Eyestrain as a Cause of Headache and other Func. tional Nervous Disorders, J. Ellis Jennings, St. Louis. Tracheotomy in Diphtheria in Conjunction with An titoxin, E. VonQuast, Kansas City.

Sessions will open at 9 A.M. The Society will be welcomed on the part of the City by Mayor Stephens. The joint meeting will be held at the McCasland Opera House, East St. Louis, May 18, at 8 PM.. and will conThe Use of Antitoxin in Diphtheria, E. C. Evans, sist of addresses of welcome and responses by the State Sedalia. Presidents, Drs. Corr and Duncan; the President's AnThe Possibilities and Limitations of Serotherapy, P. nual Address; Address of the several Sections, etc. Paquin, St. Louis.

May 19, at 8 P.M., this Society will meet the Missouri Primary Tuberculosis of the Rectum, Leon Straus, St. State Medical Association at the Century Theater, St. Louis.

Surgical Tuberculosis, L. T. Riesmeyer, St. Louis. Obstruction of the Bowels, T. F. Prewitt, St. Louis. Gastro Jejunostomy in Gastrectasis, H. H Cordier, Kansas City.

Intermittent Hydronephrosis, N. B. Carson, St. Louis. The Subjective Symptomatology of Renal and Ureteral Diseases, J. P. Bryson, St. Louis.

Seminal Vesiculitis as an Obscure and Elusive Affec.

tion; with Remarks on Treatment, Bransford Lewis, St.

Louis.

The Nervous Dyspnea of Bright's Disease, Robert F. Brooks, Carthage.

Diet in Its Relations to Uricacidemia, A. B. Miller,

Macon.

Louis; exercises of the previous night.

May 20, both Societies will adjourn at 12 M. and meet on the steamer Grand Republic for their joint social outing, refreshments being furnished during the trip.

reduced rates-one and one-third fare for the round The usual arrangements with the railroads regarding trip-will be operative during the meeting. It is necessary that you obtain proper certificates from your presented to the Secretary on your arrival, who will local agent when you purchase tickets; this must be certify your attendance at the meeting. This certificate, with one third regular fare, will secure your return dations for all, and the rate will not exceed $2 per day; ticket. Hotels will be amply able to furnish accommo

A Case of Enlargement of the Lymph Spaces; Pre-but, should their capacity be taxed, citizens will keep opeu house during the meeting.

sentation of Patient, A. H. Ohmann Dumesnil, St. Louis.
Preroseolar Syphilis, Joseph Grindon, St. Louis.
The Blood Changes in Early Syphilis, M. A. Bliss,

St. Louis.

Post Syphilitic Diseases of the Nervous System and the Early Treatment of Syphilis, F. R. Fry, St. Louis. Syphilis of the Upper Air Passages, J. C. Mulhall, St. Louis.

A Satisfactory Treatment of Acute Gonorrhea of Women, Emory Lanphear, St. Louis.

A Case of Strangulated Hernia with Resection of

Bowel, H. C. Dalton, St. Louis.

There is nothing in the foregoing which will exclude the ladies from participating in the work and social pleasure; on the contrary, every effort will be made to make the visit of those who attend pleasant and profit

able.

Southern Illinois Medical Association.

The Twenty-third Semi-annual meeting will be held at Mt. Vernon, Thursday and Friday, May 13 and 14, Salpingitis Vegetans Perforativa. Adenoma Salpin- 1897, the sessions will convene in the Supreme Court gis, J. B. Ross, St. Louis.

The X-Ray as a Means of Diagnosis, C. C. Morris, St. Louis.

Peritonitis In Question, Pinckney French, St. Louis. Some Practical Points in Appendicitis Operations, A. V. L. Brokaw, St. Louis.

Room.

Thursday evening the Mt. Vernon Military Band will entertain the members with one of their royal concerts. Arrangements have been made to secure reduced railroad rate as usual on the certificate plan.

The local Committee, together with the good citizens

Surgical Treatment of Varicose Ulcers, A. H. Meis- of Mt. Vernon, extend a cordial invitation to the proenbach, St. Louis.

fession and their friends to attend; let every one attend.

Infection of the Liver in Appendicitis, A. R. Kieffer, We hope to meet the 800 doctors of Southern Illinois, St. Louis.

Illinois State Medical Society.

The annual meeting will be held in East St. Louis, Ill., May 18, 19 and 20, 1897. The meetings will be held at Music Hall, No. 309 Collinsville avenue, this is about six blocks from the Relay Depot. Proper Committees will meet arrivals and direct them to the place; they will then be assigned to their hotel or place of entertainment.

and many others at this meeting. We are laboring night and day to make this program the most comprehensive and instructive of any heretofore presented.

We desire the honor of your presence for our mutual pleasure, for your good, and for the benefit of all. If you stand with a broken Code in your hands, come and bring it to this lovefeast, and ask your brother's pardon, and, our word for it, you will go away a happier man— a better physician, than you have ever been before. If you are not already a member, come and seek admission. We hope to enlist everyone who is eligible, at this meeting, and present him with the necessary credentials

Discussion opened by R. A. Goodner, Nashville. Serum Therapy, John T. McAnally, Carbondale. Discussion opened by Paul Paquin, St. Louis. Rheumatism-Its Pathology and Treatment, J. W. which will meet in St. Louis, May 18, 19 and 20, promArmstrong, Centralia.

Dr. E. C. Runge, Superintendent of the St. Louis Insane Asylum, has recently become a member of the Health Commissioner's Report.-During the Society of German Physicians of this city. Dr. Albert week ending April 24, 177 deaths were reported in St. E. Taussig was proposed as a member at the last meet-Louis, three less than in the week preceding and eighting of the Society. een less than were registered during the corresponding period of last year. Basedon an estimated population

Dr. Emma Wakefield, a colored woman, has of 600,000 the death rate last week was 15 per 1,000 per received a license to practice medicine from the Louisi-annum. One hundred and ninety-four births were ana State Board of Medical Examiners says the Medical registered during the week. Record. She is the first woman of her race to receive a medical license in the South, and, it is claimed, in the Union.

The contagious disease report for the past week is as follows: Small-pox, 1 case, no deaths; Diphtheria, 14 cases, 4 deaths; scarlatina, 3 cases, no deaths; typhoid fever, 7 cases, 2 deaths; measles, 5 cases, no deaths; whooping cough, 1 case, no deaths.

New York University-Bellevue Hospital Medical College.-Dr. William H. Welch and Dr. William Osler, of the Johns Hopkins Medical School Milk Adulteration.-Dr. Howard Carter, Milk of Baltimore, have declined the call extended to them Inspector, is on the war path. During the past week by the University of New York, which has lately been consolidated with Bellevue Hospital.

Tennessee Physicians and Surgeons.-The sixth annual meeting of the West Tennessee Medical and Surgical Association was held in Jackson, Tenn., April 22 and 24, with President J. T. Jones in the chair. A large number of physicians from all over the State were present. The meeting was one of the largest in the history of the Association.

St. Louis Medical Society.-The following is the programme of the St. Louis Medical Society for the meeting of Saturday evening, May 1, 1897: Dr. W. N. Beggs, paper: "Denver and Pulmonary Tuberculosis." Read by Dr. R. H. Finley. H. W. LOEB, Chairman, R. H. FINLAY,

M. F. ENGMAN,

Executive Committee.

he has analyzed numerous samples of milk obtained from wagons on the streets and the sellers of those found to be below the standard are posted upon the "black list" in the Doctor's office in big letters. One sample of milk obtained was found to be adulterated with water, and two others from the same dealers—one of milk and the other of cream-were artificially colored. A sample of skimmed milk taken from another wagon was found to be diluted with water and artificial coloring matter. A sample taken from a "pure cream" can was also found to contain artificial coloring matter.

Dispensary Evil.-Under the new constitution of the State of New York, supervision over all charitable institutions is vested in the State Board of Chari. ties (Brooklyn Medical Journal). We are informed that this body is now engaged in an investigation of the various dispensaries of New York, with a view to ascer. taining how far their privileges are abused by those who are able to pay. We are assured that enough has Society of German Physicians. Dr. G. already been learned to warrant the statement that the Baumgarten read a paper at the last meeting of the So- result, when published, will prove interesting reading ciety of German Peysicians entitled "Remarks on the to the medical profession. If it should develop that Treatment of Nephritis." Dr. W. E. Fischel reported one fourth of the population is receiving gratuitious a most interesting case of what appeared to be Spontan- medical treatment, as has been demonstrated in other eous Bleeding from one Kidney in an apparently healthy large cities where inquiry has been made, we should not person. Dr. L. P. Pollmann related some cases of Sar-be greatly surprised.

Hospital Staffs and Close Corporations.- taken place in public and in fortresses after court martial A committee of physicians recently called upon Mayor proceedings have been held. How many executions Strong, of New York City, to protest against the method have taken place out in the fields no man can even con. by which appointments are made to the public hospitals, jecture. During the six days from March 17 to 23, in and to ask that the selection be made from the body of Matanzas seventeen were shot in this way that I know the profession instead of from the comparatively small of and can personally vouch for, and I am creditably number of those connected with the medical schools. informed, and I draw my information in this instance They said with truth that there were very many physi. from Spanish sources, that ninety-two men have been cians in the city, not connected with the schools, who shot in San Severino during the period from December would gladly give their services as members of the vis. 1 to March 20, and during the same time there took iting staff of any of the city Hospitals. They also sug place in the Cabana prison in Havana sixty-four execu. gest that it would be a wise thing to appoint a physician tions. In Santa Clara prison and in Cienfuegos, during on the board of charity commissioners.-Medical Record. the same period, there have taken place at least one hundred and sixty of these executions, to which the Death of Dr. J. M. Leete. - Dr. J. M. Leete Spanish public is admitted, doubtless, as in the case of died at Mineral Springs, Wis., April 24. Dr. Leete was the mutilated bodies, "to warm the soul."-S. Bonsal, 64 years old, and passed most of his life in St. Louis. in May Review of Reviews. His residence for a quarter of a century was on Washington Avenue, a short distance west of Pilgrim Church. He will be remembered as the man who headed the movement against the chimes in the belfry of that church in the 70s. He and several other residents of the neighborhood contended that the "chimes" were unmusical and even detrimental to the health of the people compelled to constantly listen to them. He went to court and tried to have them stopped by man damus proceedings, but the decision there was against him. Dr. Leete ranked high as a physician, and he took an active interest in public matters.

The Dispensary Bill.-A telegram to the daily papers from Albany says that a bill introduced by Mr. J. J. Sullivan regulating the operation of dispensaries and bringing them under the supervision of the State Board of Charities was approved by the Board, and has passed both Houses of the Legislature. A report presented by Dr. Stephen Smith, of New York City, with relation to the dispensary system of New York City and Brooklyn, stated that there are one hundred and five dispensaries in New York City, and in a large per centage of these no examination or investigation is made to decide as to the need of applicants for charitable assistance. In Brooklyn there are twenty-two dispensaries, and in at least eighteen of these no examination or investigation is made to determine the needs of applicants.-Medical Record.

PUBLISHER'S DEPARTMENT.

Southern Illinois Medical Association.— To those of our readers who expect to attend the meeting of this Association, which will be held in Mt. Vernon, Ill., May 13 and 14, 1897, we wish to announce that the Louisville, Evansville and St. Louis Railway have very kindly made a special low rate of one and one-third fare from all Illinois points to Mt. Vernon, and making the fare from St. Louis to Mt. Vernon $3.38. Tickets will be on sale at their office, 104 North Fourth Street, St. Louis.

We are assured by the Committee on Arrangements that this will be a very interesting meeting, as many valuable papers will be presented by some of the most active workers in the medical profession. The L. E. & S. L. R. R. has been generous in making this low rate and you will be profited by attending this meeting.

A New Lake and New Trout.-Rear Admiral Beardslee of the Pacific Coast Squadron, U. S. N. about a year ago brought to the attention of tourists and anglers a beautiful lake in Northwestern Washington, that contains new varieties of monstrous trout.

13 pounds and ranging from 10 to 30 inches in length. They are caught by trolling, at a distance of 30 feet or more below the lake's surface, and are the gamiest sort of trout, full of fight. Already, anglers have gone from the far east to Lake Crescent to enjoy the rare sport found there.

President Jordan of Stanford University, California, an authority on fishes, pronounced them entirely new Murder by Court-Martial in Cuba.-There to science. They are very large, weighing from 10 to is no record kept, or at least there is no record that is accessible, of the number of so-called insurgents that have been shot down since the beginning of the war. Be it said to his credit that during the regime of Martinez Campos the first year of the war but one Cuban patriot was murdered in this dastardly way, and Gen. Campos has said openly and publicly that he deplored it, and would regret not having prevented it, every day of life. Under Gen. Weyler there have been at least a thousand assassinations of this order during the last year. I refer, of course, only to the shootings that have

A long chapter on this beautiful lake and its finny inhabitants, located in the heart of the Olympic Mountains, is found in the Northern Pacific New Tourist Book, Wonderland '97. Send six cents for it to Chas. S. Fee, Gen. Pass. Agent, St. Paul, Minn.

MEDICAL REVIEW,

VOL. XXXV.

A WEEKLY JOURNAL OF MEDICINE AND SURGERY

ST. LOUIS, MO., MAY 8, 1897.

ORIGINAL: ARTICLES

The Indications and Limitations of
Celiotomy for Non-Traumatic
Perforations of Intestines.1

BY A. F BOCK, M.D., ST. LOUIS.

The indications and limitations of celiotomy for nontraumatic perforations of the intestines have not up to the present time been determined. The question is a very difficult one, and, I believe as yet a definite answer can not be given to it.

Non traumatic perforations which may call for celiotomy are: Perforating typhoid ulcer, perforating stercoral ulcer, perforating duodenal ulcer, and perforating tuberculous ulcer.

NO. 19.

foration, any operative interference should be contem. plated. Most authors agree as to the almost certain fatality of typhoid perforations of the bowel. Dr. Loomis in discussing the subject says: "I do not remember to have seen a single recovery after there were unmistakable evidences of intestinal perforation. Recovery from a local peritonitis complicating typhoid fever is not uncommon, but when the characteristic symptoms of intestinal perforation are present, in my opinion, a fatal issue soon follows" Griesinger says: "There is never a possibility of recovery in cases of general peritonitis following typhoid perforation, only when the inflammation is wholly circumscribed." According to Dr. Osler's recent statistics, in 114 cases of the 2,000 Munich autopsies (5 7 per cent), and in fourteen instances of his series, the intestine was perforated and death caused by peritonitis. Hemorrhage from the bowels occurred in 99 of the Munich cases, and in 9 of Dr. Osler's series. Dr. James C. Wilson, of Philadel phia, was the first in this country to advocate surgical interference in these cases. He says: "I take it for granted that almost every case of free extravasation of intestinal contents, however small in amount, into the The typhoid are the most common variety of perfora peritoneal cavity terminates fatally. There is little tions. Up to the beginning of the year 1897, there had reason to believe that any case of this kind recovers. been altogether about 47 operations reported with 13 It is important to note that the cases of peritonitis in recoveries (27 65 per cent), a truly remarkable showing. enteric fever in which recovery is possible can be clinic When one considers the poor condition of such patients, ally distinguished from those which will terminate rapand the bad state of the intestines in these cases, with idly in death. The clinical picture of the two condi. such promise of recovery, the question can not hence tions is almost as distinct as are the pathological lesions. forth seriously be asked if operation is ever justifiable Where there is extravasation of the intestinal contents in these cases. In peritonitis resulting from perforating into the peritoneal cavity, the collapse is like that typhoid ulcer, celiotomy offers the only chance of sav. caused by the escape of an amount of foreign matter, ing the patient, if the proper moment for intervention the result of a perforating gunshot wound of the intes can be determined. According to Greig Smith, "there tine. The proposition which I submit for discussion must be a selection of cases.' ." Those which would most arises directly from a consideration of the matter in fully justify operation would be of the mildest or this way. Until within a few years, no surgeon real"ambulating" variety, and a few of those cases of per- ized the possibility of treating cases of gunshot injury foration taking place during the period of convales of the abdomen with perforation of the intestine and escape of blood and fecal matter by the operation of laparotomy, washing out the peritoneal cavity, excising bruised and lacerated portions of the intestines and bringing the parts together by suture. Yet this is now the recognized procedure in such cases, and has been of late practiced in many instances with success in cases that under the old plan of opium and expectancy would

cence.

But in a moderately severe case of typhoid, operation as a sequence to perforation must be undertaken with extreme caution. It can not be denied that in a select class of cases the operation has a future be fore it, though such a future can not be very bright, and it is doubtful whether for the majority of cases of per

'Read before the St. Louis Medical Society, Saturday Evening, have inevitably perished Are we ready to adopt the March 20, 1897.

same measure in perforation of the intestine with simi