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ten or fifteen minutes. He had been treated in numerous hospitals with internal remedies and by local irrigations through the catheter with only temporary relief. Under hydraulic pressure 22 C. C. was the largest amount that the bladder would hold without severe pain. He was treated with irrigations of Thompson's fluid at a pressure of four feet. He rapidly improved, the urine became acid, the capacity of the bladder increased to 115 c. c. in eighteen days and to 250 c. c. in two months, when he could retain his urine for four hours. A year after the treatment was begun there was no tendency to recurrence. Some points in the technique of Dr. Young's method may be mentioned. A conical urethral nozzle which will fit tightly the meatus is required. The patient lies on his back. The bag containing the fluid is elevated three or four feet, and the urethra is alternately distended and emptied to clean the anterior urethra; the nozzle is then pressed tightly into the meatus, and the bag is raised to an elevation of about seven feet. The urethra will become ballooned, and for a time the flow will stop; soon the sphincters give way and the fluid enters the bladder, and the patient experiences a sensation of fullness and gradually increasing pain. The nozzle is withdrawn, and the fluid is ejected with considerable force. The operation is repeated until a quart of fluid has been used. Bland fluids, such as Thompson's or boric acid (two per cent), are the most satisfactory in general; silver nitrate (one half grain to one ounce) may be used occasionally. The effect of the dilatation is probably to separate or loosen bundles of fibrous tissue and to smooth out pockets in the mucous membrane, and also to give the antiseptic the best opportunities of acting on the mucous membrane. Is there any danger of ureteral reflux and of the carrying of pus or organisms up to the kidneys? As a result of his clinical experience and of experiments on the cadaver and on dogs, Dr. Young concludes that there is not.Lancet.

A FATAL CASE OF GONORRHEA.-Gohn and Schlagen haufer (Wien. klin. Woch., 1898, No. 24) record the case of a young girl who, when admitted into hospital, had been suffering for four weeks with pains in the limbs and the symptoms of influenza; four days before admission she had begun to have rigors, which were still continuing. On examination it was found that she had acute gonorrheal inflammation of the urethra and Bartholin's glands. Intermittent fever developed, and six days later there was sudden pain in the right foot, which became cold and bluish, while the sensibility of the whole limb was diminished. This became steadily worse, and in five days more the foot was gangrenous, The heart sounds had been previously obscured by murmurs, but now became audible, and enabled the murmurs to be recognized as mainly systolic and most marked at the base on the left side. The patient became rapidly worse, and died next day. At the necropsy it was found that ulcerative endocarditis had attacked the aortic valves, and that septic abscesses were present in the myocardium ; the heart was secondarily dilated and hypertrophied. The gangrene of the

foot and leg was the result of an embolus in the femoral artery. There was an abscess in the peritoneal covering of the posterior wall of the uterus. The gonorrheal process had affected the urethra, the vagina, and the cervical portion of the uterus. There was parenchymatous degeneration of the liver and myocardium, together with edema of the lungs. In the heart lesion gonococci were found, and the endocarditis was thus obviously gonorrheal. It is very noticeable that many of the ordinary signs of malignant or pyemic endocarditis, such as septic emboli and enlargement of the spleen, were absent, as also was the typical gonorrheal joint affection. The bacillus was tested by cultivation, and eventually by introduction into the human urethra ; it was not present in the embolus, but was found in the retro-uterine abscess. The urethra contained a large number of small, highly vascular polypoid excrescences, developed from the subepithelial connective tissue ; these are common in subacute and chronic gonorrhea. The point of entry of the infection into the blood or lymphatic system could not be determined. British Medical Journal.

MUMPS WITHOUT INFLAMMATION OF THE SALIVARY GLANDS.--It is gradually becoming more and more evident that the only essential element of an infectious disease is the invasion of the body by a specific microbe. The resulting symptoms and lesions are indefinitely variable. Of late years, partly from clinical observations, but mainly from bacteriological researches, the limits of these variations have been considerably extended. Lesions once supposed to be so characteristic that they entered into the definition of the disease may be entirely absent. Thus typhoid fever is not necessarily enteric; there may be no intestinal lesions. The pneumococcus, the most usual cause of acute pneumonia and the presence of which in other tissues causes the so-called complications of that disease, may attack these tissues and exempt the lung, producing a primary pneumococcic arthritis, pericarditis, etc. At a recent meeting of the Societe Medicale des Hopitaux Dr. M. A. Beclere read a case which showed without doubt that mumps may manifest itself by orchitis without parotitis or inflammation of the other salivary glands. This has already been stated by M. Laveran, and seems to be well known in France, but it does not appear to have been observed in this country, though Dr. Eustace Smith states that the orchitis may exceptionally appear before the parotitis. A boy, aged fifteen years, was suddenly seized with violent headache, pyrexia, and repeated vomiting. On the fifth day the right testicle became painful. On the following day he was seen by a distinguished surgeon, who finding orchitis with predominating epididymitis, thought, as there was no urethritis, that the case was one of acute-tuberculous orchitis, although the temperature was 104° F. Dr. Beclere saw the boy on the eighth day. He ascertained that three of his school-fellows had mumps, and diagnosed the orchitis accordingly. Resolution was complete on the fourteenth day. All doubts as to the diagnosis were soon removed, for his two sisters had typical attacks of mumps.

Dr.

Beclere pointed out that the diagnosis should be made by the history of an epidemic, the sudden onset of the illness, and the interval of four or five days between the general symptoms and the orchitis. The diagnosis is of importance if only to enable the practitioner to warn the patient's friends that atrophy of the testicle sometimes results.Lancet.

THE EXAMINATION OF THE SPUTUM.-A Hoffmann (Centralbl. f. inn. Med., May 14, 1898) draws attention to two kinds of cells which are differentiated by the eosin stain : (1) There is a cell about the size of the white blood cell which contains several small deeply-stained nuclei. Hoffmann looks upon this as a polynucleated white cell. Such cells are seen in specimens of the blood from marked anemia, especially that occurring in chronic nephritis. (2) The other kind of cell is rarer but more striking. It shows a sharp outline and contains an area inside which is either unstained or only slightly stained. In this area there are several well-stained molecules of varying shape. Sometimes these molecules are so numerous as to fill the unstained area, but they mostly number from two to five. These cells are larger than pus cells. The author found them most abundantly in whoopingcough, but they are also present in other diseases. They are most often found in the sputum of children. They are rarely seen where eosinophile cells are present. In many forms of bronchitis, as well as in asthma, eosinophile cells are found, and Hoffmann would look upon what he terms “eosinophile bronchitis" as an incomplete form of asthma. The second kind of cell described here is present in an acute bronchitis which has no relationship with asthma. Their origin is difficult to explain, but the author regards them as altered nuclei of the cylindrical epithelium of the bronchial tract.-British Medical Journal.

CASIMIROA EDULIS.—This rutaceous tree, the zapote blanco of the Mexican Pharmacopeia, was made the subject of examination by Professor Maisch, of Philadelphia, twelve years ago. He wrote of it, in the American Journal of Pharmacy for April, 1886, that the fruit was anthelminthic; that the pulp of the fruit was said to be hypnotic, though unwholesome; and that the seeds were regarded as poisonous. Now, according to the Therapist for July 15, 1898, a new hypnotic, analgetic, and antithermic has been extracted from the seeds. Long experimentation, it says, and tests on several hundred persons have established its action and its freedom from secondary effects, and determined its toxic dose. It seems “to favor natural sleep, from which one wakes refreshed" in from four to six hours, and its use is especially appropriate in insomnia from cerebral excitement or alcoholism.-- New York Medical Journal.

The article appearing in the issue of November 15th, entitled “Puerperal Eclampsia," was contributed by Dr. D. B. Stone, of Hydro, Ky., and not by Dr. W. B. Stone, as erroneously printed.

Special Notices.

ARTICULAR RHEUMATISM OF INFECTIOUS ORIGIN.-Dr. L. T. Riesmeyer, of St. Louis (Medical Review, October 22, 1898), calls attention to the growing tendency to attribute articular rheumatism to an infection with pyogenic micro-organisms. He reports in detail three cases in which a demonstrable primary inflammatory focus preceded the attack, the first patient liaving suffered from a purulent catarrh of the cervix uteri, the second from a parametric suppuration, and the third from follicular tonsillitis before the occurrence of the rheumatism. The author believes that the prompt action of Salophen in the treatment of these cases also speaks in favor of the microbic etiology of rheumatism. He regards salicylic acid, of which Salophen is a derivative, as one of the few true specifics in medicine. Its administration in the pure form is objectionable, however, on account of its irritation of the stomach. The salicylates, too, have irritating properties and produce disturbances of digestion, anorexia, nausea, and a heavily coated tongue; they also have a depressing effect upon the heart and irritate the kidneys. These disadvantages are overcome by the administration of Salophen, which passes through the stomach unaltered and separates in the intestine, on account of the alkaline contents, into salicylic acid and acetyl-paramidophenol. It produces no heart depression nor any other untoward symptoms, and may be advantageously administered in all cases where salicylic acid is indicated, that is, for the purpose of diminishing the activity of micro-organisms which produce inflammation, fermentation, and putrefaction.

SECONDARY ANEMIA.—Dr. Miltou P. Creel, of Central City, Ky., in his capacity as a railway surgeon and general surgical consultant, finds the most intractable forms of secondary anemia are those which follow upon severe injury, where amputation is necessary. In these cases he has failed altogether with the more common iron preparations, they producing biliousness and often severe constipation. To obtain the best results he has now accustomed himself to the employment of Henry's Three Chlorides, in doses of one to two fluid drachms three times daily after eating. The small amounts of bichloride mercury and chloride arsenic add, he holds, to the efficiency of the protochloride of iron which the preparation contains, besides it is most grateful to the palate of adults and children.

F. E. HARRISON, M. D., Abbeville, S. C., says: I have used Celerina in appropriate cases, and can heartily recommend it to all who wish an elegant preparation, combined with undiminished therapeutic activity. It is peculiarly fitted to such cases as delirium tremens, headache from debauch or excessive mental or physical exertion.

LABOR SAVING: The American Medical Publishers' Association is prepared to furnish carefully revised lists, set by the Mergenthaler Linotype Machine, as follows:

List No. I contains the name and address of all reputable advertisers in the United States who use medical and pharmaceutical publications, including many new customers just entering the field. In book forin, 50 cents.

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List No. 2 is furnished in gummed sheets, for use on your mailer, and will be found a great convenience in sending out reprints and exchanges. If you do not use a mailing machine, these lists can readily be cut apart and applied as quickly as postage stamps, insuring accuracy in delivery and saving your office help valuable time.

These lists are furnished free of charge to members of the Association. Address CHARLES Wood FASSETT, Secretary, cor. Sixth and Charles streets, St. Joseph, Mo.

THE

NEC TENUI PENNA."

Vol. XXVI.

LOUISVILLE, Ky., DECEMBER 15, 1898.

No. 12

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

SOME DESULTORY REMARKS ON RETINAL HEMORRHAGES IN

CERTAIN BLOOD CONDITIONS.*

BY J. MORRISON RAY, M. D.
Clinical Professor of Ophthalmology, University of Louisville.

Extravasations of blood into the retinal tissue from the bloodvessels therein contained is a condition frequently found by those accustomed to the use of the ophthalmoscope. The blood may come from either an artery or a vein. It is most often found in connection with an inflammation involving the optic nerve and retina. Under such conditions the inflammatory process precedes the retinal extrayasations, and is the predominating local change.

Often we find cases in which blood is poured out in the different planes of the fundus without local inflammation, showing that diseased conditions in remote parts may be a factor in their etiology. These hemorrhages may be single or multiple, abundant or consist of one small hemorrhage directly in the macular region. Their influence on vision will depend principally on their location. If central, they interfere seriously with visal acuteness. If eccentric, they may be abundant and yet interfere but little with normal vision, and their discovery accidental.

Their prognostic importance is of the greatest significance.

The late Dr. Agnew once stated to the writer that whenever he encountered a case of sinple retinal hemorrhage in a person after sixty years of age, he expected death would take place inside of three years, usually from cerebral hemorrhage. Where they occur earlier in life, * Read before the Louisville Medico-Chirurgical Society, December 16, 1898. For discussion see p. 459.

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