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Outer edge of foot especially hypertrophed. Tendo achillis and malleoli not especially large. Arch of foot not lost. The patellae enlarged and hips broad. Leg and thigh normal in size. His gait is lumbering and heavy. Hips are prominent. He perspires profusely, especially lately since he has been on K. I. Receives strychnine 1-60 b. i. d. No increased thirst or appetite.

DISCUSSION OF DR. SWIFT'S PAPER. DR. THOMAS R. McNAB:-Referred to two cases of the disease in which enlarged thyroid was present, both cases responding well to the thyroid extract. The connection between thyroid, pituitary and adrenal glands was very interesting.

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DR. H. G. BRAINERD:-Cited a case seen at the New York Academy of Medicine in which attending physician had reported diminution in size of feet and hands, from treatment with fresh pituitary glands obtained from the abattoir.

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Reports of cases were then called for: DR. F. C. E. MATTISON:-Presented a bottle of 585 small gall stones of peculiar pearly white color. Saw the patient five years ago. Had recurrent attacks of cholecystitis. In one of such attacks, on February 8th, he hal persuaded her to be operated upon, and on that occasion had removed these stones.

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DR. A. TYROLER:-A week ago a patient from Nevada had come to him with an ulcer of three weeks' standing, on the great toe. History and examination negative. Ulcer fails to respond to antiseptic treatment. Asked for suggestions.

DR. E. SWEET:-Had gotten good results from ichthyol in similar cases.

DR. F. C. E. MATTISON:-Had seen enzymol, through its digestive action, bring good results in torpid X-ray burns.

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DR. L. D. JOHNSON:-A young woman of previous health good, history negative, had a sudden eruption appear on the feet. Itching, burning, painful. Large watery blisters appeared on sides of feet and on heels and toes. After 24 hours pain subsided. Feet looked almost gangrenous. Blisters later contained thick yellow fluid. Tissue beneath looked ridtlled or honey combed. After some weeks, skin looks shriveled. Patient able to walk again. The cause cannot be placed and the course is very unusual.

DR. A. L. KELSEY:-Cited a case of complete adhesion of soft-palate to post-pharyngeal wall, due to syphilis, twenty years ago, and fifteen years ago a Seattle surgeon had endeavored to make openings by two lateral incisions and the use of rubber bands but had failed.

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DR. J. A. McGARRY:-Reported a case of Otitis media, with pronounced bulging of the drum, but in which whispering voice could be heard at 20 feet. Could not understand absence of deafness. Had subsequently punctured drum in posterior quadrant and blood and pus had exuded.

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DR. S. A. AUSTIN:-Reported case of pneumonia, woman, 59 years, with fever, increased respirations and heart action; claimed no chill; found dullness over right apex which extended. Consultant advised codeine for extreme restlessness. Another patient had chilliness but no chill. Pain as in previous case commenced in the head. Dullness over right apex. Sent patient to hospital. On third day rusty sputa appeared which changed four days later to orange yellow color.

DR. GEORGE L. COLE:-Felt that while mcrphine was valuable during first two days of a pneumonia its action at later periods was to be carefully watched.

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H. Seymour as Clerk and Dr. Titian Coffey as Councilor. The chairman appointed a committee of three, consisting of Doctors Paul A. Adams, Sherwin Gibbons and E. M. Lazard, to draw up a constitution and by-laws and to report on the same at the next meeting.

In opening the meeting, Dr. M. L. Moore stated his gratification at the action of the Council in deeming Obstetrics, (a branch of medicine practiced by nearly all practitioners,) as being worthy of a separate section. He was sure the section could be made a source of much aid to its members. For himself he was by no means proud of the manner in which he had practiced obstetrics in the earlier years of his career, and if the members of the section would keep case histories, there was no reason why there should not be an abundance of interesting material to draw from, so that by the end of the year, every member would have material for an excellent paper.

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DR. E. M. LAZARD read the paper of the evening entitled "Some of the More Unusual Causes of Disturbed Puerperium."

The term puerperal fever should give way to the term puerperal infection, since there were conditions other than infection which might give rise to fever in the puerperium. The term fever, among the laity was interpreted to mean infection, and the term on that account not infrequently was a source of undeserved reproach, even when all aseptic precautions had been successfully practiced.

There are oldstanding cases of latent bacterial infection which remain in abeyance during pregnancy, but which light up into activity after confinement.

Phlegmasia dolens is another condition not dependent on infection which may lead to fever. Other post-partal

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Dr. M. L. Moore then called for reports of cases, stating that no program had been prepared since the organization of the Section was the major business of the evening:

DR. P. C. PAHL:-Was recently pressed into service to deliver a woman, in whom labor was very rapid, and where after delivery no perineal tear was found, but in which there protruded a firm mass that prevented the cervix from being reached except along posterior boundary of the vagina. The attending physician arriving at that time, Dr. Pahl retired from the case, but had not been able to learn the exact nature of the protruded tissue.

DR. LASHER:-Was called on several years ago to do a Caeserian section, and upon arrival at the patient's humble home in Sonora-town, found an occluded vagina, into which not even the

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DR. M. L. MOORE:-Recently had under his care a primipara who had been in excellent health. Was under observation for six months, but her last specimen of urine showed a trace of albumen. He called the next day and found puffed eyelids, headache and other symptoms of toxaemia. Had nurse come, prescribed calomel, salines and sweats. Next morning patient was vomiting, symptoms were worse and she transferred to hospital, but in the trip, the membranes were ruptured. By evening labor had commenced and dilatation had advanced to size of a dollar. Would have done version had waters not escaped. Did a mechanical dilatation, but efforts of himself and assistant with axis-traction forceps made no impression. General condition was growing worse and did a craniotomy which was done with great difficulty. was a healthy woman with normal pelvis with queer complication at the end. Showed the necessity of watching patients carefully throughout pregnacy.

BOOK REVIEWS.

NASAL SINUS SURGERY WITH OPERATIONS ON NOSE AND THROAT. By Beaman Douglass, M.D., Professor of Diseases of the Nose and Throat in the New York Post-Graduate Medical School and Hospital. Illustrated with 68 full-page half-tone and colored plates, including nearly 100 figures. Royal octavo, 256 pages. Bound in extra cloth. Price, $2.50, net. F. A. Davis Company, Publishers, 1914-16 Cherry street, Philadelphia, Pa.

The author has given us a most excellent practical treatise, the text being most beautifully helped out by the variety and number of the illustrations. The surgery of the accessory sinuses is briefly but concisely handled. However, some of the latest septal operations such as Frier's are not mentioned by name. And this is also true in regard to some recent intra-nasal instruments coming from Chicago. Can it be possible that

Here

out Eastern friends think that nothing good can come out of the West?

ON

LECTURES AUTO-INTOXICATION IN DISEASE, or Self-Poisoning of the Individual. By Ch. Bouchard, Professor of Pathology and Therapeutics; Member of the Academy of Medicine and Physician to the Hospitals, París. Translated, with a Preface and New Chapters added, by Thomas Oliver, M.A., M.D., F.R.C.P., Professor of Physiology, University of Durham; Physician to the Royal Infirmary, New CastleUpon-Tyne; Formerly Examiner in Medicine, Royal College of Physicians, London. Second Revised Edition. Crown octavo, 342 pages, Extra Cloth. Price, $2, net. F. A. Davis Company, Publishers, 1914-16 Cherry street, Philadelphia.

For a book to have become a classic within fifteen years is a triumph, but that has been achieved by this present volume. The main positions taken by

the author, though at that time new and radical, have been in all important respects corroborated by the later developments of medical science. A few modifications have been called for, but these have been chiefly in matters of detail.

The service which Bouchard has rendered to practicing medicine can hardly be over estimated. The conception that our patients, both in health and disease, are continually poisoning themselves, and only saved from serious consequences by the neutralizing activity of certain organs of the body, is a key which unlocks many problems by the bedside. Particularly fruitful has it been in the case of the poisons formed in the process of digestion and their neutralization by the liver, and the later work of Murray on the thyroid, and Abel on the adrenal, have simply enlarged and emphasized the value of Bouchard's original views.

It would be well for us if we would recognize these views even more fully and constantly than we do. While the work of the editor, Dr. Oliver, has been in the main admirably done, there are one or two points which a little more thorough bringing up to date could have been desired. For instance, in speaking of the part played by micro-organisms in the mouth and alimentary canal, he refers to the seventeen species of microbes isolated from the saliva, when Miller described thirty-six, at least six or seven years ago. But these are mere spots on the sun.

A MANUAL OF DISEASES OF INFANTS AND CHILDREN. By John Ruhrah, M.D., Clinic Professor of Diseases of Children, College of Physicians and Surgeons, Baltimore. 12mo volume of 404 pages, fully illustrated. Philadelphia and London: W. B. Saunders & Company, 1905. Flexible leather, $2. net.

Dr. Ruhrah is to be congratulated upon the production of a manual that presents the subject of pediatrics in such a clear yet concise manner. He has outlined the therapeutics of infancy and childhood in a way that cannot fail to

make for this work a place of first importance in its field. He has given explicit instructions for dosage and prescribing, and a number of useful prescriptions are appended. Infant feeding is given in detail. All the illustrations are practical, and include three inserts. A very valuable feature consists in the many references to pediatric literature so selected as to be easily accessible by the student, enabling him to ascertain the sum of knowledge on any given disease. We give Dr. Ruhrah's work our unqualified recommendation in so far as it is possible for a manual of this size to cover the subject.

NEW (7TH) EDITION, THOROUGHLY REVISED. A MANUAL OF THE PRACTICE OF MEDICINE. By A. A. Stevens, A.M., M.D., Professor of Pathology in the Woman's Medical Colleg of Pennsylvania and Lecturer on Physical Diagnosis at the University of Pennsylvania. Seventh Edition, Revised; 12mo of 556 pages, illustrated. Philadelphia and London: W. B. Saunders & Company, 1905. Flexible Leather, $2.50 net.

We know of no work on practice of the same size containing so much practical information concisely stated, as this handy little book by Dr. Stevens. The author's epigrammatic style is no doubt the result of his extensive experience in the lecture room, enabling him to group allied symptoms in such a manner that they can be easily retained in the mind of the student. a judicious elimination of theories and redundant explanations he has brought within a small compass a complete outline of practice of inestimable value. Indeed, for the student, the practitioner, and the nurse as well, we know no better manual.

By

PROGRESSIVE MEDICINE, VOL. IV, DECEMBER, 1905. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo, 367 pages, 41 engravings and 5 fullpage colored plates. Per annum, in four cloth-bound volumes, $9; in paper binding, $6: carriage paid to any address. Lea

Brothers & Co., Publishers, Philadelphia and
New York.

With this volume Progressive Medicine completes its seventh year of publication. The work has from its inception embodied an earnest effort to present a contemporary record of the best that is being thought and done in medicine, both from a scientific and practical standpoint.

The plan and execution of the work are very practical. No medical man has the time to read all the medical literature of the world in all languages, and this is a part of the service rendered by Progressive Medicine. Its authors not only read, but also sift out the good and helpful matter and discard the useless or doubtful. This, however, is only the beginning. These authors, all of whom are selected for peculiar ability, and experience in their special fields, interweave this matter with their own knowledge and achievements, and each tells a connected, logical, interesting original narrative, giving reports of their cases and investigations and abundant bibliographical references for those readers who may wish to carry their study deeper.

Under "Diseases of the Liver," by J. Dutton Steel on page 101, Schmidt is quoted as saying, "That the old statement which is sometimes found in recent text-books, that intestinal putrefaction is increased when bile is absent, is entirely wrong. Bile has undoubtedly some properties and the ethereal sulphates are increased in the urine in jaundice, but more reliable methods of measuring the intestinal putrefaction and of estimating the intestinal bacteria (Strasburger) show that putrefactive changes in the stool are really less than normal when bile is absent. The reaction of such stools is always acid, but that is due to the fatty acids present and not to fermentation.

The reason for this lack of putrefaction is found in the large proportion of fat in the stools of jaundice. Fat does

not putrefy and thus the albumin in feces from cases of pancreatic insufficiency, and consequently foul stools are not a symptom of liver disease, but of insufficient albumen digestion, such as is present in pancreatic diseases. Consequently, jaundice does not lead to enteritis, as does disease of the pancreas, and bile may be absent for long periods of time without intestinal irritation.”

A quarterly of and especially

INTERNATIONAL CLINICS. illustrated clinical lectures prepared original articles on treatment, medicine, surgery, neurology pediatrics, obstetrics. gynecology, orthopedics, pathology, dermatology, ophthalmology, otology, rhinology, laryngology, hygiene, and other topICS or interest to students and practitioners by leading members of the medical profession throughout the world. Edited by A. O. J. Kelly, A.M., M.D., Philadelphia, U.S.A., with the collaboration of Wm. Osler, M.D., Baltimore; John H. Musser, M. D., Philadelphia; Jas. Stewart, M.D., Montreal; J. B. Murphy, M.D., Chicago; A. McPhedran, M.D., Toronto; Thos. M. Rotch, M.D., Boston; John G. Clark, M.D., Philadelphia; James J. Walsh, M.D., New York; J. W. Ballantyne, M.D., Edinburgh; John Harold, M.D., London; Edmund Landolt, M.D., Paris; Richard Kretz, M.D., Vienna; with regular correspondents in Montreal, Berlin, London, Paris, Vienna, Leipsic, Brussels and Carlsbad. Vol. III, XV series This volume comes to us with such names as Sanger Brown, Daniel R. Brower, and Charles H. Knight of this country, W. G. Sym of Edinborough and Tuffier of Paris.

McPhedran of Toronto has contributed an interesting clinic on Membranous Colitis. After showing two rather typical cases, and giving their history, he speaks of the treatment as follows: "In the treatment of mucous colic, the neurotic state should be kept in mind, as well as the bile affection. In many cases a cure will follow an improvement in the mental state resulting from a change of scene, removal from depressing surroundings or the overzealous attention of friends. Probably not a few of the milder cases recover under reverses by which they are compelled to assume responsibilities, even to the over-taxing of their energies. In

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