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Let us briefly enumerate the cases. We have broad costal angle, the distance from the umtemporary stenosis from inflammatory swell. bilicus to the ensiform is less tban the dising in acute gastritis; this is usually easily tance from the middle line to the anterior determined from the symptoms and the transi- auxillary line, seldom suffer with functional tory character and need not concern us at this diseases, but are the victims of organic distime. A foreign body may become lodged If, therefore, you find the greater our. in the pylorus. The latter will normally
al. vature below the umbilicus, and the patient low a silver dollar to pass (Cohnheim). Col- presents the “babitus enteroptoticus,“' the lections of hair and gall-stones, as well as probability is that gastresctasia does not expolypus of the stomach have also caused ob- ist. In fact, we cannot say a patient has distruction. An ulcer with thickened walls latation until we demonstrate that stagnation often causes stenosis; in some uf these cases exists. The stomach is like the heart, when a tumor is distinctly palpable. Small ulcers, there is obstruction to the outflow, the musby inducing spasm of the pylorus, may also cular wall hypertrophies and furnishes the cause stenosis, likewise a cicatrix of a healed necessary force to empty the organ, and when ulcer. The latter contracts, gradually nar- the obstruction becomes so great that the rowing the orifice and often years pass before power of the muscle is insufficient, the organ symptoms indicate the condition. A tumor dilates. The stomach, like the heart, dilates external to the stomach and adhesions may when muscular insufficiency exists. So long, compress, and thus narrow or occlude the then, as the stomach is able to overcome the pylorus. Also, in gastroptosis, acute kink- obstruction, neither gastrectasia or stagnation ing of the stomach and the duodenum may are found, even if the pylorus is narrowed. also cause stenosis. These are the causes in In these cases if the passage of food through the benign cases, and the malignant ones are, the pylorus is markedly compromised, the with rare exceptions, carcinoma. Ulcer, or quantity of urine decreases, and when the the cicatrix following and carcinoma are the total quantity for twenty-four hours falls becauses in almost all cases.
low 500 co. (one pint), and this is not in. Now, how are we to diagnose stenosis? creased by proper diet, it is an indication This depends on tbe establishment of two that operative interference offers the only conditions, stagnation and gastrecasia. By hope of relief (Cobnheim stagnation we mean that the stomach does not When we have established the existence of empty itself in seven or eight hours. Much pyloric stenosis we must determine whether has been written about atony as
à cause of
the lesion causing it is benign or malignant. stagnation, and I am not prepared to say it This is done in part by the history, but more does not do so in rare cases, but I do say that surely by the examination of the secretions. when you find stagnation, in almost all cases, Benign cases are of longer duration, do not you have a stenosis of the pylorus. If, there- 80 markedly affect the general health, and fore, you find in the stonach in the morning, wbile great emaciation may exist, there is no food which was taken the evening before, you caobexia. The benign cases also usually give are practically certain that there is an ob- history of ulcer, or some acute inflammatory struction at the pylorus.
disease or of some lesion outside of the stomIf, in addition to this, you find the stom. ach. The malignant cases are attended by aob dilated, the diagnosis of stenosis is com- more rapid emaciation, cachexia, pain, vomplete. Let me here direct your attention to iting of blood and mucus, and the developa few points too often overlooked. If you ment of tumor. The secretions, however, find the greater curvature below the umbili. give us rery reliable information, and while cus, it does not follow that you have dilata- not pathognomonic, is nearly so. tion; it may mean that the normal position If stenosis exists and there is an excess of of the stomach is more nearly vertical. This hydrochloric acid, free and combined, the is true in those who have the “babitus en- case is benign; if it is diminished or absent, teroptoticus” first pointed out by Stillen. it is malignant. A carcinomatous ulcer at the This he used to designate those individuals pylorus is an exception to this rule, and I who had an acute costal angle, and the dis. have seen two cases in which the excess of tance from the umbilicus to the ensiform car. hydrochloric acid persisted to the end, but tilage was greater than from the middle line
comparatively rare exceptions. to the anterior axillary line, and also a float- Still nore rare is a benign obstruction develing tenth rib. Such individuals are usually oping in a patient who has chronic acid gasunder-nourished, and are prone to displace- tritis with atrophy of glands, in which the ment of viscera, including stomach, liver, hydrochloric acid is diminished. These eskidney and uterus, and they, as a rule, sufferceptions should not divert you from the fact from functional diseases. On the other hand, that the rule given above is true in probably those who have the normal habitus, viz., 98 to 99 per cent of all cases.
Let me briefly report a case to illustrate not carcinoinu. I did a pylorectomy after the mode of procedure:
the method of Kocher. She made a full and The patient in question was a lady,55 years complete recovery, and since that time has of age; she was married and bad two child- been entirely well. ren; family history was good and ber own My object in writing this paper is to bring health had been excellent, excepting at her distinctly to your mind the symptoms wbich fifteenth year she bad some trouble with her will enable you to make tbe diagnosis of pystomach, which was attended with daily pain loric stenosis, and also to differentiate the and occasional vomiting. This continued malignant and benign, and not to enter into about one year, after wþich she fully recov. a discussion of the technique of operation. ered and had no illness of any character until the present trouble. Three years ago she noticed that she would occasionally become bloated and there was rumbling in the bowels,
THE TREATMENT OF CHLOROSIS. and fourteen months ago she began to vomit. The vomiting would reour daily, sometimes
GEO. F. BUTLER, M. D. once and occasionally two or three times daily, usually four or five hours after meals, and the quantity ejected was generally large. THERE are four important things to do. About this time she began to use lavage There may be otbers. 1. Eliminate. 2. which was continued for one year, giving her Regulate diet. 3. Rest, in plenty of fresh temporary relief. The vomitus often con. air and sunlight. 4. Administer bematics. tained food taken the day before, and the The bowels must be kept open. Constipaquantity sometimes was as much as a gallon. tion with its accompanying autotoxemia preShe had never vomited blood, and never had disposes to anemia, and if it continues, makes any severe pain; her bowels were generally the condition worse. constipated. Her normal weight was 206 A saline laxative should be given every pounds, and at the time she applied for treat- morning. Aloin or some pill containing it ment she weighed just 100 pounds. On pby. is often of great value. A good combination sical examination I note first that she had is: Aloin gr. 1-25, strychnine 'sulphate gr. 1a normal babitus, the abdominal wall was 500, atropine sulpbate gr. 1-2500, oloeresin flaccid and through it, the dilated stomach capsicum gr. 1.500; emetine gr. 1.500, with and the peristaltic wave could be distinctly a trace of bile. From three to six of these seen, the greater curvature was four finger- may be given three times a day. They will breaths below the umbilicus.
tone up the bowels and serve to overcome The contents of the stomach was 120 chronic constipation. ounces and was removed eight hours after tak- The diet should be light, nutritious and ing food. In this the free acid was 50, and capable of easy digestion. Milk is an exthe total acidity 120. I then washed out her cellent food, but falls short in that it constomach thoroughly, and that evening had tains too little iron, and large quantities her eat a few raisins; the next morning gave must be taken to satisfy the patient. Animal her a test breakfast (two oz. of bread with food, soups and broths, are indicated in small four-fifths pint of water) and an hour after, quantities often repeated. Farinaceous food removed the specimen for examination. The alone will not suffice. The blood must be raisins were found and the stomach contents built up by an increase in the formation of yielded a free acidity of 40, total acidity of 90 blood corpuscles. To secure this the diet and the rennin test was 50 per cent above must be fairly rich in nitrogen. normal. At that time she declined any oper. It should be gradually made more stimulatative interference, and I put her on a stenosis ing, and a little burgundy, port, or maderia diet, that is, a diet in which the articles are wine may be profitably given. soft and fluid; under this diet she gained in Rest in bed in a well-ventilated and wellflesh and strength for a short time, but soon lighted room, or on a couch out of doors, grew worse, lost weight, and finally decided must be insisted upon for a while. It should to submit to an operation.
be remembered that in chlorosis the cardiao In this case you will note that in the first muscle underoes fatty changes, and if the place she had stagnation, for we found the heart-wall is to recover itself and perform its articles from the day before.
function normally afterwards it must have trectasia, which was easily discerned by in. as much rest as possible during the treatment. spection and palpation. We know also there As the patient improves, change of place was insufficiency because of the stagnation and scenery, with out-of.door exercise, which and know, too, from the fact that the total ac- inspire the psychical impulses and give a new idity was above normal, that the disease was direction to the thoughts, are all very useful.
She bad gas
Iron in some form is necessary.
Blaud's NEW MEDICAL COLLEGE ORGANIZED. mass freshly prepared is usually preferred. The College of Physicians and Surgeons of Give one pill three times a day, after each Little Rock has been incorporated by Drs. meal, the first week of treatment; during the Joseph P. Runyan, William P. Illing. David second week two pills three times daily, and C. Walt, Arthur E. Sweatland, Charles C. during the third week three pills three times Stephenson, Joseph P. Sheppard, Beauredaily. The dose may be diminished, but the gard W. Flinn, Charles R. Shinault, S. Paul patient should have some salt of iron for Vaughter, Edwin Meek, Thomas E. Hodge, three months at least. Not uncommonly, the George M. D. Cantrell, William B. Hughes, anemia will assume an obdurate persistency, W. B. Smitb, Emmet N. Davis, Clinton P. and defy your best laid schemes.
Meriwether, Daniel R. Hardeman and Rezin Under these circumstances the patient W. Lindsey, with a capital stock of $100,000, should go to a chalybeate spring. The amount of which $55,000 has been subscribed, to of dilution is a matter of the greatest moment conduct a school for the teacbing of medicine in attempting to bring the system under the and surgery in all their branches; of pbarinfluence of chalybeates in many cases. Iron macy and dentistry; a training school for is more effective when taken with large nurses, and to maintain and operate a sani. draughts of water. Under certain conditions, tarium and hospital. The officers chosen are water is a benjatic. Not only does water as follows: Dr. Charles R. Shinault, presi. wash away the accumulated waste matter, but dent; Dr. George M. D. Cantrell, vice-presi. in doing so it paves the way for the growth dent; Dr. William P. Illing, secretary and of new material.
treasurer, and Drs. Charles Ř Sbinault
, WilThe cheerful society and babits of others liam P. Illing, David C. Walt, Arthur E. at chaly beate springs form a great incentive Sweatland and Edward Meek, directors. The to invalids, who are inclined to be despon- board of directors, at a meeting, July 11, dent, to exert themselves, and so aid in their elected Dr. Jospeh P. Runyan, dean, and Dr. recovery.
William P. Illing, secretary of the college. These facts alone often make the difference The directors also elected the following between failure at home and success at a members of the faculty: Dr. Arthur E. Sweatspring.
land, professor of anatomy; Dr. Thomas E. The arsenate of iron, 1-6 gr. three times a Hodges, associate professor of anatomy and day, increased if necessary, is a powerful lecturer on osteology; Dr. S. Paul Vaughter, remedy in chlorosis.
associate professor and demonstrator of anatStrychnine, quassin, or some other equally omy; Dr. Beauregard W. Flinn, professor of good bitter tonio, may be given before meals physiology; Dr. Emmet N. Davis, professor if the appetite is poor.
of chemistry; Dr. Rezin W. Lindsey, proHydriatic measures, such as cold sponging fessor of clinical medicine; Dr. George M.D. over the spine, and inside and outside the Cantrell, professor of physical diangosis and thighs; general graduated cold baths with diseases of the chest; Dr. David C. Walt, probrisk rubbing, cold abdominal douche, and fessor of the theory and practice of medicine; general massage, will be found of great bene. Dr. Clinton P. Meriwether, professor of fit. Cold water properly applied is one of materia medica and therapeutics; Dr. Edwin the most valuable curative measures in Meek, professor of obstetrics; Dr. Daniel R. chlorosis.
Hardeman, professor of diseases of children; Quite often it will be found that the iron Dr. William P. Illing, professor of mental simply passes through the bowels and is and nervous diseases; Dr. C. Travis Dren. ejected, or else it accumulates in the liver, nen, professor of syphilology and dermatolin both cases failing to be utilized and as- ogy; Dr. Charles C. Stephenson, professor similated into a living part of the vitalized of disease of the eye. ear, nose and throat; organism. In this case it bas been found Dr. Joseph P. Sheppard, professor of genitothat the addition of nuclein solution to the urinary diseases; professor of pathology, to prescription, in doses not exceeding a drachm be supplied; Dr. Joseph P. Runyan, prodaily, preferably administered by being fessor of surgery; Dr. Charles R. Sbinault, dropped on the tongue, apparently causes professor of gynecology; W. B. Smith, prothe fixation of the iron in the blood and tis. fessor of medical jurisprudence and M. E. sues; and the gain will far exceed that ac. Dunawav, professor of English and literaoruing frum the use of either iron or nuclein ture. The adjunct professors and clinical alone.
assistants will be supplied later.
ENONYMIN is claimed to be an excellent JUGLANS is a good vermifuge and it is remedy for prostration with irritation of claimed that it has destroyed tape-worms. nerve centers,
and to the numerous entertainments offered
The MEDICAL FORTNIGHTLY by the Provincial organization
A matter of not a little interest was the Issued Tenth and Twenty-Fifth of Every Month. wearing of Academic regalia by the officers, THOMAS A. HOPKINS,
speakers and invited guests at the general Managing Editor.
sessions. The impressiveness of ceremonial at Editorial Staff :
these sessions is a thing unusual in America 0. E. LADEMANN, Internal Medicine.
and might be advantageously copied by us. JOHN MCHALE DEAN, Surgery.
The principal addresses of the meeting were F. P. NORBURY, Nervous and Mental Diseases. R. B. H GRADWOHL Pathology and Bacteriology.
the Address in Medicine by Sir James Barr, W. H. VOGT, Obstetrics and Gynecology. WALDEMAR FISCHER, Ophthalmology.
M.D., F.R.C.S., F.R.S.M., who spoke on A. LEVY, Pediatrics.
"The Circulation · Viewed from the PeriW. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology.
pheral Standpoint;" the Address in Surgery HERMAN STOLTE, Laryngology and Rhinology. T. A. HOPKINS, Genito-Urinary Diseases.
by Sir Victor Horsley, M.B., F.R.C.S., F.R. ROBERT H. DAVIS, Dermatology.
S., on "The Technique of Operations on the Editorial Rooms, Suite 319-321 Century Build g, St. Louis.
Central Nervous System;" and the Address in Obstetrics by Walter Spencer Anderson
Griffith, M.D., F.R.C.S., on “The Teaching EDITORIAL
of Obstetrios." Eaob of these addresses was
a masterpiece, that of Sir Victor Horsley THE recent convention of the British Medi.
was especially remarkable, and we regret cal Association in Toronto was easily the that every reader of the FORTNIGHTLY could
most important medical not bave heard it. Unfortunately it is of a
event of the year, for character that we may not reproduce it. The Toronto
tbe American continent, The work of the thirteen sections was upi. Meeting of the if not for the world, and formly excellent, the presence in each secBritish Medical
it is a matter of con. tion of various celebrities from various cor. Association. gratulation to Ameri. ners of the British domain contributed materi.
cans that so many of ally to the interest for Canadians and Ameri
our physicians were able oans present. It was a great privilege to to be present. The Association convened on listen to such men as Drs. Norman Walker, the morning of the 21st, the general sessions J. Dundas Grant, Sir Thos. Barlow, Sir being held in Convocation Hall and the thir. Wm. Broadbent, Osler, Adami, Murdoch teen sections meeting in the neighboring Cameron, Sir Hector Clare Cameron, and buildings of Toronto University.
others too numerous to mention. To us it meeting-place the University left nothing to was a little disappointing that so generous a be desired, the buildings are splendidly ar- place on the program was allowed the ranged for the purpose and the Campus, or American profession, flattering though the Queen's Park as it is called, made the sur. fact is, for we desired the British to buve roundings charming in the extreme. Unfor the floor as much of the time as was possitunately the days of the meeting were so ex- ble. Among the papers read, by Americans tremely warm that life was a burden for those were three by men from St. Louis, Drs. Jas. who had gone North with an expectation of Moores Ball, Geo. Homan and H. W. Loeb finding a very different temperature; the doing the hovors for our city in this. beat to a degree affected the enthusiasm of Aside from the scientific entertainment of the gathering, but there being no other ad- the occasion the members of the Association verse condition no material lack of interest feasted and feted from their arrival to their was manifest, and meeting was ultimately departure. Various excursions were arranged, a tremendous success.
to Niagara, to the Thousand Islands, to Mus. The organization of this Association at- koka, and to many other points, and members tracted considerable interest among the Amer- of the Association generally availed themican visitors, the committees and subcom- selves of so much as their time would allow. mittees, with their various ramifications Those Americans who were a little apprehenseemed complicated, and to some extent sive that our going was at a bad time, as the confusing, but the machinery worked with Canadian profession would have its hands such smoothness as indicated absolute un- full with the entertainment of its guests from derstanding in every department, a matter across the ocean, and would bave little time which does not always so noticeably exist in for near neighbors, were given a demonstraour own larger gatherings. Visitors from tion of what genuine Canadian hospitality America were accorded all privileges of means, and none of us returned with any members for the time, wearing the member's doubt of what Canada can do when she inbutton and being welcome at all meetings tends doing it.
The total registration up to noon, August cause another lacks our balance and commits 24, was 1,986, of whom 650 were from the excesses. Impartially weighing the evidence United States. Of these 1,390 were registered leaves no doubt that the lid is a good thing as members and 596 as visitors.
and should continue. The lid bas spread Of those registered as members, 1,078 were from Missouri to all sections of the conti. from the Dominion of Canada, 145 from nent and is, in some places, more strictly on England, 48 from Scotland, 19 from Ireland, than here, clcsing saloons in the evening, 4 from Wales, 17 from the British colonies, covering other lines of business in its Sun3 from Continental Europe, and 54 from the day requirement and in places working a real United States, chiefly from the following hardship, but in spite of this we believe that states: New York, 9; Illinois, 7; Massachu- the lid works to the advantage of the vast setts, 5; Miobigan, 4, Missouri, 1, etc. majority of our people. In this connection
Of the 596 visitors, 8 registered from Eu. it was a matter of not a little interest that rope, 26 from Canada, and the remainder, 562 men of such scientific position as Sir Victor from the United States.
Horsley and Professor Woodhead, of CamThe following physicians from Missouri bridge, have lately declared before the British attended the meeting: Drs. W. B. Dorsett, Association that alcohol is worthless, or W. E. Fischel, Roland Hill, Geo. Homan, nearly so, as a medicine, and that milk and Jas. Moores Ball, Howard Carter, Jno. M. soda is a better tonic for the sick, and in Dean, Thos. A. Hopkins, Chas. H. Hughes, this they were upheld by many of our foreJ. Ellis Jennings, H. W. Loeb, Frank J. most physician as well as a number from Lutz, Mary H. McLean, K. C. Millican, E. abroad, when this can happen the man who W. Spooner, A. H. Meisen bach, A. J. Steele, make "medicine” an excuse for his daily St. Louis; O. L. McKillip, C. A. Ritter, dram had better be looking for another exKansas City; Chas. Wood Fassett, St.Joseph. cuse, for he is losing his backing. We are not
quite ready to accept Sir Victor's belief as final, but we can agree that mighty little that
is good comes from it except when it is used It is now some months since the Governor as a medicine. inaugurated the enforcement of the law re
quiring that saloons be Speaking of lids, the association journal closed on Sundays, no
tells us that France is to have the real thing The Lid.
community has felt the in this line:
effect of this more than "A bill bas been before the French parSt. Louis, for here the requirement bas been liament for fifteen years and bas finally been enforced and continuously effective longer passed which imposes Sunday rest. Compul. than at any other point. It would seem that sory closing of shops on Sunday is now rethe benefit or detriment of the law must by quired, and cessation of week-day work is imthis time be generally recognized, though perative on all employes or workmen in a there is really no concerted sentiment on the manufacturing or commercial establishment subject. Our coroner tells us that there has or its dependencies, whatever its nature, pub. been a material decrease in homicide; from lic or private, lay or clerical, even if it bas a the dispensaries we learn of a largely de- character of professional instruction or benevoreased number of stabbings, shootings, etc.,
olence There are numerous exceptions proand from the police department comes a def
vided for. Whenever it is evident that the inite statement that arrests are fewer from the Sunday rest for all the personnel of an estaboffences of intoxication, fighting, beatings lishment would be prejudical to the public and the interference with the rights of others or would compromise the normal function in ways which call for police interference; ing of the establishment, the day of rest can the citizens of St. Louis appreciate the un- be given on some other day than on the Sun. questionable fact that we have a more or day or divided among several days, or the perderly city than we had when we were “wide sonnel of the establishment may take turns open. Whether there will be demonstrated in the Sunday rest. A special permit is better health conditions later, which may be necessary to have a right to these excepa result, it is still too early to predict, but it tional privileges of remaining open all or would appear possible. On the other side, we part of Sunday, except in the case of hoshave our ideas of inberent liberty of action, pitals, dispensaries, drug stores and saloons. and our dislike for anything which may even The Semaine Medicale luments this special in a slight degree interfere with the catering favor granted to saloons, stating that there to our individual appetites, and we do not is one saloon in France for every fifteen like to be held responsible for the errors of adult males, and their closing on Sunday others, or to be deprived of something be- would be a national blessing.