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in the a know human was

by Christianity was not that of Christ's re. and ignorance, that, therefore, God had sent ligion, but was taken backward.

had only begotten Son to teach me how they In the problem of immortality there was should live in order to inherit the kingdom the question of future fact of what is to be, of heaven. What, then, was my amazement as Tennyson voicing the common sense of the to find that centuries before Christ, pbilosn. race states, Does our individuality endure? phers had lived in Greece who taught all that And there was the question of fact of what seemed to me most admirable and most needed is : Do we share in an eternal life, and does for the spiritual salvation of mankind in the the connection become a matter of experi. Christian religion. Where, I asked was the ence? If man is a reproduction or differen- need of God to incarnate in human form in tiation of the eternal mind, and so partaker order to reveal truths, a knowledge of which of an eternal life, it does not follow that re. already existed in the world. I found little or garded as an individual spirit, he is eternal. nothing in the ethical teaching of Jesus su. And if this metaphysical tie is what gives perior to what one might find in the pbiloso. absolute value to human life the tbing of ab- phy of Plato, and I might also add of Epicsolute value might remain, while individual tetus and Marcus Aurelius. I may bave been spirits were extinguished, provided the race wrong-probably I was—but at any rate the continued.

discovery of tbis fact, if fact it was, first The mystery of tbis unfathomable universe shook the foundations of my belief. is one that the plummet of our thought will My religious convictions received their never sound. But at least we can avoid, and second shock when I read Darwin's epochas an intellectual duty we are bound to avoid, making "Origin of Species.” Here we had plain and palpable self-contradictions. We the cosmology and biology of the Old Testacannot assert in the same breath the reality ment absolutely subverted. My belief did, of evil and the fact of creation by an omni. however, in an enfeebled form survive that potent, omniscient and benevolent being. shock. It was possible to argue that those

Neither Greek philosophy nor Persian re parts of the Bible, which were inconsistent ligion were subject to a like embarrassment with modern science were allegorical, or in with our theology. The one assigned evil to the termination of the Swedenborgians, an active principle, the one to the intractable "written according to the law of correspondnature of matter, tthe other to a malignant ences.” spirit.

But this kind of quibbling of tortuous and Our theology says: “God is all,”: “God is sophistical attempts at reconciliation became, good,” therefore "all is good,” or in other as time went on, more and more repugnant words, there is no evil. Our Christian theism to my sense of intelleotual honesty. If must deny one of the premises. Must we Christ was omniscient why did he not correct deny that God is good? Yet we can worship the popular ideas in respeot of these things? a being partly evil. Or, we must deny that Soon after this I was introduced to the God is all. This means that we must give study of Hindu and Buddhist philosopby. up, making religion into a theory of the uni. This, however, did not effect further subverse and regard it as a passion of the heart. version of my belief in Christian religion.

Now for the conscience to condemn God, Quite the contrary, whatever there was of is & peril to religion, and not to condemn beauty and truth in the Christian religion, God is a peril to morality. Is it the God of appeared to me, in full blaze, to be but an Nature revealed to us by science, or the God imperfeot reflection of that light, the primal whom our heart reveals to us?

source of all the great religions. This theory We must choose between these. And yet of a common origin solved the puzzled para. how one sided and untrue to faot, says St. lellisms found in so many great religions, George Stook, if addressed to tbe God of even incidents and circumstances in the lives Nature. For to nature belongs the ugly of the founders. The ethical teachings of equally with the beautiful, the awful and sin some of the philosophies embraced the highister as well as the benign; the bowling est conceptions of the Christain religion, or wastes of blackness as well as the sunlit went even beyond them in the sublimity of pastures.

its ideals, and even included in its benevo. Dr. Jethro Brown in his Passing of Con. lence not only the human race, but all that viction, says “I well remember how when I lives, and appeared better adapted to the was a boy of about seventeen, and a devout practical needs of our daily life. ardent Christian, my faith sustained its first Take for instance what may be called the shook from a study of Greek philosophy. I pivotal doctrine of Christianity, the Divinbad always been given to understand that be ity of Christ. Well, the idea of a divine in. fore the advent of Jesus Christ the world was carnation or Avatar, has probably been famil. sunk in the lowest depths of wiokedness, iar to the Hindu mind for several thousand years. In the Bhagavad Gita, Krishna ning, swift, murderous, silent, implacable claims to be the supreme being, to know all foe We have put our hands into a hos of things, to have created all things, to be im- snakes; while Roosevelt by his pro-English manent in all tbings. Further, he declares course during the Japano-Russian war, of. that it is by a knowledge of him that salva. fended Russia by bis insistence on peace, he, tion is attained. “They verily who worship now, has offended Japan. Practically the me, with devotion, they are in me, and I in United States sits down between two stools, them," says Krishna.

by the Rooseveltian “statesmanship.” The idea of the sacrifice of a divine buman person "himself to himself," at about the time of the vernal equinox, for the redemp

CLEAN STREET CARS.—Topeka's board of

health requires that the street railway coution of the sins of the people was no new one.

pany of tbat city shall fumigate its cars at Before the light of modern science the gloomy theology of the “Fall” has vanished,

least once a month. and a cloud has been lifted from men's “MEDICAL OFFICES" CLOSED.-Fifty-two minds.

illegal “medioal offices” in New York and When pulpits are occupied by men whose Brooklyn have recently been closed by the reading has been wide and catholio, when post-office authorities. their minds are no longer invincibly biased

LUPULIN.—T. F. Reilly, New York (Jour. by their education; when their career and A. M. A.. April 7). states that he finds lupu. their very livelihood no longer depend upon

lin a valuable mild anodyne and hypnotio the acceptance of certain antiquated beliefs, and often an excellent substitute for more ac. then, and not till then, shall we find our tive drugs of this class. He believes it will churches better attended for the inculcation

be an excellent and safe substitute for the

; of natural morals, by the more reflecting and

coal-tar preparations in cases in wbich the better informed members of the laity.”

latter have been employed. In neurotic and

high-strung people, who do not require an Great wars seem to be in preparation.

opiate, but are very liable to cultivate a drug Within my copy of Haeckel's "Insulinde" I

habit, for non-organic pains, aches and in. found a four-page illustrated notice of a book

somnia, it is admirably adapted. For child. by Dr. Alex. Pfluger, privat docent at the

ren it is often a good substitute for opium, University of Bonn, telling of his travels in

as also for old people suffering from ad. the South Pacific Ocean. I translate the

vanced renal disease, and it is of especial following:

value for sleeplessness and nervousness fol. The future of Germany lies upon the loa

lowing a mild debauch. water; the Germans must spread out more, and get the air of foreign zones in their TURBINECTOMY. - E. Harrison Griffin noses. To make the Kaiser's word practica. (Med. Rec., April 14, 1906) does not believe ble has been the leading thought of Pfluger in complete turbinectomy. He declares that in bis travels and in the preparation of the only so much of the bone should be removed book. I believe another war is not far away, as is necessary to restore the normal canal Yes, for it looks like a hara-kiri of the flagship and to give back to nature the proper funcof thọ Japanese navy, the Mikasa that would tion of the nose. A partial turbinectomy is be the natural answer of the naval officers to not nearly so easy to perform as a complete their Emperor's polioy. They would not ex- operation. The great objection to the latter press their disapproval openly. The army is is that it makes the passage too large and re. yet to be heard from. Even if they thought moves something, which belong there, and their Emperor had done wrong they would which has a function to perform. Partial not revolt against his holy authority; but turbinectomy restores the normal anatomy. would turn their enmity towards England The writer has observed many cases of deaf. and America, and the Japanese advisers about ness in which the restoraton of the nasal passhim, who had wronged (or misled) their holy age has brought back hearing. Hemoravatar. They would protect their emperor rhages should be guarded against both before against such advice. Strange people! Malay and after this operation. Nasal examination and Negro-Britain may regret the alliance. sometimes suggests the existence of Bright's Nobody can forejudge the East with any sat disease. The local use of cocaine has made isfaction. An American lawyer, who returned the operation of turbinectomy perfectly pain. a few days ago from the Philippines where he less. Re-established nasal breathing results is established as member of the bar, says: in a better supply of oxygen and consequent “Chief Ali is organizing a rebellion against improved nutrition. The writer has operated the United States." He makes it plain that upon over ten thousand cases, and always our white troops are “up against" a cun- with gratifying results.

The Medical Society of City Hospital Alumni

President, LOUIS H. BEHRENS, 3742 Olive Street Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
Vice-Pres., WALTER C. G. KIRCHNER, City Hospital Treasurer, JULES M. BRADY, 1467 Union Avenue

CHAIRMEN OF STANDING COMMITTEES :

Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive. A. Ravold, Century Building

Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.

Public Health, R. B. H. Gradwohl, 522 Washington Ave.

OFFICIAL TRANSACTIONS.

REPORT OF A CASE OF MEGALOGASTRIA* teroptosis I inflated the patient's stomach.

The stomach was found to be not sunken, but WM. RUSH, M. D.

greatly enlarged. The percussion figure

measured 20 cm. in beight in the median line, ST. LOUIS.

and 21 om. in width midway between the um. In September of the past year there came bilicus and the ensiform cartilage. The nor. to the Wasbington University Clinio a patient mal dimensions of the percussion figure for 74 years of age, a widow, complaining of pal. woman is about 10 cm. height and 18 om. pitation of the beart. The woman was of width. German descent, a native of Pennsylvania, The patient was put upon 6 gr. daily of of long lived parents, free from all diseases sod, nitrite. On her return one week later of hereditary significance. As a girl and the palpitation bad entirely ceased and the young adult she had done much hard work in blood pressure had fallen to 155 mm the field. She had had no infectious diseases The evening before the patient's second except measles, pertussis and influenza. Men. visit she ate her customary dinner between 6 struation began at 14, was fairly regular. and 7 o’olock, and the following morning Was married at 23, tbree normal labors, no at 6 she ate a light breakfast of coffee, rolls miscarriage, menopause without notable in and one egg. At 11 a.m. the stomach tube cident.

was introduced, and patient received tbrough The trouble of which the patient com. the tube, without distress, 3000 cc. of luke. plained, a somewhat annoying consciousness warm water. This water was discharged en. of the beating of the heart, had existed for tirely free from food remnants of either the about a year, without, however, causing any evening or morning meal. The stomach was serious inconvenience. The patient ate well, again inflated, and the area of tympany found had no discomfort connected with the taking exaotly what it was before, 20 by 21 cm., exof food, bowels regular without laxatives, tending from near the ensiform cartilage slept well, only moderately nervous.

snugly down into the left iliac region and to Patient was small of stature, but erect, ac- the symphysis pubis. tive and unusually well preserved for one of The patient repeated tbat she ate every. her years. Lungs normal. Apex beat in thing she liked, and that she had no sort of fifth interspace in the mammary line, im.

digestive disturbance. From the size of the pulse rather forcible. Cardiac dullness from

percussion figure of this stomach, and from the midsternal line to the mammary line; no the amount of water that it will contain heart murmur; first heart sound at the apex without distress to the patient it is olear that distinctly divided. Liver dullness at seventh its capacity is far greater than that of the rib, edge of liver palpable, normal in consist.

pormal organ. Furthermore, from the ab. ence, two cm. below costal margin on deep sence of all subjective symptoms of digestive inspiration. Lower half of right kidney pal. disturbance, as well as the absence of the pable on deep inspiration, left kidney and objective signs of motor insufficiency, we spleen not palpable. No abdominal tender must conclude that this is not a dilated or ness, and further than mentioned above no atonic stomach, but that it is a physiologi. abnormal resistance.

cally or naturally enlarged organ that is Uripe: twenty-four hours amount 750 cc., properly performing all its functions a con. specifio gravity 1018, pale, acid, trace albu. dition known as megastria, or more generally min, no sugar, many hyaline casts.

I believe as megalogastria. Pulse regular, 80 per mm., radial artery not palpable. Blood pressure (Riva-Rocoi), 195

DISCUSSION. mm.

Dr. A. E. Taussig had seen this patient a Suspecting a possible gastroptosis or en- number of times with Dr. Rush. The oase * Read at the meeting of February 1, 1906.

presented the three cardinal features of a

megalog astria: (1) the enormous stomach, largement of any of the other organs noted. (2) the lack of any gastrio disturbance so far Of course it was impossible to say anything as the patient was concerned, and (3) the about the size of the intestine. This was not ability on the part of the stomach to empty a dilated stomach, it was simply enlarged. He itself as well as the normal stomach. The did not like the term physiologio enlargement. physician's interest in this stomach might Naturally enlarged” better described these be termed a purely platonic one. The pa- cases, where the stomach was simply large, not tient was not sick, she had called upon the dilated or atonic. As to the possibility of doctor on account of a cardiac disturbance. this being a case of vertical stomach, the lat. There was no way of determining how fre- eral boundaries of the percussion figure es. quent such cases might be, but they must cluded that. It was 21 cm. in width, this often be overlooked for the reason that the measurement being taken midway between patient did not draw attention to the stoniach. the ensiform cartilage and the umbilious. The etiology was not clear. It was probably This woman weighed less than 100 pounds. a congenital abnormality, the patient being In reply to Dr. Taussig's question Dr. Rush born with the enlarged stomach. How such stated that by the use of the elastio tube re. a stomach was able to dispose of its contents ferred to one could determine the lower border without any difficulty was an interesting ques. of the stomach, but not its capacity. The tion.

boundaries of the stomach could be deterDr. William S. Deutsch asked if at the

mined with just as great accuracy by same time any of the other organs were en.

air and water percussion as by the larged.

means referred to. There was much varia

tion in the reports as to the amount of Dr. Lippe thought it quite as commendable

water the stomach would hold. Ewald stated of the patient as of the doctor to overlook that 1600 co., (or from 250 oc. to 1680 co.) this condition of the stomaoh.

was probably a fair estimate. Others had Dr. Charles Sbattinger wanted to know the

given an estimate as high as 5500 cc. It latural boundaries as shown by the peroussion

would seem about as impossible that the norfigures. The question was whether the long

mal stomach would hold so large an amount measurement (from the ensiform cartilage

as it did that any normal stomach would down to the symphysis) could possibly bave

bold but 205 co. One author had given 2500 been due to vertical position of the stomach

co. in case of a very large man (height 7 feet) rather than increase of size.

as abnormally large. Recently Dr. Rush had

filled the stomach of a patient with water, Dr. Horace Soper said that the case was and found that he could introduce but 1200 interesting inasmuch as there was often de. co. witbout discomfort. A dilated stomach scribed a condition of dilatation of the stom. with the same boundaries as the one consid. ach in pathological conditions, but this case ered this evening held 2500 0.c. of water, was rare. It was bard to understand how though this patient was a man 6 feet in such a stomach in that position could emp height. The charaoteristio feature of the ty itself as this stomach evidently did. In dilated stomach is not its size, but its motor connection with the physiological enlarge power, which is always impaired. ment of the stomach there was evidently a compensatory hypertrophy. Dr. F. J. Taussig, in this connection, men

PRESENTATION OF SPECIMENS. tioned Dr. Myer's method of estimating the size of the stomach by taking an X-ray pho.

FRANCIS REDER, M. D. tograph of the stomach after introducing into

ST. LOUIS. the stomach a rubber tube containing a metallio center, and he wanted to know if RESECTION OF RUPTURED BOWEL. this was not a more accurate means than

The first one of these cases required imthe percussion method. He wished to know,

mediate abdominal section. It was a case too, just how accurate were the peroussion

where the history was totally obscure. This results compared with the findings at post

man sustained a compound fracture of the mortem.

lower left femur about 4 o'clock one afterDr. Rush, in closing, said, in regard to the noon. He was taken to the hospital where size of the other organs, that this woman's bis condition became alarming. His pulse cardiac hypertrophy had no connection with steadily increased and his temperature lowthe enlargement of the stomaob. The liver ered. When I saw him twenty-six hours might possibly have been slightly enlarged, after the accident, the pulse was 132, temperbut if so, very slightly. There was no en. ature 99 degs. He had a pulse of 98, tem per

diabetic had ouble for the great aches

ature of 102 deg, a few hours after the acci. next day it pained her very much. She dent. I found the abdomen tympanitic, there bad a normal pulse and temperature, and was much pain in the right hypochondriao slept fairly well. Examination revealed pus region, his face was searching in expression, in phalangeal action of this toe. I found there was an anxious look, with pinched feat. sugar in the urine. The operation was done ures. Upon being asked if anything had under local anesthesia. She did not feel struok him upon the abdomen he at first the insertion of the needle, and though I failed to recall any such experience, then said used but very little cocaine she experienced that a clod of earth had struck him on the no pain in the ablation of the toe. A great lower rib and glanced off, that it did not deal of pus bas penetrated into the joint and amount to anything. It required an hour and collected underneath the tissue. I have put a half to convince those interested in the pa. ber on biohloride of mercury, which I have tient that a serious condition existed in the found beneficial in some cases of diabetes abdomen and to get their consent to an oper. mellitus. The end of the toe is gangrenous. ation. When section was made, not knowing I have seen two deaths as a result of infec. just what the condition was, or the exact loca. tion following the paring of corns. What tion, I entered at the median line. The the result will be in this case I am not yet rigidity of the abdominal muscles was not re- able to state. From the amount of sugar lieved by the firm and constant pressure of in the urine the prognosis is an unfavorable the hand; no vomiting. I had no difficulty one. The patient is 70 years old. in locating the injury after abdominal sec. tion. It was near the ileocecal junotion and

DISCUSSION. proved to be a torn mesentery and a ruptured Dr. Norvelle Wallace Sharpe did not think bowel. I resected eighteen inches of the any one was in a position to criticise the wisbowel. The abdomen was full of blood. dom of this amputation. He had at this Blood was removed by dry mopping-drain time a diabetio case that was bothering him. was introduced. This is a gangrenous con- A gentleman had called upon him for an dition that took place eighteen or twenty opinion upon a trouble with his foot. He hours after the injury. The man lived five had an infected foot. The great toe of the days and then died, I presume, of a septic right foot had two ulcerated patches and peritonitis. I was surprised after noting the brawny induration running well up to the condition of the peritoneum that he did live ankle joint. Dr. Sharpe knew something of five days. The tear is along the mesenteric this gentleman's history. About eighteen attaohment of the ileum.

months before this, he had been told, that

"he was threatened with a diabetic gangrene GALL BLADDER WITH GALL STONE IN CYSTIC

of the foot,” and since that time he had had DUCT.

an infected foot with which he had been The other case is a gall bladder removed walking, and upon which no intelligent care from a woman who had been ill ten years. had been bestowed. The urine showed conShe was very much emaciated, with a com- siderable sugar, abundance of albumin, hya. plexion like parcbment, the skin seeming at. line and granular casts. It was remarkable tached to the bone, there being no fatty tis. that a man with so marked a type of diabetes sue. She said she had at times been very bad been able to carry an infected foot for sick and was readily exhausted after doing a that length of time without serious conse. little work about the house. The liver was quences. Dr. Sharpe had advised him to have in a normal state as to size, but markedly the foot thoroughly cleaned, as it was a men. greyish in color. This stone occupied all of ace to him, and while assuring him that any the gall bladder and extended into the oystic operative procedure was fraught with danger, duot, pressing upon the common duct, it his actual peril was greater with the septic caused permanent jaundice. I kept her in foot than with the operation. The toe nail the hospital for general observation. Her was removed and at the base of it the tissues condition changed rapidly. Her cheeks took looked gangrenuus. Within forty-eight hours on color, she called for food and the bowels a true gangrene supervened. This was main. began to move without aid. She was brought tained in the dry form. The dry gangrene in on a stretcher and was able to walk out finally merged into the moist, but it did not four weeks later.

spread rapidly. After seven weeks the

phalanx terminal had to be removed, and GANGRENOUS TOE.

there was a fair quantity of pus. Dr.Sharpe The third specimen is the little toe that I then deemed it necessary to remove the proxremoved today. The woman last week went imal phalanx, (the patient had persistently dowu town and her toe began to ache. She refused high amputation, saying that below pared it with a knife causing it to bleed. The the ankle anything might be done, but even

the

bad bee; and upon with whicim. he had had

dorable beer upon with that is botia told

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