"The symptoms of the case were interesting. There was marked diarrhea, which is quite common in these cases; after awhile a mitral murmur. Mitral murmurs may be anemic as well as organic. In this instance I am sure it was inorganic. It became more distinct as anemia increased. The weakness, the dizziness, the loss of appetite, the nausea and vomiting, all were well marked, and would indicate some recent complication, some form of chronic though hitherto latent nephritis. Later there was evidence of recent complications at times, however, not very marked. The patient died from exhaustion, asthenia, heart failure.

"He went away from the city without my knowledge, and, going to work before he was able to do so, he speedily relapsed. When he returned to Louisville it was to die. The red corpuscles on his return were reduced to one half the normal proportion, and the disease was past the stage where it was possible to do anything for him."

At the conclusion of the discussion the nominating committee announced itself ready to report, and its chairman read as follows:

President-Geo. W. Beeler, Clinton; Senior Vice-President-J. M. Poyntz, Madison; Junior Vice-President-A. M. Vance, Louisville; Permanent Secretary-S. Bailey, Stanford; Assistant Secretary-J. Y. Oldham, Lexington; Treasurer-J. B. Kennard, Lancaster; Librarian-T. B. Greenly, West Point. Place of meeting, Lexington.

Chairman Committee of ArrangementsDavid Barrow.

Dr. W. M. Hannah, Henderson, and Dr. J. G. Brooks, Paducah, were added to the Board of Censors in place of the two last named in the list, whose terms have expired.

The President then read the list of delegates to the American Medical Association, as follows:

Delegates to the American Medical Association: J. P. Thomas, Pembroke; Andrew Seargent, Hopkinsville; W. H. Wathen, Louisville; L. S. McMurtry, Louisville; J. A. Ouchterlony, Louisville; A. S. Burt, J. H. Letcher, D. L. Reynolds, T. B. Greenly, B. L. Coleman, David Barrow, D. Skillman, S. S. Foss, Mathews, McCormack, S. G. Dabney, J. M. Ray, S. M.

Letcher, L. Beecher Todd, W. Hampton Caldwell.

Delegates to the Tenth International Congress at Berlin: James Lewis Howe, Louisville; J. M. Mathews, Louisville; J. A. Larrabee, W. H. Wathen, Dudley S. Reynolds, J. A. Ouchterlony.

The report being unanimously adopted, the President appointed a committee to conduct the President-elect, Dr. Geo. W. Beeler, to the stage. He was introduced, and expressed his appreciation of and thanks for the honor the Association had bestowed upon him.

The scientific exercises were resumed by the reading of a paper on "Lithemia and Uric Acid Diathesis in Affections of the Eye, Ear, Throat, and Nose," by W. Cheatham, M. D., of Louisville. (See page 333.)

DISCUSSION.

Dr. S. G. Dabney said: "I do not know of any pathognomonic symptoms of rheumatic sore. throat. I was in hopes the doctor would say something in reference to rheumatism in relation to diseases of the eye. Probably fifty per cent of the cases of plastic iritis are due to rheumatism. We are all familiar with the tonsil troubles that attack people of the rheumatic tendency.

Dr. W. H. Wathen, of Louisville, in presenting several pathological specimens as illustrative of the various conditions demanding laparotomy, took occasion to speak as follows:

"I wish to present to this Society a few pathological specimens supplemental to the report made on this subject yesterday. I will only briefly relate the history of the cases and the results.

"A young married lady from the central part of the State applied to me some months ago, suffering from disturbance in the pelvis that had been annoying her for five years, growing worse, and making her at the time she presented herself nearly a confirmed invalid. She was frequently confined to her bed. She suffered torturing pain on the slightest exertion, and had decreased in weight from a hundred and thirty or forty to about ninety pounds.

"Laparotomy was done, the ovaries and tubes exposed, and found non-adherent but

cirrhotic. They were removed as close as pos sible to the uterus, the wound closed within three or four days after the operation, and the woman expressed herself as freer from pain than she had been for several years. She left the city for her home in two weeks, and has now gained ten or fifteen pounds. Menstruation has never returned. She has had some of the nervous manifestations that usually occur at the menopause.

"Case 2. Here is a specimen removed from a lady whose home is in Michigan. She had been an invalid since before she was married. She had borne two children-one about eight months before the operation. She suffered intense pain in the pelvis; rectal disturbance to a degree requiring operation for fissure; painful micturition; great nervousness, sleeplessness, and disturbed digestion; in short, she was a confirmed invalid. The rectum was examined and found free from trouble, as was also the bladder and urethra.

"Laparotomy was done at Norton Infirmary, both tubes and ovaries being removed, the right at the time of operation being three or four times its normal size, prolapsed with the tube into Douglas' pouch, and contained an abscess. The left ovary seemed almost normal, but, as a second operation is usually called for if one is left, I removed it also. The woman recovered promptly without a bad symptom, and has now gained twenty or twenty five pounds.

"Case 3 is a laparotomy I did only a few days ago. My friend, Dr. Grant, referred a woman with a tumor to me. It was impossible to make out the character of the difficulty. She had been suffering four or five years from pain, and for three years past had not been free from suffering. She was anxious to be relieved, and readily consented to an operation, which was made last Tuesday a week ago. The tumor was found to be adherent over two thirds its extent and a dermoid cyst in character. In this case I used a drainage tube. She did not lose more than an ounce or two of blood, but I was afraid a little of the contents of the tumor had escaped into the cavity. Irrigation was resorted to, and the tube remained in position thirty-six hours.

"Case 4, I referred to yesterday, is an hysterectomy for carcinoma done about a year and a half ago. This woman had no untoward symptom after operation, and left the infirmary on the nineteenth day. She at once gained twenty or thirty pounds, and continued this way about a year, when she again presented herself with the di-ease recurrent on one side. It had then extended beyond reach, and the difficulty is now constitutional. She is still living and attending to her domestic affairs. After the operation she began almost immediately on her return from the infirmary having sexual connection with her husband, though she informed me that she experienced no pleasure from the congress. In this case all the diseased structure was taken away.

"Case 5 was published two months ago in the New York Medical Journal. The operation was done in December, after a diagnosis of extrauterine pregnancy at three and a half months. The woman had been exhibiting all the symptoms of pregnancy in an exaggerated degree. She had great disturbance of the bladder and

rectum.

"The operation was done and the diagnosis confirmed. A pregnancy existing in the fold of the right broad ligament, with the placenta adherent to Douglas' pouch, to the pelvic structures on the right side, and behind the uterus.

"The placenta and membranes were readily separated, and the broad ligament ligated, the abdomen flooded, dried, and closed without a drainage tube. The hemorrhage was slight. The woman had no shock, pulse of 75, and no untoward symptoms from the operation.

"When the adhesions were being separated, it was observed a coil of intestine was adherent to the right side. The uterus was pressed up and also adherent. The intestine was not interfered with, but the others were broken up. A few days after the operation this woman had a terrific diarrhea, watery discharges, and passed quite a number of large, white, round worms. There was an enlargement in the left broad ligament which caused her considerable pain by pressure upon the bladder and rectum. This enlargement was apparently an hematocele. In a couple or three weeks the woman began having some fever; there was no fluctu

ation discernible by vaginal, rectal, or abdominal palpation. Finally the hematocele ruptured into the bowel and a great quantity of disorganized blood came away by the anus. The woman, of course, from that time made a tedious recovery.

"The specimen presented is probably as beautiful as was ever removed from a living subject. It offers another evidence that extrauterine pregnancy begins in the tubes and ruptures into the broad ligament, with consequent hematocele suppuration and rupture into the peritoneal cavity and death, unless laparotomy is done.

"In conclusion, the only treatment that is justifiable in extra-uterine pregnancy, in any stage from the time it is known to exist up to full term, is laparotomy. I wish to place my self upon record as absolutely and unqualifiedly opposed to electricity to destroy an ectopic pregnancy, for the reason that if you destroy the life of the fetus you leave the subject's life in constant danger.

"When laparotomy is carefully done, recovery will be the rule, and death the very rare exception."

DISCUSSION.

Dr. A. C. Bernays, of St. Louis, said: "The justifiability of hysterectomy has been questioned, and, as usual in questions of this kind, the solution has been given by the Germans, who discovered that when cancerous degenerations of the vagina and cervix exist and are removed, there soon recurs cancerous deposits in the mucous membrane of the body of the uterus. This specimen is a case in point. It shows the cancerous invasion of the growth into the mucous membrane of the body of the uterus above the internal os, and no operation of amputation, however high, could have included this whole disease. The cancer would have been left, and the conclusion is evident. The rule should be, as soon as a diagnosis of cancer of the uterus is made, no matter if it is not larger than a pea, then that woman's uterus should be removed. The statistics of the mortality of recent operations show only six per cent of fatalities. I should like to go on record even more radically than that. Statis

tical examination ought to show the heredity of the disease. A woman has no use for the uterus after the menopause; and now suppose we could show when a woman has reached forty-five years of age that her aunt, or her cousin, or her mother ceased to menstruate at about that period, and that shortly thereafter one, or both, or all of them suffered from cancer of the womb. Would there be any good reason why that woman's womb should not be removed? Would there not exist good reasons why it should?"

Dr. McMurtry, of Louisville, said: "I wish only to allude to the case of extra-uterine pregnancy reported. There are cases that die every year with the vague history of peritonitis and cellulitis that are sometimes attended by hemorrhage or severe collapse. We have only recently learned how to deal with them, and that is surgically. The uterus is generally about as much enlarged as if it had been normally impregnated."

The report on "Otology," by S. G. Dabney, M. D., of Louisville: (See page 337.)

Dr. A. M. Vance, of Louisville, read on "Wound Drainage:" (See page 341)

DISCUSSION.

Dr. A. C. Bernays said: "The question of wound drainage is one that has recently been very much thought about and discussed. It has been claimed by one party that the object of the drainage tube is to serve as a sewer through which bacteria might drain away from the wound. By bacteria I mean all sorts of pus or ptomaine-producing organisms that result in its formation. I can not agree with that position. It seems to me that, theoretically at least, we must maintain that we can make some wounds aseptic. Take, for instance, a patient who has a wound of the surface, which is easily accessible, and who has no fever. I think we must mean that that kind of wound can be kept aseptic. The great point about asepsis, however, lies in this, that formerly we tried to disinfect the air; then we laid the greatest stress upon the purity and the disinfection of the wound by means of running through it quantities of aseptic, poisonous solutions; to-day we do not use these antiseptic solutions.

At my last visit to Bergmann's clinic, nothing but water was used-sterilized water.

"We know that we can disinfect our hands and instruments and the surface of the skin upon which we are to operate. The point of difference is in the transference of sterilization from the air and the wound to the patient and to ourselves.

"Geo. M. Sternberg, of the army, has shown that disease is introduced into wounds by our fingers and instruments, not from germs that float in the air. They live under our fingernails; we pick them up on our rounds from patients with erysipelas or suppurating wounds. Since our attention has been transferred from wounds and concentrated on ourselves and our instruments, antiseptic surgery has gained ground.

"Theoretically, we ought always to know when a wound is aseptic, but practically we do not; hence the necessity for drainage.

"There are certain kinds of wounds that will always require drainage; for instance, when we have a so-called dead space or a cavity filled with air; in such wounds where, for instance, you chisel out a strumous or tuberculous bone where the sides of the wound can not be approximated. In such cases two methods of treatment have been suggested, one by means of a blood clot, after the method of Shroeder, which, if a wound is aseptic, ought to become organized without a drop of pus; or, as is usually resorted to, because of uncertainty of aseptic conditions existing, by means of drainage."

(CONCLUDED IN NEXT ISSUE.)

Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.] Professor Hacket, who has made many experiments with kola, states that, contrary to the assertion of Dr. Germain Sée, caffeine is not the only active principle of the kola nut. It also contains a red substance to which he has given the name of "kolaine." This substance prevents rapid waste of tissue during fatiguing exercise, while the caffeine with which it is combined stimulates the muscles. The kola nut was experimented with during

the autumn maneuvers of last year with such success as to lead the German war office to order no less than thirty tons of the nut for consumption in the German army.

From recently obtained results hydrochlorate of orexin appears to be a genuine stomachic, not only having the power of improving the appetite, but of strengthening the digestive functions. The compound was given for loss of appetite from most various causes, as from severe operations-the success of which often depends upon whether the patient eats or notfrom tuberculosis, and from a few diseases of the stomach (wherein, as a whole, the irritating though absolutely non-corrosive action of the compound on the mucous membranes does not favor its use). It was further tried in cases where the loss of appetite evidently hindered the recovery or improvement of the patient, or where it was the only appreciable symptom of the illness. As a matter of course, the effects of "suggestion" were excluded by avoiding all mention of the expected results. In all, the cures numbered thirty-six, in only five of which it is stated the effect was not conspicuous and even astonishing. The appetite did not, as a rule, appear so soon (within a few hours) as was observed with the healthy provers. Commonly several doses were given for a few days. Sometimes, however, from a single dose the effect suddenly appeared after an interval of one to several days. In such cases the connection of cure and effect was not so clear. Yet the anorexia had generally lasted so long previously that even its "accidental" disappearance two days after the administration of orexin was very remarkable. Unpleasant subsidiary symptoms were seldom seen from suitable doses. In one case a burning sensation was felt along the esophagus; this was thought to be caused by the compound escaping from the capsule and coming into direct contact with the mucous lining of the passage. As a rule, a single, and at most a once repeated dose of 5 to 8 grains, given at 10 A. M., was sufficiIf no effect was produced, the dose was increased to 7 or 10 grains daily, and eventually to 5 to 8 grains three times a day; 24 grains pro die was not exceeded. If, after four or five days, the expected result was still absent,

ent.

the treatment was dropped for a few days and then again resumed. The remedy was prescribed in gelatine-coated pills, and each dose was accompanied by a cupful of broth.

At the last meeting of the Royal United Service Institution Dr. J. Lane Notter read a paper on the "Sanitation of Barracks." After dwelling at some length on the importance of building on suitable soil, Dr. Notter went on to urge that barracks should not be erected in crowded cities, that they should have a zone of aeration around them, and be exposed to plenty of sunlight. Barrack rooms were, as a rule, very bady lighted, and a recruit giving much time to reading would probably injure his sight. The gas fouled the air, and the sooner the electric light was introduced the better. Fifty years ago there were 14 deaths in 1,000 from phthisis among the Foot Guards, and only 3.4 per 1,000 among the civil popula tion; but that state of things had been remedied, and now the comparison was four civilians to three soldiers of the same age. With regard to the water supply, of sixty-three samples submitted to him for analysis last year at Netley, twenty-nine, nearly all procured from wells, were unfit for use. In conclusion the lecturer claimed that the Army Medical School had done good work in promoting saniMr. J. Ernest tary progress in the army.

Lane, speaking of the diagnosis of urethral chancres, said the diseases with which they might be confounded were chancroids and gonorrhea. Chancroids, however, were seldom if ever confined to the urethra, and the diagnosis might be arrived at by inoculations conducted upon the patient, and by the fact that while the chancroid was essentially a destructive process, the chancre was a small-celled infiltration which, in this situation, was seldom attended with any loss of tissue. With regard to gonorrhea, a urethral chancre might be distinguished by the induration of the inguinal glands, and the dorsal lymphatic of the penis by the nature of the urethral discharge, and by the acute and localized pain during micturition. Mr. Lane considers that tannate of mercury in doses of one or two grains with a little opium gives the best results in the treatment of primary syphilis, as the patient

is rapidly brought under the influence of the drug, while his digestive system is not upset.

Sir James Paget occupied the chair at the twenty-fifth festival dinner for the benefit of the Royal Medical Benevolent College at Epsom, held in the White Hall Rooms, Hotel Metropole. Earl Granville was among the guests who, to the number of about 250, were thoroughly representative of the profession of medicine, comprising among others Sir An. drew Clark, Sir T. Crawford, Sir Ed. Sieveking, and Mr. Jonathan Hutchinson. In an eloquent speech pleading the cause of the institution, the chairman referred to its dual function of affording education to students and bestowing annuities on members of the profession or their widows, who, in their declining years, have been reduced to want. He eulogized the attention paid to physical training not only for the benefit carried to the body, but for its moral effect, and all moral aids were to be welcomed; for in medicine, as in other professions, dishonesty would often secure ill gotten gains.

66

In the April number of the "Fortnightly Review" will be found a very strong indictment of the Royal College of Surgeons, drawn up by Sir Morell Mackenzie. It would appear from the article that most things are wrong in that unfortunate institution, its government, its internal administration, its official acts, and the relation of its officers to the general body of members. The college is declared to be practically in the hands of metropolitan hospital surgeons," and "little more than a huge shop for the sale of surgical licenses." It has not promoted the study of surgery, it has not encouraged students to resort to its library or its museum for purposes of self-instruction, and it has not even rightly administered its own funds. Above all, it would seem to be a very close corporation indeed. From all these and many other iniquities, the article hopes that the institution may be delivered through the agency of the bill which is shortly to be introduced into the House of Lords by the Earl of Dunraven.

An anonymous donor whose attention was attracted to some sick children suffering from chronic diseases. who had been sent home from