its eyes; what the character of the trouble was I am unable to say.

While cases of anophthalmos are not common, many of them are scattered through medical literature.

The essay of the evening, "Oxyluria and Urethritis," written by Dr. I. N. Bloom, in his absence was read by Dr. Vernon Robins. [See p. 4.]

DISCUSSION.

Dr. James B. Bullitt: The general symptoms coincident with the presence of crystals of oxalate of lime in the urine are not new. That they are produced, however, by the oxalate of lime is very much doubted by many authorities. When it comes to urethral irritation, I take it that the relationship between the presence of oxalate of lime and the production of symptoms is one less difficult of explanation than the other symptoms referred to. It is readily conceivable, however, that these pointed, sharp crystals could act mechanically in passing through the urethra, over the delicate mucous membrane, produce mechanical irritation, and set up an irritation with a chronic discharge simulating gonorrhea. The origin of oxalate of lime in the system is still a matter of considerable doubt. It is taken into the system in various kinds of food, and, like uric acid, is to be looked upon as due to incomplete oxygenation of these various food substances which have been ingested. In speaking of diet, the essayist does not mention the exclusion of those articles which apparently contain more oxalic acid than other varieties, as for instance, green peas, lettuce, the envelopes of certain other vegetables, and all kind of fruits, the peelings of which are said to contain relatively large quantities of oxalic acid. It would be proper to call to the attention of patients, in regulating the diet, that these particular articles should be excluded. Irritation of the urethra due to the presence of oxalate of lime is frequently relieved by the administration of nitromuriatic acid and regulation of diet. I can readily see how a urethritis might be produced in this way which might correspond in every respect to gonorrhea,

except that the same degree of pain and congestion might not exist, and of course the gonococci would not be present.

Dr. J. G. Sherrill: It has always been my plan in treating cases oxyluria to exclude from the diet green foods, but my results in many instances have not been such as pictured. The question of the formation of oxalate of lime within the body is still shrouded in obscurity. Theoretically we are led to believe that oxalic acid and its products are the result of changes in the tissue, in the process of assimilation; that in these tissue changes incomplete action produces oxalate and uric acid, and complete oxidation of the tissue (the nitrogenous particles) produces urea. Whether or not this is true I am unable to state. In the treatment of these cases uric acid may disappear from the urine, while oxalate of lime remains, which later also disappears. Despondency is the most prominent symptom present in many instances. In one of my cases of oxyluria the patient complained of extreme weakness of the knees, which at times became quite painful. I take it that it was not the presence of oxalate of lime that caused this symptom, but it was the condition of the system which produces the oxalate of lime. Fre

quently you will find a much larger proportionate amount of oxalate of lime excreted than can be accounted for by that ingested.

In regard to urethritis resulting from oxalate of lime in the urine: I have never seen a case that I could trace to that cause. While the presence of these crystals in the urine may irritate the urethra and cause congestion, perhaps a mucous discharge, I believe it impossible for pus to occur unless we have in the urine or in the urethra some of the germs of suppuration. If a man has had an attack of gonorrhea at any time in his life, I believe that the germs (gonococci, etc.) may exist in his urethra for months and even years, and be excited to renewed invasion and activity by the passage of the crystals of oxalate of lime and other ingredients of a highly concentrated urine. I believe this is the explanation of the majority of such cases.

Dr. A. M. Cartledge: Dr. Sherrill has expressed my sentiments in the latter part of his speech. Certainly I think many old chronic cases of urethral disease, having their origin in infections of the usual type, might be relighted by irritation from the passage of urine containing a large amount of crystalline deposit observed in oxalate of lime.

Pepper several years ago made the point that dilute nitro-muriatic acid as a rule was unreliable, and advised the use of strong acid, having it properly diluted by the patient just before taking. Again, in regard to diet: I have always laid the most stress upon exclusion of the nitrogenous elements rather than other forms of foodstuffs. It is probable, however, that this has a more direct bearing upon uric acid than upon oxalic acid. The natural supposition is that tomato will markedly increase the amount of oxalic acid in the urine, and I have been in the habit of suggesting that this be eliminated from the diet list. I always exclude sweets also. Sir Henry Thompson made the statement that he had long since come to the conclusion that stone in the bladder was a stomach disease, and his suggestion may be pertinent here, as we are dealing practically with the conditions frequently leading to stone in the kidney. He was requested to write an article upon what he considered the most valuable preventive of stone in the bladder. After laboring in his practical, sensible way through many pages, his deduction was that so far as he could see, reasoning from his observation of the modes of life of patients who had stone in the bladder, their prestone history, that they were people whose digestion was wrong; that the only remedy he knew of any virtue as a preventive was the free use of saline cathartics. In this suggestion he was unconsciously hitting the foundation of uric acid and oxalate of lime. I have gone on his principle in treating these cases. They should be purged. My treatment has been the exclusion of nitrogenous foods, and the use of strong nitro-muriatic acid.

Dr. J. Brent Palmer (present by invitation): I agree perfectly in what Dr. Sherrill said in the latter part of his

talk. The immunity that the urethra is supposed to obtain after being frequently infected with gonorrhea is also of interest in this connection. Take the average so-called "sporting man, and he will tell you that he has had the clap a number of times which has gotten well without treatment. An examination may show that gonococci are still present in his urethra, though he has no discharge nor any of the symptoms of gonorrhea. The most rational explanation is that his urethra must have thrown out some form of exudation preventing the gonococci from getting a foothold in it, or that the gonococci have lost their vitality. The mechanical irritation caused by these crystals of oxalate of lime passing over the mucous membrane of the urethra may have something to do with renewed invasion of the gonococci; the exudate may be scraped off by the passage of these crystals, leaving an open, inflamed surface, so that the gonococci, even though they may have lost some of their vitality, quickly take root and multiply.

Dr. Vernon Robins: I am obliged to Dr. Bullitt for his statements concerning the different kinds of foodstuffs which should be excluded in oxyluria. Rhubarb should also be excluded.

In regard to a purulent discharge from the urethra caused by the relighting of an old gonorrheal process: Microscopical examinations in the cases reported, which ported, which were thoroughly and carefully made, did not reveal gonococci. This would seem to exclude a gonorrheal process. While some microorganisms were found, they were not of the diplococci order.

In regard to purgatives: It has been our habit in the most persistent cases to use Carlsbad salts in the morning in. order to assist in elimination.

The accidents which might occur from using strong nitro-muriatic acid. should be considered. For instance, in one case where the strong acid was prescribed, the patient had the prescription filled, put the bottle in his vest pocket, the cork came out, and the result can well be imagined. I think it advisable to use diluted acid, which should always be fresh.

THE LOUISVILLE JOURNAL

..OF..

the State. I am also specially indebted to that eminent surgeon, Dr. H. O.

VOL. 5

"Alis Volat Propriis."

JOSEPH M. MATHEWS, M.D. H. HORACE GRANT, M.D.

Articles and letters for publication, books and articles for review, communications to the editors, and advertisements and subscriptions, should be addressed to The Louisville Journal of Surgery and Medicine, Room 320 Equitable Building, Louisville, Ky.

Announcement.

It will be observed that with this

issue Mathews' Quarterly Journal of Rectal and Gastro-Intestinal Diseases is continued as a monthly under the title of The Louisville Journal of Surgery and Medicine. This journal has been made the official organ of the Louisville Surgical Society. It will be the earnest effort of its editors to make it a dignified and up-to-date journal in every respect. Special attention will be given to articles on general medicine and surgery, and all the specialities in either will be abundantly represented. In a word, it shall be a monthly visitor especially intended for the busy practitioner. The special features of Rectal and Gastro-Intestinal Diseases, which made the Quarterly so popular, will be preserved. Let us have your subscrip

tions.

Detroit Medical and Library Asso

ciation.

It was my pleasure, on the evening of April 25th, to deliver an address, in response to a kind invitation from the president, before the Detroit Medical and Library Association. Having selected as a subject "Extirpation of the Rectum," clinical material had been obtained and demonstrations were made in the amphitheater of St. Mary's Hospital. The occasion was a most enjoyable one to me, as it afforded an opportunity of meeting the profession of Detroit and many from the interior of

at the Cadellac Hotel and other courtesies. To all the members I desire to return many thanks of appreciation. J. M. MATHEWS.

Appendicitis.

If one had not the inward confidence it was bound to be there, he would hesitate to read the list of papers to be presented at an approaching medical meeting, local or national, lest he be shocked by surprise that at least 10 per cent of the list did not in some way relate to appendicitis. It has been an unfailing rule for several years, and bids fair to hold sway for several to come. Far be it from this note to intimate that such papers are not instructive and valuable or indeed that there is not much to learn about the behavior and management of our familiar enemy, the appendix. But there is another way of looking at it.

It is a constantly recurring experience with the profession that the successful performance of new operative steps in surgery is the signal for an animated and often acrimonious discussion between operators as to the best way to execute them. The present generations in medicine, both earlier and later, go over mentally the hurrah about ovariotomy, cæsarean section, pelvic surgery in its many forms, and not a few operations in other regions. Most of this is now settled in the simplest manner, viz: the recognition of the fact that definite surgical principles, in competent hands, succeed in any one of many ways.

The progressive and busy surgeon has disposed of the practical side of the appendicitis problem long ago. conditions he finds within the abdomen are met by his knowledge and applica

The

tion of surgical principles without regard to other rules, and the best obtainable results follow.

It is these conditions just referred to which constitute the key to the results. Operative skill is paralyzed in the presence of inoperable cases and handicapped by destructive lesions which can be only partially repaired.

These deplorable conditions will continue to confront the surgeon so long as the general practitioner is bewildered for the want of a common ground among the surgeons. In a multitude of disagreeing counselors there is any thing but safety.

The achievement of better results in appendicitis lies less in the line of improved surgery than in the education of those having the case first in hand. When the family physician, anxious for the welfare of his friend, the patient, and uninfluenced in nine cases out of ten by either prejudice or jealousy, clearly understands the essentials of pathology and is assured that certain easily ascertained symptoms and conditions demand a defined step which the best hope and prospect attend, then, and then only, will imperfect cures and the unnecessary mortality of this frequent and terrifying lesion be reduced to the minimum.

DR. DAVID W. YANDELL died at his home in this city on the 2d day of May. Though ill for some four years past, and not industriously active in the profession for some time previous to this illness, yet for over forty years Dr. Yandell was among the few at the top in medical centers of Louisville; and indeed since his return from service in the Civil War he was one of the best known men in the country. He was one of the incorporators of the Louisville Surgical Society, and for several successive years its president. When

his uncertain health rendered him unable to attend its meetings as prescribed by rule he was made honorary member for the only time in its history. Dr. Yandell was President of The American Medical Association in 1871. He was too well known to need special mention of his character and honors for Kentucky readers.

Book Reviews.

An American Text-Book of Genito-Urinary Diseases, Syphilis, and Diseases of the Skin. Edited by L. Bolton Bangs, M. D., Consulting Surgeon to St. Luke's Hospital and the City Hospital, Methodist Episcopal Hospital, Brooklyn; Visiting Genito-Urinary Surgeon to St. Mark's Hospital, New York; Late Professor of Genito-Urinary and Venereal Diseases, New York Post-Graduate School and Hospital. And W. A. Hardaway, A. M., M.D., Professor of Diseases of the Skin and Syphilis, Missouri Medical College, St. Louis; Physician for Diseases of the Skin to the Martha Parsons Hospital for Children, and to St. John's Hospital, St. Louis. 300 engravings and 20 full-page colored plates. The following list of contributors will prove the merit of this large and interesting work : Charles W. Allen, M. D., Q. E. Adkinson, M. D., L. Bolton Bangs, M. D., P. R. Bolton, M. D., Lewis C. Bosher, M. D., John T. Bowen, M D., J. Abbott Cantrell, M. D., William T. Corlett, M. D., L. R. C. P., B. Farquhar Curtis, M. D., Condict W. Cutler, M. D., Isadore Dyer, Ph. B., M. D., Christian Fenger, M. D., John A. Fordyce, A. M., M. D., Eugene Fuller, M. D., Robert Holmes Greene, M. D., Joseph Grindon, M. D., A. R. Robinson, M. B., L. R. C. P. and S., Francis J. Shepherd, M. D., C. M., S. C. Stanton, B. S., M. D., Emmanuel J. Stout, M. D., Alonzo E. Taylor, M. D., Robert W. Taylor, M. D., Paul Thorndyke, M. D., H. Tuholske, M. D., Arthur Van Harlingen, M. D., J. William White, M. D., James McFarlane Winfield, M. D., Alfred C. Wood, M. D., Greme M. Hammond, M. D., W. A. Hardaway, A. M., M. D., M. B. Hartzell, M. D., Louis Heitzmann, M. D., James S. Howe, M. D., George T. Jackson, M. D., Abraham Jacobi, M. D., James C. Johnston, A. B., M. D., Herman G. Klotz, M. D., J. H. Linsley, M. D., G. F. Lydston, M. D., Hartwell N. Lyon, M. D., Edward Martin, M. D., Douglas W. Montgomery, M. D., James Pederson, M. D., S. Politzer, A.

M., M. D., Thomas R. Pooley, M. D., Alfred E. Regensburger, M. D.

In

This list represents the very best talent in this line in America. looking over the volume one is impressed that for thoroughness, accuracy, and up-to-date narrative nothing has appeared equal to this work.

It appears as a single volume, hence is easily consulted. There may be, undoubtedly is, some points in which a point of discussion might be raised, yet taken all in all it is the greatest work of its kind that has been issued in this or any other country. The illustrations are perfect, and the general typographical work speaks highly for the publisher. Any library will be profited by having this splendid volume in it. W. B. Saunders, Philadelphia, publisher.

The Surgical Complications and Sequels of Typhoid Fever.

By William W. Keen, M. D., LL. D., Professor of the Principles of Surgery and of Clinical Surgery, Jefferson Medical College, Philadelphia; Vice-President of the College of Physicians of Philadelphia, Pa., etc.

This is one of the most valuable books that has been given to the medical profession for many years, coming as it does from that accomplished surgeon and splendid observer, Professor Keen. It will attract world-wide attention. It is best, too, for apparent reasons, that this work should be written by a surgeon. The work is based upon tables of 1,700 cases of actual observation. The author has been assisted in his work by Thomson S. Westcott, M. D., a valued colaborer. A chapter on the ocular complications of typhoid fever is added by Dr. George E. De Schweinitz, which alone is worth much consideration. Very appropriately a chapter on pathology begins the book, and is the most complete and satisfactory that has ever been written. The physician can have no reason to differ from the surgeon on the pathology of this disease after reading this book. The profession owes Professor Keen a great debt for his having contributed this thoroughly up-to-date and classical work to them. The book is issued by the publishing house of W. B. Saunders, Philadelphia.

Essays on Bacteriology and its Relation to the Progress of Medicine.

By Theodore Potter, A. M., M. D., Professor of Pathology and Bacteriology in the Medical College of Indiana, Indianapolis University; Member of Consulting Staff, City Hospital and the Deaconess Hospital; Consulting Physician for Diseases of the Chest, Indianapolis City Dispensary.

In the teaching of modern medicine. such books as the above are indispensable, and Dr. Potter has given a work specially adapted for use in medical schools. The germ theory is no longer under discussion, but is accepted as an author has written his book. Chapter actuality, and from this standpoint the IX is especially interesting, being devoted to "The Position of Vaccination in Pathology and Bacteriology." It is a reflection upon the intelligence of the nation that Anti-Vaccination Societies still exist in the United States. Such admirable essays as these will aid materially in dispelling this ignorance. The book is fully up to date on the subjects of which it treats, and is well printed and bound. The Indiana Medical Journal Publishing Co., publishers.

A Compendium of Insanity.

By John B. Chapin, M. D., LL.D., Physician in Chief Pennsylvania Hospital for the Insane; Late Physician Superintendent of Willard State Hospital, New York; Honorary Member of the Medico-Psychological Society of Great Britain, and of the Society of Mental Medicine, Belgium, etc. Illustrated.

This admirable little work of less than 300 pages should be in the hand of lawyer and physician alike. Insanity is so often dealt with in a manner showing so little intelligence, that the physician should read as much as possible on the subject. Here is his opportunity. A book not too large, and full of instructive points. Many of these unfortunates could be saved from the asylum and restored to reason at home if the observations of the author were followed out. The legal profession as a class is "all at sea on this important branch, and it would pay its members to peruse this book. The illustrations. are real illustrations, and help materially to instruct. W. B. Saunders, Philadelphia, publisher.