It checks hemorrhage. It arrests menstruation. It found to be an abscess containing a thick greenish pus. elevates the uterus. It skrinks the uterus. It avoids The walls were composed of very dense tissue, and its the removal of uterine myoma. It avoids vaginal internal surface was covered with a membrane, which at hernia. The author claims that he has proved many times, by subsequent examinations, that this operation will cause a shrinking and atrophying of large, hard, metritic uteri It also elevates a retroverted uterus and maintains it in position. It is superior to hysteropexy, as it leaves a movable uterus. Two objections might be raised against the operation, -the danger of gangrene and the ligation of so much tissue, but so far as is known no trouble has come from such conditions. Care must be exercised in regard to penetrating the bladder and including a ureter in the ligature. It is suggested that the ligature which includes the broad ligament should not embrace the Fallopian tube with its mucous membrane, as that might enhance the chances for suppuration. The needle could be passed just beneath the tube, and this method would not protract the operation many minutes.- Univ. Med. Magaz. first sight appeared like mucous membrane, but was truly an abscess membrane. Microscopical sections showed the abscess wall to contain the tube wall, ovarian tissue masses of caseation. An inoculation taken from the pus gave a pure culture of the pneumococcus. The patient recovered.-Univers. Med. Magaz. NOTES: AND ITEMS Death of Dr. Ahlbrandt.-Dr. H. E. Ahlbrandt died on the twenty third of July, at an age of 46 years. The deceased has been practicing medicine in this City for many years, and by his death the St. Louis Medical Society has lost a valued member and friend. He leaves a son, who is practicing medicina in St. Louis; to him, as well as the other members of the deceased's family, we wish to express our sympathy. Influenza as a Remedy.-In the Centralblatt fuer innere Medicin for June 29, Dr. Berthold Goldberg, of Chicago, records a case of chronic gonorrheal cystitis the cure of which he attributes to an attack of influenza. He quotes from Lamarque the statement that some forms of albuminuria, especially the intermittent variety, subside as the result of influenza.-New The Pneumococcus in the Pus of an Ovarian Abscess.-Von Rosthorn (Prager Medi cinische Wochenschrift) reports a case where he found the pneumococcus in the pus of an ovarian abscess, and writes that he has been able to find only two cases reported in the German literature (Sweifel and Frommel), and one case in the French literature (Morax), where this organism was found in the pus of a pyosalpinx. York Medical Journal. The first case (Sweifel) was in a girl, 18 years of age, who had had neither pneumonia nor tuberculosis. She Is Acute Tonsillitis in Any Way Depen. recovered after operation. The second case (Frommel) dent on the Rheumatic State?-Dr. George B. occurred in a woman 38 years of age, who was suffering Hope, of New York, in a paper read at the meeting of with phthisis pulmonalis. The pyosalpinx appeared the American Gynecological Association, believes that after a puerperium associated with fever. The patient the very generally accepted theory of tonsillitis attribdied with sepsis, and at the post-mortem, made sixty uting it to an underlying rheumatic or gouty diathesis, hours after death, Frankel himself prodcured an almost is not substantiated by the results of clinical experience, pure culture of the organism. Inoculations from this and considers the theory as largely the result of the culture into animals proved rapidly fatal. This case natural disposition to fall into line with time-honored proved that the pneumococcus is excessively virulent. statements which continue to pass current and are not The history of the writer's case is as follows: A ser subjected to careful analysis. vant girl, 28 years of age, had complained of pain in the lower abdomen, since a puerperium associated with fever six years before. On making a vaginal examina tion a very painful and immovable tumor, the size of an orange, was felt in the right ovarian regior. After many weeks of conservative treatment and rest without the least benefit, the tumor was removed by adbominal incision. At the operation the growth was found so universally covered with adhesions that its anatomical parts could not be recognized. The complete separa tion of the growth from the lateral wall of the uterus and pelvis was impossible, and it was therefore amputated with the thermo cautery. The site of the growth was packed with iodoform gauze, and the stump sutured to the abdominal wall. The tumor was the shape of an egg, twelve centimeters in length, and on section was The point is taken, that patients subject to tonsillitis do not commonly afford a history of rheumatism, either proximate or remote, and that, on the other hand, rheumatic individuals rarely suffer from tonsillar inflammations. It is a striking fact that the tonsil is, in later life, less and less disposed to acute attacks, while rheumatic tendencies become more and more manifest with advancing years. On pathological grounds, rheumatism should attack a sero fibrous rather then a muco fibrous or lymphatic structure such as the tonsil. Carrying the argument still further, it is claimed that peri-tonsillar suppuration is clearly of an infectious nature, and is frequently a sequel of intra nasal operations. The conclusions deduced from the foregoing propositions, is that the favorite anti rheumatic treatment, as guaiac or the salicylates, addressed to the causation is 8. The remedy is of value in myxedema. either erroneous in practice or acts independently and ual. Some of these may be due to incidental digestive by a method not clearly understood. Such remedies disorders. are not to be regarded as scientific, and must be adjusted to the varying conditions of each individual case. Moreover it is not proven that they either abort or miti gate the cause of the disease.-Medical Record. Desiccated Thyroids in Goitie. - Dr. E. Fletcher Ingals, of Chicago, read a paper with this title at the recent meeting of the American Laryngological Association. During the last fifteen years he has treated eighty seven cases of bronchocele and exoph thalmic goitre. Formerly he gave potass. iodid., grs. v. x, thrice daily. If the patients were not distinctly improved in two or three weeks, he gave iodine tinc. ture, gtts. v-xv., three or four times daily, administered in capsule and followed by a large goblet of water, be ginning with the minimum dose and increasing one drop daily; or he would inject a three to five per cent solution of carbolic acid in water and glycerine-using from twenty to fifty minims at one injection, and in jecting once a week. During the past three or four years he has used thy roid preparations of various kinds, and in his last six cases desiccated thyroids. Six grains of this prepara tion represent one entire gland. Dr. Ingals then gave outline clinical histories of his last six cases. All, with one exception, are still under treatment. Several of them had previously been subjected to the old style of treatment. He had obtained reports from other physicians who had used the desiccated thyroids, and was able to report on 50 cases in all. Taylor's series of 25 cases showed improvement in all but 7. The neck was uniformly diminished in size. As unpleasant features of the treatment, headache was reported in thirty per cent, dizziness in in thirty-seven per cent, and increased rapidity of pulse in twenty five per cent. Out of the 50 cases the size of the neck was reduced in 38. In addi tion to the foregoing unpleasant symptoms, were to be noted trembling, weakness, backache, nausea, loss of weight, and in one case uterine contraction which could be directly traced to the effects of the remedy. He would, from his study of the question, draw the following conclusions: 1. Thyroid products exert a powerful effect on the nervous and circulatory apparatus, as evidenced by head pains, rapid pulse, and fluctuations in weight. 9 In exophthalmic goitre, the gland is reduced in size, but in enlargement (not of the exophthalmic type), rapidity of cardiac action may be aggravated, instead of benefited. 10. Cystic glands do not seem to be benefited. 11. There is no evidence that thyroid therapy has any place in diseases other than the foregoing. The discussion was opened by Dr. E. L. Shurly, of Detroit. He had used the ordinary extract of thyroid in some twenty cases, with disappointing results. He related the case of a boy from whose neck the entire gland had been removed some years ago, with the re sult that it seemed to diminish the boy's physical growth, and three or four years later he had developed a mental apathy and a peculiar piping voice. The movement of the cords and arytenoids appeared normal, except that the normal phonatory tension of the former was markedly deficient. For the past two years the boy had been on thyroid extract (previous subdermic administration having proved useless), with the result that the tension of the cords was much better. He thought that laryngologists should protest against the whole removal of the gland for any purpose whatever. Experiments have shown that the retention of a very small portion will prevent the untoward results which follow its entire extirpation.- Medical Record. Sanitaria for Consumptives.- In the Union Medicale for June 22, M. Rochard remarks that the mode of treatment instituted by Dr. Detweiler at the Institut de Falkenstein was not at first taken sufficiently in earnest. The idea of consumptives living in the open air at a low temperature and allowing currents of air to pass through their bedrooms at night was looked upon as eccentric, but the advantages of this mode of treatment, says the writer, have come to be recognized, for the pure, cold air quiets the cough, lowers the fever, arrests the night sweats, restores the appetite, and retards the course of the disease. A knowledge of these results has led to the establishment of a number of sanitaria in Germany, and there are now six in existence. They are, however, accessible only to the rich; but attention has been called to the necessity of hospitals for poor consumptives, and efforts 2. These symptoms may arise from a daily dosage are now being made for the establishment of special of from one and a half to two thyroids. 3. From cases observed it is not irrational to sup pose that incautious dosage might produce fatal results. 4. The desiccated preparations are the preferable mode of administration. hospitals for their reception. In a report to the consulting committee of public hygiene, says the writer, Dr. Netter has given an outline of the precautions to be taken against the dangers of contamination in the neighborhood of these sanitaria. 5. Internal administration offers as good results as These dangers, says M. Rochard, if they exist at all, hypodermatic use. threaten the establishments themselves rather than the 6. The dosage should commense with two grains neighborhood, although, experience has shown that thrice daily, and run up to four or eight if necessary. nothing is rarer than a case of tuberculosis contracted in 7. The effects are not constant in different patients, the sanitaria which have been in existence for many nor are they the same at all times in the same individ-years in certain countries. There is no ground for the fear that patients may infect others, because greater pre cautions are taken in these sanitaria than in the general hospitals or in private houses, and the neighbors are no more exposed to danger than the inmates of the sani. taria themselves. Expired air, as is well known, does not contain the bacilli, and if the wind carries infectious germs, it is only when it contains powdered dry sputum, and this danger is done away with if the sputum is carefully destroyed. for a longer period. The writer is convinced that full doses of serum have no influence on the mere presence of bacilli after they have once obtained a foothold. He believes that our estimate of the results of the serum treatment must be based upon such cases as are clinically diphtheria, the diagnosis of which is confirmed by bacteriological examination. As to the value of the antitoxine as a protective agent he seems to have no doubt. Dr. L. Emmett Holt, in the same journal, reports the M. Netter's report, says the writer, conclude with the result of the use of the antitoxine for protection in the following precautions: Nursery and Child's Hospital and in the New York In1. Sanitaria should be built upon high ground and fant Asylum. In the first-named hospital, between Jansurrounded with cultivated grounds and parks, making uary 18 and April 18, forty-six cases of diphtheria oca boundary line between the public and the patients, curred, the diagnosis being confirmed in each case by who should avoid going beyond it as much as possible. cultures. They were not confined to a single ward, but Each establishment should possess a steam ap-were scattered throughout the institution. During the paratus for the purpose of disinfection, through which last two weeks of this period the number of new cases all the body and bed clothing should pass before being was steadily increasing. On April 18, a hundred and 3. The rooms should be painted and disinfected be. ten children were injected with serum obtained from the fore they are occupied by new patients. The floors washed. should be covered with linoleum. 4. The dejecta should be thoroughly disinfected before being disposed of. 5. The patients must be forbidden to expectorate elsewhere than in the portable spittoons, which should be disinfected every day. These regulations, says M. Rochard, have been approved by the consulting committee of public hygiene of France.-New York Medical Journal. board of health, and eight days later twenty-six were injected. This included all the children except those who had recently had diphtheria and twenty infants under two weeks of age. From that day to June 21, the date of the report, not a single case of diphtheria occurred among the children injected. In the New York Infant Asylum, in three months, thirty two, thirty and thirty-one cases of diphtheria appeared. During the first fourteen days of January twelve cases developed. Two hundred and four children were then injected with Behring's antitoxine No. 2, the dose being from one hundred to two hundred units. No case of diphtheria appeared for eighteen days, when one developed. As several cases appeared about the fortieth day, two hundred and fifteen children were injected with serum obtained from the board of health. No case appeared thereafter for thirty-one days. From the thirty-first to the sixty-fifth day three cases appeared. After that no cases occurred. The Protective Effect of the Diphtheria Antitoxine.-Considerable evidence has recently been adduced regarding the protective effects of the antitoxine of diphtheria. Dr. F. Gordon Morrill, in the Archives of Pediatrics for July, reports the results of four hundred and thirty eight protective injections made at the Children's Hospital of Boston. During the year 1894 this hospital was closed three times on account of the prevalence of diphtheria. On January 13, 1895, The shortest time after injection at which diphtheria there were nine cases of diphtheria in the infectious developed was on the thirteenth and on the eighteenth ward, five of which had appeared within forty-eight day. With these two exceptions no cases appeared hours. The question of closing the hospital for the under thirty days, although the childred were constantly fourth time was discussed, but it was decided first to exposed to infection. The writer expresses himself as try the protective effect of the antitoxine. Injections convinced that injections of antitoxine for protective were at once made, and the apparent result of this first purposes are of inestimable value.-N. Y. Med. Jour. attempt was to arrest instantly any further spread of the disease. Although the children were frequently examined for bacilli, none were found until January 29, when they were discovered in one case. Upon this all the children were again subjected to the injections. No bacilli were again found until February 15. Injec For this occasion the WABASH R. R. will sell tickets tions were at once given in all cases in which they had from St. Louis to Denver, Colorado Springs, Manitou not been employed within two weeks, and a rule was and Pueblo at the rate of $24.50 for the round trip, good established to repeat them every fortnight. With re- going on date of sale, and returning until August 25. gard to the protection afforded by the antitoxine, ex- Extensions will be granted until September 1, 1895, by perience tended to show that the serum could be relied depositing tickets with Joint Agent. City ticket office, upon to protect against anything that resembled diph-Southeast corner Broadway and Olive Street, and Union theria clinically for at least thirteen days, and probably | Station. American Pharmaceutical Association. DENVER, COLO., August 14-24, 1895. A WEEKLY JOURNAL OF MEDICINE AND SURGERY. VOL. XXXII ST. LOUIS, AUGUST 10, 1895. ORIGINAL & ARTICLES Fever. NO. 6 attention of an army of men engaged in original research, it has been observed that when any of the various specific micro-organisms or their toxines are artificially introduced into the living organism, there invariably follows a rise of temperature which continues till the poison is eliminated or till the animal dies. These observations, followed by a series of corroborative experiments, have established the doctrine of phagocytosis, a term used to signify the property of certain animal cells of attacking and taking into their substance foreign particles which are either again rejected or devoted to the nutrition of the cell. But this broad definition em. braces both a physiological, and a pathological phago BY F. M. WELLS, M.D., CHARLESTON, IND. Read before the Indiana State Medical Association, June 7, 1895. In selecting a topic for discussion that would be both interesting and profitable to a society of physicians en-cytosis. gaged in the general practice of medicine, I could think of nothing more frequently encountered in our daily routine than is fever. When a living organism is infested by a parasite or when it is injured mechanically so that poisonous material gains access to the circulation, the leukocytes and It is encountered under widely diversified conditions certain connective tissue cells, now called phagocytes, and it is frequently the only visible manifestation of attack the invading poison and a conflict begins which disease. It is surrounded by some of the most abstruse results either in the triumph of the cells and recovery problems in medicine when we consider its etiology, of the organism or in the triumph of the enemy and and when we consider its treatment, we again encounter death of the organism-this is pathological phagocytoconfusion and doubt. sis. A rise of temperature invariably accompanies this The principal obstacle in the way of an intelligent process like smoke on a battle field. We might look conception of its etiology is the failure of physiologists upon the fever, then, as Nature's spy warning us, when to give a satisfactory solution of the normal phenomena the mercury rises, to prepare for battle and, when it of heat production and heat radiation. It is not known falls, to lay down arms. why the human organism so maintains its standard temperature independent of external changes that, while the heat of the surrounding atmosphere may vary more than 100° F., the temperature of the body remains the same. This theory of febrile diseases has given rise to the question of how the abnormal temperature influences the final result of the battle; whether it is a stimulant of the resident cells and is therefore an ally of the reparative process, or whether it favors the growth and It is true that some of the important factors of this development of the invading parasite and is therefore process have been satisfactorily demonstrated. We an ally of the enemy and consequently a destructive know that heat is liberated in the normal process of process? blood and tissue oxidation and that it is radiated There seems to be a tendency with quite a number through the cutaneous surface. The vaso-motor system of physicians to hold to the former view, but I can not of nerves are also known to contribute largely toward maintaining a uniform temperature by their influence over the circulation and distribution of the blood; yet, it is conceded by all that, in the present state of science, there are insurmountable difficulties in the way of a complete analysis of this vital phenomenon. The triumph of the germ theory of disease has given new impetus to the study of fever; it has indicated new lines of thought and opened up new fields of investiga. tion. conceive of rational explanation of why the normal tis. sue cells and leukocytes should act with greater energy in eliminating poisonous material from the organism under the influence of pathological heat than under the influence of their accustomed normal temperature. According to this theory, fever is a wise provision of Nature and all ant:pyretics are not only useless but de. cidedly harmful. The latter is the theory which is now generally ac cepted. In looking over a list of the micro-organisms In the study of immunity, which is now absorbing the that have thus far been isolated and artificially culti vated, I found that the temperature most favorable to their rapid growth and development is almost invariably abc ve the normal temperature of the body. This fact alone must be accepted as a strong argument in favor of the idea that fever heat contributes material aid to the ranks of the enemy by inducing a more rapid accumulation of the invading poison. This idea of the pernicious nature of pyrexia is in harmony with our clinical experience in the manage ment of fever, and it is prominent in the writings of nearly all leading authors. Austin Flint, in an address before the ninth International Medical Congress, said: "The abstraction of heat by external cold and the reduction of temperature by antipyretics administered internally, without affecting the special cause of the fever, improve the symptoms which are secondary to the pyrexia." of artificial heat and stimulants, reaction was prompt After having used most of the coal tar group of rem. edies, I now prefer acetanilid in the treatment of fever. There seems to be a strong prejudice among physicians against this remedy and it is perhaps the most unpopu lar one of the series. I have made an effort to discover the cause of this discrepancy between those who recommend it and those who discard it as dangerous, and I am sure the cause is to be found in the manner of using it. Concluding therefore, that fever not only does not exercise any beneficial effect in limiting an infectious I confess that my early experience with the remedy process, but that it is essentially destructive; that the was not satisfactory. I began giving it, as recom reduction of temperature relieves many annoying symp-mended, in doses of five grains or more and, as a result, toms and often favorably modifies the disease; the question is suggested, How shall we treat fever? the fever declined rapidly, sometimes even to subnor. mal, there was often profuse sweating, cyanosis, depres sion, and sometimes a chill. We are usually compelled to treat it symptomatically and we therefore do not expect our remedies to influ I believe it to be bad practice in the management of ence the cause unless it is indirectly through the reduc fever, especially the high grade of fever of acute self-lim tion of temperature, yet I am sure that we often materi ited disease, to give any remedy in sufficient amount to ally lessen the duration of many diseases by a judicious reduce the temperature to normal. When I use this class of remedies in the treatment of such diseases, I usually management of the accompanying fever and prevent complications which might otherwise arise; but I am give two grains of acetanilid aud repeat it often enough not so sure that we do not sometimes prolong an illness to maintain, as nearly as possible, a uniform reduction by the injudicious and indiscriminate use of antipyretics. of the heat to 100° or 101°. It may be given in this During the last few years, enterprising chemists have manner when there is decided weakness or exhaustion placed in the hands of physicians a number of powerful and, by combining it with a tablespoonful of whiskey, I placed in the hands of physicians a number of powerful have often succeeded in reducing a high fever while at antipyretic remedies, powerful for evil, as well as pow- the same time the character of the pulse and the general erful for good, and I am of the opinion, in fact I know, condition of the patient were decidedly improved. that the early use of these remedies was often accom panied by disastrous results, due to our imperfect knowledge of their therapeutic power, and this has resulted in a wide spread skepticism as to their real value as antipyretics. While I value this remedy very highly, I never use it continuously in a prolonged illness. I have found it especially serviceable in the irritative fevers of chil dren, in all transient febrile disturbances and in the early stage of sharp fevers whatever the cause; but I believe the tendency has been to administer these when a disease begins to sap the strength of the patient, remedies in doses much too large. when the flushed countenance and the full bounding Even now I often see them recommended in doses pulse are gone, I then lay down my acetanilid. which I have found unsafe. Not long ago, a well-known firm sent me a neat little pocket-book containing samples of a new antipyretic which, according to the inclosed literature, possessed all the advantages, and none of the disadvantages, of all others hitherto discovered. The inclosed ten-grain powders were recommended as medium doses. Having a patient, Mrs. H., on hand just then with very high fever, I gave her one of these powders. In a short time a messenger came for me in a great hurry. He said they thought she was dying. When I arrived I found her with a chill and subnormal temperature, there was profuse perspiration, the extrem ities were cold and the pulse was weak. With the aid The remedy now, which, according to my experience, is superior to all others, is quinine. In typhoid fever after the first week, in pneumonia after hepatization, in capillary bronchitis, diphtheria, or in all diseases, where the infection has made a pro. found impression on the vitality of the system and when there is a high temperature, I usually rely on quinine. I have used this remedy as an antipyretic for more than twelve years and each year, I become better satisfied with its results. I have a sort of routine method of giving it as fol· lows: I first rub it up with dilute sulphuric acid and glycerine, then either make it into pills or put it in capsules. I almost invariably administer the dose in the |