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are found alone with hyaline casts in nephritis. In acute inflammations hyaline and epithelial casts will be seen; in subacute inflammations, hyaline, epithelial and granular casts in chronic inflammations, hyaline and epithelial casts have disappeared, these formations being entirely replaced by granular or fatty casts. When all these varieties of casts are seen in a specimen, the diagnosis of a chronic nephritis with an acute exacerbation is justifiable.

It has just been stated that the diagnosis of a nephritis can be made without the presence of casts, and many cases of nephritis never at any time show casts in the urine. Since physicians still solely depend upon the presence of the casts for a diagnosis of nephritis, they are frequently surprised to see at the autopsy table diseased kidneys in cases which were never at any time diagnosed during life. Cases of interstitial nephritis rarely show casts in the urine; and if they do they are found in small numbers only. In all those cases, however, the diagnosis can be positively made from the presence of epithelia from the uriniferous tubules. These epithelia in the urine are usually round or oval, distinctly larger than the pus corpuscles, and are the same which can be seen upon epithelial casts. In every inflammation a desquamation of epithelia from the tubules takes place. These epithelia appear in the urine with pus corpuscles and red blood globules, and are perfectly characteristic, so that a diagnosis of nephritis can be made from them alone. These epithelia are derived from the convoluted tubules of the kidney and are cuboidal in character, while epithelia from the straight collecting tubules can also be positively diagnosed in urine and are of the columnar variety.

All true casts may appear in three distinct sizes, according to the portion of the

uriniferous tubules from which they originate. The narrowest casts are those formed in the narrow or looped tubules of Henle; the next in size from the distal convoluted tubules or convoluted tubules of the second order, while the largest are always formed in the straight collecting tubules. Casts from the proximal convoluted tubules, those directly arising from the capsule of Bowman, never appear in the urine, since they cannot pass the narrow tubules.

A great prognostic value attaches to the size of the casts. The mildest degrees of inflammation are usually indicated by casts from the narrow tubules, with a small number only of casts from the convoluted tubules. Larger numbers of casts from the convoluted tubules are present in inflammations of medium severity and justify the diagnosis of parenchymatous nephritis in the cortical substance of the kidney. Casts of all three sizes, the largest arising from the straight collecting tubules, permit of a conclusion of parenchymatous nephritis in the entire organ, and upon this condition an unfavorable prognosis can be established.

Based upon these simple facts, a good or bad prognosis can be given in many cases where the clinical features are too obscure to be of any particular value. Not infrequently the bad prognosis which must be given on account of the presence of so many large casts from the straight collecting tubules, and which does not at first appear justified by the scarcity of clinical symptoms, is soon borne out by the fatal ending of the case.

The great importance of differentiating between true hyaline casts and mucus casts has already been pointed out. It is just as important to differentiate between true granular casts and pseudo casts resembling these. It is mostly the so-called bacterial cast which is mistaken for the

true granular variety, although formations of mildew, especially mycelia, may also resemble granular casts to a considerable degree. Micrococci are frequently present in urine and may be of entirely secondary origin. When these cocci conglomerate, especially upon mucus, they resemble granular casts, but in reality are perfectly harmless secondary formations. Many cases in which hyaline and granular casts alone are claimed to be present will be found to contain no true casts upon careful examination. It is in these cases where chemical examination for albumin does not reveal a trace, and microscopical examination shows no epithelia from the uriniferous tubules of the kidney, perhaps even no leucocytes or pus corpuscles, that mistaken diagnosis of

casts are constantly made. Many a patient is told that he suffers from so-called Bright's disease, the diagnosis being based upon such erroneous findings, whose urine upon careful examination reveals no evidence of a nephritis what

ever.

Microscopical urinary analysis is of the utmost importance to clear up many doubtful conditions of the genito-urinary tract, but such an analysis must be conducted with the greatest care, as otherwise it easily leads to wrong deductions. A diagnosis of the presence of casts in the urine should under no circumstances be based upon the findings of castlike structures alone. Such structures must always be associated with other evidences of a pathological condition before a diagnosis of nephritis becomes permissible.

MEDICAL EDUCATION.

Medical Education.-What is our object in medical education? That object is to develop, or attempt to develop, the ideal practitioner. It is not merely to develop a learned man, but to develop one who shall so bear himself in all his relations that he will be a credit to himself, his alma mater, his profession and his country; who shall be, in the first place, of the greatest possible service to those of suffering humanity to whom he ministers, and not only that, but shall be an influence for good in improving the conditions of life in the community in which he practices; who shall so minister that he aids and strengthens his fellow-workers and raises the standard of our profession as a profession; who shall add credit and lustre to the school which has produced him, and lastly, who in all his relations shall so bear himself that at the end of the day's work-as at the end of life's

work-he shall feel within himself that he has done his duty loyally and has earned his rest.

It is difficult to picture forth the ideal practitioner, nor shall I attempt it. Each of us, I doubt not, has his own idea of that ideal. In the words of Pythagoras, "There are two things which must ennoble man, and make him to resemble the Gods: to know the Truth and to do Good." The ideal practitioner of all men, it seems to me, most constantly attempts to exemplify this saying and to live the noble life. High character, good manner and marked capacity play important parts in our ideal of what he should be.-J. G. Adami, M.D.

Dr. D. B. St. John Roosa.-The death of Dr. Roosa, who died suddenly in this city March 6, 1908, removed from the ranks of active medical men one of the

greatest and best in this city and State. He was born in Bethel, N. Y., in 1838, educated in medicine at New York University, served in the army during the Civil War and began his career as an ophthalmologist and aurist in this city, wherein he obtained an eminence unsurpassed by any other practitioner.

Dr. Roosa's teaching and official positions were almost too numerous to mention. He was president of the New York State Medical Society in 1879, of the International Otological Society in 1876, of the American Otological Society, and honorary vice-president of the International Ophthalmological Society in 1894. He was president of the New York Academy of Medicine in 1893-94, and one of the surgeons and founders of the Manhattan Eye and Ear Hospital. He was a member of the Union League and Century Clubs, of the Holland Society, of which he was president from 1896 to 1897, and of the Society of the Sons of the Revolution. He received the honorary degree of M.A. from Yale in 1872, and that of LL.D. from the University of Vermont in 1880.

Dr. Roosa's contributions to medical literature were numerous and highly esteemed, among his best-known books being a translation of "Troltsch on the Eye" from the German; in collaboration with Dr. C. E. Hackley and Dr. Charles Stedman Bull, a translation of “Stellwag on the Eye"; "Vest Pocket Medical Lexi

con," "Treatise on the Ear," "The Old Hospital and Other Papers," "Clinical Manual of the Disease of the Eye" and "A Doctor's Suggestions on the Necessity of Wearing Glasses."

The insufficiency of medical training in this country enlisted his attention, and every plan for its improvement received his effective support. All legislation relating to the practice of medicine in New York State was promoted by Dr. Roosa's constant and enthusiastic advocacy. His most notable efforts for improved medical education resulted in the formation of the New York Post-graduate Medical School and Hospital, of which he was president from 1882 until his death. The school has become the foremost institution of its kind in the world, and every such institution, both in the United States and in Europe, has been patterned after Dr. Roosa's Post-graduate. It is a source of supreme satisfaction to his friends that this great school for practitioners of medicine was on an enduring basis before his death and that there will be no interruption to its constant growth and prosperity.

Dr. Roosa will be always regarded as a great and successful leader of men, and his friends, as well as his enemies (of whom he was fortunately provided), will unite in bestowing upon him the tribute of their warmest appreciation for the good accomplished through his instrumentality.

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Medical Review of Reviews stitute for Medical Research, are con

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APRIL 25, 1908.

ANTI-VIVISECTION.

The Legislature of New York is nearly ended, and at the present writing has not passed the bill which the anti-vivisectionists have proposed, and the title of which should be "An Act to Interfere with Scientific Experiments Upon Animals." New York has been called upon periodically for the past 30 years to enact such a law, and the present movement is a recrudescence of these old movements.

It is scarcely to the credit of the lay press that some influential papers have freely opened their pages to denunciations of the medical men who, like the scientists connected with Rockefeller In

justly say: Use the human being for these investigations, for such studies must be pursued if we would progress in the knowledge and treatment of disease. But even the anti-vivisectionists do not approve of experiments upon the human being, and have maliciously declared that physicians will soon be making them unless their absurd limitations of experiments are enacted into laws.

Cases of wanton cruelty to animals are unknown in our experiments. The small number of physicians who are engaged in these studies are men of the highest character. Members of our profession are noted for their humanity, and every man, woman or child who was ever attended by a doctor knows this to be true, and the claims to the contrary are unsupported by a single fact.

In other words, the present agitation is uncalled for, disingenuous and unjust, and the Legislature should not be inveigled into passing the bill. If it should accidentally be enacted, we shall expect an executive veto.

THE SANITARY PROTECTION OF NEW YORK BAY.

We are all in possession of a general knowledge of the pollution of the waters of New York bay and its tributaries by the deposit therein of raw or impurified sewage. We have become so accustomed to the unsanitary condition of our shores that we only complain when the back water from a ferryboat entering its slip or the slime we notice clinging to a sea

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