sufficient space the exuberant edges of the ul. enter from the genitalia or the lower intescer were pared, the base was curetted, and the tinal tract, the presence of albuminuria is de. thermo-cautery lightly applied to as much of pendent on the previous condition of the kidthe ulcerated surface as could be reached, the neys. The history will probably suggest the very slight bleeding following curettage be- causative germ. In treating the condition, ing easily checked by the same means. The urinary and intestinal antiseptios, urotropin gastric and abdominal wounds were then (hexamethylenamin), salol, boric acid and olosed by suture. The tissues removed were large draughts of water are advised. Vesical examined by Dr. P. G. Wooley, who reported instrumentation and irrigations are to be as follows: "The tissue from the base sug- avoided so far as possible. In spinal disease gested malignancy, for there were small masses with paralysis of the compressor muscle, bacof epithelial cells surrounded by a fibrous teriuria is a constant attendant affection, and stroma; but the edges of the ulcer were sim- when the urine becomes ammoniacal, cystitis ply fibrous tissue and muscle, the former in is inevitable. The danger of life in these excess and there was no marked infiltration. cases from ascending urinary affection makes The base was markedly inflammatory and not bacteriuria a serious inatter, and every one malignant.” That the condition was not recognizes the value of thorough, gentle, asepone of ulcus simplex of unusual dimensions tic bladder drainage in their treatment. In such as have been reported in medical litera- cases, as in the aged, dependent on colitis and ture, from time to time may be difficult to constipation, free purgation, regulated diet prove. Dr. Lafleur, however, reports that the and intestinal antiseptics are essential. Co. man was not a chronio dyspeptic and that an lonic lavage for two or three months is prac. acidity and not hyperacidity existed from the ticed by Janet. A case of very marked baconset of the illness. The chief argument is teriuria following dysentery is reported. drawn from the anatomic character of the lesion. Histologically the tissue removed bore a close resemblance to those in the case reported by Dr. Flaxner as gastric syphilis, in Vol. XIII of the Transactions of the

The reduction in the amount of typhoid Association of American Physicians. It is

fever is the most remarkable fact in the saniover three years since the operation was per

tary history of Chicago during the last deformed. During this period he has been in

cade. The weekly bulletin of the health deprefect health, weight up to his standard and

partment reports that the mortality there no indigestion.

from typhoid fever during the ten years from

1885 to 1894 inolusive was 7.9 per 10,000. Bacteriuria. — Bacteriuria, understanding

In 1891 it was 17.31, being greater that year by the term the presence of bacteria in the than in any other city in the civilized world. urinary tract above tbe compressor urethrae After the drainage canal and intercepting muscle, is, according to G. P. La Roque

sewers were built the typhoid mortality was (Jour. A. M. A., June 16), a much more com

reduced in the decade from 1895 to 1904 inmon condition than is generally supposed.

clusive to 3.2, and in 1905 it was 90 per cent Unless associated with suppuration it pro. less than it was in 1891. duces none of the symptoms of true inflam. mation in a healthy person, but such may FORMIC ACID IS THE LATEST REJUVENAfollow in conditions of lessened vital resist. TOR.-It is better than the once celebrated ance. Local symptoms, when present, are: Brown-Sequard elixir, or the muoh praised Slight increased frequency of micturition, glycero phosphates. It is claimed that sodi. mild ardor urinae, ocoasionally incontinence, um formate in fifteen-grain doses three or and in children there may be nervous dis. four times a day is the proper administration turbances. If no abrasions exist, toxins are for a healthy individual wbo is anxious to not absorbed In many cases there are no sub. work without fatigue. The Critic and Guide jective symptoms. The most common infect quotes physicians who profess faith in this ing organism is the bacillus coli and it is "wonderful” remedy. The British Columpresent in nearly all cases, often in pure cul. bia Pharmaceutical Record states that a ture. In some cases of typhoid bacteriuria it customer far advanced in years regularly is absent. Alkalinity of the urine means the buys formic acid which he believes has presence of the staphylococcus or bacillus prolonged his life. Sometimes he eats red proteus vulgaris; all other organisms, these ants, we suppose with a view of getting the being absent, produce an acid urine. When formic acid at nature's fountain. It is worth the bacteria come by way of the kidneys, as while to mention that formio acid has for in typhoid septicemia or scarlatina, there is many ages been an article of materia medica. always a positive albuminuria. When they — Meyer Bros. Druggist.

THE MEDICAL FORTNIGHTLY B Acidi salicylici................ 3j

B Acidi salicylici.......

......... 3 ;

....... 3 v M. ft. ungt. Sig. : Apply locally to the affected joint. Or: aucureu Jomb. B Extracti belladonna.......... gr. v

Acidi salicylici.............
Sodii salicylici............aa gr. xx .

.... 3 iv M. ft. ungt. Sig. Apply locally. Or: B Ichthyoli....... ....... 3j.

Lanolini........... .. 3 ij-vj M. ft. ungt. Sig. Apply locally.—Jour

Postage to

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B Chloretoni.......

Orthoformi............... gr. xxxvij
Ungt. belladonnae ........
Iodoformi ...... ....aa gr. xxx

Adipis lanae hydrosi, 3vj M. et ft. ungt. Sig. Apply several times a day.

Indication.-Used to relieve painful internal piles with prolapse. - Ex. MALARIA.—

. R Euquininae............... gr. 4-8 Pip. nigr.........

...... gr. 2-3 Dr. tal. dos. No. 15. One capsule two or three times a day. B Euquininae......

Ferri sulph. exsic.......... gr. 18
Acidi arsenosi.............. gr. 1
Pulv, capsici.......

gr. 10
M. pil, mass in pil. No. 40 dividenda.
Sig. Two pills after each meal.-Bjorkman,
Merck's Archives.

Gout. - The following is a formula for the treatment of this disease: For external appli. cation: R Ol. gaultheriae...

Ol olivae...
Lini. saponis......
Tinct. aconiti .............

Tinct, opii..................aa f.3 ij. M. Sig. Apply freely and cover with cot. ton batting.-Satterlee, The Med. Bull.

PURULENT OPTHALMIA.-Scrini thoroughly removes the secretions from the lids by means of absorbent cotton, and applies the following lotions : By Potass. perman .............. gr. Aq. dest...

....... O ij M. Sig.: To be used as an irrigation to the lids.

Three or four hours later the following should be applied locally: R Argenti nitratis (crys.)...... gr. iij

Aq. dest........... ...... 3 v M. Sig. : To be applied locally by means of an application. This should be neutral. ized by a solution of sodium chloride.

If a one to two per cent solution of silver nitrate gives no relief in two or three days, it should be increased to four or five per cent. In case of corneal infiltration or ulceration, the silver nitrate should not be allowed to come in contact with the cornea. In such cases the following ointment should be applied: R Iodoformi (dissolved in ether). gr. iv

Vaselini (neutral)............ 3 iiss
M. Sig. : Apply locally.

If perforation seems probable, instill a few drops of a four per cent solution of atropine into the ev into the eye.-American Medicine.

INHALATION IN CHRONIC BRONCHITIS. The Bulletin Generale de Therapie recommends the inhalation, from a bottle provided with two tubes, of air saturated with the vapor of the following mixture: R Oil of eucalyptus......... 30 parts Menthol..

5 parts Thymol....

2 parts Guaiacol, crystal ..... 5 parts Water................

...200 parts

........... gr. 90

During the performance of a bernia operation it is often helpful for the anesthetist to allow the patient to react sufficiently to strain into view a sac that has slipped baok abdomen.

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Papers for the original department must be contributed ex- the closely adjacent multiple organs of the clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans right side is difficult-frequently impossible. lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

The conditions that cause the excruciating, reprints may be obtained at cost, if request accompanies the agonizing, shocking pain in appendicitis is proof.

Engravings from photographs or pen drawings will be fur perforation and extravasation into the perito. nished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

neal cavity. Right-sided muscular rigidity

means that the motor (intercostal) nerves COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco.

supplying the abdominal muscles are irriM. V. BALL, M, D., Warren, Pa.

tated. It may be any kind of peritoneal inFRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.

fection (extravasation from any viscus, hepaC. G. CHADDOCK, M. D., St. Louis, Mo.

tic, intestinal, ureteral or genital). RightS. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

sided cutaneous hyperesthesia means that the N. S. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.

sensory (intercostal) nerves supplying the FRANK R. FRY, M. D., St. Louis.

abdominal skin are affected. It may depend Mr. REGINALD HARRISON, London, England. RICHARD T. HEWLETT, M. D., London, England. on any kind of peritoneal infection. Sudden J. N. HALL, M. D., Denver. HOBART A. HARÉ, M. D., Philadelphia.

cessation of severe symptoms, as rapid dim. CHARLES JEWETT, M. D., Brooklyn.

inishing of high temperature and pulse and THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.

abdominal rigidity is an evil omen-gangrene E. E. MONTGOMERY, M. D., Philadelphia. NICHOLAS SENN, M. D., Chicago.

of the appendix has probably occurred. ImFERD C. VALENTINE, M. D., New York.

mediate operation should occur. EDWIN WALKER, M. D., Evansville, Ind. REYNOLD W. WILCOX, M. D., New York.

For years I have made it a rule to recomH. M. WHELPLEY, M. D., St. Louis. WM. H. WILDER, M. D., Chicago, Ill.

mend appendectomy to patients having experienced two attacks. Fifty per cent of sub

joets who have bad one attack experience no LEADING ARTICLES


In perforation it is very difficult to interSUDDEN ABDOMINAL PAIN-ITS SIGNIF

pret the sudden abdominal pain. Associated ICANCE.

ciroumstances would aid. In typhoid fever one would naturally suspect perforation if

sudden acute abdominal pain arose, and my BYRON ROBINSON, B. S., M. D.

colleague, Dr. Weller Van Hook, successfully CHICAGO.

operated on a typhoid perforation diagnosed (Continued from page 358.)

by his medical friend. One might think if

he was called to a young woman with sudden APPENDICITIS.

aoute abdominal pain that it was a round, Appendicitis is the most dangerous and perforating ulcer of the stomach, after exclud. treacherous of abdominal diseases—danger. ing pelvic and appendicular disease, but the ous because it kills, and treacherous because sudden acute abdominal pain of perforation its capricious course cannot be prognosed. is so vague and indefinite that only an exThe peritonitis it produces is either enteron. ploratory incision would interpret it. ic (dangerous-absorptive) or colonic (mild The sudden acute abdominal pain from ap. -exudative).

pendicitis (perforation) is more apt to be A concise clinical history should be ob. diagnosed from probability. Now probabil. tained when sudden pain arises in the right ity is the rule of life, and when one is called side of the abdomen for it might be due to to a boy or man with sudden acute abdominal perforated appendix, gall-bladder or gestating pain, it is likely appendicitis. The pain of oviduot. The right-sided pain may arise appendicitis is at first sudden and generally from biliary, pancreatic or ureteral calculus diffuse, and in appendicitis this is, in my exor ureteral flexion.

perience, a characteristic and conspicuous Pleurisy or intercostal neuralgia (right) feature. The sudden acute pain in appendimay confuse. In the right side, so closely citis is doubtless due to violent appendicular adjacent are eight important viscera, mo. peristalsis (colic) of an inflamed appendix, or mentous in surgery, that a silver dollar will to the rupture allowing the bowel contents to touch the pylorus, gall-bladder, head of the come in contact with the peritoneum, and pancreas, kidney, adrenal, duodenum, ureter also inducing violent irregular peristalsis of and possibly the appendix. Hence differen- the adjacent bowel loops. It is the agoniztial diagnosis of sudden abdominal pain in ing, excruciating, pain of peritoneal extrava. sation. Rigidity of the abdominal muscles pendix lies on the psoas muscle in man more over the seat of pathology in appendicitis is frequently than in woman, and on its long. a great aid to interpreting the pain. The est range of activity, hence when the apmuscular rigidity is protective and due to the pendix contains virulent and pathogenic transmission of the visceral irritation to the germs the long range of action of the psoas spinal cord, which is reflected to the abdom. 80 traumatizes the appendix that it induces the inal skin (sensory) and to abdominal muscles escape or migration of the accidental virulent (motor). There is a nice balance between pathogenic microbes through the appendicthe peripheral visceral and the peripheral ular walls into the peritoneal cavity. Com. cutaneous nerves in the abdominal muscles mon sense and experience would dictate that through the spinal cord. Looal tenderness the pain on pressure would occur in any and local rigidity of the abdominal muscles point of the abdomen possessing inflamed is a great aid in signification of the sudden structures. Sinoe probability is the rule of acute pain in appendicitis. It might be well life it is well to look to three great regions of to suggest that the position of the appendix dangerous peritonitis, viz., the pelvic, appenis located at any point from the liver to the dicular and gall-bladder regions. floor of the pelvis, and also many times where there was more or less of a mesenter.

BILIARY CHANNELS. ium commune, the cecum approached the The digestive tract bas still another comvertebral column, and the appendix is then mon seat for sudden acute abdominal pain, liable to lie among the enteronic coils—the and that is the gall-bladder region. The dangerous ground of peritonitis. It is likely sudden aoute abdominal pain in bepatic the pain in appendioitis depends on the seat colic is not generally so violent as many of the disease, i.e., the mucous membrane bas others accompanying acute diseases of the di. become ulcerated, inducing painful appendi. gestive tract. Patients relate that the pain is cular colic (peristalsis), wbile the sudden aching, dragging, and in the active stage of exacerbation of violent diffuse abdominal cutting or tearing. Some relate a feeling of pain is due to the involving of the peritoneum tightness or fulness. But it depends on itself from the extravsation and from violent whether the calculus is attempting to enter peristalsis. I see nothing especially worthy constricted portions of the duct, or whether of attention in the so-called McBurney point. it has already entered. I have had typical Pain over the seat of disease is certainly a cases wbere operation proved that the oalculi natural feature, and generally the appendix, only attempted to enter the constricted por.. lies under a point midway between the um. tion of the duct. No doubt these are the bilicus and anterior superior spine of the cases which say so often that they have severe ileum. But it is not always so by any pains at any time, but especially after taking means, for I examined with great and anx. hot meals or hot stimulating drinks, or vigorious care, a short time ago, a young physi. ous exercise; whence arises excessive peristal. cian with severe pain over the so-called sis, inducing short, temporary hepatic colic. McBurney point, when on operation the long Now, when the gall-bladder has many calouli appendix was in the pelvis and perforated in it, and when one more or less often atMcBurney's point is partially a cutanevus tempts to engage in the neck of the gall-bladhyperesthesia. Then again, pain on pressure der, the pain is rhythmical. It begins slowly may be reflex, appearing in remote regions and rises to a maximum, at the maximum of the abdomen. The sudden, acute, diffuse the pain is intense. We have observed such abdominal pain arising in appendicitis, gen. cases and afterwards operated on them, reerally subsides in the right iliac fossa after moving many small calculi. Gall.stone perthirty-six hours, and one can nearly always haps four times as frequent in women as in elicit pain on pressure there. This pain on men; why, we do not know. In my experipressure is doubtless the motion transmitted ence patients can generally locate the pain in to a sensitive, inflamed peritoneum, and not hepatic calculi more accurately and definitely the dragging of an adhesion, as some as- than almost any other sudden acute abdom. sert, for adhesions so newly formed can have inal pain. They refer the pain to its proper no nerves formed in them. But man is sub- locality; however, I must admit that this refject to appendicitis four times as frequently erence is before rupture. After rupture of as woman, due, perbaps to Gerlach’s valve the cholecyst or duct the pain is indefinite, being small in man, and thus not allowing like other perforation in the peritoneum. The the foreign body to escape after entrance, sudden acute abdominal pain in biliary duct and due also to the greater activity of the disease is characterized by more slowness, psoas muscle in man inducing more peri- less acute intensely and distinct periodicity, toneal adhesions to compromise the anatomy than invagination, appendicitis or perforation and physiology of the appendix. The ap- of the digestive tract. Jaundice is not nec

essary. Jaundice is determined by the color

URINARY TRACT. of the eyeball, and not of the skin. A feature in gall-bladder pain is that it extends

In ureteral colic it must be said that the well towards the dorsum. Age aids in diag.

pain resembles that of hepatic colio in many nosing calculus in the biliary passages to

ways, the rhythm being paroxysmal. It in

termits and is often agonizingly spasmodic. some extent. The patient, frequently middle-aged wo

It requires much careful study to differentiate men, is suddenly seized with agonizing pain

the sudden acute abdominal pain in hepatio in the epigastrium, vomiting and occasionally

and ureteral colic. This is important, for the collapse. The pulse rapid and small, the

plan of action is very different. The pain in epigastrium tender (cutaneous hyperestbesia)

resthesia appendicitis, ureteral and hepatic colio are

appe and the right abdominal muscles rigid (inter- o close relation and resemble each other. costal motor nerves irritated, corresponding

Sudden pain in the lumbar region, with to its sensory roots of the spinal cord). With progressive radiation toward the inguinal reprogress of the case the pain localizes in the gion, and especially testicular retractions, is right hypochondrium and peritonitis begins. suggestive of ureteral calculus. The kidney I have had cases of rupture of the gall-blad is frequently tender on pressure. Ureteral der with no known premonitory symptoms. calculus permits time to complete the diag.

It must be borne in mind that gall-bladder nosis, as it is non-inflammatory, hence we perforation presents a different picture than examine .the urine for albumen, blood and merely violent peristalsis (colio) due to gall. pus and with the X-ray for shadows. stone in the biliary passages.

The perforation of the ureter will result in The pain of non-perforated biliary colio extra-peritoneal extravasation which does not arises sudden, is agonizing, and especially induce such excruciating pain as intra-peri. intense in the gallbladder region. It is gen. toneal extravasation. earlly limited in duration, and frequently 1. Pain is a cardinal symptom of ureteral associated with jaundice. Biliary calculus caloulus. may exist without pain (autopsies are rich in 2. Pain is not a sign of ureteral calculus. this testimony)

3. Pain as a single standard is liable to

lead to erroneous conclusions and to an inACUTE HEMORRHAGIC PANCREATITIS.

correot diagnosis. The pain in acute hemorrhagio peritonitis 4. In eighty operations with pain as the is characterized by being sudden, terrible, guiding symptom for ureteral caclulus 70% agonizing and remains persistent in the re. failed to demonstrate calculus. gion of the pancreas. The patient is attacked 5. The vast dimensions of the plexus ner80 violently that he faints, collapses. The vosus ureteris in number of ganglia and num. vomitus is a greenish fluid contain in bile ber of strands permits irritation from the and blood. The patient suffers intensely in ureter to pass with facility and rapidity to the epigastric region. It presents the symp. the abdominal brain, whence it becomes reor. toms of peritoneal extravasation (hence ex. ganized and emitted: (1) Over the sympacruciating pain) small, rapid pulse, rigid ab- thetic nerves of the abdomnial visceral plexdomen with sensitive, tender skin, skin cool uses inducing pain, aching, reflexes in the and bedecked with a clammy perspiration. adjacent viscera; (2) the reorganized irritation Temperature ranges high. Profound sepsis in the abdominal brain is emitted over the gradually deepens and death super venes in spinal nerves; (a) the intercostals (pain in three days. Acute hemorrhagic pancreatitis abdominal walls); (b) over the lumbar plexus is a rare disease; I saw no case in some 700 (pain in inguinal, hypogastric and external autopsies. It is seldom diagnosed as we still geneital regions); (o) over the sacral plexus possess no standard differentiating symp- (pain in the nates, genitals, rectum, thigh, toms. Diabetes is suggestive of hemorrhagic leg and foot). (3) The irritation of the plex. pancreatitis or fat necrosis.

us of nerves passes to the abdominal brain

where it is recognized and emitted over the EMBOLUS WITH MESENTERIC VESSELS.

cranial nerves (vagus which aids in inducing Embolus of the mesenteric vessels, a rare nausea and vomiting). These reflex pains in disease, produces sudden severe abdominal ureteral valculus confuses by involving the pain. It is difficult to diagnose and is likely sympathetic, spinal and cranial nerves of disto be equally difficult to treat by any means tant regions, and also because other condi. at our command. The difficulty will be in tions of the ureters than ureteral calculus my estimating the amount of intestinal resection duplicate or simulate the reflex pain. required on account of the indefinite demar. 6. Pain simulating that of ureteral caloucation of the line of gangrene due to the lus is a common symptom of many diseases embolus.

of the abdominal viscera.

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