watchword of future scientific research and the aid of physiological chemistry will, above all, be necessary to solve this great problem.

The difficulties attending the efforts of research in this field of science are very great and only known to those who are sufficiently grounded in organic chemistry to be familiar with the difficulties that may arise in a chemical analysis of some organic bodies. We might cite, with some degree of correctness, as an analogon illustrating this difficulty, the well known impediments to a successful differentiation between certain poisonous vegetable alkaloids and some ptomaines, which are isomeric bodies, containing the same elements and in the same proportion, but differing in the arrangement or grouping of their atoms and the structure of their molecules. The fact that the exact chemical nature of the diphtheria antitoxin is still shrouded in darkness also serves as an illustration of this difficulty, which is even greater than the classification of some pleomorphous fungi, e. g., the tubercle bacillus, by the botanist or bacteriologist.

*

Every contribution assisting in throwing light upon the subject of natural immunity is therefore welcomed by all disciples of the healing art, who hope that by thus placing brick upon brick the final superb structure, erected by such patient and necessarily laborious contributions, will naturally lead to the discovery of a truth which at present everybody, who has paid attention to the progress of biological and chemical research, sees as through a telescope in the far distance; the view, however, is still blurred as though it were perceived through a semitransparent veil, which, above all, the physiological chemist will be destined to lift.

**

*

sented by the quantity of food taken, deducting, of course, what has not been digested and taking into consideration the relative weight of the body. For the amount of heat produced by a certain quantity of ingesta is equivalent to the amount of heat which these ingesta would produce if they were subjected to a more rapid chemical process, for instance, cremation. Whatever quantity of potential energy, which has been appropri ated by the body in the form of food, can not be ac connted for in the form of heat, by the use of the calorimeter, is to be attributed to an imperfection of the method of procedure, or to energies that thus far can not be accounted for by scientific methods.

Although it may be possible that the various forms of kinetic energy, manifested by the animal body, may in the future be measured individually, as they are now collectively, there will remain, after all, one form of energy, referred to above, which it will be impossible to measure "separately," namely, the energy of intellec. tuality, of cerebration, thought-conscions or uncon. scious. The same may be the case with a possible hypothetic, kinetic force, the product of conversion of either another kinetic, or a potential energy, which might play some role in the destruction of germs and the production of natural immunity.

* *

*

We feel constrained, by force of the association of ideas, to again harp upon the one undeniable fact, that the cells of the body that are well supplied with adequate nourishment and, in consequence of a healthy function, able to assimilate and appropriate such nourishment and give it up to the fluids and tissues of the body, will con stitute the ideal bulwark against diseases in general, which, unless pathogenic germs are present in an overwhelmingly large quantity, will frustrate all attacks of There will be, however, another obstacle to the final infectious disease. There are, no doubt, octogenerians, satisfactory solution of this great problem, namely, the ore even centenarians, who have never been sick and influence which may possibly be exerted by physical this phenomenon can only be explained by the hypotheforces, more or less difficult to measure, namely, the sis of a possibility of a more or less perfect natural imstored-up potential energy as well as its products munity against all diseases. Whether this ideal imof conversion, known or unknown kinetic ener- munity can be attained for the majority of people will gies, or energies of motion or life, and their be, considering the present artificial mode of life among possible influence upon the realization of immunity. all civilized nations, doubtful; probably our manner of For the same law of the preservation of the forces, that existence would have to be much simplified. The present prevails in the inorganic or death world, also exists in wear and tear of civilized life will make such a hope, to the organic or living world. Whether the nature and say the least, very improbable. The physician of the quantity of potential and kinetic energy and their re- near future will therefore exert himself to find methods ciprocal effect upon the manifestations of life, will ever of artificial immunization, until gradually this may be be measured and determined in all its bearings, will be superseded by an attempt of securing natural immunity. one of the problems for physicists and physiologists to for everybody. Whether it will be possible so reach solve. The amount of energy produced by chemical such a goal, or whether it will always remain an utopia, processes in the body may be measured with a certain the future only can tell.

degree of correctness, but there will always be a certain unknown quantity of something which it will be exceedingly difficult, if not impossible, to interpret or

measure.

The quantity of energy of the animal body, expended during a certain period, may be calculated with a certain degree of exactness by the potential energy repre

Caisson Disease.

To subject workingmen to the exceedingly unhealthy task of working, even for a short time, in compressed air, as is the case when their work is to be done in cais

sons under water, appears, to say the least, an unpar- States, by which work of a similar nature can be regu donable cruelty, when one considers the dangers con- lated so as to protect the interest of the workingmen. nected with this kind of work. In order to work under Occurrences of such a grave nature should act as a water, on the floor of a river, lake, canal, etc, this is stimulus to the law makers of this, as well as all other usually done by the aid of caissons into which air is civilized countries, to squelch the abuse of workingmen pressed in order to expell the water, until the pressure by large corporations in seeing to it that the necessary reaches several atmospheres; a procedure, which, as laws are enacted for the protection of the health, as far every American knows, was also necessary in building as possible, of workingmen engaged in this and similarly the St. Louis bridge over the Mississippi. A recent dangerous occupations.

As a prophylactic measure Prof. Schroetter, at whose clinic some of the patients suffering from caisson disease were treated, recommends that elderly men, or those who are in weak health, should not be employed ject. in this work, that the condensation of the air should be gradual, and that the time for working should be short (three or four hours a day).

It is gratifying to learn that the Austrian Council of Hygiene has requested the well known hygienist, Prof. Max Gruber, to prepare a report on the subject, and it is expected, and to be hoped, that the Government will take the proper measures to protect the workmen against the dangers of this kind of work.

The numerous illustrations, by which the understanding of the various manipulations is much enhanced, form an important feature of the work. The half tone engravings were made from carefully prepared photographs. The anatomical plates are of a very practical and instructive nature.

A careful study of the physiological effects of massage has enabled the author to develop a number of new procedures which are presented for the first time in this To our knowledge, there is no law in the United work; among these he names as especially worthy of

mention, Reflex Stroking and Percussion, Inspiratory Lifting, and several procedures in connection with pel vic and abdominal massage.

The physiological effects of massage are clearly pointed out by the author, who has devoted twenty pages to this fundamental branch of scientific massage

treatment.

tient stated, however, that it had retracted into the inguinal canal during previous attacks.

The usual mode of procedure was adopted in operat ing this afternoon at 3 o'clock. Upon opening the her. nial sac the testicle was found lodged in the inguinal canal and intimately adherent to the lower portion of the walls of the sac. The testicle itself had become almost bisected by some bands of fibrous tissue which had divided it, from below upwards, into two halves. Testicular substance was found on either side of these two bands, although it was much atrophied, and it was doubtful if the organ had ever completely descended A Manual of Human Physiology, Prepared into the scrotum, or if it had ever been functionally with Special Reference to Students of active.

The work is an eminently practical one and will be found exceedingly instructive and interesting, and a valuable addition to the library of physicians, nurses and students.

Medicine. By JOSEPH H. RAYMOND, A.M., M.D., The cord was ligated and the testicle removed. The Professor of Physiology and Hygiene in the Long operation was completed according to the manner Island College Hospital, and Director of Physiology adopted for the radical cure, Bassini's method. in the Hoagland Laboratory. With 102 Illustrations in Text and 4 Full-page Colored Plates. Philadel

**
*

DR. ROBERT FUNKHOUSER presented a specimen of

phia: W. B. Saunders, 925 Walnut street. 1894. "Pyosalpinx of the Left Side, Catarrhal Salpingitis of Price, $1.25. the Right Side, and Cystic Degeneration of Both Ovaries."

This work gives a general outline of the science of physiology and will be useful to students who wish to assimilate in as short a period as possible the main facts and principles of physiology. The scope of the book does not allow more than a most fundamental rep resentation of physiological processes, but will be found a valuable aid in committing to memory the most

essential facts of this fundamental branch of medical science.

MEDICAL SOCIETIES

Proceedings of the St. Louis Medical
Society.

W. H. FUCHS, M.D., EDITOR.

No history of gonorrheal origin could be determined. in this case, but the trouble was probably due to a very severe labor which had occurred four years previously. Further evidence of this was found in an extensive bilateral laceration of the cervix and a laceration of the perineum.

The operation for removal passed off without much of particular moment, but the adhesions on the left side were very extensive and firm. In tying off the tube on that side a slight rupture occurred before removal, some of the pus escaped but evidently not into the peritoneal cavity. Although oozing was very slight when the abdomen was closed the usual glass drainage tube was in. troduced. It proved to be a wise procedure, for more than two and one half ounces of serum exuded during the succeeding twenty four hours. The tube was removed on Wednesday.

On Monday and Tuesday there was considerable rise in temperature, reaching as high as 102° F. There was also considerable tympanitis present. An attempt was

Stated meeting, Saturday evening, June 8, 1895; the made to relieve this according to the method of Keith, President, F. D. MOONEY, M.D., in the Chair.

DR. A. H. MEISENBACH presented a testicle which had constituted a part of the contents of the sac in a case of "Strangulated Right Inguinal Hernia."

The patient, a boy twenty years of age, was first seen by speaker this morning at 12 o'clock. He had been suffering since Monday with colicky pains in the ingui nal region, which had continued since that time, refus ing to yield to ordinary methods of treatment. It was similar to a number of attacks of a like nature which had occurred during the past few years.

by injecting water, containing eight or ten grains of
quinine, into the rectum. No relief followed its appli-
cation, so that fifteen or twenty grains of ox-gall in four
or five ounces of warm water was used.
This was re
peated three or four times a day and was followed by
considerable discharge of flatus, giving the patient
prompt relief. Judging by its prompt action in this
case the use of ox gall may be recommended in all in.
stances where discomfort is caused by gaseous disten-
sion of the bowels.

DR. A. H. MEISENBACH called attention to the paralytic state of the bowels often following abdominal secAll the characteristic symptoms of an incarcerated tion. He had recently met with a very troublesome inguinal hernia were present, but the testicle on that and obstinate case, in a woman upon whom he had opside could not be located, and it was thought that the erated for incarcerated femoral hernia, of a week's hernia was complicated by a retained testicle. The pa. standing. The patient progressed favorably for two

weeks after the operation, although she was emaciated ministered with benefit in those cases where there is no and under very unfavorable hygienic surroundings. irritability of the stomach. Where vomiting does oc During the second week an apparent obstruction of the cur the safest and most efficient method is the use of bowels occurred. The abdomen became tense, the ox-gall enemata.

**

DR. A. H. MEISENBACH read a paper on (see page 67)

and demonstrated the operation on a patient.

bowels distended with flatus and they would not move. Strychnia was administered hypodermically every two or three hours in from one-sixty fourth to one-twentieth grain doses, but failed to produce the desired effect. INGROWING TOE NAIL.-A SIMPLIFIED OPERATION BY The faradic and galvanic currents were then applied to MEANS OF A NEW INSTRUMENT, the gastro intestinal tract, by means of a tongue elec trode to which one pole was attached; while the other pole was applied to the rectum by means of a male, meta), urethral catheter, the tip of which was exposed while the body was covered with a soft rubber catheter. The continuous current produced very little effect, but an interrupted current of some force was followed by a movement from the bowels, and the passage of the accumulated flatus. This treatment was repeated for several days when it became almost unbearable. The paralytic state of the bowels improved readily when the state of nutrition and of the nervous system improved.

Similar results had been attained in other cases by speaker, and, at his suggestion by some of his colleagues. His attention was first called to the procedure in Bigelow's work on electro therapeutics, in which a number of cases are cited.

DR. L. BREMER asked the speaker whether he had tried the experiment on himself, whether he had placed the electrode on the tip of the tongue and what sensa tion he had experienced. The tip of the tongue is the most sensitive part of the body to the action of electri city, and a current sufficiently strong to produce an ac tion of the bowels would be unbearable if applied to that point.

DR. FUNKHOUSER complimented Dr. Meisenbach on the ingenious instrument he has presented, but objected somewhat to the use of the anesthetic. He had employed hypnotism in the last cases, with marked suc cess. The patients experienced no pain whatever.

DR. I. N. LOVE endorsed the ingenuity of the instru ment, but condemned the operation in toto. favor of adopting temporizing methods; allowing the nail to grow long at the corners, and pressing the corners of the nail up by means of strands of gauze about two inches long obtained from a towel, and made to act as a kind of a bridle.

If the temporizing method fails the redundant soft tissue on the side of the nail should be cut away with a bistoury, and a permanent cure will result. If the nail is removed the trouble will be re-established when it grows out again.

DR. S. POLLAK had performed the operation several hundred times according to the method suggested by Dr. Love. According to Dr. Nelaton, there is no such thing as an ingrowing nail, it is usually overgrowing flesh. If the nail is cut away it will certainly come back; whereas, removal of the redundant tissue will result in the formation of a cicatrix, which, in contract. DR. MEISENBACH did not wish to imply that the ap-ing, draws the tissue back and results in a permanent plication was confined to the tip of the tongue, but that it was applied by firm pressure with the tongue elec trode. He had tried the experiment upon himself and had experienced a very peculiar sensation. He had tried it to determine its physiological effect, although he did not require the aid.

DR. BREMER did not consider that a satisfactory test. An electric current may produce an action of the bowels in a healthy person, but in a pathological condition it may not suffice.

DR. ROBERT FUNKHOUSER had never employed this remedy, and said that he would be afraid to do so, as some patients are very intolerant of electricity, either the faradic or galvanic current.

The paralytic condition of the bowels following laparotomy is a frequent and troublesome complication. Whether it is due to the attendant shock or to the slight inflammation which follows all laparotomies, it is not possible to determine definitely. The treatment varies materially with different operators. Keith prefers enemata of quinine, and goes so far as to state that nothing will free the intestines of the gas if quinine in solution will not do it. Saline purgatives may be ad

cure.

DR. EDWARD BORCK also operated by removing the redundant flesh, and directs his patient not to cut the corners of the nail round, but to allow them to grow out and then cut them square.

DR. A. R. KIEFFER was of the opinion that the trou ble is due, in most instances, to the inflammation produced by the constant digging around the toe-nail, and the infection resulting therefrom.

DR. GIVEN CAMPBELL considered the matter of anesthetics of particular interest in these minor operatione, especially with reference to the quantity and strength of the solution, the degree of anesthesia produced and the advisability of using a ligature so as to prevent the entrance of the cocaine into the general circulation. For instance, in removing a splinter which had passed very deeply under the nail he succeeded in producing complete anesthesia of the tissues with two drops of a four per cent solution of cocaine with a ligature. The same result could not be obtained without a ligature. Some patients are very susceptible to cocaine and it is advisable to use it with great caution.

DR. G. WILEY BROOME was of the opinion that the