The most eminent and successful Practitioners consider LACTOPEPTINE the Standard remedy in the treatment ACTOPEPTINE is a skillfully prepared combination of Meat-converting, Fat- convert ing and Starch-converting Materials, acidified with the small proportion of Acids always present in the healthy stomach. It is a most valuable digesting agent, and SUPERIOR TO PEPSIN ALONE."-Prof. ATTFIELD, Ph. D., F.R.S., &c., Prof. of Practical Chemistry to Pharmaceutical Society of Great Britain. of all those ailments in which deficient digestion is the direct or indirect cause of pathological conditions. LACTOPEPTINE. The most important Remedial Agent ever presented to the Profession for DYSPEPSIA, VOMITING IN PREGNANCY, CHOLERA INFANTUM, CONSTIPATION, and all diseases arising from imperfect nutrition. LACTOPEPTINE IN CHOLERA INFANTUM. We desire to direct special attention to the great value of LACTOPEPTINE in Cholera Infantum, and other intestinal troubles incident to the heated term. Send address for our Medical Almanac, containing valuable information. The New York Pharmacal Association, P. O. Box 1574. New York. scess, but abscesses were not interfered with, as a rule, unless there were positive indications for the knife. As a matter of experience, abscesses connected with hip-joint disease did no better under antiseptic conditions than those under simple incision, and neither did better than when opening took place spontaneously. The long splint without any joint at the knee was used from the beginning to the end of the treatment. In private practice, where the patients could afford to pay for it, a splint with joints was employed. nineteen cases cured after the tenth year represented in the aggregate thirty-eight inches shortening. The shortening was principally in the femur; the tibia shared it to a certain extent. The difference between the length of the two limbs almost invariably increased slowly after the disease had been cured, but the shortening did not increase indefinitely. In the cases in which eight or ten years had elapsed between the two measurements, no greater shortening was present at the last measurement than existed two or three years after the cure. In nineteen cases there was practically anchylosis of the joint: in twelve of these there had been abscess, in four no abscess; with slight motion there were four cases with abscess, two without abscess; from ten to fortyfive degrees of motion, five cases with abscess, two without abscess; with ninety degrees of motion, three cases with abscess, no case without abscess; with perfectly free motion, two cases with abscess, one without any abscess. Examination proved that motion became less as time went by. In two cases in which there had been ninety degrees of motion several years ago there was at the last examination only thirty degrees. Of the entire number of cases treated at the In no case was the difference in the circumdispensary from 1875 to 1882, only fifty-one ference of the two thighs less than one inch. coming under the restrictions of this paper It would appear there might be a maximum could be traced. Of these fifty-one cases four of muscular atrophy with a minimum of had died: two of meningitis, two of pneumo- bone-shortening, and vice versa. It seemed nia. Six of the patients had had a relapse. the nutrition of the muscles, bones, etc., in They had been under treatment two and one-hip-joint disease received a shock from which half, four, four, four, five, and seven years it never afterwards recovered. respectively; two remained well three years, two four years, and one five years before a relapse occurred. In one case the relapse was due to a fall from a cart. Of the cases which had relapsed one had afterwards entered a hospital for excision at the hip, two were still wearing the traction splint and were nearly cured a second time, one was on crutches slowly improving, the remaining two had been cured a second time by the traction apparatus. The remaining forty-one cases had been examined excepting two, which were well. Of the thirty-nine cases examined four had been under treatment two years, four for two and a half years, nine for three years, six for three and a half years, eight for four years, two for four and a half years, two for five years, one for six years, one for six and a half years, one for seven years, and two for eight years. Of the thirtynine cases, the disease had lasted before they came under observation for a less time than six months in eight cases, between six months and a year in eighteen cases, between one and two years in three cases, between two and three years in five cases, six years in one case, seven years in one case, nine years in one case, and for an indefinite time in two cases. Of the thirty-nine cases, twenty-seven had one or more abscesses at some stage of the disease; twelve had none, but the latter were by no means the least marked cases, or those in which the best results were obtained. There was shortening of the limb as much as one and a half to two inches in all of the cases excepting two; in these there was no shortening. The amount of shortening did not seem to depend upon the presence or absence of abscess. In one case there was six inches shortening. The two cases cured without any shortening were cured before the tenth year of age. Eighteen cases cured before the tenth year represented an aggregate of twenty-five inches shortening, while In fifteen of the cases in which there was little or no motion at the articulation there was no flexion of the thigh; the limp in these cases was trivial. In the cases in which the angle between the flexed thigh and the body was one hundred and twenty to one hundred and thirty-five degrees the impediment to motion was not serious, except in one case, in which there was caries of the lumbar spine. Permanent adduction of the thigh was a much more serious matter. Adduction was likely to occur after removal of the splint and increase up to a certain point. Adduction was present in thirty-three cases, but in only one was it very troublesome. In only one case of forty examined was there anything which approached at all to true lateral curvature of the spine. DISCUSSION. Dr. LOVETT, of Boston, made some remarks, and said he considered adduction the most important factor in cured cases of hipjoint disease. There might be a good deal of bone-shortening with little inconvenience in walking, but slight shortening from adduction caused the gait to become ungainly. Dr. RIDLON thought the paper showed that cases of hip-joint disease could be treated successfully at a properly-equipped dispen sary. He thought some cases were based on a tubercular, others on a syphilitic diathesis; some had a traumatic origin. He would also employ therapeutic measures. Dr. KETCH said the advantage of the mechanical treatment was not alone in obtaining good final results, but in relieving the patient of pain and enabling him to go about during the treatment. Dr. LEWIS A. SAYRE thought that, whatever the predisposing cause, the cases could be traced to some traumatism as an exciting cause. He thought the results of treatment regarding motion were much better in his private practice than in the cases seen in dispensary practice by Dr. Shaffer. He was a strong advocate of mechanical treatment, but there were conditions in which excision of the dead bone should be performed, otherwise the patient would die from amyloid degeneration of internal organs. Dr. V. P. GIBNEY had become a convert to the mechanical treatment of hip-joint disease. The results in cured cases seemed in two respects to be different from what orthopedic surgeons usually led their patients to hope for: It was shown by these statistics that the shortening increased for a time, instead of diminishing, after the cure; further, that the diminished size of the affected limb was not overcome. Dr. JUDSON thought a large shoe on the instrument or affected limb, instead of the small one usually worn, might tend to make adduc- | tion in walking more difficult, by preventing the patient from taking his weight off that limb as quickly as he was inclined to do. Dr. TAYLOR, Dr. L. H. SAYRE, and Dr. SHAFFER Continued the discussion. NEW YORK PATHOLOGICAL SOCIETY. A STATED meeting was held June 8, 1887, the President, T. MITCHELL PRUDDEN, M.D., in the chair. Dr. PUTNAM JACOBI presented for a candidate a specimen of ACUTE ATROPHY OF THE STOMACH, WITH Dr. DUDLEY presented THE UTERINE APPENDAGES her condition worse; a fifth treated her for rheumatism of the brain. Finally she came under the care of Dr. Hammond, who treated her for brain-congestion, together with other symptoms. She was always of a lively disposition when not in pain. She had never had a true spasm. Dr. Hammond placed her in the care of Dr. Dudley, who found that she was well nourished, that her menses were regular. She suffered no pain except in the head until lately, when she had pain in the side one week before and one week after menstruation. She had taken large quantities of medicine, and had been treated by almost every means for the relief of her nervous condition. She had been a masturbator for years, but said she had given up the habit some months past. The vulva was so hyperæsthetic that a physical examination was very difficult. The meatus was surrounded by a large caruncle. From a superficial examination he found the uterus retroverted, and the ovaries and tubes correspondingly low. At a second examination without ether, he was able only to replace the uterus. Saturday last he examined her under ether. The left ovary seemed to be small; the right ovary seemed to be somewhat enlarged and very sensitive. After consultation, and having obtained the previous consent of the patient, and of her brother, who was a physician, it was decided to make an exploratory operation. The right ovary was found somewhat enlarged, and contained a cyst about the size of an English walnut; the tube was tortuous, and the fimbriated extremity was bound down below the ovary; the ovary and tube were removed. The left ovary was found to be small, and contained a small cyst; the tube was tortuous and bound down to the pelvic floor, and quite close to the intestine; beneath it was a large varix. This ovary and tube, together with the varix, were removed. The patient had since done well. A point of special interest in the case reThis was the lated to the varicose veins. third case of the kind which he had operated upon during the past year. In all there had been failure to relieve the reflex symptoms by various ordinary measures, such as repairing a lacerated cervix, curetting for a fungous condition of the uterus, the administration of drugs, etc. In the first two cases the pain in of a girl aged 22. At the age of six years the side and other reflex symptoms disapthe patient had had smallpox, from which she peared after removal of the ovaries and vamade a good recovery. From six to twelve rix. The ovaries were not much enlarged. years of age she had the exanthemata and In the third case the operation had very rediphtheria. At twelve she would occasion-cently been performed. Dr. Dudley thought ally faint, and at times complained of headache. At maturity her headache grew steadily worse, and was most severe at the menstrual period. She was then put under the care of a physician, who made the diagnosis of hysteria. Another physician treated her for rheumatism, a third for chronic meningitis; a fourth applied electricity, which made that inasmuch as a varicocele in the male might give rise to almost all kinds of reflex symptoms, so also might an analogous condition exist in the female. Dr. PUTNAM JACOBI thought it would be interesting to know whether or not the small ovary was the seat of interstitial ovaritis. Two years ago she reported three cases in which the ovaries did not present any very marked lesion when examined macroscopically, but when examined microscopically there was found degeneration of the arteries and the signs of interstitial ovaritis, and she thought this was much more the cause of the severe nervous symptoms which had existed than was any slight cystic degeneration. In fact, a cyst of considerable size might exist and cause no suffering or tenderness when pressure was made over the abdomen. She referred to the case of a young lady, who, before coming East, had undergone at least one year's continuous treatment in a Western State for symptoms related presumably to an existing enlargement and prolapsus of both ovaries. The treatment by galvanism was continued, and an attempt was made to replace the ovaries, and a boro-glyceride cotton tampon was introduced into the vagina. At first this local treatment seemed to be beneficial, but the relief proved to be only temporary, and the tampon after a time seemed to cause irritation. Local treatment was then discontinued two or three months, during which time the patient received simple massage, to some extent electrical massage, the cold pack with rubbing, and general treatment. Under this plan the pain in the back and the nervous symptoms generally had entirely disappeared, also the tenderness on pressure over the ovaries, although the organs remained prolapsed and enlarged. Dr. Jacobi had seen at least two or three cases in which the enlarged and prolapsed condition of the ovaries had continued after relief of all the apparently associated symptoms. Dr. DUDLEY requested that his specimen be submitted to the Committee on Microscopy. The request was granted. Referring to the remarks of Dr. Putnam Jacobi, he expressed the belief that cotton tampons with boro-glyceride produced their beneficial effect by causing contraction of the vessels and reducing uterine congestion. He did not think that in his case there had been acute ovaritis; the patient had not complained of pain in the region of the ovary until very recently. As to the relief of symptoms by cotton tampons containing glycerin, he had two cases of prolapsus of both ovaries and tubes in which such treatment would cause almost entire disappearance of the symptoms for a month or two, but they would return with each new exposure to cold, over-exertion, etc. Dr. PUTNAM JACOBI thought that in the case related by her the uterus was perfectly healthy, and the tampons had produced only slight relief, whereas the general treatment had caused entire cessation of the subjective symptoms. The PRESIDENT said it was so seldom one found a normal ovary that it was difficult to obtain a sufficient number for demonstration before students. Interstitial ovaritis was very common, even in cases in which there had been no history of symptoms associated with it during life. Dr. W. P. NORTHRUP asked Dr. Dudley whether he had noticed in his cases any of the changes in the features alleged to take place after removal of the ovaries. Dr. DUDLEY replied that in none had he noticed any change, excepting that usually there was an increase in flesh, and some patients complained of flushes in the head after removal of the ovaries. EPILEPSY-BONY EXCRESCENCES ON THE INNER SURFACE OF THE CRANIUM. Dr. THATCHER presented the skull of a colored woman, aged about 35 years, who had complained of severe headaches for three years, which she thought were due to menstrual troubles, of which she had some. There were chronic changes in the kidneys, but no diagnosis of kidney-disease had been made by the physician in charge. The urine had, according to the report, been of fairly high specific gravity and contained no albu men. ease. There was no history of venereal dis During the past three months the patient had had occasional attacks of vertigo, with loss of consciousness and falling to the ground. The attacks became more and more frequent towards the end of life. She gradually weakened and died. The diagnosis made was epilepsy. There were found, at autopsy, bony excrescences on the inner surface of the frontal bone, and some calcified masses in the dura mater. The dura was closely adherent to the skull. REMOVAL OF THE RIGHT HALF OF THE LOWER JAW BY SLOW ENUCLEATION. Dr. JOSEPH W. HOWE sent a man who in October last received a severe blow on the under surface of the chin, exposing the bone. The wound was sewed up at St. Luke's Hospital, but failed to unite. The jaw afterward became much swollen and painful, and the patient sought admission to St. Francis's. Dr. Howe made an examination early in November, and found a swelling extending from the symphysis to the posterior part of the ramus of the jaw on the right side. A small sinus led to the dead bone. The teeth were loosened, the alveolar processes were stripped bare, were rough, and bathed in pus. The periosteum was separated along the upper line of the jaw back to the ramus, and in some places was completely destroyed. The lower teeth were removed from the jaw the following day, and a portion of the periosteum separated. This process of separating the periosteum was continued for several weeks, the parts were thoroughly cleansed, and the general health was looked after. With the stripping of the bone the periosteum gradually thickened so as to increase the swelling on the affected side. Finally, he was able to pull out the diseased jaw, leaving behind a good basis for a new jaw in the ossifying periosteum. The patient, when presented, had a new jaw, which had grown from the periosteum of the old jaw. A CASE OF INTUSSUSCEPTION. Dr. W. P. NORTHRUP presented the specimen, removed from a boy aged 5 months, who was cared for during his illness "between" two or three physicians, which would account for the meagre history and lack of diagnosis. The child was strong, and had had no previous disease. Forty-eight hours before death, the record stated, he had severe diarrhoea, with vomiting. During the last twelve hours the vomiting increased in severity, and the diarrhoeal discharges became bloody mucus. The patient cried shrilly, and had "inward convulsions." Death took place forty-eight hours after the commencement of the symptoms. At the autopsy the abdomen was tensely distended. The distention was found to be wholly of the small intestines. The stomach was empty, the colon and rectum collapsed. The small intestines were normal, except that there was a little swelling of Peyer's patches. The colon and rectum were smeared with blood-stained mucus. The only lesion found was a tumor four inches long, an inch and a quarter thick, round, firm, the color bluish, which was found to be an invagination of the cæcum into the transverse colon. The latter was in normal condition, the former deeply congested. The gut was believed to be not gangrenous. - TREATMENT OF ALOPECIA AREATA. Schachmann (Annales de Derm. et de Syph., vol. viii. No. 1) has followed successfully M. Vidal's treatment of alopecia areata by blisters. The whole surface of the area is blistered, the blistered surface being treated in the ordinary way. Generally within three days it is possible to apply another blister. Three, four, up to six or even ten blisters are used successively; and, in addition, the rest of the head is rubbed night and morning with a lotion consisting of water one hundred, turpentine twenty, ammonia five. When the affected surface is very large, or when the whole head is affected, the part to be treated is divided into fields, and the fields are treated successively. The circumference of the area is shaved to the extent of about a centimetre. Twenty-nine cases are related in which this method was employed. Ten of these were also treated by stimulating applications, such as pyroligneous acid and croton oil, which gave no good result in spite of long treatment. The duration of the malady never exceeded three months from the time the blisters were begun. In a number of cases it did not reach two months, and in others a cure took place much sooner. Sometimes the hair began to grow after three or four blisters.-London Med. Record. OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF OFFICERS SERVING IN THE MEDICAL DEPARTMENT U.S. ARMY FROM JULY 17, 1887, TO JULY 30, 1887. COLONEL D. L. MAGRUDER, SURGEON.-Granted leave of absence for one month, to take effect on or about August 10, 1887. S. O. 175, A. G. O., July 25, 1887. Paragraph 13, S. O. 167, A. G. O., July 21, 1887, assigns LIEUTENANT-COLONEL A. HEGAR, SURGEON, to duty as member of Army Retiring Board convened at Governr's Island, New York Harbor, New York, vice COLONEL CHARLES SUTHERLAND, SURGEON, hereby relieved. MAJOR D. G. CALDWELL, SURGEON.-Order relieving him trom duty at Fort D. A. Russell, Wyoming, and assigning him to duty at Fort Assiniboine, Montana, is revoked. S. O. 168, A. G. O., July 22, 1887. MAJOR P. J. A. CLEARY, SURGEON.-Ordered to Fort Assinboine, Montana, instead of Fort D. A. Russell, Wyoming. S. O. 168, A. G. O., July 22, 1887. MAJOR ELY McClellan, SURGEON.-Detailed as member of a board of survey to meet at the medical purveying depot, St. Louis, Missouri, on August 1, 1887. S. O. 173, A. G. O., July 28, 1887. CAPTAIN S. G. COWDERY, ASSISTANT-SURGEON-Granted one month's leave of absence, to take effect on or about July 24. S. O. 79, Department of Texas, July 13, 1887. By paragraph 43, S. O. 162, A. G. O., July 15, so much of paragraph 1, S. O. 156, c. s., A. G. O., as directs CAPTAIN JOHN DE B. W. GARDINER, ASSISTANT-Surgeon, to report for duty at Fort Washakie, Wyoming, is revqked. By paragraph 42, S. O. 162, A. G. O., July 15, so much of paragraph 1, S. O. 156, c. s., A. G. O, as relieves CAPTAIN GEORGE H. TORNEY, ASSISTANT-SURGEON, from duty at Fort Monroe, Virginia, is revoked. CAPTAIN R. BARNETT, Assistant-SurgeON. - Sick-leave still further extended six months, on account of sickness. S. O. 162, A. G. O., July 15, 1887. CAPTAIN H. G. BURTON, ASSISTANT-SURGEON.-Sick-leave of absence extended three months. S. O. 171, A. G. O., July 26, 1887. CAPTAIN E. F. GARDNER, ASSISTANT-SURGEON.-Ordered for duty at Fort Reno, Indian Territory. S. O. 170, A. G. O., July 25, 1887. CAPTAIN A. W. TAYLOR, ASSISTANT-SURGEON-Now at Fort Laramie, Wyoming, is ordered for temporary duty at Fort Robinson, Nebraska. S. O. 164, A. G. O., July 15, 1887. FIRST-LIEUTENANT C. S. BLACK, ASSISTANT-SURGEON.Ordered for duty as post-surgeon, Fort Bliss, Texas, during the absence on leave of Captain S. G. Cowdery, Assistant-Surgeon. S. O. 79, Department of Texas, July 13, 1887. FIRST-LIEUTENANT W. D. McCaw, Assistant-Surgeon.— Ordered for temporary duty at Fort Riley, Kansas. S. O. 78, Department of Missouri, July 25, 1887. OFFICIAL LIST OF CHANGES OF STATIONS AND DUTIES OF MEDICAL OFFICERS OF THE U.S. MARINE HOSPITAL SERVICE FOR THE WEEK ENDING JULY 23, 1887. FESSENDEN, C. S. D., SURGEON.-Granted leave of absence for thirty days, on account of sickness, July 18, 1887. MEAD, F. W., PASSED ASSISTANT-SURgeon. - Granted leave of absence for thirty days, July 19, 1887. YEMANS, H. W., PASSED ASSISTANT-SURGEON.-Granted leave of absence for thirty days, July 23, 1887. BROOKS, S. D., PASSED ASSISTANT-SURGEON.--Promoted and appointed Passed Assistant-Surgeon from July 1, 1887, July 21, 1887. WHITE, J. H., ASSISTANT-SURGEON.-To proceed to Washington, D. C., as escort to an insane seaman, July 18, 1887; ordered to examination for promotion, July 23, 1887. WATKINS, R. B., ASSISTANT-SURGEON.-Leave extended fourteen days, on account of sickness, July 20, 1857. MAGRUDER, G. M., ASSISTANT-SURGEON.-To proceed to Galveston, Texas, for temporary duty, July 21, 1887. |