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caine and other drug fiends, manufactured by about with a stock of these things in their this means as well as the rapidly increasing shopping bags, so they will be handy-po army of alcoholios made by this nefarious wonder the papers are illed with 'sudden business.

death” reports. If you people who are constantly taking In New York City the authorities claim these so-called patent medicines, only knew more deaths result from these medicines than what you were taking, you wculd soon stop. from diphtheria, scarlet fever and smallpox If you could be made to realize that the most combined. A law should be passed, comwonderful discovery of the age that you are pelling every manufacturer of such stuff, to taking, recommended by some deluded su- state on the box the exact amount of acepreme judge, congressman, and other silly tanilid in each tablet or capsule; also call. fools, is but a diluted alcohol, a cheap acid ing attention to the danger from and the preor a decoction of opium, cocaine or other cautions that should be observed while tak. babit forming drug, that the formula printed ing them. on the bottle would kill the sale of them in So-called catarrh cures is another danger. six months; I say, that if you could realize ous class of drugs, the base of the majority that this is the case, you would be less ready of them is cocaine, the newest and most to take the stuff and give it to your children, dangerous of all the habit producing drugs, or recommend it to your neighbors, as you many fiends begin the use of the drug in have in the past. If you could be made this way by sniffing the solutions up the to understand that the various stomach nose, when it is absorbed in the system. bitters, peruna, celery compound, and a score These things

never cured

case of of others are only. cheap dilutions of alcohol catarıh, and never will, but they give tem. -not whiskey, as we so often hear charged porary relief from the discomfort for a very

-but diluted crude alcohol, that was never short time, when the drug must be again intended for internal use, you would be less used. Many useful lives are snuffed out ready to praise it as a wonderful cure all. through this agency.

The government has taken the matter up Cough syrups, consumption cures, bal. in such a way that should open the eyes of sams, etc., are all loaded with opium or the publio, only the government does not morphine, and kill an army of children tell us the names of the parties that are every year. Every doctor will tell you the com pelled to take out government license on dangers of opium in lung troubles with account of their sales of these alcohulic

your children. drinks. For this is what they are, and it is Any number of other patent medicines that for tbe alcohol you take them.

claim innumerable victims, could be named, Would that I were able to portray the harm but time does not permit. I cannot do you you are doing yourselves, your children and a greater service tonight, than in recommendyour neighbors in your persistent use of these ing you to subscribe for Collier's Weekly or impure liquors.

the Ladies' Home Journal or both, wherein If you feel that you need whiskey, why you may learn the deadly nature of many of don't you go to your druggist and get the these vicious compounds. best whiskey he keeps—this is bad enough, but not half so bad as the stuff you pay three or four times as much for in a bottle put up by some house that is simply a side line for

PAIN AND THE BLOOD.-Brunton asserts some overstooked distillery.

that increased sensibility to pain is someOne of the most dangerous types of patent times due to lessened alkalinity of the medicines is the various acetanilid mixtures,

blood, and may be remedied by the adminis. sold under the name of headache tablets,

tration of alkalies. powders and capsules.

Their name is legion-bromo-quinine, anti- DR. WM. LEE HOWARD.-Report has it kamnia, orangeine, and a hundred others, but that Dr. Wm. Lee Howard, of Baltimore, is the poison is the same; they are composed removing to Boston, and will hereafter devote almost entirely of acetanilid-one of the alka. his attention exclusively to literature. Dr. line dyes, made from coal tar, a most depress- Howard has been so eminently successful in ing medicine on any kind of a heart, and one

both literature and medicine that his witb. that stops forever the action of thousands of drawal from either must needs be a matter of weakened or slightly diseased hearts.

great regret. In this case ours is the loss. The majority of cases of sudden deaths that We feel confident that he will continue definare attributed to heart failures, are due to the itely in touch with his medical interests, and deadly headache mixtures.

that his work will continue to be for the phys. Thousands of weak, nervous women go ical and mental betterment of the world.

CINCINNATI, O.

as he

THE DISEASE, DIAGNOSIS AND TREAT- Exploring the stomach through an incis

MENT OF THE RIGHT UPPER ABDOM- ion is an established procedure.
INAL CAVITY.*

Pylorectomy.-- Resection of the stomacb

for disease as first done by Pean, 1879, who BENJAMIN MERRILL RICKETTS, M. D. did it for ulcer. The case of Czerny was liv.

ing at the end of ten years. Since then it

has been done many times, but is now obsoJOURNALS and societies have been the most

lete. universal means of dissiminating knowledge.

Weir says the mortality is 52 per cent. Without them progress would indeed be

Pylorectomy for cancer had a mortality slow.

of 50 per cent until Mayo began his work. The best medical and surgical thought have Since then the mortality in his hands is but been utilized in perfecting the treatment of 5.8 per cent. This lessening of mortality is disease in tbe upper abdominal cavity.

due to improved technique. Here is to be found the pancreas, liver, biliary tract, stomach, duodenum and jujen

Pyloroplasty.Done first by Heinke, um, all of which have been attacked by the

March, 1886. A longitudinal incision is made

in line of scar on pylorus. Mortality about surgeon with equal success.

70 per cent. Now obsolete. Pancreas.-Bruner, 1662, removed the

Divulsion (Loreta's operation). - Divul. pancreas from a dog without causing death.

sion of the pylorus does not cure; only reDeGraaf, 1664, made a pancreatic fistula

lieves for a short time. Now obsolete. and collected secretion therefrom. Mikulioz bas shown that manipulation of

Gastrectomy.-First done by Conner, of

Cincinnati, December 7, 1883. Woman with the pancreas increases mortality.

cancer of stomach; died on table Liver.-Clark, 1863, inserted a trocar into

was uniting the pylorus to the esopbagus. an hepatio abscess. This is the first recorded

To his Spartan courage is probably due much attempt of the kind.

that has been accomplished in this kind of Harley, 1882, said in no case would be re

work. commend the scalpel or large trocar-only a

Schlatter, 1897; Brigham, 1898; MacDon. very small trooar to evacuate an abscess.

ald, 1898; Richardson, 1898; and Bernays, McLeod had, however, incised an abscess 1898; each made a complete gastrectomy. of the liver, 1879, November 1.

Partial gastrectomy had been done for proGall Tract.-Bobbs, 1867, was the first to Japse. Several complete gastrectomies bave romove gall-stones by operation, little know- been done, giving a mortality of 33} por cent, ing that he was laying the foundation to such but the operation cannot be advised owing to a monumental structure. In consequence of the high mortality and want of cure. having removed these concretions, he rea- Mayo says that one-third of cancers of soped that it would be routine work.

the body are in the stomach, and that all Padget and Harley, 1879, bad a patient who are operable at some stage of the disease. on March 15, 1877, passed biliary concretions Gastroplication (Birchner's operation).through the abdominal wall by abscess.

Done by folding the wall of the stomach Harley, 1882, says, “In my opinion, judg- upon itself and securing by suture. The ing from my experience in operations on greater curvature of the stomach is brought choleocystotomy, it is not one whit more

half way to the lesser curvature. dangerous than that of lithotomy and ought, Weir reports such an operation. if proper precautions are taken, to be intin

Gastro-Gastrotomy. - This is for hour. itely less so.

glass stomach, to unite the two stomach oavGastrostomy.-Was first done in 1602, but

ities. If necessary, also making a gastrowas not heard of again until late in the last

enterostomy. century.

Gastrolysis is severing adhesions about Incising the stomach has been done for

the stomach; has been done for several years. many purposes. Had it not been for Alexis

Ricketts had such a case in 1899, resulting St. Martin, the physiology of the stomach

from a pistol wound causing several bands. would not bave been so rapidly developed. Removal of hair balls and foreign bodies

Gastropexy about to be relegated for more has been done many times.

scientific and rational methods. Division of pyloric and esophageal stric

A stomach hanging low probably has pyture (Abbe) and cauterizing ulcers of the

loric stenosis, and thereby becomes overstomach has been done several times.

weighted. It demands gastroenterostomy.

Gastroenterostomy.--First done by WolfAbstract of an address read before the Davis County Medical Society, Washington, Indiana, December 14, 1903.

ler, September 28, 1881, by uniting the stomach with the jejunum in case of caroinoma. Haberkant cites 58 gastro-enterostomies for

Dunin had however suggested such a pro- cancer; 12 lived longer than one year. cedure. Bilroth was second to do this oper. Mayo gives conditions indicating gastroenation; patient dying from constant emesis. terostomy, gastric-pyloric duodenal and je.

Courvasier, 1883, inserted a loop in the junal ulcer; pyloric stricture due to cicatrices jejunum through a slip in the mesentery into or neoplasms, malignant or beningn, gastrio the posterior wall.

dilatation due to any cause, without pyloric Von Hecker, 1883, raised up the colon and stricture and peripyloric adhesions causing the mesenteric jejunal loop to posterior wall. ocntractions of the pylorus.

Gastroenterostomy has undergone many Niles says 5 per cent of all persons have evolutions, having been done first by suture,

gastric ulcer, that the average age is 38 years; then Senn's decalcified plates, Murphy but

that the greatest number is between 38 and 48 ton, McGraw ligature and many other me. years, and that sex is about equal. chanical devices, only bowever, to again be

Autopsy findings in chronic ulcer have done by suture.

been instituted in hospitals giving per cents The oblong Murphy button will probably

of gastric ulcer varying from 1.32 per cent to supplant the round button. This Murphy

20 per cent. The higher per cent being in fully advises owing to the rapidity with

deaths of more recent date and by more

skilled observers. which it can be seoured and perfect proxim. ity of the parts. Then, too, it has not been

It is fair to conclude that ulcer of the

stomach is more common than generally supretained in the stomach or gut.

My own experience has been limited to the posed and that many of the so-called cases of use of the Murphy button and various kinds gastritis, indigestion, etc., are cases of gastric

ulcers.

Such cases are common in every of suture. The use of the oblong button will probably community and they are being recognized

more and more every day. be given preference in cases of great debility, where rapid work is necessary.

Five years' work leads Mayo to believe that Murphy says in a recent personal commu- ulcer of the stomach precedes cancer in about nication, that he has never seen the work of 50 per cent of the cases, and that cases of gastro-enterostomy done so rapidly and well carcinoma with long bistories speak for preby suture or otherwise as when done with the ceding ulcer with short histories, against cblong button, while MoGraw, in a personal

ulcers as a precursor. conimunication received about the same time, In 52 cases of cancer during the first half advocates the rubber ligature.

of 1905, by him, 26 were cancer upon ulcer. Mayo reports 157 stomach operations with

Distance of anastomosis from pylorus Murphy button. Benign, 72; 6 deaths (8%);

varies. Von Hecker-20 to 25 cm. from 54 anterior; 4 deaths (8%); 4 reoperations duodeno-jejunal flexure. Keppler-40 to 60 (8%); 18 posterior, 2 deaths (11%); 4 reop

cm. from fexure. Mikulicz-- three or four erations (224 %). Malignant 85; 15 deaths

inches from flexure, and Peterson, as near the (18%), including pylorectony and partial flexure as possible, same

flexure as possible, same as Czerney's nogastrectomy.

loop method. Four deaths were due to pulling apart of

The latter is now the selection of choice attached surfaces in from six to ten days after

done on posterior surface of stomach by su. button had passed into the bowel. This is ture. Make the opening proportionate with now overcome by four or five mattress su. the size of the stomach and at the most pend. tures.

ant portion. The mortality being less than In two cases it was necessary to remove the five per cent. button at a subsequent operation.

In two cases recently operated upon by me, Moynihan says that all such mechanical a posterior anastoinosis was nade with suture devices for intestinal anastomosis have served from three to four inches from the duodeno. their purpose, and that they now are of but jejunal junction. bistorical interest.

In one case, 60 years old, that had been MoGraw Ligature (Ochsner).--He has made

confined to his room for ninety days, the 156 gastroenterostomies by this method. Of weight increased twenty-two pounds within 124 at Augustina Hospital, 28 were cancer,

sixty days after the operation. 5 died (17%); 96 ulcer, 5 died (5%).

Perforating Gastric and Duodenal The disadvantages of this method are that Ulcers.-Moynihan made his first oper. it is slow to cut through, sometimes does not ation April 30, 1897. Since then he has do so because of breaking and in secure knot- made 22 operations, 8 deaths (36%); 7 duoing and does not make opening at once for denal had perforated and 15 in which a gasdrainage.

tric ulcer had perforated.

The MEDICAL FORTNIGHTLY

m

In the first ten cases there were six deaths; in the last twelve there were two deatbs. Of the gastrio ulcers two were males and twelve were females. Of the seven duodenal, four

Issued Tenth and Twenty-Fifth of Every Month. were males and three females (one not ac

Under the Editorial Direction of counted for).

FRANK PARSONS NORBURY, Mikulioz, 1903, is in favor of both gastro

THOS. A. HOPKINS,

CARL E. BLACK. enterostomy for drainage and jejunostomy for

With the following staff of Department Editors feeding for six or ten weeks, then latter is al.

0. E. LADEMANN, Internal Medicine. lowed to close.

JOHN MCHALE DEAN, Surgery.

R. B. H. GRADWOHL. Pathology and Bacteriology. Hemorrhage may be from an ulcer, fissure W. H. VOGT, Obstetrics and Gynecology.

WALDEMAR FISCHER, Ophthalmology. or varioosity, and death may result from the

A. LEVY, Pediatrics. smallest lesion.

W. T. HIRSCHI, Therapeutics.

A. F. KOETTER, Otology. ds,

HERMAN STOLTE, Laryngology and Rhinology. Pathology.-Gastric ulcer is of two kin

F. P. NORBURY, Nervous and Mental Diseases. st,

T. A. HOPKINS, Genito-Urinary Diseases. indurated and non-indurated. In the fir

ROBERT H. DAVIS, Dermatology. all coats are involved and can be felt fro without. Non-indurated, only mucosa is in volved and cannot be felt from without.

EDITORIAL Either may be acute or chronic.

The acute is more rapid, involving the en- The development of the cystoscope has un. tire wall, with sharp edges. The chronic veiled much which has been hitherto hidden ulcer is slower, broader, more irregular in

and marks that instru. shape, and terraced or funnel shaped.

ment as easily the most

An Interesting Either may perforate a blood vessel or the

important addition to entire thickness of the stomach wall.

Anatomic

our equipment of recent The two forms may heal spontaneously,

Anomaly.

years.

Its value along but the chronio form is associated with more

diagnostic lines and as cicatricial tissue and consequent deformity. a means to direct treatment to parts otherwise

Of 231 ulcers reported by Mayo, 80 were unaccessible needs no comment. Another peptio, 56 females and 24 males.

use which appeals to both the surgeon and The symptoms and differential diagnosis the internist is the definite placing of normal of the following diseases are given in detail: anatomic relations and the detection of irreg- . Gallstones, gastralgia, gastric ulcer, perfora. ularities and anomalies. Through the cour. . tion of gastro-intestinal ulcers, perforating tesy of Dr. Bransford Lewis it has recently duodenal ulcer, distended gall-bladder, bili. en our privilege to see a case to the point. ous or acute gastric-duodenal catarrh, move. Cystoscopic examination revealed the exist. able kidney, floating kidvey with twisted ence of three ureteral orifices, one on the ureter, nephritic colio, pyo-nephrosis, tumors right and two on the left; catheterization of kidney, ureteritis, obstruction and atonic from these brought three distinct and differ. dilatation of the stomach, appendicitis, acute ent urines. The urine from the right kidney indigestion, intestinal colio, acute enteritis, was normal. From the left ureters: from one intestinal obstruction, typhoid fever and the urine was turbid, specific gravity 1005, and acute pancreatitus and carcinoma stomach. contained pus which contained gonococci;

the sample from the other left ureter was clear, specific gravity 1010 and free from pus.

A skiagraph was made of this patient with INSANITY

FROM HYSTEROTOMY AND catheters, in the lumen of which a lead wire OOPHORECTOMY.-G. M. Hammond, New bad been placed in the ureters. The picture York (Jour. A.M.A., March 10), while ad- showed the right ureter to follow its normal mitting the greater frequency of insanity course. The two on the left enter the blad. after operations on the pelvio organs, attrib- der at points on the same level and the course utes this to certain psychologic causes, read- above was parallel for three or four inches, ily understood, acting on an originally de- the inner ureter continuing in the normal fective brain, rather than to any especial rela- position of the left kidney. The outer tion existing between the integrity of the sex- crossed inward and continued upward to a ual organs and the brain. The removal of point midway between the left kidney and these organs alone never causes insanity; the the median line and somewbat lower. cases that occur are due to hereditary tend- Treatment was given through the catheter ency, the psychologic and physical effects to the affected pelvis and ureter with telling and to surgical shock, but most of all to the efficacy, as was demonstrated to us a few days originally defective brain.

later.

are tried.

Whether this patient is the possesor of

The writer does not advocate so three kidneys or bas a left embryonal kidney full a diet in every case, for each patient is the question to be determined. Dr. Lewis must be carefully studied as an individual. is of the opinion that there are three kidneys, He believes that most of the foods men. and the difference in position of the two tioned are quite as digestible, far more palpelves makes this the natural conclusion. atable, and rather less likely to cause per. Embryonal kidney might give the distinctly foration or hemorrhage by their local acdifferent urines through distinct pelves and tion, or gas production, than milk. The ureters, but unless the kidney was greatly writer appends a table of twenty-six cases. distorted and tremendously enlarged it would These patients all recovered. He adds that be impossible for the pelves to be so far sep- the advocates of the more liberal diet claim arated, and so placed in relation to each that the patient is more comfortable, the other.

attack is slightly shortened, convalescence It will be our privilege to give Dr. Lewis' is more prompt, and relapse, bemorrhage, findings later and in detail. The case is of

The case is of and perforation are not more frequent. such interest that it and all which are found of its class should be recorded for the information of the profession.

AFTER reviewing the history of the use of al. cohol as an antidote to carbolic acid poison

ing. T. W. Clarke and

E. D. Brown, Cleveland, DR. THOMAS A. CLAYTOR states (Med. Rec- Alcohol in

Ohio (Jour. A. M. A., ord) that it has been proved experimentally Carbolic Acid March 17), report the that the digestive and Poisoning.

results of a clinical and absorptive powers dur.

experimental study of A More ing typhoid fever fall off

the subject.

Thirteen Liberal Diet in only five to ten per cases of carbolic acid poisoning treated at the Typhoid fever. cent, so that impaired Lakeside Hospital, Cleveland, by lavage with

digestion is not suffi. diluted alcohol are reported, and comparison

cient argument in favor is made with other cases treated there and of the exclusive milk diet. The present trend elsewhere without alcohol. The very slight of thought is toward the belief that the ma- difference in the mortality in the two series of jority of diseases being due to specifio poi. cases and the greater apparent constitutional sons, recovery depends upon either the ex. disturbance observed when the acid was taken haustion of that poison, or the development with alcohol than when taken clear or with of an antibody of some sort which renders it water, raised grave doubts in their minds as innocuous. In order that he may withstand to the antidotal power of alcohol, which, tothe ravages of the disease until the time of gether with the statements of recent textrecovery, it is necessary to keep the patient books on toxicology, led them to undertake in the best possible condition. The writer some experimental work to better satisfy emphasizes the following points in the selec- themselves as to the true facts of the case. tion of a diet for typhoid fever patients: It The experiments were performed so as to must be sufficiently nutritious to maintain test the systemic antagonism of alcohol as far as possible the bodily equilibrium. and phenol (by intravenous injection): To The writer's treatment of a case of typhoid test the antagonism in the stomach (5 per fever, no matter what day of the disease it cent phenol): To test the efficiency of lav. may come under his care, is as follows: The age (undiluted phenol). The experiments regulation six ounce of milk are given every were performed on anesthetized dogs and two hours, night and day, while the patient rabbits, and a further series of tests of the is awake. In place of milk, in order to vary local antagonism of carbolic acid and alco. the monotony for those who can not, animal hol and other phenol solvents, was made by broths are given. After the subsidence of Prof. T. Sollmann and included in the paper. the more acute symptoms, the patient is The tests in this case were made by direct asked if he is bungry, and if he replies in application of the acid to the fingers of vari. the affirmative a soft-boiled or poached egg ous individuals followed by the antidote. is allowed, and if well borne the number is The general conclusions from all the experi. gradually increased to three or more a day. ments are given as follows: "1. Alcohol has Jelly or blanomange, custard, soft toast, the a local antidotal effect to carbolic acid burns, soft part of baked apple, and rice which has due to its solvent action. 2. There is no been boiled four hours, are the next addi- evidence of chemical antagonism between

After this, scraped beef or chop, alcohol and phenol. 3. There is no effeot very finely divided chicken, and baked potato produced by alcohol on carbolio acid poison

tions.

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