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The Pan-American Congress will be an excellent opportunity for a mid-winter vacation with scientific advantages.
Never before in its history has the New York County Medical Association been as strong and healthy as it is to-day.
Reports from several counties show an unprecedented activity in the enrolment of new members.
Ask your secretary for a few application blanks and send them to your friends. It is a great favor to them and of little trouble to you. Potential enthusiasm is of no value as suchmake it kinetic.
Chairmen of committees are incompetent as long as they wait for work to come to them. They should look for work to do.
No duty is too insignificant for the man who is capable of large affairs.
Dr. E. A. Sharp, of Katonah, member of the Westchester County Medical Association, read a paper entitled "Private Colonies for Epileptics" at the meeting of the National Association for the Study of Epileptics and the Care and Treatment of Epileptics, which was held in Boston, November 22d.
CORNING MEDICAL ASSOCIATION.-At a meeting to be held January 5, 1905, Dr. Frank H. Starr will read a paper on "Recent Advances in Orthopedic Surgery."
METROPOLITAN MEDICAL SOCIETY.-At a meeting held December 27, 1904, Dr. H. Lilienthal read a paper on "Some Recent Advances in Surgery," and Dr. A. Wiener on "Some Observations on the More Conservative Treatment of Protracted Cases of Acute Otitis Media Purulenta, with its complications."
THE PRINCIPLES OF HYGIENE. A Practical Manual for Students, Physicians, and Health Officers. By D. H. Bergey, A.M., M.D., Assistant Professor of Bacteriology, University of Pennsylvania. Illustrated. Second edition, thoroughly revised and enlarged. Philadelphia, New York and London: W. B. Saunders & Co., 1904.
The entire range of subjects comprising the comprehensive field of hygiene, causes of disease, the study of air, ventilation, heating, water supply, and disposal of sewage is based on the most recent discoveries, and represents the practical advances made in the science up to date. The subjects of food, dieting, exercise and clothing are practically discussed. The chapters on infection and immunity have been rewritten and the discussion of the subject is from the present-day standpoint.
COMPEND OF GYNECOLOGY. By William H. Wells, M.D.,
Chief of the Gynecological Staff of the Mount Sinai Hospital, Philadelphia; Demonstrator of Clinical Obstetrics in the Jefferson Medical College, Philadelphia; Fellow of the College of Physicians and of the Gynecological Section of the same; late Assistant in the Gynecological Department of the Jefferson Medical College Hospital, etc. Third edition, revised. enlarged, with 145 illustrations. Philadelphia: P. Blakiston's Son & Co., 1012 Walnut street, 1903. Price, 80 cents net.
The third edition in the revision has added a sec
tion on general therapeutics of gynecology and several new operations have been described.
A COMPEND OF HUMAN ANATOMY. By Samuel O. L. Potter, M. A., M.D., M.R., C.P., London. Formerly Professor of the Principles of Medicine in the Cooper Medical College of San Francisco; Author of the "Hand-Book of Materia Medica, Pharmacy and Therapeutics," "Quiz-Compend of Materia Medica," "Index of Comparative Therapeutics" and "Speech and Its Defects;" late Major and Surgeon of Volunteers, U. S. Army. Seventeenth edition. Revised and enlarged, with 138 wood engravings; also numerous tables and 16 plates of the arteries and nerves. Philadelphia: P. Blakiston's Son & Co., 1012 Walnut street, 1903.
In this seventh edition all changes of nomenclature and description have been carefully followed. Many plates have been added and old ones replaced by new. The author has endeavored to make this volume deserving of first rank among its kind.
Essentials of Nervous Diseases and Insanity, their Symptoms and Treatment, by John C. Shaw, M.D., late Clinical Professor of Diseases of the Mind and Nervous System, Long Island College Hospital Medical School. Fourth edition. Thoroughly revised, by Smith Ely Jelliffe, M.D., Ph.D., Clinical Assistant, Columbia University, Department of Neurology; Visiting Neurologist, City Hospital, New York. Illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
Dr. Smith Ely Jelliffe, in making the revision for this new fourth edition, has found it necessary to recast the work entirely, bringing the order of arrangement in accord with the present knowledge of these important subjects. Quite a commendable change in arrangement is the grouping of subjects in such a way as to bring out the natural relations of affiliated nervous disorders.
THE ESSENTIALS OF CHEMICAL PHYSIOLOGY, FOR USE OF STUDENTS. By W. D. Halliburton, M.D., F.R.S., Fellow of the Royal College of Physicians; Professor of Physiology in Kings College, London; Author of Text-Book of Chemical Physiology and Pathology. Fifth edition. London, New York and Bombay: Longmans, Green & Co., 1904.
This edition has been carefully and thoroughly revised, and several changes made in the arrangement of exercises. The elements contained in physiological compounds have been introduced in the elementary course. Within the moderate limits of this work the author has kept abreast with the advances in science. The book is valuable to the student, showing how work can be accomplished in a practical way.
SAUNDERS' QUESTION-COMPENDS. Essentials of Anatomy, including the Anatomy of the Viscera, arranged in the form of Questions and Answers, prepared especially for Students of Medicine, by Charles B. Nancrede, M.D., Professor of Surgery and of Clinical Surgery in the University of Michigan: Emeritus Professor of General and Orthopedic Surgery, Philadelphia Polyclinic; Senior Vice-President of the American Surgical Association; Corresponding Member of the Royal Academy of Medicine, Rome, Italy; Member of the American Academy of Medicine, etc. Seventh edition, thoroughly revised. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
In this revision the entire book has been carefully gone over and the section on the Nervous System completely rewritten. The illustrations throughout the text are excellent, showing the anatomy of various parts with unusual clearness. SAUNDERS' QUESTION-COMPENDS.
Essentials of Bacteriology. Being a Concise and Systematic Introduction to the Study of Micro-Organisms, by M. V. Ball, M.D.. formerly Resident Physician, German Hospital, Philadelphia; formerly Bacteriologist to
St. Agnes' Hospital. Fifth edition, thoroughly revised by Carl M. Vogel, M.D., Assistant in Pathology, College of Physicians and Surgeons, Columbia University, New York City. With 96 illustrations, some in colors and 6 plates. Philadelphia, New York, London: W. B. Saunders & Co., 1904. The rapid progress in Bacteriology has involved many radical changes in the science, necessitating a thorough revision in this edition. We note the recent advances in the subjects of Immunity, Tuberculosis, Yellow Fever, Dysentery, Bubonic Plague and other infectious diseases.
Essentials of Medical Chemistry, Organic and Inorganic, containing also Questions of Medical Physics, Chemical Philosophy, Analytical Processes, Toxicology, etc., Prepared especially for Students of Medicine, by Lawrence Wolff, M.D., formerly Demonstrator of Chemistry, Jefferson Medical College; Physician to the German Hospital of Philadelphia; Member of the German Chemical Society, of the Philadelphia College of Pharmacy, etc. Sixth edition, thoroughly revised by A. Feree Witmer, Ph.G., formerly Assistant Demonstrator of Physiology, University of Pennsylvania; Neurologist to the Out-Patient Department of the Hospital for Ruptured and Crippled, New York City. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
We need but mention the fact that this little work has reached its sixth edition. The recent important discoveries in physics and inorganic chemistry have rendered it necessary to make extensive additions almost to every part of the work. The subject of organic chemistry, especially organotherapy and the substituted ammonias, has also been revised and much new matter added.
SAUNDERS' QUESTION-COMPENDS. Essentials of Materia Medica, Therapeutics and Prescription Writing, arranged in the form of Questions and Answers, prepared especially for Students of Medicine, by Henry Morris, M.D., Fellow of the College of Physicians of Philadelphia; Associate Member of the Association of Military Surgeons of the United States; Member of the American Medical Association, etc. Sixth edition, thoroughly revised, by W. A. Bastedo. Ph.G., M.D., Tutor in Materia Medica and Pharmacology at Columbia University (College of Physicians and Surgeons), New York; Assistant Attending Physician in the Roosevelt Hospital Dispensary and to the Vanderbilt Clinic. Philadelphia, New York, London: W. B. Saunders & Co., 1904. Much of the text has been in great part rewritten. There have been introduced articles on adrenalin, stypticin and on the iodine and silver synthetics. TEXT-BOOK OF CLINICAL DIAGNOSIS. By Laboratory Methods. For the use of Students, Practitioners, and Laboratory Workers. By L. Napoleon Boston, A.M., M.D., Associate in Medicine and Directory of the Clinical Laboratories of the Medico-Chirurgical College, Philadelphia; formerly Bacteriologist at the Philadelphia Hospital and at the Ayer Clinical Laboratory of the Pennsylvania Hospital. Octavo volume of 547 pages, with 320 illustrations, many of them in colors. Philadelphia, New York, London: W. B. Saunders & Co., 1904. Cloth, $4.00 net: sheep or half morocco, $5.00 net.
Dr. Boston presents a practical manual of those clinical laboratory methods which furnish a guide to correct diagnosis, giving only such methods, however, that can be carried out by the busy practitioner in his office as well as by the student in the laboratory. He has given special attention to outlining in progressive steps the various procedures in clinical technic, such steps being illustrated whenever possible. All the more recent methods for the examination and staining of blood are described and illustrated by original drawings, and the subject of Serum-Diagnosis is very carefully considered. The newer methods for the estimation of Sugar, BenceJones' Albumin, Uric Acid, and Purin have received
thoughtful consideration. The subjects of Animal Parasites, Diseases of the Skin, Transudates and Exudates, and Secretions of the Eye and Ear have received an unusual amount of space. Attention has also been paid to Inoscopy and Cyto-diagnosis. Indeed the book contains much useful material throughout, and being the latest work on Clinical Diagnosis, includes the most recent advances along that line.
EXAMINATION OF THE URINE. By G. A. de Santos Saxe, M.D., Pathologist to the Columbus Hospital, New York City. 12mo volume of 391 pages, fully illustrated, including 8 colored plates. Philadelphia, New York, London: W. B. Saunders & Co., 1904. Flexible leather, $1.50 net.
Dr. Saxe has presented a work on examination of the urine unusually complete, absolutely up to date, concise, yet explicit in all its parts; and it will be found to meet fully the requirements of the student and practitioner without burdening him with unnecessary analytic procedures. Special attention has been paid to the interpretation of findings as applied to clinical diagnosis, and the student is told what each chemical element and each microscopic structure means when found in the urine. Cryoscopy and other means of functional diagnosis have been given their proper places. The work will be useful because it is practical. PATHOLOGICAL TECHNIQUE. A Practical Manual for Workers in Pathological History and Bacteriology, including Directions for the Performance of Autopes and For linical Diagnosis by Laboratory Methods. By Frank Burr Mallory, A.M., M.D., Associate Professor of Pathology, Harvard University Medical School; First Assistant Visiting Pathologist to the Boston City Hospital; Pathologist to the Children's Hospital, and James Homer Wright, A.M., M.D., Director of the Clinico-Pathological Laboratory of the Massachusetts General Hospital: Instructor in Pathology, Harvard University Medical School. Third edition, revised and enlarged, with 156 illustrations. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
The third edition of this work keeps pace with the great advances made in pathology, and it retains its value as a laboratory and post-mortem guide. Many additions have been made as the methods for the isolation of typhoid bacilli from the feces, Wright's blood stain, and directions for its application to blood films and malarial parasites. Some new photographs by Mr. L. S. Brown on the malarial parasites are particularly interesting.
A LABORATORY MANUAL OF HUMAN ANATOMY. By Lewellys F. Barker, M.B., Tor., Professor and head of the Department of Anatomy in the University of Chicago and Rush Medical College. Assisted by Dean De Witt Lewis, A.B., M.D., and Daniel Graisberry Revell, A.B., M.B., Instructors in Anatomy in the University of Chicago. Illustrated. Philadelphia and London: J. B. Lippincott Company, 1904. Price, $5.
TRANSACTIONS OF THE MEDICAL ASSOCIATION OF GEORGIA, FIFTY-FIFTH ANNUAL SESSION, 1904. Published by the Association, 1904.
TRANSACTIONS OF THE MAINE MEDICAL ASSOCIATION, 1904. Vol. XV, Part 1.
TRANSACTIONS OF THE ARKANSAS MEDICAL SOCIETY, Twenty-ninth Annual Session, held at Texarkana, Ark., May 3, 4 and 5, 1904. Press of Arkansas Democrat Company, Little Rock.
GENERAL CATALOGUE OF MEDICAL BOOKS. P. Blakiston's Sons & Co., Philadelphia.
A TEXT-BOOK OF PRACTICAL THERAPEUTICS, with especial_reference to the Application of Remedial Measures to Disease and Their Employment upon a Rational Basis. By Hobart Amory Hare, M.D., B.Sc., Professor of Therapeutics and Materia Medica in the Jefferson
Medical College of Philadelphia; Physician to the Jefferson Medical College Hospital; one-time Clinical Professor of Diseases of Children in the University of Pennsylvania; Laureate of the Royal Academy of Medicine in Belgium, of the Medical Society of London; author of "A Text-Book of Practical Diagnosis," etc. Tenth edition, enlarged, thoroughly revised and largely rewritten, illustrated with 113 engravings and 4 colored plates. Philadelphia and New York: Lea Bros. & Co.,
LIBRARY OF CONGRESS. A. L. A. CATALOG, 8,000 volumes for a Popular Library, with Notes prepared by the New York State Library and the Library of Congress under the auspices of the American Library Association Publishing Board. Editor, Melvil Dewey, Director New York State Library and Library School; Associate Editors, May Seymour, Education Librarian, New York State Library; Mrs. H. L. Elmendorf, Special Bibliographer, Buffalo Public Library. Part 1, Classed; Part 2, Dictionary. Washington Government Printing Office, October, 1904.
STRABISMUS, OR SQUINT. Latent and Fixed. A supplement to The Errors of Refraction. By Francis Valk, M.D., Professor of Diseases of the Eye, New York Post-Graduate School and Hospital; Consulting Ophthalmologist, Thrall Hospital, and formerly Assistant Surgeon, Manhattan Eye and Ear Hospital; Visiting Ophthalmologist Randall's Island Hospitals and Ophthalmologist to the New York Dispensary; Fellow of the New York Academy of Medicine and of the State and County Medical Society; Member of the Greater New York Medical Society and the Society of Medical Jurisprudence, etc. G. P. Putnam's Sons, New York and London: The Knickerbocker Press, 1904.
A MANUAL OF PERSONAL HYGIENE, PROPER LIVING UPON A PHYSIOLOGIC BASIS. By American authors. Edited by Walter L. Pyle, A.M., M.D., Assistant Surgeon to the Willis Eye Hospital, Philadelphia; Secretary of the Section on Opthalmology, American Medical Association; Associate Member of the American Opthalmological Society; Fellow of the College of Physicians of Philadelphia, etc. Contributors, D. H. Bergey, M.D., J. W. Courtney, M.D., George Howard Fox, M.D., E. Fletcher Ingals, M.D., Walter L. Pyle, M.D., B. Alexander Randall, M.D., G. N. Stewart, M.D. (Edin.), Charles G. Stockton, M.D. Second edition, revised and enlarged. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
DIET IN HEALTH AND DISEASE. By Julius Friedenwald, M.D., Clinical Professor of Diseases of the Stomach in the College of Physicians and Surgeons, Baltimore, and John Ruhräh, M.D., Clinical Professor of Diseases of Children in the College of Physicians and Surgeons, Baltimore. "These few rules of diet he that keeps, shall surely find great ease and speedy remedy by it."-Burton. Philadelphia, New York, London: W. B. Saunders & Co., 1905.
DISEASES OF THE LIVER, GALL-BLADDER AND BILEDUCTS. By H. D. Rolleston, M.A., M.D., (Contab.) F.R.C.P., Physician to St. George's Hospital, London; formerly Examiner in Medicine in the University of Durham and Fellow of St. John's College, Cambridge, England. Fully illustrated. Philadelphia, New York, London; W. B. Saunders & Co., 1905.
ATLAS AND EPITOME OF GENERAL PATHOLOGIC HISTOLOGY. By Docent Dr. Hermann Dürck, of the Pathologic Institute, Munich. Authorized translation from the German. Edited by Ludvig Hektoen, M.D., Professor of Pathology in Rush Medical College, Chicago. With 176 colored illustrations on 80 lithographic plates and 36 figures in black and colors. Philadelphia, New York, London: W. B. Saunders & Co., 1904.
GALL-STONES AND THEIR SURGICAL TREATMENT. By B. G. A. Moynihan, M.S. (London), F.R.C.S., Leeds. Fully illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1905.
AN ATYPICAL CASE OF APPENDICITIS.1
Presenting Some Unusual Features Found at the Operation.
Dr. Howard A. Kelley, in his text-book on "Operative Gymnecology," describes a condition under the name of Physometra, using it to designate a collection of gas in the uterus, associated with sepsis. The cause of the tympany in Kelley's case was the bacillus ærogenes capsulatus. The cause of the condition which we encountered was found to be due to bacteria, which will be described later.
The family history was negative.
that such as
Total quantity not obtained. Color, yellow. gravity, 1028. Hel
T Deaver, Fowler, Mynter and Ochsner, who ler's test showed a ring of albumen. Trommer's
test showed a decided trace of sugar.
have written special text-books on the subject of appendicitis, have not mentioned the possibility of the complication which we encountered in the case about to be reported, and that no similar case is recorded in the literature stamps it of sufficient rarity to warrant placing a single
case on record.
THE PRESENT SICKNESS.
On February 17th, while riding with her husband, she was thrown from a sleigh, striking on the right side and shoulder. The same night, a severe pain gradually developed in the left hypochondrium. This lasted all night, and toward morning settled to the right lumbar and right iliac regions. The pain remained of a dull, aching character during the next day, but the abdomen gradually became more sore and tender to the touch. On February 19, 1904, the family physician was sent for, and obtained the history as given above. He found the abdomen somewhat distended, markedly sore over McBurney's point, but no rigidity. The respirations were 20; pulse, 90, and temperature, 100.
General appearance very stout and fleshy. Color somewhat sallow. Height, 5 feet 4 inches. Weight, 175-180 pounds. The heart showed evidences of fatty degeneration, but no murmur was heard. Examination of the chest showed the lungs in a normal condition. Examination of the
Read at the Twenty-first Annual Meeting of The New York State Medical Association, New York, October 17-19, 1904.
abdomen revealed a large umbilical hernia, associated with a general tympanitis. There was a marked tenderness over McBurney's point, associated with board-like rigidity. The pulse was 110; temperature, 101; respiration, 24.
EXAMINATION OF THE URINE.
MICROSCOPICAL EXAMINATION OF URINE.
A drop of precipitate, thrown down by the centrifuge, showed a few pus cells and a large number of granular and hyaline casts. The diagnosis of traumatic appendicitis was made.
Owing to the bad condition of the heart and kidneys, it was thought best to defer the operation for a few days. I advised that the bowels be moved immediately by a high enema, that the starvation treatment of Ochsner be followed, and that the case be kept under the closest observa
On March 11, 1904, I saw the case again and found the condition somewhat worse. The temperature had varied during intervals from 100 to 103; the pulse from 90 to 114 per minute. The patient was then removed from the country to the hospital, a distance of seven miles.
On admission, the record shows a temperature of 102; pulse, 114, and respirations, 24. The heart was in bad condition, being very irregular, intermittent, and the pulse of very poor volume.
Examination of the abdomen at this time a general tenderness, more localized in the right side. A tumor in the same region, the size of a small apple, could easily be palpated and distinctly outlined. The previous diagnosis was confirmed and the evidences of abscess formation very suggestive. The amount of urine. passed during the previous ten days had averaged about 12 ounces.
Owing to the bad general condition and the state of the heart and kidneys, we determined to keep the case under observation, and by treatment try to improve the work of these organs. The patient was then placed on a strict liquid diet and given three pints of distilled water daily. The bowels were unloaded by small doses of calomel, followed by a saline. From the date of admission-March 11, 1904, to March 31, 1904-the patient ran an irregular temperature, varying from 100 to 103 degrees. The pulse was irregular, intermittent and of poor volume, varying from 90 to 120 beats per minute. She continued to pass large quantities of albumen and sugar. The average amount of urine passed was 15 ounces per day. Nausea was a continuous and distressing symptom, but no vomiting occurred. Pain was not complained of at any time, but the soreness and tenderness in the right side gradually grew worse. The tumor in the appendicular region increased to the size of a small cocoanut. As it seemed impossible to improve
her general condition, we determined to operate shape, according to age, the younger tending towithout further delay.
ward a round, while the older were very irregular. The potato cultures were much more irregular in shape and of a darker color, even showing a tendency in the older colonies of a yellowishbrown or dirt color. The gelatin stick cultures showed an abundant growth, along the line of puncture, grayish-white in the early growth, but tending toward the yellow as the culture aged. A few gas bubbles developed in some of the culture media. The addition of a slight amount of milk sugar to each tube of gelatin, and then followed by a stick culture, showed practically the same macroscopic appearance, but with this distinction, that there was an abundant development of gas bubbles.
Owing to the degeneration of the heart muscle, general anesthesia with ether or chloroform was considered too hazardous, so I determined to try local anesthesia. Ethyl chloride was used to anæsthetize the punctures, when the hypodermics were given and the skin incision made. A 2 per cent. solution of nirvanin was used hypodermically, for deep anesthesia. The total quantity used in the work was two grains. The operation was carried out without causing the patient any pain or suffering. An incision, two inches in length, was made over the most prominent part of the tumor. The skin was incised, and I then proceeded carefully through the muscles and came to the upper wall of a large abscess. This was opened, and, to my great surprise, a rush of foul-smelling gas came through the small incision which had been made. The sound was exactly like that of a pin-hole prick in an overdistended intestine, filled with gas. In fact, that is what we all thought had happened, that a coil
MICROSCOPICAL EXAMINATION OF SOME OF THE
A. The hanging drops of all the specimens, both gelatin plate, stick and potato, showed no mobility. B. All the specimens examined took both the fuchsine and menthylene blue readily and rapidly parted with the colors by Gram's method. C. The microscope showed a wide variation in the morphological appearance of the different specimens. All showed the same rod appearance with rounded ends. Many colonies were typical of the bacillus coli communis; the average size in most of the specimens ranged from 1 to 3 micromillimeters in length and from 0.2 to 0.7 micromillimeters in breadth. Many specimens showed a large number of bacilli of a much smaller size, and with much more of the appearance of a micrococcus. The general appearance of these small bacilli was about the same, being short rods with rounded ends, the size varying somewhat, but, in the mean, ranging from to 2 micromillimeters in length and from 0.1 to 0.5 micromillimeters in breadth. These smaller bacilli drew my attention to their close resemblance to the bacillus lactis ærogenes described by Sternberg. This suspicion I believed not to have been well founded. My second thought on the question, however, is not at all dogmatic, and 1 hope my final decision will be materially assisted by the discussion, which you men with a more varied and wider experience in bacteriology may have to offer.
We all know the reputation of the colon bacillus to such a marked variation, both in morphological appearance and biological characteristics.
Sternberg, in speaking of the bacillus coli communis, says: "Numerous varieties have been cultivated by different bacteriologists, which vary in pathogenic power, and to some extent in their growth in various culture media; but the differences described are not sufficiently characteristic or constant to justify us in considering them as distinct species.'
Under certain circumstances some of the rods in pure cultures have been observed by Escherich to present spherical, unstained portions at one or both extremities, which closely resemble spores, but which he was not able to stain by the methods usually employed for staining spores,