patient who also had purulent syphilides. Some of the uterine contents were aspirated and streptococci were found; this should always be done before using the serum. Inunctions of mercurial ointment were also used and he attributed the woman's recovery more to this than to the serum. Dr. Rohlfing said he believed there are many local affections of the genital tract with a high rise of temperature in which it is hard to determine between them and a constitutional infection. So far the antistreptococcic serum seems to have been unsuccessful. He believed that local as well as general treatment is necessary and that accumulated deritus should be removed to prevent continued infection. Dr. Hypes considered the subject of the utmost importance. In the matter of treatment minutiae should be studied more than they are. A certain line of treatment followed indiscriminately leads to error. Generally the more we interfere with obstetric cases the worse they get along. Ninety-nine per cent of obstetric cases in hovels, surrounded by filth and germs, do well if not interfered with. Among the better class of practitioners it had been found that less douching produces less sepsis and less morbidity. Ten years ago he used douches every three hours after labor and had more sepsis than ever before. Investigators had found that more germs were carried in by the douche than were washed out. Each case should be studied and treated according to circumstances. The majority arise from a septic endometritis. If the source of infection can be found and removed it is better to do so, and the resisting powers should be strengthened. Neither in practice nor belief, did he agree with Dr. Ford's plan of repeated douching. An infected endometrium should be cleansed out with the finger or the dull curette and the douche. The tissue beneath is filled with phagocytes and to disturb the tissue with the sharp curette is simply to open new avenues for the absorption of infectious material. He had never used this plan and it was opposed by Hirst, Williams, Jouett, and others. After septic material has entered the system it is useless to confine our efforts to the organ; constitutional treatment becomes necessary. This is admittedly our admittedly our weakest point. In 1895, Marmorek reported a series of cases in which he used his serum; 40% died. Ordinarily only 25% die. The report of the American Obstetrical and Gynecological Asso ciation showed litle progress in its use. He believed there are some possibilities in nuclein and nucleinic acid. Normal salt solution under the skin and by the rectum is an excellent means of combatting sepsis. Reports during the last two years show it to be good, if used in large quantities. Lately he had read of the use of the semi-recumbent posture, to facilitate drainage toward the pelvis, with good effects. Dr. Laville said that gynecologists of America and Europe object to the use of the sharp curette. It denudes the musculature and lessens resistance to the infective process. Dr. W. G. Moore commended Dr. Hypes' deductions from his practical experience. The man who uses the sharp curette may get just as good results as the man who does not, but the question is, which is sustained by reason? He well remembered Dr. Wallace who emphasized the point that with the finger the difference between sound and unsound tissue could be felt. The speaker believed that he had seen irreparable damage done in two cases with the sharp curette and thought it was frequently an instrument of danger rather than relief. He once saw a gynecologic specialist curetting after an abortion, talking as he worked and showing how easily it was done, but the case resulted disastrously. Dr. L. E. Newman said that the use of quinin is generally indicated in these cases, say ten grains every five hours. He believed that it did more good than either the curette or the douche, except in cases of retained secundines. The more or less continuous use of the ice bag to the hypogastrium is also of undoubted benefit. He had never found reason to resort to the intrauterine douche as often as had been recommended by some; in most cases its use every twelve hours is all that is necessary, although Garrigues recommended it as often as every six hours until the symptoms were under control. Under no circumstances should even the most intelligent nurse be entrusted with this important procedure. After the use of the sharp curette he believed in the application of pure carbolic acid. Dr. W. H. Ford said that his previous remarks had reference to certain cases only. He used the dull curette only; it would suffice. But in puerperal endometritis what is the condition? An incrustation of the uterine walls. Mere washing will not relieve; it is only superficial. Here the use of peroxid is indicated. Douches should be used by the physician, and the frequency of application depends upon the gravity of the case. He could not understand that general treatment is paramount to local treatment. The source of infection should be rendered as inocuous as possible. The peroxid, as is well known, penetrates the tissues and is the mortal foe of pus and infected secretions. There can not be any possible danger in its use if the cervix is patulous, as it always is, and must be in these cases, as the muscular element of the uterine is everywhere relaxed. It should be used, like the washings, only in the form of spray, from a regurgitant, or spraying syringe nozzle, invariably worked by hand. Dr. W. A. McCandless said an important point is the common site of infection, namely the placental site. Dr. Hall had called attention to the lacerated perineum and the stellate laceration of the cervix. The speaker asked how many repaired the cervix after delivery? How many do not have slight lacerations of the cervix? How many repairs of the cervix are necessary? He thought it rarely the site of infection and hazardous to sew it up at the time of confinement. Dr. F. C. Ameiss believed that there is a place for the sharp curette in these cases. Generally the finger or dull curette and douche will suffice to remove the offending material, but at times, specially in a case lasting two or three weeks or even longer, the use of the sharp curette followed by an application of carbolic acid, or Battey's solution may prove effective. Dr. Willis Hall did not agree to the use of peroxide of hydrogen in the uterus or in any cavity not having free drainage. It tends to force septic material into the tubes and sinuses. As to the sharp curette there are cases where he would not hesitate to use it, but he would use it gently. The first requisite is to know that the uterus is empty and the best instrument is the finger. In that case, however, the uterus being perhaps eight inches deep, he was obliged to use the dull curette, but no membrane was found, as stated. Condemnation of the uterine douche he did not agree to; he had used it with good result in six or eight cases, although in many, only one douche was necessary. These infections, he believed, might occur in lacerations and in this case he thought it began at the cervix. The midwife began douching twice daily after confinement. Dr. Nelson said that a month ago he delivered a woman of a male child and next day discovered that there was almost complete Absence of the Prepuce as if a perfect circumcision had been done. The mother and father were not Hebrews, else heredity might have been thought of. Dr. B. M. Hypes inquired if there might possibly have been a prenatal maternal impression. Dr. W. H. Ford had recently an interesting case of Melena in a new-born child. The child, which was a female, was born with the cord twice around the neck, and on the third day had two bloody stools. He was inclined to think that the obstruction to the circulation through the liver, due to the tension of the cord during labor, which was difficult and prolonged, was the cause of the hemorrhage. Under astringents the child recovered. In Wisconsin the compulsory vaccination bill has been vetoed by the Governor. A commission has been appointed by the Minnesota Legislature to report upon the advisability of establishing a state sanatarium for consumptives. The Pennsylvania Hospital recently celebrated its one hundred and fiftieth anniversary. The petition for the founding of the hospital was written by Benjamin Franklin, and presented to the assembly of the province of Pennsylvania, January 23, 1751. It is now one of the best equipped institutions in the world. The recently enacted Wood medical law of Indiana has had one of its provisions indirectly upheld by a circuit court decision. The suit instituted was to compel obedience of an irregular, who claimed the unconstitutionality of the law as applied to the exclusion of clairvoyants, faith-healers, Christian scientists, etc., and asked for a dismissal under that claim. The court, however, refused to dismiss on such ground, thereby sustaining the right of the law to compel equal examinations for all desiring to engage in healing the sick. Following is the program of the St. Louis Medical Society of Missouri, Saturday evening, June 15, 1901. "Comparative Treatments of Typhoid Fever," by Dr. W. G. Moore. Current Medical Literature. DERMATOLOGY AND GENITO - URINARY DIS EASES. Orchitis and Epididymitis in Typhoid Fever.* F. P. Kinnicutt, New York, reports two cases of this rare complication or sequel of typhoid fever, which occurred in his own practice, and briefly refers to fifty-three cases of testicular inflammation occurring in the course, or during the convalescence of typhoid fever, which comprise the literature of the subject. A study of these cases, the author believes, justifies the following conclusions: 1. Epididymitis or orchitis occurring in the course or during the convalescence of typhoid fever is a rare lesion and is of typhoidal origin. 2. Only very exceptionally is it due to secondary microbic infection. 3. It develops at a late period in the disease or during convalescence. 4. The lesion, although as a rule unilateral, may be bilateral; and involves either the epididymis or testicle or both, and not infrequently the cord. 5. Effusion into the tunica vaginalis is rare. 6. Termination most often is by resolution. 7. Suppuration occurs in 25 per cent of all cases. 8. Localized necrosis and extrusion of testicular tissue is not uncommon. 9. Exceptionally there is destruction of the entire testicular structures. 10. Atrophy of the testicle occurs, but is a rare sequence. 11. The lesion gives rise to little constitutional disturbance. 12. Death as a direct result of the lesion has not been noted. The Pathology of Alopecia.† Buschke, following up the observation of Giovanni that patients to whom he was administering acetate of thallium became affected with alopecia, has studied the effect of small doses of this drug on mice given in their food. The result of its administration was that the hair came out on different parts of the body. This effect was not due to any appreciable local action of the drug on the skin, but in Buschke's opinion to certain disturbances affecting the peripheral nervous system of a trophic nature. DISEASES OF CHILDREN. Serous Vaccinia in Connection with Cretinism and Rickets. Į R. Kirk, Glasgow, reports four cases where a serous vaccinia resulted in untoward sequelae at a more or less recent period. In three cases *N. Y. Med. Rec., May 25, 1901. the result was myxedema or cretinism depending on the age. The fourth patient, at the age of six years, was affected with spasmodic asthma. New Sign of Mumps.* Tresilian mentions the fact that it is difficult in children to discover the opening of Stenson's duct, whereas in several cases of mumps under his observation it was plainly visible as a bright red papilla. EYE, EAR, NOSE AND THROAT. Nasal Conditions Observed in the Aged.† B. Douglass, New York, has noted in his experience that very few people over fifty years of age seek advice for the relief of nasal troubies, while the majority of patients who seek advice, either at the hospital or in private practice, are between the ages of sixteen and forty years. In old age, with its decreasing vitality, the greater liability to disease is not diminished and we should expect the aged to complain of the effects and symptoms of nasal and pharyngeal affections. The reason for the fact that so few old people seek relief from such conditions, the author believes, must be that, although the lesions are present, they do not cause the symptoms that they give rise to earlier in life. Five cases are cited in which distinct and even marked changes are found upon examination, in none of which did the patient complain of any symptoms. It is also shown that symptoms of discharge, pain, or obstruction, are not in proportion to the amount of lesion present, but in certain cases may be entirely absent in the presence of well-developed lesions; that chronic. congestive interference with circulation, lymphatic obstruction, and neurotic temperament, are very important elements in nasal cases, and that the cure of the patients who suffer from nasal symptoms often will not result from mere mechanical removal of the lesion present in the nose. The author believes that some of these cases may be explained on the ground that the changes occur so gradually and yet so constantly that the lesions in the nose may be present from internal blood or lymphatic irritation, while active inflammatory symptoms, such as obstruction from paralysis of blood vessels, discharge, and pain, may be entirely absent. Recurrent Oculomotor Paralysis: Report of a Case, With Remarks.‡ W. M. Leszynsky, New York. The patient, a woman 29 years old, began to have attacks of *Brit. Med. Jour., April 13, 1901. †N. Y. Med. Jour., May 25, 1901. IN. Y. Med. Rec., May 25, 1901. headache confined to the right temporal and supraorbital regions, invariably accompanied by vomiting, when six years old. The attacks occurred every five or six weeks. At her twelfth year, the customary paroxysm was associated with ptosis of the right eye, from which she recovered in two weeks. The migraine continued. to recur every five or six weeks. The second attack of oculomotor paralysis took place in her nineteenth year, with the usual pain and vomiting. Complete recovery of motility ensued at the end of a few months, and she remained well save the attacks of migraine. The third attack occurred in her twenty-second year, from which complete recovery ensued in about one year. The fourth attack came in her twentyseventh year, and lasted three weeks. The fifth attack was the one from which she was suffering when first seen by the author, and was accompanied with headache, vomiting, drooping of the right upper lid, paralysis of the superior rectus, and paresis of the inferior and internal recti. There was no diplopia as she suppressed the image in the right eye. The visual fields and ocular fundi are normal. The cardinal symptoms of this condition are, the unilateral character of the headache, the limitation of the ocular paralysis to one side, the pain and paralysis being on the same side, the involvement of the same nerve in all attacks, the frequent involvement of all branches of the nerve, and the intervals of complete freedom. In many of the reported cases the patients have ultimately made a complete recovery, both from the attacks of migraine and the accompanying thirdnerve affection. But the outcome is not always so fortunate, for in other cases the paralysis. gradually increases during the intervals and ultimately becomes permanent, thus excluding the admissibility of the vague terms "reflex" and "hysterical" in the description of the etiology. HYGIENE AND BACTERIOLOGY. Investigations in Rheumatic Fever.* A. Paine, London, has continued his investigations upon rheumatic fever and states that he has demonstrated the diplococcus in three rheumatic nodules taken from two cases of rheumatic fever. He has isolated the diplococcus from the nodule in one instance in pure culture. Intravenous injection of this culture has produced valvulitis pericarditis and polyarthritis in a rabbit. He has isolated the diplococcus from *Lancet, May 4, 1901. the joint exudate of this rabbit, and the nodule is looked upon as a highly characteristic manifestation of rheumatic fever, and therefore this diplococcus is most probably the cause of rheumatic fever. A case is recorded of choreoid movement, following the inoculation of a rabbit, in which the diplococci were found in the piamater and the endothelial cells of the blood capillaries dipping into the motor cortex from the surface. The diplococci undoubtedly circulate in the blood stream, and have been found in the polymorphonuclear leucocytes. The Toxin of the Colon Bacillus.* V. C. Vaughan, Ann Arbor, has shown previously that the colon bacillus is present in practically all samples of American green cheese, and that cultures of this germ may be boiled without destroying its toxicity. Recently he has experimented further with growths in Roux flasks and arrives at the following conclusions: The toxin is contained within the germ cell from which it does not, at least, under ordinary conditions, diffuse into the germ medium. The toxin is not extracted from the cell by either alcohol or ether, nor by dilute alkalies. The germsubstance may be heated to a high temperature with water without destruction of the toxin. Boiling with two-tenths per cent H C has but little if any effect upon either cell or toxin. The toxin as separated from the cell-wall by digestion with H Cl and pepsin is markedly active. INTERNAL MEDICINE. Significance of the Stomach Splash.† Splashing in the stomach has often been given as a sign of atony or dilatation. Hans Elsner has tested the meaning of the symptom amongst J. Boas's patients, and finds that for diagnostic purposes its value is very limited. In fact, in cases of gastroptosis, and therefore especially often in women, splashing is of no diagnostic importance at all; it may occur in any condition of gastroptosis, even when the patient is fasting. Stomach splashing can only point out gastric atony when there is no gastroptosis, and when it occurs seven hours after a test meal or when the patient is fasting; even in these cases, as a symptom, it is only a poor substitute for the results of examination by emptying the stomach with a tube. *Am. Medicine, May 18, 1901. NERVOUS AND MENTAL DISEASES. The Teaching of Insanity in Relation to Its Prevention.* R. Jones, Claybury, discusses and urges the importance of the teaching of insanity to the medical student and general practitioner in relation to the prevention of insanity. Especially in its earlier stages, is it important that insanity be recognized, as then a large amount of crime could be prevented and many patients cured. PATHOLOGY. Cytodiagnosis of Ovarian Cyst and Tuberculous Peritonitist. Tuffier and Milian claim that in the ascitic form of tubercular peritonitis, the fluid contains lymphocytes. Fluid from ovarian cysts contains a multitude of different cells, the most characteristic of which are large, oval, or round cells, filled with vacuoles, and cylindrical cells having at one pole a tuft of vibratile cilia; the latter are not constant. Direct examination without coloring is best. Pathology and Diseases of the Thyroid Gland.‡ W. Edmonds reviews the present status of our knowledge of the thyroid gland, as derived from the results of experiments conducted on the lower animals. The animals, as a rule, died on total excision of the gland, but when the parathyroid glands were left, there were cases of recovery. The symptoms, forty-eight hours after the operation are fibrillary twitching followed in a day or two, by general convulsions, rapid respiration, slight temperature. attacks last for an hour or two, then pass away, and the animal seems normal again, or slightly listless. After day or two an attack returns, the animal dying about the fifth day. When only one lobe is removed, the other hypertrophies. These The Recent Buffalo Investigations Regarding the Nature of Cancer.§ Roswell Park, Buffalo, believes that the nature of cancer can be solved only by a combination of ante and post-mortem studies. The parasites of cancer, be their nature what it may, are in all probability polymorphic in extreme degree and masquerade under many forms, changing with their different stages of reproduction. So much of the personal equation enters into their consideration and investigation that one must know an individual and his meth *Lancet, May 11, 1901. +Le Progres Med., April 27, 1901. Lancet, May 11, 1901. §N. Y. Med. Rec., May 18, 1901. ods before one knows exactly what estimate to place upon his work and the weight to be attached to his views. The writer believes that it may, and probably will be found that cancer is not a question of any single organism, possibly not even of a single class. The work as recently reported by Dr. Gaylord is briefly epitomized. The opinion is advanced that carcinoma as a type of disease is, in every instance, an example of epithelial infection. Without infected. epithelium we have no cancer cells nor cancer formation. Sarcoma, on the other hand, is an infection of connective tissue, probably by the same organisms, the tissue cells reacting somewhat differently. It would seem that different forms of parasite have specific tendencies in one direction or the other; but it will take years of minute and careful study to show which kind of parasite prefers one or the other of these tissue cells. The Chemistry of Nerve Degeneration.* Mott and Halliburton made a series of observations upon cats and found that choline is present in the blood in inverse ratio to the functioning of the nerve. The tests were chemical and physiological. The cats were killed at intervals of 1 to 106 days, and the nerves (sciatic) were found practically normal as long as irritable, then showed a progressive increase in the percentage of water and decrease in the percentage of phosphorus until degeneration is complete. When regeneration occurs the nerves return approximately to their former chemical constitution. SURGERY. Strangulated Hernia.† Walter Lathrop, Hazleton, Pa., says that in the treatment of this condition we have two things before us: First, to return the contents of the sac to the abdomen by what is known as taxis, and second, to do the operation of herniotomy. It is wise before doing either of these things to try the effect of rest, opiates (hypodermically), and cold applications. In very large hernias, or in old persons, hot applications are best. Always keep the thighs flexed and the pelvis elevated. This not availing, taxis may next be tried. Personally, the writer believes taxis, and second, to do the operation of hernioshould not be longer than from three to five minutes. It is all right for emergencies, or when operation is refused or cannot be done for *Lancet, April 13, 1901. †Phila. Med. Jour., May 4, 1901. |