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turbance; there was entire absence of pain in

the stomach, and there was no vomiting. THE MEDICAL FORTNIGHTLY

Even the blood which the patient brought up he described as having been "choked up;" he coined the expression himself, because he objected to the term "vomited."

As to Dr. Deutsch's suggestion that the tin might have been swallowed in infancy, it should be remembered that the canning industry is comparatively recent. The point which the case impressed was that one should continue to study every possible way wherever the diagnosis is not entirely satisfactory.

Dr. Charles H. Shattinger.-Dr. Mardorf's remark that absence of pain in the stomach spoke against ulcer recalls a case that I had very recently. The man did not vomit blood, he would lean over the side of the bed and simply let it run. This lasted for hours. He would drink water or beer to relieve his thirst and that liquid ran out also. He had no pain in the stomach at all. He simply

had hemorrhage, but I know he had an ulcer, for he died and I made the post-mortem. I do agree, however, that in the vast majority of cases you would expect pain in stomach in ulcer. I agree with Dr. Mardorf that we owe a great deal of gratitude to Dr. Cook for the report of this case and his very frank stateI hope the doctor will not relinquish this standpoint as he grows older.

Dr. Gradwohl.-I would second Dr. Mardorf in his remarks relative to Dr. Cook's courage. I have followed up many cases at autopsy and found the conditions far removed from the diagnosis, but it has been seldom my lot to hear a man report his autopsy findings so different from what we might have expected.

Dr. Cook, in closing.—I must acknowledge that the case looks quite a little different than it did before the post-mortem. The diagnosis of carcinoma still seems to me the most probable of those considered, however I do not care to enter into a justification of my conclusion, as it has no pertinent bearing on the points I wished to emphasize. I am sorry an esophagoscope was not at hand; the laryngoscope was of course unable to reveal a body as far down the esophagus as this one.

ÖVER a million circulars of warning have been distributed during the past two years by the German Society for the Prevention of Venereal Disease. The campaign has been very thorough, physicians, dispensaries, and the army being the agencies through which the distributions were effected. It is the purpose of the society to issue a similar circular to women and girls during the coming year.

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THE endeavor by limitation of membership to insure fellowship with the scientifically

Scientific Bodies with Limited Membership.

elect has characterized a number of American medical organizations, and has been productive of adverse criticism, not alone among outsiders, but even within the ranks. The editor of the Lancet-Clinic has

admirably presented this matter as it appears to us, and we take pleasure in giving our readers the editorial. He says:

"It is rather remarkable that in democratic America, where all men are born free and equal, and where there is no nobility and aristocracy, and class distinctions have no existence, exclusive medical societies have flourished and reached a degree of development greater than in any other country on the face of the earth. Paradoxical and surprising as this may appear, when applied to any sect, profession or class of individuals, it is still more so in the profession of medicine. Medical societies should be organized solely for the advancement of science and the love of truth, and they should stand with outstretched arms to welcome all who are willing to receive and ready to impart information and knowledge. is difficult to conceive how societies of this character have been permitted to continue an apparently successful course for such a long period of time. Societies which are unnecessarily exclusive are necessarily narrow, prejudiced and bigoted, and their work will eventually partake of the same character. Additions to the societies are dominated by the same influences, and new members are qual ified by personal rather than scientific attainments. These societies, like all organizations in general, are made up of the good, bad

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and indifferent, and the close affiliation and exclusion impart to mediocrity a false, fictitious value and an intolerable air of self-satisfaction.

There can be no question that these small, non-representative societies have their shortcomings and exert unfavorable and pernicious influences, and that their existence is necessarily short-lived. The high pedestal upon which they place themselves and the aristocratic air which they boldly assume is a slur and insult to the rank and file, to which they properly belong. Left to themselves they will probably die their just, natural death. Their weakness is readily apparent, and their undoing is a matter of easy accomplishment

"The American Urological Association affords a striking example of how a society founded upon general, non-exclusive, liberal lines will flourish and prosper and completely eclipse a society conducted along the older lines. For a great many years a small exclusive body of medical men, composed mostly of general surgeons and genito-urinary specialists, formed and conducted a small exclusive society called the American Association of Genito-Urinary Surgeons. They met once a year, read some very good, some very mediocre, papers to each other, elected from time to time a few, some good, some mediocre, but for the most part personal friends, to membership, and excluded many whose scientific and personal attainments justly entitled them to membership in such society. These excluded members, under the guidance of Valentine, Guiteras and a few other, able urologists, effected the American Urological Association and adopted a broad, general, liberal organization. The new society prospered and flourished from its very beginning; its meetings have been largely attended, the papers presented have been of the highest type of excellence and of the deepest scientific interest, and the discussions of the wholesome and beneficial character. Its rostrum contains the names of the most active, energetic and prominent genito-urinary specialists of the county, and the future of the society is an assured success from every standpoint. The society has established and successfully operated its official organ, the American Journal of Urology, which has gained for itself the enviable position of the leading genitourinary journal of this country, and one of the leading genito-urinary journals of the world. Success and long life to the American Urological Association and all others of its type! It is truly American, medical and scientific in character. Let us relegate to oblivion our exclusive, un-American, unscientific societies by thorough reorganization, or let them be justly eclipsed by the

more liberal, broader and correspondingly greater special societies."

of the American Medical Association is a THE large attendance at the recent meeting

Missourians at the Boston Meeting.

matter of satisfaction to the officers of the association, and to those who were so fortunate as to be present. In a 4800, Missouri is credited with 73. registration of about Our urban delegations were usually large, while country representation was surprisingly small. The following Missouri physicians attended:

From St. Louis Drs. N. Allison, J. H. Amerland, J. M. Ball, W. Bartlett, M. A. Bliss, R. D. Carman, M. B. Clopton, W. S. Deutsch, W. L. Dickerson, C. H. Dixon, W. B. Dorsett, G. S. Drake, D. Forster, F. R. Fry, W. W. Graves, Jno. Green, Jr., T. A. Hopkins, C. H. Hughes, A. R. Kieffer, B. Lewis, A. H. Meisenbach, C. V. Mosby, H. G. Mudd, J. S. Myer, C. D. Riley, J. C. Salter, H. J. Scherck, S. I. Schwab, R. E. Schlueter, B. E. Stockwell, J. H. Tanquary, F. J. Taussig, P. Y. Tupper, H. P. Wells, M. Wiener, F. A. Baldwin, W. H. Luedde. -37.

From Kansas City, Drs. Beattie, Binnie, Block, Carbaugh, Cordier, Crowell, Curdy, Frick, C. L. Hall, F. J. Hall, Jackson, Kyger, Murphy, Neff, Pearse, Porter, Punton, Sheldon.-18.

From St Joseph Drs. Campbell, Elam, Fassett and Potter.-4.

From Hannibal, Dr. Baskett; Marshall, Drs. Gore, Gray; Summit, Dr. Rusk; Kirkwood, Dr. Wyer; Sedalia, Dr. Dunlap; Cape Girardeau, Dr. Rosenthal; Springfield, Dr. Farnsworth; Marthasburg, Dr. Alexander; Novinger, Dr. Gashwiler; Linneus, Dr. E. D. Standley; Brookfield, Dr. K. V. Standley; Laclede, Dr. Z. T. Standley; Holstein, Dr. Stewart; Plattsburg, Dr. Desmond.-14.

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and landed in Boston the following morning. A few separated themselves from the main party at Montreal and made a side trip to Quebec, arriving in Boston a day later. Without exception the members of our party rejoiced in their choice of route, it gave us, as was announced in the prospectus, a maximum of comfort and sight-seeing-it gave so much of sight-seeing that for this alone the trip was well worth taking. Not one of us returned without a determination to do lower Canada again and thoroughly.

THE AMERICAN UROLOGICAL SOCIETY at its recent meeting in Boston elected Dr. Bransford Lewis, of St. Louis, to its presidency for the ensuing year. Official recognition has not been coming this way with any great liberality from the national bodies, and it is a pleasure to note this exception. The other officers elected were: Secretary, Dr. Hugh Cabot, Boston; treasurer, Dr. F. R. Hayner, Washington. The society will hold its 1907 meeting at Atlantic City.

THE BRITISH MEDICAL ASSOCIATION AT TORONTO.-The 1906 meeting of the British Medical Association will be held in Toronto, Ontario, next August. A cordial invitation is being extended to the American profession to attend. This is an exceptional occasion, and an opportunity we seldom have, it is to be hoped that a large number of physicians from the States" will avail themselves of it. St. Louis should send a strong delegation. Rates have not yet been announced, but they will be made.

THE AMERICAN ROENTGEN RAY SOCIETY. -The seventh annual meeting of the American Roentgen Ray Society will be held August 29, 30, 31, 1906, at the Cataract and International hotels, Niagara Falls, N. Y. A large and interesting program containing the names of the best known X-ray workers in this country as well as a number from abroad, has been prepared. An interesting feature of the meeting will be the exhibit of prints and negatives. The railroads have granted a rate of a fare and a third on the certificate plan. The officers of the society are: President, Dr. Henry Hulst, Grand Rapids, Mich.; secretary, Dr. Geo. C. Johnston, Pittsburg, Pa.; treasurer, Dr. Leavitt E. Custer, Dayton, O.; vice-presidents, Dr. Russell й. Boggs, Pittsburg, Pa.; Dr. Clarence E. Skinner, New Haven, Conn.; Dr. G. Williams, Richmond, Va.; Dr. Eugene W. Caldwell, New York City. Full information regarding the meeting and application blanks for membership may be obtained by addressing the secretary, Dr. Geo. C. Johnston, 611 Fulton Building, Pittsburg, Pa.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

PATHOLOGY AND BACTERIOLOGY.

R. B. H. GRADWOHL, M. D.

ST. LOUIS.

The Bacteriological Examination of the Blood of Cadavers.- M. Otten (Virchow's Archiv f. path. Anat., Band 184, Heft 2, May, 1906) adds another chapter to the contention of Simmonds of Hamburg that the bacteriological examination of the blood of cadaver is a useful procedure in making the pathological anatomical diagnosis in autopsy work. He reports about two hundred cases in which there was a careful bacteriological examination of the heart's blood of cadavers, in 42% of which the blood was sterile and in 58% it contained bacteria of various varieties. This blood was taken out at intervals after death varying for the most part from 16 to 24 hours after death, the body being kept in a "cool room" during this time before autopsy and blood examination. The sum of his results coinicides with that of Simmonds who reported that there is practically no invasion of the heart's blood post-mortem, and that blood obtained from this place is just as useful for bacteriological analysis as that obtained from peripheral veins, all of which the reviewer of this article respectfully denies. In the December number of 1904 of the Annales de l'Institut Pasteur, the reviewer published an account of work done along this line with the blood obtained from dead bodies upon which autopsy had been performed for medico-legal reasons. Otten in his article neglected to acquaint himself with the full literature on this subject by overlooking this article, the results of which coincided with that obtained by Cannon whose work is mentioned. This work of the reviewer's showed that in 50 selected cases the

streptococcus was present in about 65% of the cases indiscriminately, even though the cause of death was of such a nature as gunshot wound of the brain or abdomen, etc. The blood from the heart showed streptococci, but that from the peripheral veins was sterile in all cases excepting those in which there was intra vitam a general pus infection.

The Histology of Callus.-Theodore Guembel (Virchow Archiv, Band 183, Heft 3, 1906) says that the subject of histological investigation of the structure of callus has often been gone over, but with the newer methods the subject needs revision. Normal and pathological ossification was studied by

Kolliker and Manasse, as well as by Kassowitz, v. Recklinghausen and Ziegler. Strict examination in a quantitative way of the metaplastic formation has not, however, been gone over. Guembel determined to investigate this problem; for his material he thanks Recklinghausen who furnished him material in the shape of fractured ribs and bones of the extremities of children; also Bethe who furnished him experimentally induced fractures in the bones of rabbits and dogs from the physiological department of the University of Strassburg. He also used an ossifying myxochondroma of the scapula in a male patient of 56 years of age. The first material used was the callus on the right ulna of a two years' old child which died in the hospital. The patient had a perineal abscess; was affected with hereditary syphilis and rachitic condition was simply a slight "rickety rosary," separation of the epiphyseal cartilages: a form of rachitis called by Recklinghausen "chondromalacia."

The

fracture of the ulna occurred on June 9, 1902, and the patient died on July 8, 1902-age of the fracture being five weeks. Autopsy showed in addition to these clinical observations cavities and broncho-pneumonic areas in the lungs. The callus had a thickness of 2 to 3 mm. A cartilaginous area was seen at the point of the fracture; osteoblasts were seen, but no osteoclasts. The bone and myxochondrom, from a male patient was well as the bones of rabbits and dogs were sectioned and stained according to the thionin-phosphorus method of Schmorl. The sum of all these observations was, that in pathological conditions of bone formation, metaplasia predominates. While in normal ossification, this plays an insignificant role, in the ossification of a callus, the formation of young bone substance follows in the wake of a metaplasia. The onset of metaplasia depends upon the vascular supply; where there is poor vascularization there is metaplastic growth of bone as well in the periosteal as in the narrow callus, with this difference, however, that there is hyaline cartilage only in the periosteal callus, while in the narrow callus there is hyaline cartilage and fibrous marrow formed. With the formation of blood vessels, the metaplasia is arrested and there follows final ossification, according to the endochondromal type The influence of division of nerves upon the transformation of periosteal callus has not yet been determined.

In cases of pain in the hip of doubtful ori. gin, examination of the kidney regions may discover the cause.

OTOLOGY.

ALBERT F. KOETTER, M. D.

A Case of Late Hereditary Syphilis of Both Labyrinths of the Ear.-(V. Behm, Archiv fuer Ohrenheilkunde.)-A patient twenty years of age, whose father had been treated for syphilis, was seized a year ago with sudden deafness of the left ear, for a half year increasing deafness of the right ear which up to this time had been very sensitive to noises. Perforation of the nasal septum, cicatrized scars of soft palate as well as the surprising results of a schmier cuse, on the hearing verilabyrinth. The excruciating pains in the left fied the diagnosis of bilateral syphilis of the to a cicatrized retraction of the handle of the ear which appeared after six weeks were due malleus in the healing of the synchronously existing leutic affection of the tympanic cavity, and was. relieved by the extraction of the malleus and breaking up of the adhesions. After a year these pains recurred, and were said by the author to be due to a specific perichondritis of the left tubal emi

nence.

hearing, this case serves On account of the rapid return of the hearing, this case serves as a warning, in spite of the doubtful prognosis given by nearly all authors in hereditary syphilis, doubtful especially, if as in this case, the late treatment and the simultaneous existence of adhesive processes in the middle ear, to inaugurate in all cases an energetic inunction treatment and try all other anti-leutic remedies.

Two Cases of Deafmutism Due to Ptomaine Poisoning.-(W. Sohier Bryant, New York Medical Record.)-Case I. Girl of two years and seven months, always healthy, was taken sick after eating fruit ice, with fever and symtoms of a gastro enteritis. Urine normal. After four days staggering gait, difficulty in drinking, spasms of the face. One week after poisoning total deafness and dumbness. Ears show no changes. Same condition after a year. Case II. Boy of two and a half years. Seven weeks ago attack of fever, four weeks later child could not walk and was deaf. Both cases are no doubt due to a toxic neuritis of the acoustic and toxic degeneration of the speech centers. Author goes thoroughly into the differential diagnosis as opposed to encephalitio processes, atropine poisoning, embolic infarcts of the brain, meningitis and bulbar paralysis.

Ear Affections in Scarlet Fever.-(Sprague, Providence, American Journal of Medical Sciences.)-Of sixty children who entered the Rhode Island Hospital from January to June, admitted to the scarlet fever division,

per

seven acquired acute suppurative otitis media, three were already affected when they entered the hospital therefore about 17 cent, seven bilateral and three unilateral. Of the seven cases developed after admission, four had earache, increased temperature and acceleration of pulse; three had no pain, and showed only high temperature. Of the seventeen cases only two showed involvement of mastoid and came to operation. Sprague divides the scarlatinous middle ear inflammation with the following forms: (1) Acute serous; (2) acute suppurative; (3) acute necrotic form. The acute serous inflammation usually occurs during stage of eruption, or at least during the first ten days. The symptoms are those of an ordinary catarrhal otitis media. If the child is old enough it complains of fullness, tinnitis, deafness and pain; in very small children restlessness and rise of temperature are noticed. During desquamation the external canal is full of scales and the activity of the ceruminal glands is increased. In the acute suppurative inflammation, which usually occurs in the latter stages of the disease the temperature reaches 103 deg. F., and more. Patient complains of lancinating pains radiating to head and neck, swelling of the glands of the neck and stiffness

of the muscles are often noted. Occasionally we find cerebral irritation, convulsion

and vomiting. The necrotic or diphtheritic form leads to rapid softening of the tissues, the membrane and the ossicles and to invasion of the labyrinth. The secretion is colored and very fetid.

Author believes that in mild cases the infection takes place through the tube, in severe cases by means of the blood or lymph route. He considers the ear secretion very contagious, in three cases where the child was dismissed after the disease had

run its course and the usual quarantine rules were observed, but the ears still suppurating, another child of the same family took sick with scarlet fever, when all other ways of transmission but that of the ear secretion could be excluded.

Cholesteatoma of the Ear.-(De Stella, Belgique Medical.)-There are two kinds of cholesteatoma: (1) The secondary or false. (2) The primary or true chclesteatoma called endothelioma. Author speaks of the several different sizes or kind and the seat of the cholesteatoma. Whereas the secondary cholesteatoma is very frequent, the true or endothelioma is met with very seldom. For its inception the following adds to its formation: (1) Epidermization of the drum membrane; (2) closure of the tube, and (3) large perfora

tion of the membrane. The etiology and pathogeny of true cholesteatoma are still very much in doubt, at all events the formation takes place at the expense of the endothelium of the tympanic cavity, attic and antrum. Then follows the clinical picture of cholesteatoma and its complications. The diag. nosis is usually very easily made. Lucase has found an odor peculiar to cholesteatoma in 98% of the cases, the author would not consider it as specific of cholesteatoma, but the result of the process of decomposition. Treatment: If the removal of the cholesteatoma does not occur in the natural way, a radical removal of the petrous portion of temporal bone and mastoid process by means of a radical operation.

Etiology of Disturbances of the Auditory Nerve Apparatus Appearing Suddenly.Stein (Monatsschrift fuer Ohrenheilkunde) quotes a number of observations where patients blame mental disturbances as the cause of subjective sensations of hearing or alteration of the hearing as well as cases of functional disturbance which are caused by traumatic influence, even though the trauma be not such as to assume severe changes of texture in the labyrinth, or in the cranial cavity, explanation of the phenomena of a disease and gives us several points of support for the

heretofore called vasomotor disturbances of by the internal examination of the objective the hearing. Common to all cases as found symptoms of the disease a more or less advanced arteriosclerosis, and by examination of the hearing apparatus the symptoms of an affection of the auditory nerve. Author, therefore, believes he may accept the alteration of hearing, as well as the subjective impressions of hearing as the local phenomena of a latent arteriosclerosis cerebri, made manifest by the psychic disturbance, or the injury, and the assumption of a vascular spasm as most plausible, which on account of the impaired elasticity of the vascular walls continued longer and its deleterious results on the brain nutrition were brought to bear on the auditory nerve apparatus.

Differential Diagnosis Between Abscess of the Cerebellum and Suppuration of the Laby. rinth.-(Neumann, Archiv fuer Ohren heilkunde.) Opposed to the symptoms common to both diseases vertigo, vomiting, character of the nystagmus, etc., Neumann has observed differential diagnostic points in several Whereas, in the labyrinth disease existing nystagmus with the progressive destruction of the labyrinth becomes weaker, it increases in intensity with the extension and continued existence of the cerebellar abscess. If there exists in the beginning of the laby

cases.

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