a successful business man, for several years had been suffering from a sinus from one of the metatarso-phalangeal joints of the left foot; that the disease was tuberculous was demonstrated by a former operation in Evansville, Ind., and the microscopic demonstration of the presence of tubercle bacilli. After the operation the sinus closed only to reopen again a second time some months later. At the time of treatment the sinus had been open 14 months. Treatment was administered June 2nd, 7th, 16th and July 1st. Within 4 weeks the sinus was closed, with no recourse to other local or general treatment. The patient is using his foot in his business (that of store manager) with no difficulty.

5. Miss C. K., age 23 years. Came with a moderate cough, evident bronchitis, anemia and afternoon temperature. History of pleurisy with adhesions, one year ago. There was little sputum and no microscopic examination was made. Injections were given July 2nd, 9th, 16th. The patient gained 8 pounds in three weeks; is doing her regular work every day and considers herself cured.

6. Mrs. J., age 61 years. For years this lady had been suffering from what evidently was chronic interstitial nephritis. The albumen content of the urine was 2.5%. The first symptoms were noticed 4 years ago and had since become progressively worse. On presentation, there was a decided puffiness under the eyes; the feet and legs were swollen; the patient suffered from dizziness and other characteristic symptoms of this condition. Six injections were given, on June 11th, 18th, 25th and July 8th and 20th. With each analysis the urine grew progressively better and soon was absolutely free from albumen (nitric acid layer test used) and has now been absolutely free from albumen for several months. The patient considers herself cured; is doing the house work on a farm and is naturally much encouraged.

7. Mr. J. R., age 33 years. Pulmonary tuberculosis; two hemorrhages before treatment began. Injections were given July 1st, 7th, 14th, 21st and 28th. The patient did not improve under this treatment and at the present writing is not expected to live.

8. Mrs. S., age 61 years. For years had suffered wtih chronic articular rheumatism involving the knees and ankles as well as the fingers and wrists. This patient received treatments July 9th, 13th, 19th, 25th and August 3rd. Soon after treatment was begun, a noticeable mobility of the affected parts was secured. The patient made all efforts to exercise these joints and now they are not only free from pain but thoroughly serviceable and the patient is well.

9. Mrs. A., age 29 years. Pulmonary tuberculosis wtih cavity and 5 severe hemorrhages before coming for treatment in July. Treat

ment was administered July 10th, 15th, 21st, 28th and Aug. 4th. Results negative.

10. Mrs. S., age 28 years. Chronic tuberculous lymphadenitis. The glands were noticeably swollen and soft, but were not ruptured. Patient treated June 11th, 17th and 21st and July 2nd, with a resulting complete disappearance of the glands and a marked increase in weight and general health.

11. Mr. G. K., age 30 years. Suffered from articular rheumatism of 2 years duration which seemed to be confined to both ankles. On July 18th and 25th he received injections with a resultant absolute cure.

12. Mrs. S. J., age 37 years. Pulmonary tuberculosis; 2 hemorrhages previous to the first visit to my office. She received treatments July 19th, 25th and August 8th and 15th. The patient is evidently much better. She manifests marked increase in weight and general health; all the classic symptoms have disappeared; she is doing her work in her home and is apparently cured.

13. Mr. J. M., age 65 years. Carpenter. Came suffering with a very severe sciatic rheumatism which had grown progressively worse since its inception 12 years before. The patient seemed evidently a bad subject, but since he had come quite a long distance for treatment he would not be refused and injections were given June 14th, 19th and 26th. The old gentleman straightened up; his pain disappeared; mobility gradually returned; his crutches were dispensed with and at the present writing, he is back again at his carpenter work.

14. B. F. M., age 41. Severe lumbago affecting the left side and complicated at times, with sciatic neuritis. This condition had bothered this gentleman off and on for 2 years. At the time of treatment he could not lift up his foot to tie his shoe. Injections given Sept. 10th, 17th and 24th. The patient has had no trouble since and has hauled 1,200 bushels of corn to market.

The

15. Miss T. K., age 37. An "incurable." patient suffered 14 years with complications of indefinite troubles prominent among which were neurasthenia with periodic headaches, anemia and severe and frequent attacks of indigestion. The headaches were growing progressively more frequent and severe requiring hypodermic injections of morphine to control them. At earnest solicitation and "as a last resort" injections were given weekly from June 14th to August 3rd with a resulting complete cessation of the headaches (the patient not using morphine since the first injection); marked improvement in the general health; weight increased 7 lbs. (the patient is a slight woman) and the patient declares she is well and "can eat anything now."

16. Mrs. L. M., age 32. Cardiac dilatation with severe asthma. Patient absolutely unable to lie down and sleep for 9 weeks previous to presenting herself at my office. So far, 3 injections have been given: On Sept. 29th, Oct. 11th and 20th. After the first injection the patient experienced marked relief; was able to lie down without distress and has done so since at

, 1910

Series, Vol. V.,

her pleasure, without any inconvenience. Her general condition seems to be improving and she has gained five pounds in weight. Still under observation.

Without going into further details and relating more cases, I feel justified in saying that during the six months I have been acquainted with this treatment, my belief in medicine has been materially increased and I have secured results which, to the casual observer, are absolutely phenomenal. If it were not that the fact, that the patients referred to above and quite a number of others, are alive to tell the tale of the change in their condition that at one time was considered hopeless, is so evident to all, I would be loath to commit myself as I have done.

The immediate results in tuberculosis have been encouraging. Of seventeen cases treated so far, four were not benefitted and should never have received this treatment; one is practically no better while the . remaining twelve assure me that they are well and in need of no further treatment. This may, or may not be true-probably not; but that there is a marked change for the better is very apparent and the results thus far are very encouraging.

In regard to the dosage. I have given a great deal of study to this treatment and have to study each individual case. If the patient is very anemic and pale, I give a small dose to begin with, say 60ms. so as to prevent too much reaction later. Gradually increase to 90ms. In many cases I make a hemoglobin test before the injection. If this test shows 60% or above, I give 90ms. at the beginning and gauge the dose from 60ms. to 90ms. in subsequent treatment according to reaction and symptoms of each case.

I place the patient in a recumbent position, and during the injection the patient.

will taste and smell the creosote, showing the medicine is circulating in the blood. I favor elimination by keeping the kidneys and bowels active during treatment. I have also, in addition to these intravenous injections, used an internal solution prepared by Mr. Bannerman, in three to ten drop doses three to four times a day and such other remedies as the exigencies of each case demanded.

To sum up: The intra-venous injection. of Bannerman's solution has, in my hands, procured results which cannot to my knowledge, by any means be equalled.

LITERARY NOTES.

Medical Vademecum in German and English, by B. Lewis, with preface by Prof. Dr. A. Politzer, Vienna, B. Lewis; London, J. & A. Churchill; Leipsic and Stuttgart, K. F. Köhler; Philadelphia, P. Blakiston's Son & Co. First edition. Pp. xv-559. Price, $5.00 net.

This is a collection of admirable clinical lectures on various pathological subjects by the younger teachers at the chief Vienna hospitals, care being taken to avoid as far as possible the subjective viewpoint. Each lecture is accompanied by an English translation, grammatically correct but sufficiently literal to enable a beginner in German to follow the original word by word. In addition, there are several dialogues with patients undergoing physical examination. A study of this work, which can well be undertaken by anyone who has had a year of German, will save intending students much time and money which they would otherwise spend in the necessarily slow acquirement of a medical German vocabulary through merely hearing lectures; it is not too much to say that the book is indispensa

ble to such students as cannot spend more than a twelvemonth in the fatherland. It

is more up-to-date than any dictionary and gives valuable hints and aids to the intelligent student that no dictionary, however complete, can supply. The idea of giving a selection of lectures in full as a supplement to the conversations was original and clever. We offer a suggestion that by the use of smaller type or by division into two volumes the work be issued in a size convenient for the pocket.

ETIOLOGY AND DIAGNOSIS.

Symptomatology

and

Diagnosis of Salinger first

Cancer of the Prostate.1 observes that in the case of enlargement of the prostate in elderly people it is always indispensable to bear in mind the possibility of malignant disease. In seeking an accurate history it is important to determine as nearly as possible the date of the commencement of nightly micturition, i. e., micturition, during the night. The most constant and reliable information is given by rectal examination in the discovery of a hard tumor or a part of one. In making an examination of this the points to be borne in mind are the hard, irregular, nodular surface, any lateral processes that may be present, and the presence or absence of isolated nodules lying near to the tumour. Pains on micturition, or at any time, "rheumatoid" pains, sciatica, and further, hæmaturia, spontaneous or after instrumental interference, are frequently absent in the commencing stages. The absence of these symptoms, therefore, must not be estimated too highly. Cachexia does not show as a rule; it is a later symptom; the notion that the growth is not a malignant one should never, under any circumstances, be assumed from its absence. The same may be said of remissions in the troubles attending micturition, improvement in the general condition, and increase in weight. In all cases of enlargement of the prostate in which Bottini's operation has been performed, the 1Med. Press and Circular, Dec. 7, 1910.

cast-off fragments from the cauterization should be carefully collected and sub

jected to a searching microscopic examination. Whether Bottini's operation should be performed for purely diagnostic purposes is a question not yet settled. The extirpation of enlarged glands, although not at the time suspicious, especially those of the groin, may, after microscopical examination, permit of a diagnosis being formed. Of symptoms that may be useful for later examinations may be mentioned commencing incontinence without much retention, associated with disease of the central nervous system, and, further, detection by means of the cystoscope of the presence of a prostatic tumour behind the symphysis pubis.

The Diagnosis of Eczema.1-The cause, characters, and diagnosis of eczema vary, says Prof. Gaucher, with the localities attacked.

Eczema of the genital organs in men is localized in the scrotum, the inguinal groove, penis, and the perinæum, extending sometimes to the anal region. The patients thus attacked suffer generally from. diabetes or arthritism in its varied forms (gout, obesity, biliary or urinary affections, emphysema, etc.).

The characters vary. In the scrotum the skin, covered with vesicles, becomes moist and finally crusts, and squamæ coat the surface. The itching is very severe, and if the affection is not treated, the skin becomes lichenified.

On the penis, oedema of the prepuce is observed, due to the laxity of the tissues. In such cases the urine should be analysed for sugar.

Intertrigo of the inguino-scrotal groove may be confounded with eczema, but the inflammation being due to irritation of the teguments by accumulation of secretion, the itching is replaced by a burning sensation especially if fissures are present.

In women, the eczema is observed on the vulva, in the vagina, and frequently on the perinæum. Nine times out of ten, diabetes. is the exciting cause.

Eczema of the anus is a very troublesome affection. The region is red, secreting 'Med. Press and Circular, Oct. 26, 1910.

, 1910

Series, Vol. V.,

Pott's disease has made marked progress in the hands of Dr. Calot, the celebrated orthopædic surgeon, whose establishment at Berck-sur-Mer has been visited by surgeons from all parts of the world.

Dr. Calvé, one of his assistants, resumes the treatment of the above affection as applied by the distinguished professor. The treatment is naturally general and local. The former needs no development: tonics, cod liver oil, arsenic, iodides, etc.

The local treatment is of the greatest importance, and is addressed to the deformity and possible complications. The principles are the same, whether the seat of the disease is in the cervical, dorsal or lumbar regions, to suppress the effects of compression through the ulcerative process, to avoid the formation of a gibbosity, or to diminish and correct an already existing gibbosity. The only really efficacious means of suppressing the effects of compression is to place the patient for months in the horizontal position which relieved the vetebræ from all weight, and diminishes contraction.

To meet the second requirement (to prevent the formation of gibbosity from inflexion forwards of the vetebral column) hyperextension of the affected region should be practised, and this is effected by the employment of a plaster jacket. The confection of this apparatus is very simple. Bands of tarlatan, of five yards in length

'Med. Press and Circular, Dec. 7, 1910.

and four inches in width, are impregnated with dry plaster and steeped in warm water at the moment of using. The body of the patient is wound round several times with these bands, after which he is suspended, the points of his feet alone touching the ground, by the aid of straps passing under his chin and the occiput, and drawn up tight by means of a pulley fixed in the ceiling. By this suspension perfect hyperextension of the rachis is obtained.

The plaster jacket should meet the requirements of the region. For the lumbar region it should be moulded on the pelvis and reach to the axillæ. It should maintain the lumbar vertebræ in forced lordosis.

Where the disease is situate in the dorsal region, the jacket should mount to the cervical portion forming a collar, while if the lesion be above the sixth cervical vetrebrae, or sub-occipital Pott's disease, the head must be kept in hyperextension by a deep collar moulded on the shoulders and reaching half way down the thorax.

The plaster jacket should be renewed every three months, to clean the skin, and correct, if necessary, the attitude. An opening, or window, is made over the seat of the threatened gibbosity, and the space filled with layers of cotton wool, which, by their compression, tend to force the rachis forwards, while a large opening is made. in front to give free play to the chest walls, and to relieve the epigastric region of any pressure.

To limit and correct a pre-existent gibbosity, curves of hyperextension above and below the gibbosity, styled compensating curves, should be obtained by renewing the jacket every two months.

If an abscess forms it should not be opened with a bistoury, but tapped with an aspirator, and through the cannula left in situ a modifying liquid injected (iodoform in ether, olive oil, with guaiacol and iodoform, etc.).

The cannula of the aspirator should be passed first through the healthy skin before reaching the abscess proper occlusion.

The patient should be kept in the horizontal position for at least two years. At the end of that period he might be allowed to sit up in bed for an hour or so each day. After the third year he is permitted to get up and walk a little; the plaster jacket

Series,

may also be replaced by a movable apparatus, made of leather or celluloid, and removed at night.

Where possible, the patient should be placed, from the very outset of the treatment, at the seaside, and in a dwelling exposed to the sunlight and to the full breeze of the sea.

SOCIETY PROCEEDINGS.

THE EASTERN MEDICAL SOCIETY

OF NEW YORK.

The regular monthly meeting of the Eastern Medical Society of the City of New York was held at the Cafe Boulevard, Friday evening, December 9, 1910, President Rongy in the chair. A large amount of executive business was attended to, including the annual election of officers, a full list of which will appear in our next issue.

After the executive session, the annual address was delivered by James J. Walsh, M. D., LL. D., on the subject of Psychotherapy in Organic Disease. This will appear in full in the January number. Following adjournment a collation was served and enjoyed by the large number present.

7. Epithelioma of the nose, treated with As2O3, Dr. Eberhard W. Dittrich.

PAPER OF THE EVENING:

The Physician in Court, Dr. Lincoln R. Graham.

Supplemented by addresses of the Hon. Joseph I. Green and the Hon. Frank F. Davis.

Discussion.

This important paper will appear in the January issue of AMERICAN MEDICINE.

SURGICAL HINTS.

Persistent lymphedema of the breast may be the first, and for a long time the only sign of a scirrhus carcinoma.

The injection through a ureter catheter of sterile olive oil against or, preferably, behind a small stone lodged in the ureter very often determines its expulsion into the bladder.

Prostatic massage for gonorrheal prostatitis is not limited in its usefulness to chronic cases. In some cases of fairly acute gonorrheal prostatis the symptoms do not abate until daily expression of the pus by massage is undertaken, and then they subside very

taken only upon proper indications, however; otherwise employed in acute cases it will cause mischief.-Amer. Jour. of Sur

gery.

In a case of known or suspected visceral carcinoma, the finding of small nodules in or just beneath the skin is of vast diagnostic and prognostic importance. If an excised nodule is shown to be cancerous this will at once establish both the diagnosis and the futility of operation. In cases of intraabdominal carcinoma these superficial metastases are curiously, most often found in the skin to the left of and below the umbilicus.-Am. Jour. of Surgery.

When the appendix is so placed that its tip is not readily delivered the "retrograde" removal of the organ is often the simplest and safest method.