"SOME COMMON ERRORS IN TERMS AND PHRASES' — ' DO YOUR BOWels move YOU DAILY?"

BY LEON L. SOLOMON, A. B., M. D.

Pathologist, Louisville City Hospital, etc.

Some terms and expressions in every-day use by physicians, and which the lay public have adopted, are very inexpressive and therefore unsatisfactory. The following is very common, and the more prominent in my mind at the present moment, because of the peculiar, however correct, answer given me recently by one of my patients. I refer to the question which every doctor uses many times each day, viz., Do your bowels move regularly?

When we pause to consider this question, how ridiculous is it, as it stands, in this language! Certainly one's bowels move every day, and every minute for that matter, unless they be paralyzed or the patient dead. I was therefore very much pleased to have the mother of a little girl patient answer this question satisfactorily by saying, "Yes, doctor, her bowels move her every day, at least once." Now this is correct, and it is expressive-the bowels not only move, but they actually move the patient, or, as a member of a class of medical students said, "They make the patient get a move on himself." We also say to our patients, "Do your kidneys act?" and they often answer, "Yes, but too frequently," when the fact is, the bladder is probably irritable, or the neck inflamed, and the desire to evacuate it, therefore frequent. These are common errors. Let us accept the change as made by this patient, because it is correct.

LOUISVILLE.

QUARANTINED PATIENTS WITHOUT FOOD.--At Middlesboro, Ky., forty cases of variola and twenty-nine suspects are quarantined in the pest-house, and there are no funds to pay for their care. Dr. McCormack, chief inspector of the State Board of Health, says the State has no funds to be used for this purpose, the county refuses to make an appropriation, and the city is bankrupt. Surgeon Wertenbaker, of the Marine Hospital Service, who was sent to investigate the situation, is anxious and willing to render Federal assistance, but can only do so on invitation of the State Board of Health. Dr. McCormack vigorously opposes Federal intervention, and states that if the county does not render the necessary aid, he will withdraw and release the patients. Meanwhile the latter have been without food for two days and threaten to make their escape.

Reports of Societies.

LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.*

Stated Meeting, March 11, 1898, the President, Frank C. Wilson, M. D., in the chair. Stone Removed from the Pelvis of the Kidney. Dr. W. O. Roberts: I have here a stone, and as soon as you examine it you will imagine where it came from-the kidney. The patient was operated upon three weeks ago. I found this stone with a sharp point sticking down into the ureter, the body of it in the pelvis of the kidney. The woman has done well since the operation. An incision was made in the back and through the convex border of the kidney; there was an abscess which was opened and drained, but I did not remove the kidney.

The patient had been sick about two years. I opened an abscess of the kidney a year ago; at that time no stone could be found. The abscess was drained with a tube; the tumor disappeared, but pus still discharged from the opening, which had contracted down to a small fistula. Three weeks ago I cut down with the view of removing the kidney itself; I found it very adherent to the ascending colon; it was exposed, and I split the kidney throughout its entire length, and finding two pockets of pus, opened them; I found this stone in the pelvis, the smaller portion fitting into the orifice of the ureter. Before the operation there was considerable discharge of pus from the fistula, but little or none was found in the urine. The patient's condition was such that I thought it wise not to attempt to romove the kidney, although this will ultimately be necessary.

Discussion. Dr. H. A. Cottell: This case is of considerable interest to me inasmuch as the woman was originally my patient; but, it being a surgical case, I referred her to Dr. Roberts. Something over a year ago the woman came to my office and said she had a swelling she thought in her stomach somewhere; that she had been under the care. of a physician who had treated her, but viewed her symptoms lightly, stating that he did not think there was any thing serious the matter with her. I made an examination and found a large tumor in her right inguinal region. I called for a specimen of her urine, and after

Stenographically reported for this journal by C. C. Mapes, Louisville, Kentucky.

examining it, the result taken in connection with the tumor caused me to make a diagnosis of pyonephrosis. I sent for Dr. Roberts, who saw the case with me and confirmed the diagnosis. The subsequent history of the case he has given you. I have no doubt now that this stone was present when we first saw the case; that it was so situated as to form a sort of plung valve; at times it would be down in the ureter and shut off all communication; at other tiimes it would work up sufficiently to allow pus to escape, else we would not have found pus in the urine as we did in abundance at times. Dr. Marvin has expressed the opinion that the stone is principally oxalate of lime; I think that this is true, or perhaps it is of a mixed variety. If it is oxalate of lime there is a moral connected with the case, viz., That doctors do not treat the disease oxaluria as a thing of sufficient importance. When they discover it they give it attention, but there are thousands of people having oxaluria whose condition is never suspected. Oxaluria can not be made out except by the microscope; you may guess at it, but unless microscopic examination of the urine is made we can not be certain of the diagnosis, and sometimes then with a glass of the medium power you may overlook the crystals of lime oxalate. I have several times made a diagnosis of oxaluria with a high power glass, where the disease would have been overlooked had a lower power been used, for instance, the ordinary one-quarter or one-fifth glass commonly employed. Sometimes crystals of oxalate of lime are large enough to rival the triple phosphatic in size. They may possibly be made out with the naked eye, but this is extremely rare. Generally they are about the diameter of a pus corpuscle. Sometimes it requires a lens magnifying five hundred diameters or even more to make them out. If oxaluria is neglected it may produce a pyelitis by irritation, and now and then there is the formation of kidney stones.

Dr. A. M. Cartledge: Outside of dietary regimen, what do you consider the best treatment of oxaluria?

Dr. H. A. Cottell: I usually give nitromuriatic acid, sometimes hydrochloric acid. The dietary is very important. As for medicines I would say that nitromuriatic acid ranks first, with hydrochloric acid next.

Dr. A. M. Cartledge: I would like to ask what Dr. Roberts' experience has been in these kidney cases where he does a nephrotomy either for the removal of pus or a stone, for abscess of the kidney pelvis, or parenchyma, as to the subsequent closure of the sinus in the back.

Dr. W. O. Roberts: I have never had a sinus of this kind to close, and it is necessary to later do a nephrectomy in order to complete the In the case I have reported I did not believe it safe to remove the kidney as the patient was in such bad condition.

cure.

Meningocele. Dr. A. M. Vance: Two or three weeks ago I was called by Dr. H. M. Goodman to see a child, aged five months, with a large tumor on the right side of its skull, just over the right eye. The history was that the mother of the child had been married eight years, and this was the first baby; it was delivered with forceps after a very hard labor. The child was wonderfully well developed and seemed to be natural in every way for a baby of this age, except the tumor. Transmitted light showed the tumor to be perfectly translucent, and I took it to be a meningocele. It measured twelve inches around its base. According to the mother's statement the tumor was noticed soon after birth; it was very small at first and had gradually increased. in size until the time I saw it.

I advised aspiration to determine how large the cleft was through which this meningocele came. This was consented to after further consultation, and I aspirated it at ten thirty in the morning, removing eight and a half ounces of light straw-colored fluid by introducing a fine aspirator needle into the scalp some distance from the tumor and carrying it under the skin to the base of the tumor. This little operation was done without anesthesia, and the child showed no symptom. of pain. At twelve o'clock I received a telephone message that the cap I had arranged over the child's head had come off. I was surprised at that, and wishing to know the cause went out to see the child, and found that the tumor had refilled to two thirds its former size. To go back a little I will say that after aspiration the sac collapsed and the cleft could be felt just in the suture between the parietal and frontal bones, about as large as my index finger and about as long. I was surprised that the sac should have refilled so promptly, and by the morning of the next day it had become distended even larger than when I first saw it. The child had no symptoms whatever. The anterior edge of the cleft of the bone seemed to be exaggerated, the suture was lifted up edgewise resembling the top of a picket fence, which could be felt along the edge of the tumor even before emptying it. I then recommended these people to have an operation performed, which was to dissect out the sac and close the dura, possibly breaking down these

little spiculæ of bone and closing up the cleft. I did this without promising them any thing in the way of benefit, fearing that by shutting off this increased secretion of fluid there might be overaccumulation, pressure, convulsions, and paralysis. However, they consented to the operation. I reason that probably the whole cerebro-spinal system is distended with this fluid, and when relief was had by aspiration the membranes contracting below forced the fluid already present into the sac, and that the fluid was not actually secreted, as I can hardly recognize that in two or three hours that much fluid could be secreted by a baby of that age where we know the cerebro-spinal system is very small.

There is very little available literature on this subject. Dr. Roberts has had one of the few cases that has recovered. It is rather a rare condition, especially as to the extent and size of the cleft. On the side of the head at the base of the tumor is a scar produced by the forceps in delivery; whether that has any thing to do with the case or not I do not know. It is a case that will be rather trying to the surgeon, and, as I have heard nothing from it for several days, I have been rather congratulating myself that it has fallen into other hands. I have not been called upon to carry out my proposition.

Discussion. Dr. W. O. Roberts: The case referred to by Dr. Vance that I operated upon was a patient from Breckinridge County, Kentucky, a child that was brought to me by Dr. Milner. I do not remember exactly the age of the child, but think it was under two months, and the tumor was located where they most frequently are, that is on the back part of the head where the two pieces of the occipital bone come together. The tumor was about as large, if not larger, than a hen's egg. I opened the scalp down to the tumor and isolated it, then transfixed the tumor with a ligature and removed it, cutting it off and pushing the pedicle inside the skull, then closed the wound over it. The child made a prompt recovery.

I had another case with Dr. Cottell. The tumor was situated on the front part of the head where the two halves of the frontal bone come together, but in that case the cleft had closed before any operation was undertaken. The fluid in the tumor was perfectly clear, like spring water. Very few of these cases get well. If you remove the tumor when the child is very young and bulging does not take place, the child usually goes on and dies of hydrocephalus.