ITEMS.

The Erie Railroad is making unusually desirable arrangements for the transportation of physicians to the meeting of the American Medical Association at Columbus next month. They invite correspondence or communication by telephone with their office at 242 South Clark street.

Time heals all wounds; the trouble is, however, our time on this planet is limited.

The graduating classes in almost all of the medical colleges are larger this year than for several years past.

A good general practitioner can find an exceptional opening by addressing Dr. A. Striemer, Wilmot, S. D., for particulars.

The American Association of Physicians and Surgeons will hold its ninth annual meeting in Chicago May 31 to June 3, inclusive.

A combination of some of the St. Louis medical colleges is said to be threatening. Stranger things than a similar occurrence might happen in Chicago.

The chair of gynecology in the Chicago. Polyclinic, nominally filled by the late Dr. Etheridge, has been filled by the election of Dr. H. P. Newman to the place.

Dr. F. E. Waxham has betaken himself abroad, not for study, but for a much needed rest and recuperation. We sincerely hope the doctor will find even more of this very necessary article than he anticipates.

All indications point to an unusualy large meeting at Columbus. Many new men are contemplating attendance, and a large majority of the older members will be accompanied by their wives or families.

The commencement exercises of Rush Medical College were held at Studebaker Hall, in the Fine Arts building, on May 26. The degree of doctor of medicine. was conferred on 167 graduates of the class of 1899. Fellowships and medals were awarded as follows: Fellowship in pathology to H. Gideon Wells, fellowship in chemistry to Oscar Theodore Roberg, fel

lowship in cutaneous pathology to Howard T. Ricketts, the Benjamin Rush medal to John Fulton Roe, the J. W. Freer medal to Oscar A. Dahms and the Daniel Brainard medal to James Harmon Fowler.

It is currently reported that Dr. J. C. Webster of McGill University, Montreal, has been elected to fill the chair of gynecology and obstetrics in Rush Medical, made vacant by the death of Prof. J. H. Etheridge.

Dr. Reuben Ludlam, president of the Hahneman Medical College, Chicago, died very suddenly recently, as the result of heart paralysis coming on while he was engaged in operating on a patient in Hahneman Hospital. He lived only about ten minutes after the stroke.

The College of Physicians and Surgeons, Chicago, has this year a graduate in the person of Mrs. Maria A. Fellows, a colored woman, who is as well educated and charming in manner as she is plucky. She speaks German fluently and is an accomplished musician.

On other pages of this issue will be found the complete text of the new medical practice act which will become a law on July I. That it is open to some criticism no one will for a moment deny; that it is as good as was obtainable at the time is possibly true; that we must take it for what it is, good or bad, is undeniable. Next month we will likely have something editorially to say of the bill and its provisions.

The third International Congress of Gynecology and Obstetrics will be held in Amsterdam from the 8th to the 12th of August, this year. The leading questions for discussion will be: 1. Surgical treatment of fibromyoma. 2. The relative value of antisepsis and improved technique for actual results in gynecological surgery. 3. The influence of posture on the form and dimensions of the pelvis. 4. Indications for Cæsarean section compared with those for symphyseotomy, craniotomy and premature induction of labor. A large number of leading gynecologists and obstetricians in Europe and America have signified their intention of being present and participating in the scientific work of the Congress. English, French, German and Italian will be the official languages.-Recorder.

MODERN THERAPY.

BISOL.

Elegance in pharmacy often will achieve a success for the physician which is unattainable by even the greatest ability or painstaking care on his part. Particularly is this true in pediatric practice. When one intestinal astringent can be given in a pleasant and palatable solution, while another also with desirable therapeutic action is unsightly and distasteful, there certainly is no question as to which should be chosen. For these reasons a soluble form of bismuth, known as Bisol, is a most desirable drug at this time of year, in the treatment of the numerous gastro-intestinal disorders of the little ones. It is a salt, virtually harmless, which is prescribed in smaller doses than the older series of bismuth salts (3-7 grains), and has the additional advantage of forming a perfectly clear solution in water. It has been found highly efficacious also in the diarrheas of typhoid, of dysentery and of phthisis. In gastralgia and vomiting it is of the greatest service. By adding tannin to a solution of Bisol there may be prepared a moist tannate, or a salicylate of bismuth stronger by far than the usual forms of these drugs, in that they contain more tannin or more salicylic acid, and besides seem to possess a power which may be compared to that of a substance in the nascent state.

KRYOFINE.

The anodyne properties of Kryofine are so marked as to render it a drug of incalculable value in all conditions attended by pain. More especially is it efficient in febrile diseases, since it also acts as a prompt and safe antipyretic. In addition it induces a marked sense of well-being, of euphoria. Under its influence pain, delirium, high temperature and restlessness disappear to give place to calm, peaceful and recuperative sleep. An important feature, also, is that it can be administered in an elegant and palatable solution and combined with other drugs that may be desirable in the individual case. The dosage is small, 4 to 7 grains.

"VIN MARIANI" is essentially the brain and nerve tonic of those who have talent and genius. These it is who compose the great army of intellectual workers, and the ravages made upon their nervous systems by the demands made upon them are at times truly appalling. This damage and consequent drain yield to nothing more quickly than to "Vin Mariani." The most noted European physicians, literateurs, musicians, singers, artists and diplomats have sent the most flattering letters to M. Mariani, extolling his product. Not only these, but crowned heads as well have been mentally invigorated and rejuvenated by "Vin Mariani" and never tire of speaking words in its praise. It must be acknowledged that unsolicited testimonials, couched in such glowing terms, from such sources, are the best evidence possible that can be offered for the merits of the preparation. When "Vin Mariani" becomes as well known in this country as it is in Europe, it will be adopted as one of the indispensable remedies in the household.The St. Louis Medical and Surgical Journal, May, 1899.

REMOVAL NOTICE.

On and after May 1, 1899, the address of our Chicago office will be Suite 404, Trude building, 67 Wabash avenue, southwest corner of Randolph street. We shall there have improved facilities for serving our friends and invite calls or inquiries. Our telephone number will be Central 1595. PARKE, DAVIS & CO.

SANMETTO AND IMITATIONS.

I have used Sanmetto extensively for the last five or six years in both old and young, male and female, in all forms of irritation of the urinary organs, from nocturnal enuresis in the young to cystitis in the aged, and have been disappointed in but few cases in obtaining good results. Have tried imitations (owing to their cheapness). The results were unsatisfactory. Have returned to the use of Sanmetto as a sheet anchor in both acute and chronic conditions of the urinary tract. I obtain speedier and more satisfactory results when given four times a day in drachm doses in hot water.

T. B. GULLEFER, M. D., Greensburg, Ind. Coroner.

VOL. XII-No. 6.

Nephrolithiasis.

By A. H. CORDIER, M. D., Kansas City, Mo. Professor of Abdominal Surgery, University Medical College, Kansas City, Mo.

A surgical disease that attacks a life essential organ should receive most careful attention, a stone in the kidney being no exception to this rule. In nephrolithiasis the all-important question of early diagnosis is of paramount interest, as upon an early diagnosis and timely surgery depends the relief of existing lesions and symptoms and the prevention of irreparable damage to the organ affected. A diagnosis of a stone's presence in the kidney should not receive only a passing thought, with the too frequent advice to drink lithia water and wait for development.

While I have much faith in the utility of X-rays in locating some forms of stone in the kidney, especially if that stone is a large one, I am sure that to place too much reliance on the negative findings by the rays will be to make many mistakes in diagnosis, and thus prevent many patients from submitting to operative procedures for the relief of existing, but undetected stones. Positive findings are valuable, yet negative discoveries are not conclusive. I am thoroughly convinced that many cases presenting obscure septic symptoms extending over a period of months, or probably years, will have this uncertainty cleared up and the symptoms made to disappear by the removal of a stone hidden away in a kidney, or the opening and free drainage of a small cortical focus of infection. One of the conditions simulating the presence of a stone in the kidney is a movable kidney with a long pedicle, permitting the ureter to become actually bent.

A lady twenty-six years of age, the mother of two children, gave the history of repeated severe pains in right side near the normal location of the kidney. The pains were so severe that large doses of morphine were necessary to relieve her, the

JUNE, 1899.

pain usually lasting for thirty-six hours; leaving very much tenderness and uneasiness, lasting for a week. It was noticed, at each attack, that there was a swelling the size of the fist in the upper costo-iliac space, the same being quite tender. With the subsidence of the pain, this enlargement disappeared. The pain during the acute attack was as that of a stone to all appearances, in its severity, duration and location. The enlargement, it was plain to be seen, was the right kidney distended with urine.

On examining her during the interval of attack, I found a free mobility of kidney. Operation revealed the true pathologythe kidney was freely movable; dilated as result of urinary retention; the ureter was found bound down at a point that produced a complete closure when the kidney descended. To make doubly sure of my diagnosis the kidney was incised, and carefully explored for stone, but none found; opening in the organ was closed, and the kidney replaced and fixed. It is now one year since the operation, and she has remained free from all painful symptoms, and is in perfect health.

In many cases the diagnosis of renal calculi is easy, while in other cases the symptoms are so obscure that it is impossible to say that a calculus does or does not exist.

When the patient has had recurring attacks of severe pain in region of kidney, passing down the ureter with retraction of testicle on that side, with the presence of blood in urine, absence of tenderness or other symptoms of an acute inflammatory trouble, one may be quite safe in saying that a stone exists.

All cases of nephrolithiasis do not present these typical symptoms ; far from it. The largest stone I have ever removed from the kidney (Fig. 1) weighing three ounces, had never produced any severe suffering, only a sense of uneasiness on the affected side, with an abundance of pus in the urine, with the presence of enlargement, which led to the