site the lodgment of concretion, walls greatly thinned. Lymph nodes were numerous, but no general inflammatory infiltration. Epithelial lining partially destroyed by erosion. The immediate recovery was uneventful. Highest temperature, 100.2; highest pulse-rate, 126. Both were normal after the first week. Wound healed by first intention and patient was able to go to the country on the 19th. Report, May 30, 1905; April and May periods were painless. She took no morphine. She had not, however, as yet regained her full strength. This patient had been subjected to a specific infection at the age of 18, which had inaugurated active inflammatory changes in organs already congested by their malposition. Drainage by dilation, disinfection, and replacement of uterus, as done in December, seemed a rational treatment. Had this been done earlier, the result would probably have been different. There were no adhesions about the tubes nor ovaries, yet the replacing of the uterus did not replace these congested and infiltrated organs. The corpus luteum of pregnancy remains large for a few months. on account of physiological congestion attending pregnancy. Pathological congestions may also apparently induce a similar enlargement and prevent the normal atrophy. I do not know that the method here described, of supporting an ovary by attaching its ligament to the round ligament anterior to the broad ligament, has previously been used. The cure of dysmenorrhoea often involves the correction of many pathological changes, both local and systemic. In this case no medication was used; the environment was the same attending each of her operations. Case IV. Pyelitis attending kinking of ureter. (a) Segregation of urines by Luys' method. (Dec. 7.) Miss B., aet. 22. Father died at 40 of alcoholism. One brother died of tuberculosis. Her menses began at 13; normal. One miscarriage, 5 months ago. On Sept 22nd had right kidney fixed in position and hemorrhoids removed. The symptoms preceding this operation were those of intermittent obstruction of the ureter and extreme nervousness. The hospital report upon the urine showed the presence of pus, epithelium, and granular debris. On Oct. 9, 1904, by means of Luys' segregator, it was shown that the pus was coming from the right kidney. The patient being brought into the clinic, the same instrument is now employed to determine the degree of improvement, as was also done on Nov. 7th. A word regarding the development of this method may be in order. Lambotte in Brussels is said to have been the first to attempt to effect the instrumental separation of urines from the two kidneys, reporting the same in 1890. In 1898 Harris, of Chicago, described an apparatus invented by himself, which has since been used with moderate success by many. Early in 1902 Luys brought out a new separating apparatus. I have found this instrument satisfactory, especially in the female. There is less danger of infecting the kidneys by its use than by catherism of the ureter, but each instrument has its respective advantages. The Cathelin instrument, of more recent invention, has not proved so satisfactory in my hands. No general anaesthetic is required. The patient remains in a semi-sitting position. A 10 per cent cocaine solution is applied to the meatus urinarius. The mixed urine, taken from this case, shows pus in small quantity, trace of albumin, and 2.75 per cent urea. Methylene blue is now given, five grains in a glass of water, to aid in determining the relative functional capacity of the kidneys. Segregation Oct. 10th gave urine, examination as follows: From right kidney, From left kidney. 2.7 per cent. None. Casts Present. Color, Greenish yellow. Absent. On Nov. 7th, findings were similar except that on Oct. 10th the urea excreted in a given time by the right kidney was 24 per cent of that excreted by the left, while on Nov. 10th it had increased to 48 per cent. In the specimens today there is still a difference in color. That from the left is a deep bluish green, while that from the right is a transparent green. Subsequent examination of the specimens gave, from portions execreted in corresponding periods, the following: Right kidney. 8 c. c. 2.35 per cent urea. Left kidney. These portions were taken in the early part of the observation and it is of interest to note that the mixed urine drawn from the bladder just previously gave a urea content of 2.75 per cent. The relative improvement over the condition prevailing Oct. 10th is apparent. In such cases, several observations should be made before definite conclusions are drawn. Her treatment has been occasional doses of urotropin and helmitol and large quantities of water. (b) Catheterism of ureter. (Dec. 8th.) The specimen of urine thus obtained showed a trace of albumin, probably due to the small quantity of pus present. The ureteral catheter is valuable not only for what comes through it, but for its use as an x-ray landmark when its stylet is left in place. I use is not, in any event, without danger to the healthy kidney. Report upon this case June 2nd, patient apparently in perfect health. Examination of urine, same date, normal in every particular. Case V. Adhesions about biliary tract, with attacks of biliary colic. (Dec. 7.) Mrs. D., aet. 35. Family history negative. Menses began at 10; flow excessive. was Married at 14; first child at 15. Had typhoid fever for 3 months at 26. This preceded by miscarriage and followed by inflammation of the bowels. (The probability is that instead of typhoid fever she suffered sepsis following miscarriage, which resulted in general peritonitis.) Apr. 30, 1904, the uterus and its appendages were removed because of double pyosalpinx and metritis. The most marked symptoms before the hysterectomy were aching in the top and back of head and tenderness in lower abdomen and epigastrium, profuse leucorrhoea, constipation, dyspepsia, and insomnia. Her temperature when first seen was 102. Her condition is so far improved that she returns with temperature, blood, and urine normal; but she has occasional severe attacks of cutting pain in the epigastrium and right hypochondrium, lasting one-half to one hour, during which attacks she sometimes faints. This is followed by dull aching pain for 2 or 3 days, referred as well to the right shoulder-blade. (This colicky pain is not due to over-distention, inflammation, neoplasm, nor flexion alone, but indicates the passage of a concretion into or through the duct.) Patient always vomited during these attacks. There was marked hyperaesthesia over the area of the gall-bladder. Chilly sensations were frequent with moderate elevations of temperature, and the attacks were followed by jaundice. No tumor can be determined. From the above symptoms it would appear that there are, or at least have been, calculi present. Moreover the patient says that such have been found in the feces. Stones may be present in the gallbladder without producing symptoms, but when forced into the ducts symptoms similar to the above are presented. Incision, 8.5 cm. in length, parallel to the costal margin, disclosed adhesions of stomach to anterior abdominal wall, and adhesion of gall-bladder throughout its entire length to duodenum. All adhesions were freed, the gall-bladder drained and suspended to abdominal wall. No gall-stones were found. I think concretions must have passed through the duct to have caused the colic. Her recovery was uneventful; the highest temperature was 99.8 and highest pulse rate, 100. On Dec. 24th she was sitting up. Wound healed by first intention, except where drainage-tube passed. Drainage wound completely closed Dec. 30th. Attempts should not be made to close drainage opening from an infected gall-bladder. Nature will close it as soon as result of infection, i. e., thickening of mucous membrane, is relieved. Until such time drainage is desirable. Report from her physician, dated May 20th, 1905, says she has gained about twenty pounds in weight and appears well. She complains of discomfort in the region of the gall-bladder only when she over-works. (To be Continued) J. 2. AMERICAN CLIMIATOLOGICAL SOCIETY, ANNUAL MEETING. Provisional Program-Detroit, June 29-30. President's Address......DR. W. F. R. PHILLIPS, Washington, D. C. Health Resorts in Southern California; Personal Experience.... ...GEN. C. H. ALDEN, U. S. A., Ret'd, Newtonville, Mass. Climate of the East Coast of Florida.... ..DR. FRANZ TRENTON-SMITH, Washington, D. C. 3. Relations of the Practitioner to the Physician at Health Re sorts... .DR. C. W. RICHARDSON, Washington, D. C. 4. Haemoptysis in Cardiac Diseases..DR. ROLAND G. CURTIS, Philadelphia Blood Pressure at High Altitudes. 5 ..DR. C. F. GARDINER and DR. H. W. HOAGLAND, Colorado Springs 6. The Influence of Climate upon Gout....Dr. C. C. RANSON, New York 7. Permanency of Results in the Treatment of Pulmonary Tuberculosis; the After History of Twenty-seven Cases Treated by the Combined Hygienic-Dietetic, Open-air, and Tuberculin Treatment... ..DR. F. M. POTTENGER, Los Angeles 8. The Sea-air Treatment of Tuberculosis of the Bones and Glands in Children. Illustrated by Lantern Slides... . .DR. JOHN WINTER BRANNAN, New York 9. Respiratory Movements of the Bronchial Tubes... IO. II. [2. DR. E. FLETCHER INGALS, Chicago Aortic Aneurysm.... 13. The Preventive and Remedial Treatment of Acute Rheumatic 14. Paper.. ..........DR. GUY HINSDALE, Hot Springs, Va. 17. Immobilization of One-half the Thorax with the Author's Completed Scheme for Preparing and Applying Traction Plasters to Arrest Pulmonary Hemmorrhages, to Relieve Pleurisies and to Contract Lung Excavation. . DR. CHARLES DENISON, Denver Meetings at Russell House. The profession cordially invited to attend. DETROIT MEDICAL JOURNAL A MONTHLY EPITOME OF PRACTICE AND THERAPEUTICS HERBERT M. RICH, M. D., Managing Editor COLLABORATORS-Frank Burr Tibbals, M. D., Augustus Wright Ives, M. D., Joseph Sill, M. D., Henry Jasper Hartz, M. D., Don M. Campbell, M. D., Preston M. Hickey, M. D., Burt Russel Shurly, M. D. J. F. HARTZ, Business Manager. SUBSCRIPTION PRICE, $1.00 PER YEAR. SINGLE COPIES, 15 CENTS. NOTE.-W. do not assume responsibility for the opinions of contributors. The management cannot undertake to return rejected manuscript unless full postage for the purpose is submitted with the contribution. Requests for reprints should accompany manuscript. Address all communications to 103 and 105 Miami Avenue. Detroit, Michigan, U. S. A. "Imprisonment at Hard Labor and Typhoid Fever." No. 3. The imprisonment of the English soldiers in the Black Hole of Calcutta has stood for a generation as a type of extreme cruelty to prisoners. It was doubtless unintentional, so far as its extremes reached; it was an accident of war. Far more reprehensible seems the deliberate neglect of responsibility in the piping times of peace. Such was the infection of diphtheria antitoxin with tetanus in the St. Louis City Laboratory, not long ago. In this connection the following editorial from the Jackson Patriot of May 21st, is noteworthy. It seems to have been litrally true that for years the state of Michigan sentenced criminals to "imprisonment at hard labor and typhoid fever." We are glad to print this, for two principal reasons: first, because of its medical interest to the State, and, second, because it is an unusually good lay editorial on a professional subject: AN INSTANCE OF PREVENTION. No scientific fact is more positively established than that such diseases as typhoid fever are bred of dirt and perpetuated by neglect and ignorance. If the surroundings be controlled, they are absolutely preventable. Within a few years an example has been furnished, right here in Jackson. For many years there was no time in which typhoid fever was not prevalent at the prison. Occasionally there were as many as forty or fifty cases in the hospital at one time. Of course, search was made for the source of the persisting epidemics-that is, in recent years, when mankind began to realize that such afflictions could not be laid at the door of a malevolent deity. One theory was that typhoid fever was inseparable from prisons because the prisoners were continually subject to infection from the unsanitary jails which were the previous residences of most of the gray brethren, and this was generally accepted. A particularly bad epidemic was one time traced to the ice supply, which was found to come from a clay-hole north of the prison, which served as a cesspool for a family which had been afflicted with the disease. For long years the evidence of the nose the proof furnished by the foul smell which always permeated the prison—was disregarded. It was calmly accepted as part of the prison life as necessary as part of the process as the "prison pallor" and the zebra stripes. The present administration could not understand why a prison should necessarily smell bad, and began looking after the drains. Soon is found a sewer, running from the "oid west wing," which was the place where the worst and most persistent of the epidemics prevailed. The old sewer had become clogged up, and someone had closed the opening, and it had been forgottn. But it furnished an admirable apparatus for the propagation of disease. After it was taken out there was less of the fever, but still a great deal. Finally it was decreed that the old cell block should be demolished. Then the secret source of hundreds upon hundreds of cases of typhoid-the cause of hundreds of deaths from that disease in the years of the prison's history-was revealed. The cells, built tier upon tier, had been originally floored with oak planks. In the course of years these had rotted away, as a result of the frequent scrubbings with which the vermin were combated. Then, instead of removing the old planks, new ones were laid over them. The wash water and the horde of prison inmates not enrolled on the official register found congenial homes in the crevices between These layers of planks, and the smells increased and multiplied. After more years another flooring was laid on top of the second. In some instances the men demolishing the block found four floors superimposed on each other, and the mass of filth stirred up was indescribable. "The men tearing up the old floors needed strong stomachs to stand it," said an official. Still, for years the state of Michigan had been crowding men into "holes in a wall"-stone cells, maybe a very little more than three feet wide, and with a floor and roof such as described. There was no ventilation; a filthy wooden bucket was the nearest approach to a "sanitary toilet appliance." They had died by scores, while the experts, if they thought at all, considered such matters inevitable concomitants of prison "life," or laid the fault at the doors of the county jail keepers. Assuredly, the people of the state of Michigan never intended to impose a sentence of imprisonment at hard labor and typhoid fever. Nevertheless it has required years to bring a realization that just this had been done. For with the removal of the sewer and the demolition of this old cell block went the disease. And now for months there has not been a single case of this sickness. The State Meeting. Many factors combine to make the announcement of the coming annual meeting of the State Medical Society an attractive one. The place itself, Petoskey, is well worth the trip in June. The yigor and success of the Society at present make a large attendance probable, and one will see and make many professional friends. The program itself contains many of the representative names of the profession in the State, and Dr. J. Wesley Bovee, of Washington, will address the section on Obstetrics and Gynecology. The question with every doctor who pretends to keep abreast of his profession should be, not, Can I afford to go? but, Can I afford to miss it? The Legislature. The news reaches us just as we are going to press that in the last few crowded days of the session of the Michigan Legislature they passed two bills which are of especial interest to the medical profession. The first one was the bill reducing the time in which a suit may be brought against a physician for malpractice to not more than two years later than the alleged malpractice. This bill was passed largely through the efforts of Dr. Frank B. Tibbals, of Detroit. The other measure was the establishment of a Sanatorium for cases of incipient tuberculosis. For this purpose, $30,000 was appropriated. An immense amount of pressure had been brought to bear upon the leg-. islature by the committee in charge of this bill, and many agencies throughout the State, and it passed both the Senate and House unanimously. Editorial comment upon these two bills will be made later. |