consisting of a thick layer of green soap, spread on a single layer of muslin or lint; over this apply an ice-bag or ice-coil; relieve the bowels by soap and water enema; keep the stomach at rest while vomiting exists; restrict the diet to milk or clear broth; note temperature, pulse and respiration every four hours.

I never give morphin or opium, except in cases of abdominal shock from rupture of the appendix. In closing I wish to urge the use of ice in place of the so-common poultice, as it lessens danger of peritonitis, checks the growth of bacteria and relieves pain. The magnesium sulphate removes the effete material from the intestinal tract, eliminates the bacteria, and, I think, too, that it lessens the danger of general peritonitis. So far I have had no deaths and I am sure there would have been, had operation been employed, with the hospital equipment we have at our command.

ORIGINAL ABSTRACTS.

MEDICINE.

BY GEORGE DOCK, A. M., M. D., ANN ARBOR, MICHIGAN.

PROFESSOR OF MEDICINE IN THE UNIVERSITY OF MICHIGAN.

AND

DAVID MURRAY COWIE, M. D., ANN ARBOR, MICHIGAN.

FIRST ASSISTANT IN MEDICINE IN THE UNIVERSITY OF MICHIGAN.

THE ACTION OF HUMAN GASTRIC JUICE UPON THE
TUBERCLE BACILLUS: A CONTRIBUTION TO

THE STUDY OF PRIMARY GASTRO

INTESTINAL TUBERCULOSIS.

FERRANNINI (Journal of Tuberculosis, Ocober, 1903) in considering the subject of the paper refers to what might be styled the two schools of gastrointestinal tuberculosis, one of which adheres to the belief that it is possible for infection to take place through the stomach, and the other taking the opposite view. The results of the author's experiments lead him to coincide with the views of the former.

The author is of the opinion that the various experiments instituted by previous workers have not been conducted under the best conditions and for this reason the results obtained are uncertain and of no value in clinical work. He further points out that as early as 1884 Sormani noted that the gastric juice of some animals does not possess the power of destroying the virus of tuberculosis, and also that the tuberculosis virus is quite resistant to artificial gastric juice. On the other hand in certain other animals the gastric juice is capable of destroying the tuberculosis virus.

The author criticises the fact that, in view of Sormani's work, subsequent observations were not confined to experiments with human instead of artificial gastric juice.

In his work Ferrannini attempted to imitate the conditions obtained during digestion by placing tubes containing gastric juice of varying acidities in the incubator at body temperature after adding to them fatal doses of human tubercle bacilli. The tubes were allowed to remain in the incubator for from one to two hours, then neutralized and injected intraperitoneally into guinea pigs. The results in all cases were quite uniform. No pig escaped infection. Those inoculated with gastric juice containing two per mille of free hydrochloric acid died later than the others.

The author concludes that human gastric juice, even when it contains two parts per one thousand, cannot protect the gastrointestinal tract from tuberculosis infection.

D. M. C.

THE BACTERIOLOGIC EXAMINATION OF THE BLOOD IN

TYPHOID FEVER.

RUEDEGER, in Medicine for April, gives the results of his investigations of the blood of thirty cases of clinical typhoid fever, two of which proved to be paratyphoid and one doubtful. The method employed is that detailed by Cole. The value of this method of diagnosis may be best understood from the author's deductions, which are as follows:

In all probability typhoid bacilli circulate in the peripheral blood of all typhoid fever patients during the first few days of fever and at the beginning of relapses and recrudescences, disappearing from the blood shortly before the temperature begins to fall. As the typhoid bacilli are abundant in the peripheral blood during the first few days of the disease, it becomes possible, by the demonstration of their presence, to make an early and positive diagnosis, frequently before the reaction of agglutination can be obtained. By cultures from the blood it also. becomes possible to differentiate between typhoid and paratyphoid fever. The method of blood culture is comparatively easy and simple and can readily be applied in clinical work, private as well as hospital. It must be applied early in the disease.

SURGERY.

BY HENRY O. WALKER, M. D., Detroit, MICHIGAN.

D. M. C.

PROFESSOr of surgERY AND CLINICAL SURGERY IN THE Detroit college oF MEDICINE.

AND

CYRENUS GAVITT DARLING, M. D., ANN ARBOR, MICHIGAN.

LECTURER ON SURGERY AND DEMONSTRATOR OF SURGERY IN THE UNIVERSITY OF MICHIGAN.

GASTRIC ULCER.

A. H. CORDIER, M. D., of Kansas City, read a paper before the American Medical Association at the New Orleans meeting, entitled, "Gastric Ulcer" (Journal of the American Medical Association). He remarked that the surgeon has once more pushed himself into the

domain of medicine and has taken not alone the glory but the cases as well from the general practician. Pylorectomy and gastroenterostomy both performed in 1881, he considers the starting point of modern stomach surgery. He has carefully excluded tuberculosis and malignant disease from the cases selected and notes that the most common location for gastric ulcer is the pyloric end and the posterior wall of the lesser curvature. Hemorrhage causes death in five per cent of acute cases and twenty per cent of chronic cases. The symptoms are considered in a general way but more attention is given to operative measures. He has performed gastroenterostomy for three cases, using the Murphy button. All of the buttons were recovered, one at postmortem six years later. He says that the buttons did the patient no harm though one end of it was partially destroyed. Success in these operations leads him to believe that many cases resisting medical treatment should have a gastroenterostomy performed as the mortality in this operation is far less than for the removal of the ulcer. Doctor Carstens agreed with him in his remarks but would prefer to use a McGraw ligature rather than leave a Murphy button in the stomach for six years.

CALCULOUS ANURIA: ITS DIAGNOSIS AND TREATMENT.

ARTHUR TRACY CABOT, of Boston (Annals of Surgery). Calculous disease of the kidney may cause suppression, the calculi irritating the kidney substance and causing it to become disorganized. The condition terminates fatally with symptoms of uremia but suppression in this form is rarely complete until the end of life.

The ureter may be blocked by à stone. This is calculous anuria. Suppression is usually complete until the stone is removed or there is a fatal termination in from three to ten days. The stone may shift and a flow of urine may be followed by improvement in symptoms to be repeated again. Both kidneys may be affected at the same time. kidney may be absent or previously destroyed. The stone may back up into the kidney, or come down to the bladder, but such a termination is rare, an operation usually being necessary. The mortality under the expectant plan of treatment is very great, about eighty per cent. Various methods of diagnosis may be employed, rectal and vaginal touch, the r-ray, urethral cystoscopy, and catheterization of the ureters. A number of cases are then reported to point out the difficulties encountered in diagnosis and operation.

Operation consists in removing the stone. This has sometimes been done by vigorous massage along the line of the ureter. When located in the pelvis of the kidney or near that point in the ureter, it may be removed by nephrotomy. In the lower end of the ureter in the female it may be removed by an incision through the vagina. A stone has been removed from the ureter near the bladder end, through a dilated urethra. The lower end of the male ureter may be opened by a Kraske incision. When the symptoms are present but no stone can

be demonstrated, the operator is advised to cut down upon and open the kidney, explore the ureter or strip it from above downward. When in doubt as to the side involved, open the abdomen and carefully examine both kidneys. If a stone is found in the pelvis of the kidney, remove it by an extraperitoneal incision.

GYNECOLOGY.

BY REUBEN PETERSON, A. B., M. D., ANN ARBOR, MICHIGAN.

Professor of GYNECOLOGY AND OBSTETRICS in the University of MICHIGAN.

AND

CHARLES LANPHIER PATTON, M. D., ANN ARBOR, MICHIGAN.

FIRST ASSISTANT IN GYNECOLOGY AND OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.

PELVIC DISEASE IN YOUNG GIRLS.

F. F. LAWRENCE, of Columbus, Ohio (Journal of the American Medical Association, October 17, 1903), calls attention to the popular prejudice against examination of the genital structures in young girls. and the evils resulting from this neglect. He asserts that the symptomatology is very misleading but states that the most common and important symptoms of pelvic disease in this class of patients is menstrual pain. The causes of this pain he classifies as follows:

Displacement is not in itself sufficient to cause this pain, which is due to the resulting inflammation of uterus, tubes and ovaries with the consequent formation of adhesions.

An infantile uterus is unable to perform its proper function on account of the almost embryonic condition of the endometrium. Pregnancy or removal of tubes and ovaries is the only cure.

Metritis is a common cause of pain. This is due to irritation of the uterine ganglia and pressure on the pelvic vessels, which retards. the amyloid degeneration of the superficial mucosa and destruction of

the mucosa. This condition should be relieved by curetment and local

treatment.

Uterine fibroids produce pain by mechanical obstruction of the pelvic vessels and compression of the pelvic nerves. A cure may be effected by removal of tumor or by producing an artificial menopause.

Salpingitis usually follows an endometritis and is associated with venous engorgement of tubes and ovaries. This causes marked premenstrual pain which is relieved by the establishment of the flow. Curettage, if resorted to early, will prevent involvement of tubes and ovaries.

Ovarian hyperemia is a common cause of pain. The treatment should be such as to direct the patient's attention from her genital organs because the hyperemia is often due to ungratified sexual desire. Change of social and domestic surroundings is necessary for, if this condition is not relieved, a chronic ovaritis may result which will often necessitate removal of tubes and ovaries.

The pain of prolapse is due to the resulting inflammation and adhesions and should be corrected by operative measures, either by removal of the ovary or shortening the uteroovarian ligament.

Extrapelvic conditions are frequently the cause of menstrual pain. Anemia, chlorosis and neurasthenia often produce this. Treatment for these conditions should be faithfully pursued. Care should be taken to exclude all local organic disease.

Leucorrhea is always evidence of pelvic disease. Tuberculosis, gonorrhea, herpes genitalis or traumatism may be the exciting cause. In conclusion, Lawrence lays special emphasis on the following: A thorough examination should always be made in all cases of menstrual, premenstrual or intermenstrual pain.

Microscopic examination should be made of leucorrheal discharges. All cases of excessive flowing should be thoroughly examined. The cause should be determined in all cases of amenorrhea. Neurotic symptoms in young girls are often due to pelvic disease. A pelvic examination should be made if menstrual pain, irregularity, leucorrhea or neurotic disturbances follow the exanthemata. In all virgins the rectoabdomnial method of examination should be used if possible-the vaginal touch when absolutely necessary..

OPHTHALMOLOGY.

C. L. P.

BY WALTER ROBERT PARKER, B. S., M. D., DETROIT, MICHIGAN.

CLINICAL ASSISTANT IN OPHTHALMOLOGY IN THE DETROIT COLLEGE OF MEDICINE,

CHANGES IN REFRACTION.

S. D. RISLEY, Philadelphia (Ophthalmic Record, March, 1893). In the writer's early experience he had come to believe that the static. refraction of an eye was a "fixed or practicly immutable quantity" except in the presence of pathologic conditions; and that when the