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ist. The Health Department desires to know TRI-STATE MEDICAL SOCIETY OF Iowa, where each dose of antitoxin is used and to ILLINOIS AND MISSOURI.—This association prevent the possible use of it in patients will hold its fourteenth annual meeting in whose family can afford to purchase same. Galesburg, Ill., on June 26 and 27, under the

2d. Inasmuch as antitoxin is issued by the presidenoy of Dr. Wallace C, Abbott, of Health Department the responsibility of its ad- Chicago. The secretary, Dr. C. F. Wabrer, ministration must rest with the physicians of Ft. Madison, has prepared an excellent connected with the Health Department. program for the oscasion, comprising fifty

The antitoxin administered will be pur- eight papers, including the president's ad. chased from one of the best and most reliable dress. The other officers of tbe society are Eastern manufacturers, and a certificate will 88 follows: First vice-president, Dr. J. W. accompany it certifying to its purity and free. Hanna, Winfield, la.; second vice-president, dom from any contamination.

Dr. H. B. Young, Burlington, Ia., treasur. A history will be kept of each case, which er, Dr. Emory Lanphear, St Louis, Mo. will serve to prove the efficacy of this treatment as well as its value as a preventive MEETING OF INSURANCE EXAMINERS.—The among those children who are directly ex. seventeenth annual meeting of the American posed to cases of the disease.

Association of Life Insurance Examining Sur. Very truly yours,

geons will be held at Hotel Thorndike, Boston, H. J. SCHERCK,

Mass., Monday, June 4th, 1906. A most inChief Dispensary Physician. teresting program has been arranged and the

meeting will be one of exceptional interest ST. LOUIS, MO., May 15th, 1906.

from all points of view. Those going to the DR. H. J. SCHERCK,

meeting of the A.M.A. will do well to arrange Chief Dispensary Physician.

their itinerary to reach Boston in time for the Dear Sir:- In the annual appropriation for session of this Association. Following are the the fiscal year 1906-1907 there is a fund for officers for 1905-1906: . President-Henry the purchase of diphtheria antitoxin; in order Wells Dewey, Tacoma, Wash.; Vice-Presithat this fund may be used to the best advan- dent-William Moore, New York; Vice Presitage the following suggestions occur to me as dent-A. S. McDaniel, San Antonio, Texas; being of importance in the proper handling of Vice-President-M. A Robinson, Victor, Col.; this work:

Vice-President-William F. Amos, Portland, ist. To prepare a blank form in the nature Ore.; Resident Secy.–Mark N. Richardson, of a certificate to be signed by the attending Boston; Recording Secy-J. Carlisle DeVries, physician to the effect that he certifies on New York; Secy.-Treas.—John Guy Monihonor that the patient or his family is finan: cially unable to purchase antitoxin and is a fit subject for charity.

TRIP TO BOSTON.-A number of excursion 2d. Upon the receipt of this certificate you parties are being organized in the West to are to send a physician connected with your attend the meeting of the American Medical staff to the home of the patient to administer Association in Boston, June 5 to 8. The the antitoxin as often as it becomes neces general plan of the various parties is to sary.

charter special cars at principal points and 3d. That where the patient is surrounded join bands in Chicago on June 1st, where arby other children that an immunizing dose rangments have been perfected for a special shall be administered to those who have come train via the Grand Trunk Ry., to be known as in contact with the case.

the “Missouri Valley Special.” This train 4th. To prepare a blank history form, on will stop at Niagara Falls and Toronto, and which is to be recorded a personal and clinical from Kingston to Montreal, tbe trip down the history of the case and the various points St. Lawrence will be by boat, through the connected with it, together with a statement famous Thousand Islands. The Missouri of the result obtained from the treatment of Valley party will arrive in Boston morning the case, certified to by the physician of your of June 4 (one day ahead of the other delegastaff in attendance on the case. These his- tions) affording members an opportunity to tories to be kept properly filed and to serve as see Boston, attend the auxiliary meetings and a basis of statistics in order to demonstrate get located before the rush. Members desir. the advisability of continuing this work. ing to join this party at St. Louis should

The details of management and supervision communicate at once with Dr. T. A. Hopof this work to be under your direction.

kins, Century Building. Those who are lo. Very truly yours,

cated further west should make reservations (Signed) H. WHEELER BOND, through the secretary, Dr. Chas. Wood Fas

Health Commissioner. sett, St. Joseph, Mo..

INTERNAL MEDICINE.

tubules, and the latter even more than the

former. The result, therefore, favors the 0. E. LADEMANN, M. D.

theory of urinary secretion advanced by BowEhrlich's Diazo-Reaction in Pulmonary Tu.

man. 5. There is a general but not accurate berculosis.-Junker (Beitr. zur Klinik der

correspondence between urine outflow, kidney Tuberculosa, Bd. V, Heft 1, 1906) analyzed

volume, and blood pressure. The relation. the urine of two hunderd consumptives as

sbip between the first and second is closer often as eight to thirty-five times. A posi.

than the first and third. A state of almost tive reaction occurred in only the second and

complete suppression may coexist with a tbird stages of the disease. A negative re

comparatively high blood pressure. 6. In action does not warrant the conclusion of a

prolonged narcosis, with marked diminution favorable prognosis, while a continued diazo

of urine volume, there is a considerable exu.

dation into the renal tubules of leucooytes, is always significant of an evil omen, as may well be in ferred from the clinical character

which subsequently escape with the urine. istics in general. Junker often observed a

The condition is probably produced by more positive reaction occurring during the course

or less vascular stasis in the glomerular ves. of some intercurrent affection, as influenza,

sels. · 7. The excretion of chlorides is much intestinal' disturbances, etc.; thus it may be

increased both during and after chloroform said that transitory reactions are of no prog

narcosis. In the fourth period after removal

of the anesthetic the amount may be ten nostic significance. Consumptive individuals

times the normal quantity in the urine of the with a continued positive diazo-reaction apparently seemed to respond less favorably to

dog. 8. Albumin appears in a small propor. tuberculin therapy tban those otherwise in

tion of experiments after chloroform inhalaan advance stage.

tion. 9. Reducing substances other than

glucose are almost invariable increased. The Anesthetics and Renal Activity.—Thomp nature of the reducing substance bas not been son's (British Med.. Jour., March 17, 1906) definitely determined. results of an experimental investigation into

Belladonna Poisoning Due to Belladonna the effects of prolonged chloroform anesthesia are summarized as follows: 1. The volume

Plasters.- Doland (Am. Jour, of the Med. of urine secreted by the kidney is, as a rule,

Scs., April, 1906) reports tbree cases of bellaaffected during chloroform narcosis in two

donna intoxication following the application ways: In the early stages, when the anes.

of belladonna plasters. The symptoms in thesia is light, the quantity is frequently in.

each case were typical. In one case the toxic creased. During full anesthesia the secre

symptoms evidenced themselves two hours tion is always diminished, and may be sup

after the application of a small belladonna pressed. 2. The after affect is invariably a

plaster applied to the chest, while the sympgreat increase, which in certain periods may

toms in the other two cases did not appear reach to four times the normal volume for

until a few days after. the same period of time. The maximum Recurrent Motorocular Paralysis as a Comoutflow occurs about three hours after re- plication of Typhoid.—Jockmann (Deutsche moval of the anesthetic. 3. The total excre. med. Wochenschrift, No. 16, 1906) defines tion of nitrogen is, as a rule, greatly re periodical paralysis of the third nerve as a duced-more so than the quantity of urine. manifestation making its first appearance in The average taken from experiments with infancy or early life, limited to the motorocdiminished urine volume show that during ular associated with headache and vomiting, the anesthetic period the excretion of ni. and recurring at irregular intervals (Möbius). trogen fell to 18% of the normal, whereas He next discusses the theoretical aspects rethe quantity of urine in the same series fell garding the nature of the condition, and re. only to 35% of that amount. In the min. ports in detail an interesting case as follows: ority of the experiments with increased urine A young man, 19 years old, with a negative volume the total nitrogen per period was also family history. His first attack appearing increased, but to a much less extent than the at the age of eight years with beadache, vomvolume of urine in the same experiments. 4. iting and a paralysis of the left aculomotor The urine secreted during chloroform anes. nerve. During the ensuing years attacks of thesia is almost invariably more dilute (con. migraine occurred at frequent intervals, three tains less nitrogen per cent) than the normal of these attacks with a concomitant motor urine. This holds good even when the vol. ocular paralysis, the last occurring during an ume of urine is diminished, hence it is in- attack of typhoid fever. It is hardly probaferred that chloroform affeots not only the ble that the simultaneous occurrence of ty. blood flow through the glomerulus, but also phoid fever can be regarded as a mere cointhe secretion of nitrogenous solids into the cidence. It is more likely that the typhoid infection, in lowering the vitality, acted as Di-methyl-amido-azo-Benzol as an Indicator an exciting factor in a predisposed individ. for Free Hydrochloric Acid in Gastric Analysis. ual. The prolonged existence of the paraly. -Elmer (Jour. A. M. A., April 14, 1906) sis in this attack (three months) is strongly speaks of the sources of error observed in suggestive of the late presumption, while in using di-methyl-amido-azo-benzol as an inthe first attack the paralysis lasted eight dicator for the quantitative determination of days, and only four days in the second and free hydroobloric acid in the gastrio contents. tbird. The case in question presented all The principal difficulty with this indicator the characteristics of a periodic oculomotor is not in its lack of delicacy, but the fact that paralysis in the sense of Möbius; the at certain organic acids found in the gastrio tacks beginning in childhood and were of contents, when in proper concentratiou, will a longer duration than the ordinary attacks give the same color change as free hydroof migraine, a complete absence of visual chlorio acid. Of these, lactic acid is the only aura, nothing suggestive of anything bered one ocourring in sufficient amount to interitary, and a non-oocurience of migraine in fere with the reaction. Elmer proposes the the other members of the family. Some following remedy: The test meal is to be what out of the ordinary were the frequent practically free from lactio acid, and for this rudimentary attaoks without any püralysis, purpose one consisting of one sbredded the latter being in evidence but four times. wheat biscuit and 300 oc. of water, adminis. Noteworthy is the fact that the attaoks were tered after a fast of eight to twelve hours, limited to the left side, quite unlike ordin- and removed from three-fourths to one hour, ary migraine, which is apt to shift from meet all indications. Should lactic acid be one side to the other. Jockmann regards the present in the expressed gastric contents the occurrence of the paralysis in the first attack error may be practically eliminated by suffias a significant differentiating feature from ciently diluting the contents. By repeated the ordinary migraine, as those cases in which trials the author determined one part in fif. a motorooular paralysis followed hemicrania teen hundred the smallest amount of lactic did so only after severe and repeated attacks, acid that would respond to the di-methyland sometimes years after its existence. amido-azo-benzol test. The highest dilution

of lactic acid whioh would give a character. What Causes the Pylorus to Relax ?-Ben- istic Kelling reaction was in the proportion edict (N. Y. Med. Jour., April, 7, 1906) of one to twenty-two thousand, or approxi. offers the following summary as his objec. mately fifteen times the dilution required to tions to the acid theory of relaxation and give the di-methyl-amido-azo-benzol test. closure of the pylorus: 1. The local obanges in reaction are physiologically inevitable. 2. Attitude in Angina Pectoris.—Minervini The relative acidity of the chyme is not di. (Riforma Medica, Nos. 46 and 47, 1905) deminished by the passage outward of a small scribes nine cases of angina pectoris to illus. portion, yet the pylorus does not remain pa- trate the position assumed during an attack. tulous. 3. While this failure of a continu. This peculiar attitude consists in throwing ous relaxation of the pylorus may be ex- the head backwards and straightening the plained by distal acidity, it is in close anal. body, somewhat simulating the attitude of ogy with the action of other alimentary opisthotonus, the arms hang down, or one sphincters, which close without any exciting may be placed orer the region of the beart. reflex that can be ascribed to differences in Patients invariably seek such a position when clinical reaction. 4. Fully half the stomach an attack manifests itself, regardless of the contents normally escape before it is con- posture prior to the attack. If standing be ceivable that any great proportion of hydro- leans against a wall throwing his head backcbloric acid is present. 5. Clinical experi. wards, if possible; if seated he leans his head ences with dietaries shows that other things over the back of the chair. This attitude being equal, meats that call for considerable sign, as the author styles it, is an apparent bydrochloric acid secretion usually remain diagnostic index of stenocardia and is in diin the stomach longer than those which do rect contrast to asthma and kindred condinot. 6. Clinical experience with stomach tions, when the patient leans forward in order contents proves conclusively that deviation to have as free access to the air as possible. from the normal standard of hydrochloric Minervini regards this characteristic posture acid secretion produces just the opposite ef. as an instinctive act on part of the individ. fect to that which would be expected if ibis ual, who seemingly aims to get away from were the cause of pylorio relaxation. Even the heart. By means of the forced backward in acbylia gastrica, there is no necessary ab. flexion of the head tbe venous Aow in the normality of pyloric function, certainly not neck is hindered, and in consequence thereof in the direotion of retention.

there is an increased intracranial pressure with the affect of paralyzing the vasomotor nephritis and pyonepbrosis from the ordinary centers. This increased, beneficial pressure pus-producing infections, tumor and intermay be momentarily augmented by amyl mittent hydronephrosis. Each of these is nitrite or morpbin, thus terminating the at. noticed separately. The only positive evi. tack. Bodily extension likewise increases dence of renal tuberculosis is the finding of the blood pressure and the subsequent de- tbe tubercle bacillus in the urine or produccrease in the pulse rate, regulating the coron. ing the disease in animals by inoculation Ary blood supply, also aots favorably on tbe with the diseased urine or tissues. Other attack. The differential diagnosis between symptoms are all more o less unreliable. stenocardia and uremic dyspnea is readily The differential stain must always be em. identified by the posture; in the former, ployed in diagnosing tuberculosis from the fear, bodily immobility and retroversion pre. finding of acid fast bacilli in the urine, as vail, while in tbe latter, tbe patient is in & is shown by a case bere reported. It may state of agitation and retroversion, to any de. be impossible to diagnose pyelitis, pyelonegree, is always absent. In the respiratory phritis or pyonepbrosis from an infeoted forms of neuroses, antiversion of the body is nepbrolithiasis except by operation, nor is the rule. In attacks of laryngeal stenosis the it easy to differentiate between caloulus and patient suddenly assumes tho sitting posi. tumor, and here also the chief dependence tion, rusbes out of bed, tears away any inter. is on the urinary examination. A movable fering clotbing from the body and seeks sup kidney and kinking of the ureter may cause port to bold himself ereot.

altaoks closely simulating those of calculus, The Diagnostic Value of Leucocytes.

but the enlarged and movable kidney during Grünbaum (Practitioner, Deo., 1905) belieres

the attack and the relief of pain and increased that an accurate leucocyte count is a valu.

flow of urine on its return to normal size will able index in determining the presence of

aid the diagnosis. In this connection, Hunner pus in the body. A large increase in the

mentions the unaccountable renal bemor. polymorpbonuclear neutrophiles, together

rhages known as idiopathio hematuria or with a glycogen reaction, an increase in the

renal epistaxis, and says there is, he believes, blood-plates and in the fibrin of the

a tendency nowadays to conneot these with blood is strongly indicative of pus in

the chronic interstitial form of Bright's dis. the economy. When counts are made

ease. The diseases of neighboring organs at sbort intervals (every four hours) and the

noticed as having to the differentiated from leucocytes found to be on the increase the

calculus of the kidney are gallstones, appenassumption that the inflammation is extend.

dicitis, intestinal obstruction, pancreatio cal. ing is justifiable. A negative blood examin.

culus and Henocb's purpura and angio-neuation, on the other hand, does not warrant

rotic edema; oases are reported illustrating the exclusion of pus. A palpable gastrio

the difficulties sometimes encountered. The tumor of obscure nature with a pronounced

history of the case, examination of the urine, digestive leucocytosis is a strong evidence

eto., are generally the main dependence in against malignancy, pointing to an inflam.

the differentiation. Kelly's method, injecting matory trouble, although small cancers of

the kidney pelvis with a bland solution, is the stomach are frequently associated with

mentioned as one of the best diagnostic a considerable digestive leucooytosis. The

aids in case of suspected gallstones. In con. presence of choline in the blood is an im.

clusion he refers to Israel's saying that in portant symptom in the differential diagnosis

diagnosing other than typical cases, one between hysteria and disseminating spinal

must, first of all, divest bimself of the sclerosis, as this substance is only found

sobematic picture so often presented in the wben there is an active process of nerve de.

text.books. generation going on in the body.

DOCTOR, you should investigate the plan of

the Physicians Defense Company of For. THE DIAGNOSIS OF RENAL CALCULUS.-G. Wayne, Indiana, for the successful prevent L. Hunner, Baltimore (Jour. A.M. A., Maroh tion and defense of the malpractice suit. 24), remarks that few diseases present more The records of the company show that they protean symptoms and simulate so varied an have prevented all annoyance in over 75% of array of other maladies as stone in the kid. all the suits threatened against their contract ney. Large calouli may exist in and cause holders. The company bas an admirable his. destruction of both kidneys witbout marked tory and has dealt fairly and honestly with symptoms, while minute calculi may give rise the medical profession during the seven years to agonizing pains. The more common kid. of its existence. A postal addressed to the ney disease to be considered in the diagnosis Physicians Defense Company, Fort Wayne, of calculus are tuberculosis, pyelitis, pyelo. Indiana, will bring full information.

SOCIETY PROCEEDINGS the seared stump the end of the duodenum

was olosed. The proximal end of stomach MEDICAL SOCIETY OF THE NEW YORK was double clamped along the MiouliczPOLYCLINIC MEDICAL SCHOOL AND

Hartman line, and divided with a cautery HOSPITAL.

one-fourth inch projection. Then gastro

jejunostomy was done. Stated meeting held Maroh 5, 1906. The tumor was found to ncoupy the pylorio The President, Dr. J. J. MacPhee, in the end of the stomach, extending around the obair.

whole circumference. No adhesions were PARTIAL GASTROECTOMY FOR CARCINOMA.

present. There was a delay in finding the

nearest point of jejunum that could be This patient was presented by Dr. J. I. brought to the stomach wall, and in taking Edgerton. G.C.H. ; male; 41 years of age. great pains to suture the opening in the Father living and in good health at 78; mesocolon so as to prevent hernia into the mother died of stowach trouble, probably lesser cavity of the peritoneum. cancer, at 58 years of age. Patient bad ma His temperature at no time following the laria severely 25 years ago, but has bad no operation was above 96. degrees F., and there recurrences. He indulges moderately in tea, has been no vomiting since operation. He coffee and alcohol, and smokes regularly from took water in eight bours and liquid nourish. fifteen to twenty cigarettes daily. For the ment in twenty-four. His bowels were past thirteen years he suffered with heart. moved by enemas during the first week, but burn, which had been more constant during three was no distension; in fact, no more dis. the past two years, during which time be also comfort than from an ordinary exploratory suffered from nausea and pain in the epigas. laparotowy alone. The man has gained about trium after eating. During tbe last few twenty-five pounds in weight, and is at his months he bad burning pains after eating; regular employment again with no discomfort was hungry all the time, but afraid to satisfy whatever referred to his stomach. bis bunger, for when he took solid food it re.

CASE OF MORPHINE POISONING. mained in the stomach for an hour or so, and .. then was vomited. On one occasion last win. The report of this case was presented by ter he vomited some mucous streaked with Dr. D. A. Sinclair. The patient was 63 blood. He began washing out the stomach years of age, weighed 180 pounds, was 5 feet twice a day on October 4th and brought up 6 inches in height, full blooded, with greenish olumps of mucous resembling marked organic beart disease. He had been moss. There was no vertigo. His bowels coming to the speaker's cffice for the past two were constipated, and he lost about twenty or three years suffering from alcoholism. He five pounds in weight during the last few was a periodio drinker, and when first seen, months.

two or three years ago, bad been treated On November 27, 1905, the stomach con along the regular lines for such a condition. tents contained free bydrochlorio acid; mod. He informed the speaker that he had been erate reaction; odor butyric. A mass could in the habit of receiving injections of morbe felt over the region of the pylorus, and phine from previous doctors and that was operation was advised and aocepted by the the only treatment that did him any good. patient. The usual preparation of cleansing Accordingly one-fourth of a grain of mor. the stomach by lavage was performed, and in phine was injected, which the patient rethe operation Mayo's teohnic was followed. ported at the next visit was of no benefit The abdomen was opened near the median whatever, stating that it was, he knew, a line and the gastrio artery was doubled, ligated very small amount-nothing like what he and divided near the cardiac. The gastro- had been used to getting. The dose of mor. hepatic omentum was also doubled and ligated phine was very carefully increased to oneclose to the liver, leaving most of its structure half grain without any effect, and finally, at attached to the stomach. The superior py. the earnest solicitation of the patient and his loric artery treated in the same manner, and assurances that he could stand the morphine, the upper inch or more of the duodenum the dose was increased to one grain. This freed. With the fingers as a guide beneath injection bore out his statements as to his the pylorus in the lesser cavity of the perito. previous experiences and “just about steadied neum, the right gastroduodenal artery was him,” without producing any thing but a ligated. The gastrocolic omentum was cut very short sleep. His subsequeut periodic distal to the glands and vessels, up to an ap. sprees were treated along the same lines, from propriate point on the greater curvature and three-fourths to one grain being used as an the left gastroepiploio vessels were ligated. injection. It became so much a matter of

With a running suture of catgut through course to inject this patient and see no unto.

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