESSURE PALSY FROM STILTS.--Bergonie and Berdier (British Medical Journal) report a case of paralysis from pressure on the right anterior tibial nerve, just below the division of the external popliteal nerve into its anterior tibial and peroneal branches. The tibialis anticus and the extensors of the toes and the great toe were the muscles affected. The peronei had escaped. The patient The patient lived in the marshy districts near Bordeaux, where the use of stilts is common, and walked several miles daily upon them. The stilt was buckled round the upper part of the leg by a stout leathern strap, and beneath the strap he wore a pad of leather. It was this pad which had compressed the nerve. On the left side the pad fitted better, and the nerve had escaped injury. * * ANTITOXINE IN DIPHTHERIA.-Dr. Francis H. Williams, in quoting in the Boston Medical and Surgical Journal, from a French writer on antitoxine, says: Antitoxine has as yet been little used in this country; but from the Continent, where it has been employed in large numbers of cases, we have very favorable reports. My own experience includes thus far only a few cases. It is probable that the antitoxine will find its chief usefulness in the early rather than in the late stages of the disease. There are three makes of antitoxine, Behring's, Aronson's and Roux's. The latter has not reached this country yet so far as I am aware: Behring's solution is made in three strengths, No. 3 being two and a half times as strong as No. 1. His solutions will keep several months if put in a cool, dark place. For making the injections Behring recommends the use of a Koch's syringe, which will hold ten cubic contimeters. The injection should be made where the skin is loose, as on the chest or thigh, and not upon parts of the body where the patient would lie. Scrupulous care should be taken to have the syringe perfectly clean, and the skin should be carefully cleansed at the place where the injection is to be made. * PHARYNGOTHERAPY.-Heller (British Medical Journal) advocates this treatment in many of the infective diseases. It consists in washing out the nose and nasopharynx with water which has been previously boiled, or with sterilized saline solution. This is done with a caoutchouc bag, having a suitable nozzle. Two or three injections are given on each side. If the fluid is injected very gently and slowly, as it always should be, there is no danger of damage to the ears. The author believes that most of the infective diseases are inhalation diseases, the first localization being in the upper air passages from which the generalization occurs. The diseases in which the author, during many years, has found this treatment useful are diphtheria, whooping-cough, scarlet fever, measles, variola, even typhoid fever, and acute rheumatism, etc. He contends that it has a distinct expectorant effect. * * * A NEW CATHETER FOR USE IN SUPRAPUBIC CYSTOTOMY.-Englisch de. scribes (British Medical Journal) an instrument devised for overcoming two accidents that may occur during the performance of suprapubic cystotomy. In cases in which there is much vesical irritability the bladder as soon as it is opened may discharge most of its fluid contents, and sink behind the symphysis, whence it cannot be elevated by a sound or catheter without risk of lacerating its walls. In most cases in which cystotomy is indicated the urine is decomposed and infected, and, although the bladder itself may be washed out and its contents purified in some cases, it is impossible to disinfect any foul urine that might descend from the kidney in the course of the operation. Hence there is always a risk of the external wound being infected when the bladder is opened and its fluid contents discharged. The instrument described by the author is a curved catheter with a wide opening extending along the concavity of its curve, through |