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caine and other drug fiends, manufactured by this means as well as the rapidly increasing army of alcoholics made by this nefarious business.

If you people who are constantly taking these so-called patent medicines, only knew what you were taking, you would soon stop. If you could be made to realize that the most wonderful discovery of the age that you are taking, recommended by some deluded supreme judge, congressman, and other silly fools, is but a diluted alcohol, a cheap acid or a decoction of opium, cocaine or other habit forming drug, that the formula printed on the bottle would kill the sale of them in six months; I say, that if you could realize that this is the case, you would be less ready to take the stuff and give it to your children, or recommend it to your neighbors, as you have in the past. If you could be made to understand that the various stomach bitters, peruna, celery compound, and a score of others are only cheap dilutions of alcohol -not whiskey, as we so often hear charged. -but diluted crude alcohol, that was never intended for internal use, you would be less ready to praise it as a wonderful cure all.

The government has taken the matter up in such a way that should open the eyes of the public, only the government does not tell us the names of the parties that are compelled to take out government license on account of their sales of these alcoholic drinks. For this is what they are, and it is for the alcohol you take them.

Would that I were able to portray the harm you are doing yourselves, your children and your neighbors in your persistent use of these impure liquors.

If you feel that you need whiskey, why don't you go to your druggist and get the 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 some overstocked distillery.

One of the most dangerous types of patent medicines is the various acetanilid mixtures, sold under the name of headache tablets, powders and capsules.

Their name is legion-bromo-quinine, antikamnia, orangeine, and a hundred others, but the poison is the same; they are composed almost entirely of acetanilid-one of the alkaline dyes, made from coal tar, a most depressing medicine on any kind of a heart, and one that stops forever the action of thousands of weakened or slightly diseased hearts.

The majority of cases of sudden deaths that are attributed to heart failures, are due to the deadly headache mixtures.

Thousands of weak, nervous Women go

about with a stock of these things in their shopping bags, so they will be handy-no wonder the papers are filled with "sudden death" reports.

In New York City the authorities claim more deaths result from these medicines than from diphtheria, scarlet fever and smallpox combined. A law should be passed, compelling every manufacturer of such stuff, to state on the box the exact amount of acetanilid in each tablet or capsule; also calling attention to the danger from and the precautions that should be observed while taking them.

So-called catarrh cures is another dangerous class of drugs, the base of the majority of them is cocaine, the newest and most dangerous of all the habit producing drugs, many fiends begin the use of the drug in this way by sniffing the solutions up the nose, when it is absorbed in the system.

These things never cured a case of catarrh, and never will, but they give temporary relief from the discomfort for a very short time, when the drug must be again used. Many useful lives are snuffed out through this agency.

Cough syrups, consumption cures, balsams, etc., are all loaded with opium or morphine, and kill an army of children every year. Every doctor will tell you the dangers of opium in lung troubles with your children.

Any number of other patent medicines that claim innumerable victims, could be named, but time does not permit. I cannot do you a greater service tonight, than in recommending you to subscribe for Collier's Weekly or the Ladies' Home Journal or both, wherein you may learn the deadly nature of many of these vicious compounds.

PAIN AND THE BLOOD.-Brunton asserts that increased sensibility to pain is sometimes due to lessened alkalinity of the blood, and may be remedied by the administration of alkalies.

DR. WM. LEE HOWARD.-Report has it that Dr. Wm. Lee Howard, of Baltimore, is removing to Boston, and will hereafter devote his attention exclusively to literature. Dr. Howard has been so eminently successful in both literature and medicine that his withdrawal from either must needs be a matter of great regret. In this case ours is the loss. We feel confident that he will continue definitely in touch with his medical interests, and that his work will continue to be for the physical and mental betterment of the world.

THE DISEASE, DIAGNOSIS AND TREATMENT OF THE RIGHT UPPER ABDOMINAL CAVITY.*

BENJAMIN MERRILL RICKETTS, M. D.

CINCINNATI, O.

JOURNALS and societies have been the most universal means of dissiminating knowledge. Without them progress would indeed be slow.

The best medical and surgical thought have been utilized in perfecting the treatment of disease in the upper abdominal cavity.

Here is to be found the pancreas, liver, biliary tract, stomach, duodenum and jujenum, all of which have been attacked by the surgeon with equal success.

Pancreas.-Bruner, 1662, removed the pancreas from a dog without causing death. DeGraaf, 1664, made a pancreatic fistula and collected secretion therefrom.

Mikulicz has shown that manipulation of the pancreas increases mortality.

Liver.-Clark, 1863, inserted a trocar into an hepatic abscess. This is the first recorded attempt of the kind.

Harley, 1882, said in no case would he recommend the scalpel or large trocar-only a very small trocar to evacuate an abscess.

McLeod had, however, incised an abscess of the liver, 1879, November 1.

Gall Tract.-Bobbs, 1867, was the first to remove gall-stones by operation, little knowing that he was laying the foundation to such a monumental structure. In consequence of having removed these concretions, he reasoned that it would be routine work.

Padget and Harley, 1879, had a patient who on March 15, 1877, passed biliary concretions through the abdominal wall by abscess.

Harley, 1882, says, "In my opinion, judging from my experience in operations on choleocystotomy, it is not one whit more dangerous than that of lithotomy and ought, if proper precautions are taken, to be infinitely less so.

Gastrostomy.-Was first done in 1602, but was not heard of again until late in the last century.

Incising the stomach has been done for many purposes. Had it not been for Alexis St. Martin, the physiology of the stomach would not have been so rapidly developed.

Removal of hair balls and foreign bodies has been done many times.

Division of pyloric and esophageal stricture (Abbe) and cauterizing ulcers of the stomach has been done several times.

Abstract of an address read before the Davis County Medical Society, Washington, Indiana, December 14, 1905.

Exploring the stomach through an incision is an established procedure.

Pylorectomy.-Resection of the stomach for disease as first done by Pean, 1879, who did it for ulcer. The case of Czerny was living at the end of ten years. Since then it has been done many times, but is now obsolete.

Weir says the mortality is 52 per cent.

Pylorectomy for cancer had a mortality of 50 per cent until Mayo began his work. Since then the mortality in his hands is but 5.8 per cent. This lessening of mortality is due to improved technique.

March, 1886. A longitudinal incision is made Pyloroplasty.-Done first by Heinke, in line of scar on pylorus. Mortality about 70 per cent. Now obsolete. Divulsion (Loreta's operation).-Divulsion of the pylorus does not cure; only relieves for a short time. Now obsolete.

Gastrectomy.-First done by Conner, of Cincinnati, December 7, 1883. Woman with cancer of stomach; died on table as he was uniting the pylorus to the esophagus. To his Spartan courage is probably due much that has been accomplished in this kind of work.

Schlatter, 1897; Brigham, 1898; MacDonald, 1898; Richardson, 1898; and Bernays, 1898; each made a complete gastrectomy.

Partial gastrectomy had been done for prolapse. Several complete gastrectomies have been done, giving a mortality of 33 per cent, but the operation cannot be advised owing to the high mortality and want of cure.

Mayo says that one-third of cancers of the body are in the stomach, and that all are operable at some stage of the disease.

Gastroplication (Birchner's operation).Done by folding the wall of the stomach upon itself and securing by suture. The greater curvature of the stomach is brought half way to the lesser curvature.

Weir reports such an operation.

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Gastro-Gastrotomy. This is for hourglass stomach, to unite the two stomach cavities. If necessary, also making a gastroenterostomy.

Gastrolysis is severing adhesions about the stomach; has been done for several years. Ricketts had such a case in 1899, resulting from a pistol wound causing several bands. Gastropexy about to be relegated for more scientific and rational methods.

A stomach hanging low probably has pyloric stenosis, and thereby becomes overweighted. It demands gastroenterostomy. Gastroenterostomy.-First done by Wolfler, September 28, 1881, by uniting the stom

ach with the jejunum in case of carcinoma.

Dunin had however suggested such a procedure. Bilroth was second to do this operation; patient dying from constant emesis.

Courvasier, 1883, inserted a loop in the jejunum through a slip in the mesentery into the posterior wall.

Von Hecker, 1883, raised up the colon and the mesenteric jejunal loop to posterior wall.

Gastroenterostomy has undergone many evolutions, having been done first by suture, then Senn's decalcified plates, Murphy button, McGraw ligature and many other mechanical devices, only however, to again be done by suture.

The oblong Murphy button will probably This Murphy supplant the round button. fully advises owing to the rapidity with which it can be secured and perfect proximity of the parts. Then, too, it has not been retained in the stomach or gut.

My own experience has been limited to the use of the Murphy button and various kinds of suture.

The use of the oblong button will probably be given preference in cases of great debility, where rapid work is necessary.

Murphy says in a recent personal communication, that he has never seen the work of gastro-enterostomy done so rapidly and well by suture or otherwise as when done with the cblong button, while McGraw, in a personal communication received about the same time, advocates the rubber ligature.

Mayo reports 157 stomach operations with Murphy button. Benign, 72; 6 deaths (8%); 54 anterior; 4 deaths (8%); 4 reoperations (8%); 18 posterior, 2 deaths (11%); 4 reoperations (22%). Malignant 85; 15 deaths (18%), including pylorectomy and partial gastrectomy.

Four deaths were due to pulling apart of attached surfaces in from six to ten days after button had passed into the bowel. This is now overcome by four or five mattress sutures.

In two cases it was necessary to remove the button at a subsequent operation.

Moynihan says that all such mechanical devices for intestinal anastomosis have served their purpose, and that they now are of but historical interest.

McGraw Ligature (Ochsner).-He has made 156 gastroenterostomies by this method. Of 124 at Augustina Hospital, 28 were cancer, 5 died (17%); 96 ulcer, 5 died (5%).

The disadvantages of this method are that it is slow to cut through, sometimes does not do so because of breaking and in secure knoting and does not make opening at once for drainage.

Haberkant cites 58 gastro-enterostomies for cancer; 12 lived longer than one year.

Mayo gives conditions indicating gastroenterostomy, gastric-pyloric duodenal and jejunal ulcer; pyloric stricture due to cicatrices or neoplasms, malignant or beningn, gastric dilatation due to any cause, without pyloric stricture and peripyloric adhesions causing contractions of the pylorus.

Niles says 5 per cent of all persons have gastric ulcer, that the average age is 38 years; that the greatest number is between 38 and 48 years, and that sex is about equal.

Autopsy findings in chronic ulcer have been instituted in hospitals giving per cents of gastric ulcer varying from 1.32 per cent to 20 per cent. The higher per cent being in deaths of more recent date and by more skilled observers.

It is fair to conclude that ulcer of the stomach is more common than generally supposed and that many of the so-called cases of gastritis, indigestion, etc., are cases of gastric ulcers. Such cases are common in every community and they are being recognized more and more every day.

Five years' work leads Mayo to believe that ulcer of the stomach precedes cancer in about 50 per cent of the cases, and that cases of carcinoma with long histories speak for preceding ulcer with short histories, against ulcers as a precursor.

In 52 cases of cancer during the first half of 1905, by him, 26 were cancer upon ulcer.

Distance of anastomosis from pylorus varies. Von Hecker-20 to 25 cm. from duodeno-jejunal flexure. Keppler-40 to 60 cm. from flexure. Mikulicz- three or four inches from flexure, and Peterson, as near the flexure as possible, same as Czerney's noloop method.

The latter is now the selection of choice done on posterior surface of stomach by suture. Make the opening proportionate with the size of the stomach and at the most pendant portion. The mortality being less than five per cent.

In two cases recently operated upon by me, a posterior anastomosis was made with suture from three to four inches from the duodenojejunal junction.

In one case, 60 years old, that had been confined to his room for ninety days, the weight increased twenty-two pounds within sixty days after the operation.

Perforating Gastric and Duodenal Ulcers.-Moynihan made his first operation April 30, 1897. Since then he has made 22 operations, 8 deaths (36%); 7 duodenal had perforated and 15 in which a gastric ulcer had perforated.

In the first ten cases there were six deaths; in the last twelve there were two deaths. Of the gastric ulcers two were males and twelve were females. Of the seven duodenal, four were males and three females (one not accounted for).

Mikulicz, 1903, is in favor of both gastroenterostomy for drainage and jejunostomy for feeding for six or ten weeks, then latter is allowed to close.

Hemorrhage may be from an ulcer, fissure or varicosity, and death may result from the smallest lesion.

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Pathology.-Gastric ulcer is of two kin indurated and non-indurated. In the fir all coats are involved and can be felt fro without. Non-indurated, only mucosa is in volved and cannot be felt from without. Either may be acute or chronic.

The acute is more rapid, involving the entire wall, with sharp edges. The chronic ulcer is slower, broader, more irregular in shape, and terraced or funnel shaped.

Either may perforate a blood vessel or the entire thickness of the stomach wall.

The two forms may heal spontaneously, but the chronic form is associated with more cicatricial tissue and consequent deformity. Of 231 ulcers reported by Mayo, 80 were peptic, 56 females and 24 males.

The symptoms and differential diagnosis of the following diseases are given in detail: Gallstones, gastralgia, gastric ulcer, perforation of gastro-intestinal ulcers, perforating duodenal ulcer, distended gall-bladder, bilious or acute gastric-duodenal catarrh, moveable kidney, floating kidney with twisted ureter, nephritic colio, pyo-nephrosis, tumors of kidney, ureteritis, obstruction and atonic dilatation of the stomach, appendicitis, acute indigestion, intestinal colic, acute enteritis, intestinal obstruction, typhoid fever and acute pancreatitus and carcinoma stomach.

AND

INSANITY FROM HYSTEROTOMY OOPHORECTOMY.-G. M. Hammond, New York (Jour. A.M.A., March 10), while admitting the greater frequency of insanity after operations on the pelvic organs, attributes this to certain psychologic causes, readily understood, acting on an originally defective brain, rather than to any especial relation existing between the integrity of the sexual organs and the brain. The removal of these organs alone never causes insanity; the cases that occur are due to hereditary tendency, the psychologic and physical effects and to surgical shock, but most of all to the originally defective brain.

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An Interesting Anatomic Anomaly.

and marks that instrument as easily the most important addition to our equipment of recent years. Its value along diagnostic lines and as a means to direct treatment to parts otherwise unaccessible needs no comment. Another use which appeals to both the surgeon and the internist is the definite placing of normal anatomic relations and the detection of irregularities and anomalies. ularities and anomalies. Through the courtesy of Dr. Bransford Lewis it has recently been our privilege to see a case to the point. Cystoscopic examination revealed the existence of three ureteral orifices, one on the right and two on the left; catheterization from these brought three distinct and different urines. The urine from the right kidney was normal. From the left ureters: from one the urine was turbid, specific gravity 1005, and 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 catheters, in the lumen of which a lead wire had been placed in the ureters. The picture showed the right ureter to follow its normal course. The two on the left enter the bladder at points on the same level and the course above was parallel for three or four inches, the inner ureter continuing in the normal position of the left kidney. The outer crossed inward and continued upward to a point midway between the left kidney and the median line and somewhat lower.

Treatment was given through the catheter to the affected pelvis and ureter with telling efficacy, as was demonstrated to us a few days later.

Whether this patient is the possesor of three kidneys or has a left embryonal kidney is the question to be determined. Dr. Lewis is of the opinion that there are three kidneys, and the difference in position of the two pelves makes this the natural conclusion. Embryonal kidney might give the distinctly different urines through distinct pelves and ureters, but unless the kidney was greatly distorted and tremendously enlarged it would be impossible for the pelves to be so far separated, and so placed in relation to each other.

It will be our privilege to give Dr. Lewis' findings later and in detail. The case is of The case is of such interest that it and all which are found of its class should be recorded for the information of the profession.

A More
Liberal Diet in
Typhoid Fever.

DR. THOMAS A. CLAYTOR states (Med. Record) that it has been proved experimentally that the digestive and absorptive powers during typhoid fever fall off only five to ten per cent, so that impaired digestion is not sufficient argument in favor of the exclusive milk diet. The present trend of thought is toward the belief that the majority of diseases being due to specific poisons, recovery depends upon either the exhaustion of that poison, or the development of an antibody of some sort which renders it innocuous. In order that he may withstand the ravages of the disease until the time of recovery, it is necessary to keep the patient in the best possible condition. The writer emphasizes the following points in the selection of a diet for typhoid fever patients: It must be sufficiently nutritious to maintain as far as possible the bodily equilibrium. The writer's treatment of a case of typhoid fever, no matter what day of the disease it may come under his care, is as follows: The regulation six ounce of milk are given every two hours, night and day, while the patient is awake. In place of milk, in order to vary the monotony for those who can not, animal broths are given. After the subsidence of the more acute symptoms, the patient is asked if he is hungry, and if he replies in the affirmative a soft-boiled or poached egg is allowed, and if well borne the number is gradually increased to three or more a day. a day. Jelly or blancmange, custard, soft toast, the soft part of baked apple, and rice which has been boiled four hours, are the next additi ons. After this, scraped beef or chop, very finely divided chicken, and baked potato

are tried. The writer does not advocate so full a diet in every case, for each patient must be carefully studied as an individual. He believes that most of the foods mentioned are quite as digestible, far more palatable, and rather less likely to cause perforation or hemorrhage by their local action, or gas production, than milk. writer appends a table of twenty-six cases. These patients all recovered. He adds that the advocates of the more liberal diet claim that the patient is more comfortable, the attack is slightly shortened, convalescence is more prompt, and relapse, hemorrhage, and perforation are not more frequent.

Alcohol in Carbolic Acid Poisoning.

The

AFTER reviewing the history of the use of alcohol as an antidote to carbolic acid poisoning. T. W. Clarke and E. D. Brown, Cleveland, Ohio (Jour. A. M. A., March 17), report the results of a clinical and experimental study of the subject. Thirteen cases of carbolic acid poisoning treated at the Lakeside Hospital, Cleveland, by lavage with. diluted alcohol are reported, and comparison is made with other cases treated there and elsewhere without alcohol. The very slight difference in the mortality in the two series of cases and the greater apparent constitutional disturbance observed when the acid was taken with alcohol than when taken clear or with water, raised grave doubts in their minds as to the antidotal power of alcohol, which, together with the statements of recent textbooks on toxicology, led them to undertake some experimental work to better satisfy themselves as to the true facts of the case. The experiments were performed so as to test the systemic antagonism of alcohol and phenol (by intravenous injection): To test the antagonism in the stomach (5 per cent phenol): To test the efficiency of lavage (undiluted phenol). The experiments were performed on anesthetized dogs and rabbits, and a further series of tests of the local antagonism of carbolic acid and alcohol and other phenol solvents, was made by Prof. T. Sollmann and included in the paper. The tests in this case were made by direct application of the acid to the fingers of various individuals followed by the antidote. The general conclusions from all the experiments are given as follows: "1. Alcohol has a local antidotal effect to carbolic acid burns, due to its solvent action. 2. There is no evidence of chemical antagonism between alcohol and phenol. 3. There is no effect produced by alcohol on carbolic acid poison

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