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with the affect of paralyzing the vasomotor nephritis and pyonepbrosis from the ordinary centers. This increased, beneficial pressure pus-producing infections, tumor and intermay be momentarily augmented by amyl mittent hydronephrosis. Each of these is nitrite or morpbin, thus terminating the at. noticed separately. The only positive evi. tack. Bodily extension likewise increases dence of renal tuberculosis is the finding of the blood pressure and the subsequent de- the tubercle bacillus in the urine or produccrease in the pulse rate, regulating the coron- ing the disease in animals by inoculation Ary blood supply, also acts favorably on the with the diseased urine or tissues. Other attack. The differential diagnosis between symptoms are all more o less unreliable. stenocardia and uremic dyspnea is readily The differential stain must always be emidentified by the posture; in the former, ployed in diagnosing tuberculosis from the fear, bodily immobility and retroversion pre- inding of acid fast bacilli in the urine, as vail, while in the latter, the patient is in a is shown by a case bere reported. It may state of agitation and retroversion, to any de. be impossible to diagnose pyelitis, pyelone. gree, is always absent. In the respiratory phritis or pyonepbrosis from an infected forms of neuroses, antiversion of the body is nepbrolithiasis except by operation, nor is the rule. In attacks of laryngeal stenosis the it easy to differentiate between calculus and patient suddenly assumes the sitting posi. tumor, and here also the chief dependence tion, rusbes out of bed, tears away any inter- is on the urinary examination. A movable fering clothing from the body and seeks sup- kidney and kinking of the ureter may cause port to bold himself ereot.
attacks closely simulating those of calculus, The Diagnostic Value of Leucocytes.
but the enlarged and movable kidney during Grünbaum (Practitioner, Deo., 1905) belieres
the attack and the relief of pain and increased that an accurate leucocyte count is a valu
flow of urine on its return to normal size will able index in determining the presence of
aid the diagnosis. In this connection, Hunner
mentions the unaccountable renal bemorpus in the body. A large increase in the polymorpbonuclear neutrophiles, together rhages known as idiopathio hematuria or with a glycogen reaction, an increase in the
renal epistaxis, and says there is, he believes, blood-plates and in the fibrin of the
a tendency nowadays to connect these with blood is strongly indicative of pus in
the chronic interstitial form of Bright's disthe economy. When counts
The diseases of neighboring organs
made at short intervals (every four hours) and the
noticed as having to the differentiated from leucocytes found to be on the increase the
calculus of the kidney are gallstones, appen. assumption that the inflammation is extend dicitis, intestinal obstruction, pancreatic caling is justifiable. A negative blood examin.
culus and Henocb's purpura and angio-neuation, on the other hand, does not warrant
rotio edema; oases are reported illustrating the exclusion of pus.
A palpable gastrio the difficulties sometimes encountered. The tumor of obscure nature with a pronounced history of the case, examination of the urine, digestive leucocytosis is a strong evidence
eto., are generally the main dependence in against malignancy, pointing to an inflam
the differentiation. Kelly's method, injecting matory trouble, although small cancers of
the kidney pelvis with a bland solution, is the stomach are frequently associated with
mentioned as one of the best diagnostic a considerable digestive leucooytosis. The
aids in case of suspected gallstones. In conpresence of choline in the blood is an im.clusion he refers to Israel's saying that in portant symptom in the differential diagnosis diagnosing other than typical cases, one between hysteria and disseminating spinal must, first of all, divest himself of the sclerosis, as this substance is only found
sobematic picture so often presented in the wben there is an active process of nerve de
text-books. generation going on in the body.
DOCTOR, you should investigate the plan of
the Physicians Defense Company of ForTHE DIAGNOSIS OF RENAL CALOULUS.-G. Wayne, Indiana, for the successful prevent L. Hunner, Baltimore (Jour. A.M. A., March tion and defense of the malpractice suit. 24), remarks that few diseases present more The records of thu company show that they protean symptoms and simulate so varied an have prevented all annoyance in over 75% of array of other maladies as stone in the kid. all the suits threatened against their contract ney. Large calouli may exist in and cause holders. The company has an admirable hisdestruction of both kidneys without marked tory and has dealt fairly and honestly with symptoms, while minute calculi may give rise the medical profession during the seven years to agonizing pains, The more common kid. of its existence. A postal addressed to the ney disease to be considered in the diagnosis Physicians Defense Company, Fort Wayne, of calculus are tuberculosis, pyelitis, pyelo. Indiana, will bring full information.
SOCIETY PROCEEDINGS the seared stump the end of the duodenum
The proximal end of stomach MEDICAL SOCIETY OF THE NEW YORK was double clamped along the MiouliczPOLYCLINIC MEDICAL SCHOOL AND
Hartman line, and divided with a cautery HOSPITAL.
one-fourth inoh projection. Then gastro
jejunostomy was done. Stated
meeting held Maroh 5, 1906. The tumor was found to ncoupy the pylorio The President, Dr. J. J. MacPhee, in the end of the stomach, extending around the obair.
whole circumference. No adhesions were
present. There was a delay in finding the PARTIAL GASTROECTOMY FOR CARCINOMA.
nearest point of jejunum that could be This patient was presented by Dr. J. I. brought to the stomach wall, and in taking Edgerton. G.C.H.; male; 41 years of age. great pains to suture the opening in the Father living and in good health at 78; mesocolon so as to prevent hernia into the mother died of stomach trouble, probably lesser cavity of the peritoneum. cancer, at 58
age. Patient had ma- His temperature at no time following the laria severely 25 years ago, but has bad no operation was above 96. degrees F., and there recurrences. He indulges moderately in tea, has been no vomiting since operation. He coffee and alcohol, and smokes regularly from
took water in eight bours and liquid nourish. fifteen to twenty cigarettes daily. For the
ment in twenty-four. His bowels were past thirteen years he suffered with heart- moved by enemas during the first week, but burn, which had been more constant during three was no distension; in fact, no more disthe past two years, during wbich time be also comfort than from an ordinary exploratory suffered from nausea and pain in the epigas- laparotony alone. The man has gained about trium after eating. During the last few twenty-five pounds in weight, and is at his months he had burning pains after eating; regular employment again with no discomfort was hungry all the time, but afraid to satisfy
whatever referred to his stomach. bis hunger, for when he took sclid food it re
CASE OF MORPHINE POISONING. mained in the stomach for an hour or so, and then was vomited. On one occasion last win. The report of this case was presented by ter he vomited some mucous streaked with Dr. D. A. Sinclair. The patient was 63 blood. He began washing out the stomach years of age, weighed 180 pounds, was 5 feet twice a day on October 4th and brought up 6 inches in height, full blooded, with greenish clumps of mucous resembling marked organic heart disease. He had been
oss. There was no vertigo. His bowels coming to the speaker's office for the past two were constipated, and he lost about twenty- or three years suffering from alcoholism. He five pounds in weight during the last few was a periodio drinker, and when first seen, months.
two or three years ago, bad been treated On November 27, 1905, the stomach con. along the regular lines for such a condition. tents contained free bydrooblorio acid; mod. He informed the speaker that he bad been erate reaction; odor butyric. A mass could
in the habit of receiving injections of mor. be felt over the region of the pylorus, and pbine from previous doctors and that was operation was advised and accepted by the the only treatment that did him any good. patient. The usual preparation of cleansing Accordingly one-fourth of a grain of mor. the stomach by lavage was performed, and in pbine was injected, which the patient rethe operation Mayo's technic was followed. ported at the next visit was of no benefit The abdomen was opened near the median whatever, stating that it was, he knew, a line and the gastrio artery was doubled, ligated very small amount-nothing like what he and divided near the cardiac. The gastro. had been used to getting. The dose of mor. hepatic omentum was also doubled and ligated phine was very carefully increased to oneclose to the liver, leaving most of its structure half grain without any effect, and finally, at attached to the stomach. The superior py:
the earnest solicitation of the patient and his lorio artery treated in the same manner, and assurances that he could stand the morpbine, the upper inch or more of the duodenum the dose was increased to one grain. This freed. With the fingers as a guide beneath injection bore out bis statements as to his the pylorus in the lesser cavity of the peritovity of the perito. previous experiences and just about steadied
“ neum, the right gastroduodenal artery was him," without producing any thing but a ligated. The gastrocolic omentum was cut very short sleep. His subsequent periodic distal to the glands and vessels, up to an ap. sprees were treated along the same lines, from propriate point on the greater curvature and three-fourths to one grain being used as an the left gastroepiploic vessels were ligated. injection. It became so much a matter of
With a running suture of catgut through course to inject this patient and see no unto.
war effects whatsoever that there was no hes- this case shows that even in apparently fatal itatiou on the part of the speaker about giv- cases life may be saved. ing him a grain of morpbine two or three
Dr. R. H. M. Dawbarn opened the distimes day according to the exigencies of the
cussion of this case which, he said, recalled occasion. Between the sprees the man, who
to his mind a case of morphine poisoning was of more than average intelligence, not only abstained from alcohol, but did not have Nursery and Child's Hospital.
which occurred when he was interne at the
He placed the slightest desire for morpbine or any other
the patient on bis back and administered drug.
atropine (the first dose of which dilated the The treatment detailed above was carried tubes) until, from morphine poisoning, the out until the last spree, about a month ago. patient developed a case of atropine poison- . On this occasion be presented bimself, in, ing. Life was saved by artificial respiration, toxicated, but retaining all his faculties, and which was kept up for eight hours by the begged for an injection of morphine, saying speaker and his assistant, each taking twothat he would only be put "on the ragged minute turns. Walking the patient up and edge," as he expressed it, if he received the
down was tried, but the exertion seemed usual dose. He stated that he had taken as only to make the heart weaker. If he were many as three grains of morphine without to criticise the treatment of the case under any bad effects, but this statement he after. discussion it would be the giving of deward denied. He had a very important meet pressing narcotics, as after vomiting from
, ing for the next day, and therefore was de. an overdose of morphine the patient usually sirous of securing a good night's rest. One collapsed. and one-half grains of morphine sulphate
Dr. Maurice Packard said that in a series were injected into his left arm. In about half an hour the speaker was called to him
of experiments in which he had been interhurriedly, and found him in a much stupefied
ested, which were being conducted by Drs. condition.
Bodine and Jeffries, they were trying to find
out from guinea pigs how much morphine This was about 8 p.m. a small dose of co
would act as an antidote for a given injection cain was injected and the speaker left, re
of cocain, acting upon the principle that coturning about 9 o'clock, when the patient cain is a physioloigcal antidote for morphine. was beathing slowly, about five to six a
Previously atropine had been used for this minute He was walked up and down until about 11 o'clook, at which time his respira- similarly, in that both had
purpose, but atropine and morphine acted
a tendency to tions had diminished to one in two minutes.
depress the smooth muscle fibres as well Up to tbis time there had been injected by
as secretion, while, on the other hand, copodermatically 3-5 of a grain of cocain, 4-150
cain stimulates the smooth muscle fibres of atropine sulphate, 4-30 of strychnine and
and increases secretion, as is shown by 4-10 of nitroglycerine. He had also been
the druling at the mouth and the frequency given about a quart of strong, black coffee.
of urination. The best possible treatment, The situation being desperate, at the re- he thought, was the stomach tube. After quest of the man's family 1-12 of apomor- using it once, however, it must be used every phine sulphate was injected as an emetic and half hour, for the mucous membrane of the was effectual in about one-half a minute. stomach will repeatedly secrete morphine. The patient went steadily into a deep coma, With the stomach tube and the proper use of became very blue and was apparently dying. cocain, most of these cases will end in reArtificial respiration and the administration covery. of oxygen were then resorted to and the
The paper of the evening was read by Dr. tongue pulled forward with artery forceps. E. L. Keyes, Jr., and was entitled At 1:30 p.m. be began breathing at the rate of about four a minute. About a quart of
RENAL COLIC. black coffee was given as an enema, and at He said, in part renal colic is usually conabout 3 a.m. he was breathing about ten sidered a symptom of kidney stone; but it is times a minute and was conscious.
not absolutely pathognomic of stone, nor are The oxygen and artificial respiration, to. the position and character of the colic pains gether with the cocain, probably saved the always an infallible index of the position of man's life. Two lessons should be learned the stone. Indeed, so misleading is renal from this case: (1) not to be importuned into colic in a certain few cases, and yet so rarely giving any patient a large dose of morphine, is it a symptom of anything but stone, that even though he is used to it; and (2) not to think it by no means waste of energy t abandon hope or relax one's efforts, even when study attentively some of the cases whic the patient is apparently beyond hope, as have come under my observation, and i
which renal colio has been a misleading and und, finally, at the end of three and a half often a confusing symptom.
weeks, the patient died from asthenia and The late Dr. Bryson once formulated in a failure of kidney function. tentative way the theory that stone in the It is noteworthy that in the case we were pelvis of the kidney causes pain in the loin able to arrive at a diagnosis with the aid radiating down the ureter, while stone at the of an X-ray photograph, while the practitioner lower end of the ureter causes frequent and who had previously treated it had failed painful urination and pain in the pelvis. to make the diagnosis, because he had not This distinction holds true in the great ma- employed this expedient. jority of cases; yet I have seen one case that In contrast to the above case, in which a was a striking exception to this role, in that patient with stone suffered from a pain that the only pain suffered from was frequent and did not resemble renal colio, the second case painful urination, although he had but one shows the brilliant contrast of a patient with stone, and that lay in the pelvis of his kid. renal colio, but without stone. ney.
The patient, 58 years of age, complained of The first patient, a lean asthmatio man, 63 repeated attacks of renal colic. He never years old, complained of frequent urination. passed blood, never had any anuria or bladder Sixteen years ago he applied for insurance symptoms, although since the first attack he was refused on account of albuminuria. He had urinated twice at night and every three consulted a surgeon, who stated that he bad hours by day. No lumbar tenderness could a surgical inflammation of the kidney.
Ex. be evoked by palpation, nor was it possible cept for the passage of two calouli from the to feel either kidney. X-ray photographs right kidney, eight and five years ago respeo- showed small solerotic kidneys, but no shadow tively, and except that he had to rise once or suggestive of stone. Examination of urine twice at night to empty his bladder, there showed many pus cells, but no bacteria. were no symptoms until about a year ago, Macroscopically there was no pus and very when bis urination became more frequent, few blood cells. He was given an alkaline and he consulted an eminent urologist who mixture, advised to drink very freely of water began and bas since continued treating him and to exercise to the limit of toleration; and for chronic oystitis attributed to prostatic I believe that in January, 1906, he had no hypertrophy. His symptoms have grown further renal colic. gradually worse.
A detailed history was presented of a pa. Examination showed the right kidney to tient who suffered from most violent attacks be readily palpable, somewhat large and of renal colio brought on by digestive causes. tender; the left kidney could just be felt, but A carefully restricted diet, much exercise was pot tender. The urine was bazy with and water and the administration of betapus; specific gravity 1016; albumin 1% by naphthol, bismuth and salol caused a cessaweight; various casts of many kinds; many tion of these attacks. red blood cells; a total excretion of from 25 In further contrast to this case was case to 30 ounces; the bladder capacity was 81 V, in which the colic caused by digestive ounces. The prostate was not enlarged; there disturbance was intestinal and not renal, alwas no residual urine. X-ray examination though the pain was precisely that of renal revealed a shadow in the region of the right colio. kidney pelvis, but for various reasons the The last history presented by the speaker operation postponed for eighteen was an example of a class of cases which he months, when the patient's condition was so considered very important.
They are relaunsatisfactory that it became imperative. tively infrequent and cause objective symp
Upon openiug the right kidney, an oxalate toms absolutely characteristic of renal stone; stone was found fitting in the upper end of yet a careful examination will reveal the fact the ureter and was removed through an inci- that they suffer from nothing more than semsion in the the kidney pelvis. The kidney inal vesiculitis. itself was considerably dilated and covered with small cysts which contained serous bloody and sero-purulent fluid. It was sus.
LUMBAGO.-The Medical Review of Repected, because of the nature of the symp. views recommends the following as a local toms, that there was a stone in the ureter, application: But careful search failed to reveal one. After R Tinct. iodine.....
2 drains operation, instead of passing urine constantly, Tinct. aconite root.
3 drams as be had done heretofore, he had to be cathe. Spts. chloroform..
4 drams terized until the second day, when he began Soap liniment, q. s....
3 ounces to urinate at intervals of from two to four M. Sig. : Apply locally several times hours. The secretion of urine remained low, daily.- Prescription.
The MEDICAL FORINIGHTLY
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May 30-June 1. THE BOSTON SESSION OF THE AMERICAN
American Surgical Association, Cleveland, MEDICAL ASSOCIATION.-It would seem that May 30-June 1. the medical profession of Boston intends to
American Laryngological Association, Ni. have the approaching session of the Ameri. agara Falls, May 31-June 2. can Medical Association one long to be re
American Association of Genito-Urinary membered for the high grade of its scientific Surgeons, New York, June 1-2. proceedings, the cordiality of its entertain- American Academy of Medicine, Boston, , ments and the elaborateness of the clinical
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Massachusetts Medical Society, Boston, EFFECT OF PROPRIETARY LITERATURE ON June 12-13. MEDICAL MEN.-N. S. Davis, Chicago (Jour. Maine Medical Association, Portland, June A. M. A., May 5), calls attention to the evil 13-15. effects of medical advertisements, written as Minnesota State Medical Association, they are to sell the goods and not, as a rule, Minneapolis, June 20. to state the complete truth, even about the West Virginia State Medical Association, really worthy and scientific preparations. Webster Springs, June 20-22. Ready-made prescriptions lead to slovenly therapeutics, and if all members of the med ical profession would refuse to employ ready-made mixtures they would destroy THE NORTH MISSOURI MEDICAL ASSOCIA. one of the greatest bindrances of rational TION will meet at Moberly, on June 21 and therapy. Most of us are inclined to ac- 22. An interesting program is being pre. cept new things and new ideas without pared. E. C. Grim, seoretary, Kirksville, sufficiently testing them or demanding the Mo.