St. Mary's Infirmary was founded by the Sisters of St. Mary, of the Roman Catholic Church, in February of 1877. The building at present occupied by the hosptial at 1536 Papin street, is but lately completed, its foundation was laid in 1887, and the completed building has cost the Sisters $158.000. The institution accommodated 1836 patients during 1905, of which number probably a larger per cent of charity work is included than in the gross work of any other private institution. Dr. W. A. McCandless is surgeon-in-chief to St. Mary's, while the medical work is under the supervision of Drs. F. Neuhoff and E. Bribach.

an

THE WORM TURNED.-A village doctor whose most troublesome patient was elderly woman practically on the free list, received a sound rating from her one day for not coming when summoned the night before.

"You can go to see your other patients at night," she said, "why can't you come when I send for you? Ain't my money as good as other people's?"

"I do not know, madam," was the reply. "I never saw any of it."-Lippincott's Maga

zine.

GAILLARD'S SOUTHERN MEDICINE.-Dr. W. E Fitch, owner and editor of Gaillard's Southern Medicine, announces his removal from Savannah, Ga., to New York City, where he will be found at 21 West 97th street. Dr. Fitch has had this move in contemplation for a number of years, and its accomplishment is but the bringing into effect of a definite purpose. The doctor intends that Gaillard's shall continue distinctively a Southern journal, but he will see that his broadened horizon is appreciated by all read. ers of his journal. Our best wishes to you, dootor!

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

The Diagnosis of Gastric Ulcer.-Weinstein (New York Med. Jour., Sept. 8, 1906) says the diagnosis of gastric ulcer should present no difficulties, as the symptoms are few and characteristic. Frequently, how. ever, these cases are not diagnosed at a stage when treatment may be effective. Ulcers of the stomach when left untreated may result in one of the three following conditions: (1) Severe hemorrhage by rupture of a vessel in the stomach wall. (2) The serosa becoming involved in the ulcerative process may rupture, or, if adhesions to neighboring organs are present, an encapsulated abscess will ensue. (3) Frequently the ulcer extends both laterally and in depth, presenting a funnelshaped terraced appearance, and it may attain the size of the palm of the hand. Gastric hemorrhage cannot always be prevented, as there are cases where a small and recent ulceration will give rise to severe hemorrhage without any other manifestations of the dis

ease.

A gastric hemorrhage may or may not end fatally. Rupture of the stomach and subphrenic abscess are extremely dangerous complications. Chronic ulcer probably never heals completely, and if cicatrization of a large ulcerated surface does take place the contraction of the cicatrix deforms the stomach and seriously interferes with its motor and secretory function. Surgical interference is the only logical procedure in these conditions. In view of these dire results from neglected ulcer, it is imperative that all our energy should be bent toward making an early diagnosis. In the diagnosis of gastric ulcer it must be remembered that its development is very slow, and the only symptoms manifest may be discomfort and painful pressure in the epigastrium after a full meal, which may entirely disappear if the patient takes only a liquid diet. At this stage careful inquiry will disclose the fact that the pain in the epigastrium or back appears, or, if constant, is aggravated after a meal Physical examination will elicit an epigastric or dorsal pain point or both. If in addition to the foregoing, which by the way, are the most reliable symptoms of ulcer, there are evidences of hyperacidity as expressed in acid eructations, vomiting of sour material, headaches and constipation, then we may safely conclude that the case before us is one of ulcer, and no time should be lost in insti

tuting appropriate measures.

It is not nec

essary to wait for hematemesis to confirm the diagnosis, and we may rest assured that sooner or later this positive symptom will appear if we but wait for it. Hematemesis ocours in about one-third of the cases of ulcer, but it is most always a late symptoms and, therefore, preventable. Absence of hemorrhage is usually the cause of failure to diagnosticate ulcer. There is a train of symptoms in young anemic girls suggestive of byperchlorhydria, which may be taken for a preulcerative stage. The anthor's experience in these cases show that sooner or later there develops either an ulcer or fissure at the pylorus followed by pylorospasmus and a mild degree of atony.

Gastric Ulcer and Cancer.-Graham (Boston Medical and Surgical Jour., Aug. 3, 1906) states that in view of the fact that ulcer may, and often does, have a latent period of years, and that cancers with short histories frequently show old ulcer base, it seems just to assume that many, if not all, rapidly developing gastric cancers have found fertile soil on a previously developed ulcer area. He distinguishes four stages in the development of gastric ulcer and when a cancer develops it is usually in the fourth stage. The symptoms in the first stage of ulcer or pain in the epigastrium occurring from two to five hours after meals, there is an unusually good appetite with nutrition at par or even excessive. The second stage may be established some months later, following several intermissions with recurrences, each increasing more or less in severity; pain is more intense and comes on shortly after eating; appetite is good, though perhaps not above normal. In the third stage the patient is afraid to eat because of distress. Pain, gas, vomiting, sour eructations, burning stomach, etc., are prominent. Perhaps there are obstructive symptoms; loss of flesh is usual and even cachexia may be present. In the fourth or cancerous stage the whole picture is intensified. In his series of cases the males and females ran in proportion of four to one, and ranged in age from 29 to 76, the average being a little over 50. About three-fourths presented themselves for the amelioration of symptoms that had been present for one year or less. In the series of 1905 pain was rather constant, being present in 73. Vomiting was not recorded in eleven histories, three patients stated no vomiting, while 68 complained of it. In 42 the lesion was situated at the pylorus or lesser curvature, in 3 at the cardia. In many of the inoperable cases the lesion was not recorded. Of the whole number operated upon, 67 had

A Contribution to the Study of Spanemic Heart. Jackson (New York Medical Journal, Aug. 25, 1906) understands by the term spanemic heart, as one which, by reason of deficient nutrition of its muscle is dilated or dilatable. He considers the following three varieties: (1) The heart insufficiently nourished on account of anemia. (2) The heart insufficiently nourished because of more or less persistent vasomotor failure, the blood being normal. (3) The insufficiently nourished heart from a combination of blood disease and vasomotor instability. He cites four cases in point. Concerning the treat

ment he says the first variety calls for the free administration of iron, and whether dilation be present or not, much good follows thorough control of the heart by digitalis or strophanthus during the anemic state. Arsenic is also of value. The treatment of the second class demands not only the use of digitalis, but also direct vasoconstrictors. got and cannabis indica seemed to give good results. The third form calls for cardiac and anemic treatment, and for direct vasoconstrictors as well.

Er.

3.

Remarks on Banti's Disease (Splenomegalia and Cirrhosis of the Liver).-Einhorn (Med. Rec., Sept. 1, 1906) gives a full resumé of the history of Banti's disease and publishes eighteen cases which he observed during the last twelve years. He tabulates and considers them into three groups: 1. Pure form; splenomegalia, anemia, cirrhosis of the liver, ascites. 2. Hemorrhagic form, showing in addition to the symptoms just enumerated, gastric and intestinal hemorrhages. Splenomegalia, enlargement of the liver, anemia sometimes associated with grave gastric symptoms. With reference to the treatment, the author says we must consider with which group and stage of the disease we have to deal. In group one and two during the preascitic stage extirpation of the spleen might be considered, as first recommended by Banti himself. The X-ray treatment has offered good results. Gastric hemorrhages should be treated according to the accepted rules; we may be slightly bolder in giving food in these cases. In the ascitic stage little hopes of im.

paracentesis affords but temporary relief, the fluid rapidly reaccumulates, and thus the patients gradually approach their death. It is different in the third group. Here we often meet with cures, not only in the beginning of the disease, but also when the symptoms have advanced. The stomach symptoms should be combated and a strengthening diet is indicated. The administration of sodium iodide with iron and sometimes arsenic is generally followed by good results.

Sternomastoid Breathing.-Chase (N. Y. Med. Jour., Aug. 25, 1906) made a study of sternomastoid breathing in the dying state on 1,500 patients. Sternomastoid breathing consists of an up and down rocking movement of the head synchronous with the breathing, exhibiting itself shortly before death supervenes. This manifestation, which the author designates as a veritable death's call, is due to a strong contraction of the sternomastoid muscles in an effort to facilitate breathing. The duration of this phenomenon varies from one minute to seven hours, the average length of time that it lasted be fore death was twenty minutes. Chase claims that sternomastoid breathing is a reliable sign of approaching death, and one which may serve the physician in forming an estimate of the length of time the patient may live, without depending on signs of less value; its onset indicates that death is probably very close at hand, generally within half an hour; it is a definite symptom on which the physi cian may predicate his instructions or advice; that it is a sign to mark the time when the family may be summoned to the bedside.

The Open-Air Treatment of Pneumonia.Northup (Med. Review of Reviews, Aug. 25, 1906) makes a plea for the wider adoption of cool fresh air as a routine treatment in pneumonia. For more than eleven years he has been treating pneumonia patients by gradually placing their beds nearer and nearer to the open window. His comment regarding the beneficial effects of open air treatment is founded mainly on last year's experience with patients treated out on the roof of the Presbyterian Hospital. His deductions are as follows: The cases most favorably affected by open-air treatment are those with severe poisoning, with delirium, partial cyanosis or deep stupor ('dopey'). In his experience all cases fare better in cool fresh air. Open air may be secured by screening off the bed and a portion of the room next to the window. In his experience no cases of pneumonia have been injured and a few have been much aided; possibly saved, by the cool fresh-air treatment. If pneumonia due to an