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a late tertiary manifestation. In the first gesta the patients were kept on an exclusive variety, other symptoms of the constitutional milk diet for two weeks; other proteid materdisease make the diagnosis clear. It is in ials were then substituted for the milk. The the second variety that diagnostic errors changes observed during the milk diet were are so frequently made. It occurs in two diminution of the albumin, in the larger num. forms: 1. As a true interstitial orchitis. 2. ber of cases in which any changes at all ocThe gummatous variety. The first variety curred, and in a smaller proportion, an inoccurs late in the course of the disease, and crease. The influence of rest in diminishing may appear long after other symptoms have the albuminuria seems marked in these exdisappeared. The enlargement is usually periments. The change to other proteid diet gradual, and for some time may not attract was more frequently accompanied by a transthe patient's attention. While there may be itory increase than by a decrease though_in slight pain at first it soon disappears, and the majority, no effect was observed. His when the condition is well developed, in conclusions as regards carbohydrates and fats most cases, the testicle is insensitive to are that they have practically little effect on pressure. The enlargement is smooth, hard the production of albumin and rise and fall and board-like, and the gland is about twice of the albumipurio excretion. The ingestion its normal size, or even larger. The epididy- of large amounts of water, while it enhances mis is usually not involved. Both testicles diuresis and intestinal peristalsis, and favors may be affected, though usually but one is. gastro-intestinal disorders, bas little or no The gummatous variety is characterized by effect on the albuminuria in the vast majority the formation of multiple nodules and by the

With smaller amounts (up to 35 greater size of the testicle. When a patient 0.0. per kilogram of body weight daily) there presents bimself with a large smooth testicle, may be slight temporary but not permanent hard, and almost entirely insensitive to pres. Augmentation of the albuminuria. In the sure, it is next to impossible to make a differ- treatment of albuminuria per se the maximum ential diagnosis between sypbilis of the inter. ' amount of water taken is of little practical stitial variety and some form of malignant importance unless some advanced heart or disease. The additional question of a possi- kidney trouble, or some gastrointestinal disble tuberculous origin may further obscure order exists; and the minimum amount of the diagnosis. The clam shell''enlargement water should not for any length of time be of the epididymis wbiob Keyes considers less than is required for the introsystemic pathognomonic of the gum matous variety osmotic processes. would help to clear_the diagnosis in that form of the disease. To quote from his book: The Treatment of Tuberculosis of the Urin"The globus major is commonly involved, ary Tract of Women.-E. Garceau, Boston globus minor less often. The inflaned por.. (Jour. A.M.A. Nov. 3), reviews the subject tion of the epididymis forms a solid mass of tuberculosis of the bladder, kidneys and with a sharp edge which I have seen half as ureters in women, reporting eighteen cases. large as the palm of the band. It caps the The prognosis of these conditions is today end of the testicle, separated from it by a dis- vastly better than it was, thanks to better tinct sulcus, so that the organ seems to be means of diagnosis and better methods of resting in a clam shell. There are no nod. treatment. The treatment of vesical tuber- . ules, as in tuberculosis, and the cord is un- culosis is considered under the three heads inflamed. The pathognomonic clam shell is of hygiene and climate, local treatment and usually seen abuve the testicle, sometimes be

surgery. In very early cases in the well-to-do low it; at the same time the body of the tes. and in those not suffering severely a change ticle is usually implicated.”

of climate, with close observance of hygienio

requirements, exercise and rest, abundant The Diet and Albuminuria.-H. Stern, New nourishment and constant medical supervi. York (Jour. A.M.A., Nov. 17), recapitulates sion, will be best to begin with and has the results of a series of experimental studies affected cures. Patients suffering severely deof 82 patients who bad the one common symp- mand immediate relief. A general hygienic tom of excretion of serum albumin in the treatment is also recommended in very ad. urine. The object was to determine the in- vanced cases in which the whole urinary fluence of certain types of nutritives and in- tract has been invaded; in these, outdoor gesta not on the underlying disease, but on life in a well-regulated sanitarium will make the accompanying symptoms of albuminuria. conditions more endurable while life lasts The substances tested were proteids in the and may even arrest the disease. Vesical tuberform of milk, eggs and meats. The com

culosis has two stages; the one before tubermonly employed carbohydrates and water. cle formation, and the other after. In the Before adding the other proteid.containing in- first, local treatment does no good and is exoessively painful and it is best to enjoin rest cure before operating: Eighteen cases of and to administer general sedatives. The bladder and kidney tuberculosis are reported urine should be kept as bland as possible and discussed, including three absolute cures. and hygienio measures, rest and a regulated in two of the bladder cases the disease was diet should be insured. In the second stage primary, but the series does not tbrow much when the tuberole has broken down and ulcers light on the question of primary involvement are appearing, local treatment with corrosive of the kidney. Garceau thinks that a more sublimate and nitrate of silver can do a vast careful routine practice by physicians of amount of good and sometimes effect a cure, watching for symptoms and of urine examin. and a great advantage is that the method can ation ought to aid us in this matter. be carried out in hospital practice and is available for the poor. Garceau gives details of the methods of using both these remedies,

CORRESPONDENCE the former in solution according to the Guyon method and the nitrate by direct ap

PHILADELPHIA, December 5th, 1906. plication to the ulcers under local or general anesthesia. If this treatment should fail or

MY DEAR DR. HOPKINS: it can not be borne by the patient, recourse I have just received a copy of the MEDICAL should be had to a vaginal cystotomy which FORTNIGHTLY for November 26th with a note gives immediate relief and makes subsequent on some''Errors in Medical English" to wbich local measures

more endurable. He be- I called attention. I am very much obliged lieves that it should be resorted to early in a to you for copying this, because it is only in larger number of cases, provided the patient this way that we can diffuse the knowledge of is willing to submit to subsequent careful these errors. Curiously enougb, my criti. supervision. Tuberculous ulcers only rarely oism of the use of such a phrase, "Three are deep enough to require excision, and this Further Cases have been Observed and Oper. measure should be resorted to only after fail. ated Here," seems to have been interpreted ure of the persistent use of nitrate of silver. as a criticism of the use of the word "case" Granulations may call for ouretting, but this instead of "patient" or some equivalent, should never be done in an early case while missing entirely the point of the criticism on the tubercles are just appearing as it gan the verb "operated" instead of "operated on then do nc good and only opens up new or upon.' areas for infection. Incipient kidney tu.

Yours very truly, berculosis is best treated by a change of cli.

W. W. KEEN. mate, but this is sometimes disappointing, and it is, moreover, seldom diagnosed in the After tracheotomy the air of the phtient's incipient stage. Its frequent association room should be kept reasonably warm and with tuberculous disease in other parts of the moist. Draughts of cold air provoke much body is also noted by Garceau, and the ad

irritation. ditional peril it involves in operation. Nevertheless a moderate fouus elsewhere does not

Aneurism of the Posterior Wall of the Left absolutely prohibit operation and the ques.

Ventricle.-Riehl's (Münchner Med. Wochtion must be decided according to the sur

enschrift, Oct. 30, 1906) case is all the more geon's judgment. A diseased kidney left in

A diseased kidney left in noteworthy on account of the unusual locathe body can only do barm and in time tion of the aneurism. The patient, a woman must be fatal, so a certain risk is justifiable. eighty years old, presented the following subThe mortality of nephrectomy, though still ject symptoms: attacks of dyspnea with a high, has been reduced and improvements in sense of oppression in the precordial region. technic and better selection of

Pain in the region of the heart radiating probably reduce it still more. Nephrotomy in the arms (angina pectoris), quite a conis only palliative and unless followed by stant symptom of aneurism of the heart, was nephrectomy leaves usually an intractable absent. The objective symptoms were those fistula. When the two operations are done common to sclerotic changes; dyspnea and successively the results have been brilliant cyanosis, cardiac murmurs-a small pulse, and in bad purulent cases this should be the bui no enlargement on percussion, either to course adopted. Resection is unjustifiable the right or left, was discernable. The lungo as one can not be sure of leaving no diseased were emphysematous. At the autopsy there tissue. A tuberculous ureter should always was found, among other things, a thrombosis be removed and an ulcer of the bladder at its and complete obliteration of the posterior lower end can well be removed with it. If branch of the right coronary artery with an the ureter is diseased only in its lower por- unruptured aneurism of the musculature tion it may be worth while to try the climate about the size of a hen's egg.

cases will

MEDICAL MISCELLANY

A DYING PROFESSION.-The Medical Age

for October 25th says that an interesting ALCOHOL in diabetes is advocated by commentary on recent progress is shown in American Medicine on the ground that there

a statement recently made by the president is reason to believe that the first step in of the London Royal College of Veterinary sugar metabolism by the cells is to convert Surgeons, who asserts that in so short a it into alcohol. During the period then period as three years from the present time that sugar and starches are withheld it is there will be employment for only 300 vetbelieved to be well to deliver alcohol to the erinary surgeons in London. Before automo. cells in minute doses and frequently, in biles were introduced into the Englisb capi. order that the body may, by being built up,

tal 6000 veterinary surgeons were practising secure control of sugar metabolism. Small their profession in that city. This is prob. doses frequently repeated and well diluted ably the first instance in the world's his. appear to give excellent results.

tory where machinery has affected those

following a profession; heretofore only the The Hot Sand Bag.–Many people appre- trades have been in any way affected by the oiate the value of a hot water bag to relieve introduction of some labor-saving device. pain or improve the circulation. It is said

THE PUBLIC HEALTH DEFENSE LEAGUE. that a hot sand bag is still better for this

-A national society for the protection of purpose. A physician gives the following health and morals, to be known by the above directions: "Get some clean, fine sand, and

title, was formed November 15 in New York dry it thoroughly in a kettle on the stove; City, under the auspices of the New York make a bag about eight inobes square, of

Resolutions flannel, 611 it with the dry sand, sew the open adopted define the objects of the society as

County Medical Society. ing carefully togetber, and cover the bag with

follows: To disseminate accurate information cotton or linen olotb. This will prevent the concerning practices dangerous to public sand from sifting out, and also enable you to

health; to work for the enactment of laws in heat the bag quickly by placing it in the oven or on the top of the stove. After once using prevention of quackery and criminal prao

the interest of public health; to work for the this you will never again attempt to warm

. the feet or hands of a sick person with a

tices; to prevent adulteration and substitu

tion of drugs and foods, and to prevent the bottle or a brick. The sand holds the beat

sending through the mails of matter advocatfor a long time, and the bag can be tucked

ing quack medicines. A large number of up to the back without hurting the invalid.”

laymen were present and practically directed TABLET IN HONOR OF DR. WALTER REED.

the meeting. -At its annual dinner, November 21, the MASSACHUSETTS ADMITS THE HOMEOPATHS. Society of Ex-Internes of Kings County -At the one hundred and twenty-fifth annual Hospital, Brooklyn, presented to the hospital meeting of the Massachusetts Medical Soassociation a bronze memorial tablet in mem- ciey, held at Boston, June 12 and 13, the ory of the late Walter Reed, who was an in- question of amending the by-laws relating to terne there in 1871, prior to his entrance into membership in the society provoked an ani. the medical department of the United States mated discussion. For thirty years or more Army. The presentation address was made the society had forbidden its members to by Dr. A. T. Bristow, and that of acceptance practice "spiritualism, homeopathy, allo- . by R. W. Hibberd, commissioner of public pathy, Thomsonianism, eclecticism or any charities of New York City. Short addresses other irregular or exclusive system, generally commendatory of Dr. Reed and his work were recognized as suoh by the profession, or demade by. Dr. Howard Kelly of Johns Hop- clared so by the councilors of the society.” kins University, Dr. Joseph Bryant of New Practically homeopaths formed a class chiefly York City, the Rev. Lindsay Parker, and under discussion, and a committee, of which Colonel Phiilp F. Harvey, assistant surgeon Dr. F. C. Shattuck of Boston, was chairman, general, United States Army. The tablet after calling attention to the demise of bears the following inscription:

some of the other sects, presented an amend"Erected by the Association of Ex-In- ment allowing, under strict educational ternes of Kings County Hospital to the mem- qualifications, one to become a member,proory of Walter Reed, M.D., interne in this vided he does not profess to treat diseases hospital, 1871. Major and Surgeon, 0. S. by, or does not intend to practice any excluA.; chairman, U, S. Yellow Fever Commis. sive system, generally recognized as such by sion, 1900-1901. He robbed the pestilence the profession, or declared so by the council. of its terrors and caused the cities of the ors of the society.” After considerable dissouthland to sit in peace witbin their gates.” cussion, the amendment was adopted.

FRONT

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LOUIS

The MEDICAL FORTNIGHTLY

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'A Cormopolitan Blwookly for the General Practitioner

The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature. and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited.

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Contributions and books for review should be addressed to the Managing Editor, 319 and 320 Century Building, St. Louis, Mo.

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Tinct opii campb...
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FERMENTATION DYSPEPSIA. When fermentation is present with anorexia the fol. lowing formula after Ewald is advised : Be Tinct. nuois vom......

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Or, as a liniment, the following:
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Linimenti belladonnae. ... fzi M. Sig. : Rub in well and cover with cotton and oil silk or muslin.

As an ointment the following composition: B Chloralis hydratis....

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gr. XV

FAVORITE PRESCRIPTIONS

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LINIMENT FOR INFLAMED Joints. B Acid salicylic..

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MYALGIA.-.
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Ziss
Aromatio elixir.........q.s.ad ziij
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A LOPECIA.
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Giss
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........ad 3vj. --M Sig. : Apply to head two or three times daily.-Gross.

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