vomica, with other bitters. The milk cure is effective. For acute gastritis, etc., hydrocyanic acid and morphia.

News and Miscellany.

THE WILLIAM F. JENKS MEMORIAL PRIZE.— The first triennial prize, of two hundred and fifty dollars, under the deed of trust of Mrs. William F. Jenks, will be awarded to the author of the best essay on "The Diagnosis and Treatment of Extra-Uterine Pregnancy." The conditions annexed by the founder of this prize are, that the "prize or award must always be for some subject connected with Obstetrics, or the Diseases of Women, or the Diseases of Children ;" and that "the Trustees, under this deed for the time being, can, in their discretion, publish the successful essay, or any paper written upon any subject for which they may offer a reward, provided the income in their hands may, in their judgment, be sufficient for that purpose, and the essay or paper be considered by them worthy of publication. If published, the distribution of said essay shall be entirely under the control of said Trustees. In case they do not publish the said essay or paper, it shall be the property of the College of Physicians of Philadelphia. The prize is open for competition to the whole world, but the essay must be the production of a single person. The essay, which must be written in the English language, or if in foreign language, accompanied by an English translation, should be sent to the College of Physicians of Philadelphia, Pennsylvania, U. S. A., addressed to Ellwood Wilson, M. D., Chairman of the William F. Jenks Prize Committee, before January 1st, 1889.

A PEREMPTORY CALL (CAUL).—Dr. John Morris, of Baltimore, sends to the Maryland Medical Journal, February 11th, the following letter, which was received recently by an old Charles County physician :

BALTIMORE, Oct. 25th, 1887. DEAR SIR:-I respectfully call your attention to the fact that I was born with a caul on, and I understand you kept it. You may forget who I am, but so there will be no mistake I will tell you: you remember some nineteen years ago, when Mr. S. first came down in that part of the country, he brought with him his sister-in-law, Mrs. E., who is my mother, and who, at the time, did not know the value of the caul, but my grandmother asked you for it at the time, which you refused to give her.

I have made inquiries from some of our head

doctors in Baltimore and other cities, who inform me you had no right to keep it, and it being a part of me I can claim it, and now I write you to know whether you have it or to find out what you have done with it, and I will leave nothing unturned in trying to get it.

If you will kindly give me this information you will greatly oblige, Yours Truly,

N. B.-I will expect a quick answer to this. P. S.-I have good proof you kept it.

THE UNITED STATES MARINE HOSPITAL SERVICE. According to a statement in the Maryland Medical Journal, a bill has been introduced into the United States Senate, providing that medical officers of the Marine Hospital Service of the United States shall hereafter be appointed by the President, by and with the advice and consent of the Senate; and no person shall be so appointed until after passing a satisfactory examination in the several branches of medicine, surgery and hygiene before a board of medical officers of the said service. Said examination shall be conducted according to rules prepared by the Supervising SurgeonGeneral, and approved by the Secretary of the Treasury and President.

MEETING OF THE AMERICAN MEDICAL AssoCIATION.-A circular letter from Dr. W. B. Atkinson, Permanent Secretary, American Medical Association, informs us that the Thirty-ninth Annual Session will be held in Cincinnati, Ohio, on Tuesday, Wednesday, Thursday and Friday, May 8th, 9th, Ioth and 11th, commencing on Tuesday, at II A.M. The delegates receive their appointment from permanently organized State Medical Societies, and such County and District Medical Societies as are recognized by representation in their respective State Societies, and from the Medical Department of the Army and Navy, and the Marine Hospital Service of the United States.

The following are the officers of each Section:Practice of Medicine, Materia Medica and Physiology: Dr.* Chairman; Dr. N. S. Davis,

Jr., Chicago, Ill., Secretary.

Obstetrics and Diseases of Women and Children: Dr. Eli Van De Warker, Syracuse, N. Y., Chairman; Dr. E. W. Cushing, Boston, Mass., Secretary.

Surgery and Anatomy: Dr. Donald McLean, Detroit, Mich., Chairman; Dr. B. A. Watson, Jersey City, N. J., Secretary.

State Medicine: Dr. H. B. Baker, Lansing, Mich.,

*Vacant by the death of Dr. A. B. Palmer.

Service, Secretary.

Ophthalmology, Otology and Laryngology: Dr. F. C. Hotz, Chicago, Ill., Chairman; Dr. Edw. Jackson, Philadelphia, Pa., Secretary.

Diseases of Children: Dr. F. E. Waxham, Chicago, Ill., Chairman; Dr. W. B. Lawrence, Batesville, Ark., Secretary.

Oral and Dental Surgery: Dr. J. Taft, Cincinnati, Ohio, Chairman; Dr. E. S. Talbot, Chicago, Ill., Secretary.

Medical Jurisprudence: Dr. E. M. Reid, Baltimore, Md., Chairman; Dr. C. B. Bell, Suffolk, Mass., Secretary.

Dermatology and Syphilography: Dr. L. D. Bulkley, New York, Chairman; Dr. S. F. Dunlap, Danville, Ky., Secretary.

Committee of Arrangements.-Dr. W. W. Dawson, Cincinnati, Ohio, Chairman.

-Whenever you have an inquiry about electrical appliances for medical use, you will never go astray in commending those made by Jerome Kidder & Co., 820 Broadway, New York. Every desirable feature of electrical methods of treatment are embraced in the varieties of instruments they manufacture. They have stood the test of time, of medical surveillance, of public observation, and to-day they lead all others in merit and sale.Pharmaceutical Record, Nov. 1st, 1887.

-Dr. W. S. Cline, of Tom's Brook, Virginia, writes as follows in answer to a correspondent in an exchange asking for the treatment of incontinence of urine: "If he will get 100 parvules cantharides, gr., prepared by Wm. R. Warner & Co., and give one thrice daily, he can cure his patient, and she can drink all the water she wants. I never withdraw usual diets; I have never seen a failure."

-It is said that the statement of a sea captain that the Esquimaux were dying off with scurvy was not founded on fact. It was merely a salt rheumor.

-The name of the Mississippi Valley Medical Monthly has been changed to the Memphis Medical Monthly. Its editors, Drs. Sim and Neely, have our best wishes for continued success.

-A London druggist displays the following card in his window: "Come in and get twelve emetics for a shilling."

PERSONALS.-Prof. Samuel O. L. Potter (J. M. C., 1882), of San Francisco, gives, in the Western Lancet, a statement of his reasons for abandoning homœopathy before entering into practice, the

drug experimentation, conducted under scientific safeguards, could meet with any degree of appreciation from the majority of that sect. He also found that ninety-nine out of every one hundred so-called homoeopathic physicians were in the habit of resorting to regular therapeutics whenever there was any active therapy to be done.

Dr. Addinell Hewson, Jr. (J. M. C., 1879), was appointed by the Faculty of Jefferson Medical College to lecture to the class on anatomy during the temporary absence of Prof. Forbes, who was prevented, by an attack of erysipelas, from attending to his professional duties.

Dr. Thomas H. Andrews (J. M. C., 1864), formerly Demonstrator of Anatomy at Jefferson Medical College, has been appointed Police Surgeon of Philadelphia.

Dr. J. D. Orr (J. M. C., 1885) has received the appointment of Penna. Railroad Surgeon, his division extending from Altoona to Pittsburgh, Pa. Dr. O. P. Rex (J. M. C., 1867) has been elected Lecturer on Diseases of Children in the Jefferson Medical College.

BENERMAN-PECKMAN.-At St. Louis, Mo., on Feb. 22d, 1888, L. C. Benerman, M.D. (J. M. C., 1887), of St. Louis, Mo., to Mary Peckman, of Philadelphia.

HANSELL-VOGDES.-At New York, January 3d, 1888, H. F. Hansell, M.D. (J. M. C., 1879), and Emilie Read, daughter of General Israel Vogdes, U.S. A.

Kalb-LeffleR.-At Stockton, California, Janu. ary 4th, 1888, George Bigham Kalb, M.D. (J. M. C.), of Audenried, Penna., and Margaret Imla

Leffler.

Deaths.

BRINGHURST.—At Philadelphia, Feb. 21st, 1888, A. Melvina, wife of William Bringhurst, M.D. (J. M. C., 1876).

DAVIS.- At Dover, Delaware, October 14th, 1887, of membranous croup, Chalice Da Costa Garfield, son of William F. Davis, M.D. (J. M. C., 1876), aged five years and eleven months.

HAMILTON.-At San Bernardino, California, of cerebral hemorrhage, Jan. 14th, 1888, S. M. Hamilton, M.D. (J. M. C., 1855), late of Monmouth, Ill.

Vol. IX. No. 4. April, 1888.

Clinical Lecture.

A CASE OF PROBABLE GENERAL EMBOLISM.-ACUTE RHEUMATISM.-ACUTE PNEUMONIA OF THE APEX, LEADING TO THE FORMATION OF ABSCESS.→R EMARKS UPON THE PRESENCE OF TRANSVERSE MARKING OF THE NAILS AS AN INDICATION OF PREVIOUS DISEASE.

A Clinical Lecture Delivered at the Pennsylvania Hospital, BY MORRIS LONGSTRETH, M. D., Physician to the Hospital.

Reported by WILLIAM H. MORRISON, M.D.

A CASE OF PROBABLE GENERAL EMBOLISM.

I wish first to show you an interesting case from a diagnostic point of view. The history that we have obtained is as follows: C.-, age twenty years, was admitted to the hospital two days ago. He is a clerk by occupation. He states that two years ago he had typhoid fever, but that beyond this he has had no illness whatsoever. Five days before admission the present sickness commenced. The first thing that he noticed was pain in the left shoulder, not precisely in the joint, but in this region. Within a few hours he noticed pains all over the body, with the exception of the hands and feet. He also had severe headache. The pain in the region of the shoulder soon moderated, and he then suffered most with deep-seated pain in the lumbar region. He also had some cough; but at first no expectoration. He had some bleeding from the nose. The bowels were constipated. It is noted that the urine was scanty, and at times of a very dark color and at other times of a bright red color.

The above symptoms continued three days, when a new feature was added, that is, with the cough he began to expectorate mucus, streaked with blood; to this should be added the statement that at no time has there been any swelling or pain in any joint.

When admitted, two days ago, he was wellnourished, and even now, looking at his face, he does not appear to be very ill. The face

79

was flushed, and there is now more redness on the right cheek than there has been at all. We would speak of the face and neck as being congested. The tongue was coated, white in the centre and red at the edges. The cough was rather increased and the expectoration more abundant and more streaked with blood after admission than before. The headache was very severe, the pain in the lumbar region was still very severe. Examination of the heart showed a very soft, blowing systolic murmur at the apex-a mitral regurgitant murmur. Examination of the lung showed flatness over the right lung, more especially marked at the base posteriorly, and in that region bronchial breathing was heard. There was also some congestion in the left lung, not confined to the base, but scattered throughout the organ.

The urine, which was small in quantity, was passed frequently. It is of a bright red color distinctly smoky. There is perhaps even more blood than we find in smoky urine. The specific gravity is 1010, the reaction is acid and it is found to contain one-twelfth its bulk of albumen. Therefore very little more albumen than would be accounted for by the amount of blood present, indicating that it was the presence of the blood that caused the albuminuria. Microscopical examination shows a considerable number of blood corpuscles, and while a few hyaline casts are found, most of the casts are composed of blood.

What have we in this case? The initial symptoms seem to point to rheumatism. He never had rheumatism before. The fact that the pain spread to all parts of the body would be against this diagnosis. Then we have this striking feature of bloody urine. This might seem to indicate an acute inflammation of the kidney. In addition, we find consolidation at the base of one lung, which is clearly not a pneumonia in the ordinary acceptation of that term. We have consolidation, bronchial breathing and expectoration of mucus tinged with blood. Besides these we have a cardiac murmur, referable to the mitral orifices. I saw the case for the first time yesterday after

noon, and have, therefore, not had sufficient time to watch it carefully, and make up my mind positively as to the nature of the affection with which we have to deal in this patient, but I shall give you my ideas in reference to it.

As soon as I saw the urine, I at once thought of that group of cases in which there is embolism taking place, where there are numerous scattered emboli entering the kidneys, and blocking up certain of the vessels and causing the appearance of blood in the urine. If this blood came from acute inflammation of the kidney, the urine would contain such a large quantity of albumen that, on boiling, it would become solid. There is, I think, no exception to this rule. In this instance, on the other hand, the urine contains a very small quantity of albumen. If a sound were passed into the bladder, and the mucous lining of the organ wounded, causing bleeding, there would then be only a small quantity of albumen in the urine, as we have in this case. It is important to make this distinction. We have in addition a few hyaline casts, as I have already stated. I cannot escape the conclusion that this hemorrhage from the kidney is due to some local obstruction of the blood vessels.

What other features have we in support of this view? We have the pain first in one region and then in another—a very common condition where there is embolus. Having this clue, I at once turned to an examination of the mucous membranes. Evidences of embolism can often be found on the mucous membranes when they cannot be detected anywhere else. These evidences are transitory. Yesterday I found on the lower lip one or two spots the size of a pin's head, which did not disappear upon pressure. The tongue is a good deal coated, so that we cannot make a satisfactory examination of its mucous surface.

In support of this view of embolism, we also have the epistaxis, and the condition of the lung. There is, on auscultation, bronchial breathing. I then pass to an area of vesicular breathing with mucous râles. We have

then an area of consolidation, and immediately adjacent an area of perfectly healthy lung tissue. We have not here an ordinary pneumonia with an area of consolidation from which we pass to a portion of the lung, only partially consolidated, and where we hear fine crepitation. We have here, so to. speak, a lung blocked up by pulmonary apoplexy. The blood vessels have become stopped, bleeding has occurred, producing consolidation of the lung.

When the patient was admitted to the hospital his temperature was 103°, but it is to be remembered that when a patient is moved from his home to a hospital, the temperature, as a rule, rises. We must therefore discard this first observation. This morning the temperature is 101.2°. The respirations have been frequent. At first they were only 26 in the minute, but during the course of the first day, when this area of consolidation developed, they ran up to 42 per minute, and this morning they are 40. The pulse at times has been as high as 120. This morning it is 94 per minute.

I here show you the appearance of the matters expectorated. It is not quite so bloody as it has been. The mucus is more abundant and the blood is more mixed with it and appears less brilliant. The bleeding seems to be stopping.

A diagnosis of embolism is a difficult one to make general unless it is made by exclusion and by observation of the case over a number of days. I ought to say that in this case we may have had a severe cold resulting in rheumatism at first, followed by an acute localized pneumonia. We may have had a rheumatism which has developed this endocarditis. I should, however, rely strongly on the condition of the urine as excluding Bright's disease, and I know of nothing but embolism that could give us this condition of the urine.

Now as to the prognosis: there is nothing more grave than general embolism. I have seen a number of cases of this kind, sometimes from chronic heart trouble. Here we do not know whether the cardiac disease is