more likely to break down than if they were pushed at ter it on an empty stomach with a glass of water. Al the one or the other alone. In adolescence the heart, though it would probably prove useless to give mor like other muscles, though it was more easily strained, phine for a case of biliary colic, or antipyrin for a recovered more readily, and with moderate care would headache, by the mouth shortly after food, the same recover completely. treatment would succeed if the patient's stomach were empty. In conclusion, Dr. Brunton dwelt on the important point that, while in middle life the heart was less liable Though the quantity of a drug absorbed in the to strain, yet as age advanced, and especially if the ar-stomach will always be small, it is increased by delay, teries became atheromatous, the heart was not only and diminished by rapidity of evacuation into the inmore easily affected by strain, but has less power of re testines, especially when diluted. The further rule can covery-a fact which has its obvious bearing on the now be made, that where it is for any reason necessary kind and amount of exercise which should be taken as to give a drug soluble in the stomach by the mouth, age advances.-British Medical Journal. and yet it is advisable to spare the gastric mucosa as much as possible, it is best given fasting with water. The Conditions Necessary for the Ab- This applies only to cases whose gastric motor power is sorption of Drugs.-Recent researches by Prof. unimpaired. In atony or pyloric obstruction, if drugs Moritz (Muench. Med Woch.; Med. and Surg. Review must be given by the mouth, they should be exhibited of Reviews) has proved that the stomach has practically in strong alcoholic or spiced solutions which increase no power of absorption, except for very concentrated absorption from the stomach itself. solutions. The writer and von Mering found independ ently that almost the whole quantity of water drunk by a dog with a duodenal fistula could be recovered through it very shortly afterward. The practical result of this and many other observations is that the intestines, not the stomach, must be considered to be the absorbing organs, and that the rapidity of absorp tion of any drug depends on the speed with which it is passed from the stomach into the intestines. Starting with this knowledge, Prof. Moritz has made further experiments on the conditions favoring, or otherwise, a speedy evacuation of the stomach, which have a very important bearing on the best time for adminis. tering medicines. They consisted in principle in giving some easily recognizable drug, after which at varying periods the stomach was washed out and an analysis made. They prove, in the first place, that of liquids, water or weak sodium chloride solutions leave the stomach quickest, next to them, but after a considerably longer interval, solutions of acid of the strength of the gastric juice, water containing carbon dioxide, soup, milk, beer, and last of all oil. An important point is that the time spent in the stomach is in proportion to the amount of gastric juice excreted through their pres ence. Secondly, the proof is given that the rapidity with which a liquid passes on into the intestines depends not only on its physical characters but on whether it is taken fasting or after the ingestion of solid food. In the latter case it is delayed, probably because the solids have provoked a copious excretion of gastric juice. We are now in a position to formulate the following rules:-A dose of medicine (1) will leave the stomach and be absorbed most quickly when taken fasting with plain water; (2) less quickly when given with soup, milk, wine, etc.; (3) still more slowly when taken with liquid after food; (4) and most slowly after food with out liquid. Obviously then to ensure the quickest pos sible absorption of a drug the indication is to adminis Health Reports.-The following statistics concerning small-pox, yellow fever, cholera and plague, have been received in the office of the Supervising Surgeon-General of the U. S. Marine Hospital Service during the week ending February 18, 1899: SMALL-POX-UNITED STATES. COLORADO- New Orleans.... Auburn, . Feb. 7. Cases.-Deaths. 6 .. Feb. 8. The American Year-Book of Medicine and Surgery. Being a Yearly Digest of Scientific Pro gress and Authoritative Opinion in all Branches of Medicine and Surgery, drawn from journals, mono graphs, and text books of the leading American and Foreign Authors and Investigators. Under the gen. eral charge of GEORGE M. GOULD, M D. Illustrated. 1899. Price, cloth, $6.50; half morocco, $7 50. For sale by subscription. [Publisher: W. B. Saunders, Philadelphia.] The volume before us presents, in a condensed form, the essential medical literature of the past year. The work is as complete a digest of the more important con. tributions, as regards original research, or new sugges. tions, in the various branches of medicine as can possi bly be condensed in a single volume. The Year-Book is intended to be a summary of medical progress rather than a literary review of all published matter. This is a most valuable distinguishing feature which has been most successfully aimed at by the various contributors. It is a very difficult task for the general practitioner, or even the specialist, to keep himself informed on that which is new and original in recent medical literature, and a work like this is of the greatest help and importance to assist the practitioner in this onerous task. Throughout the entire work we perceive the trained head and hand of men experienced in the branches of medicine allotted to them, as well as in the selection and condensation of the more useful and important contributions to medical literature. Officers and Members of the Illinois State Board of Health.-At the last election, held on January 17, the following named physicians were elected officers and members for 1899: Dr. C. B. Johnson, of Champaign, President; Dr. R. F. Bennett, of Litchfield, Treasurer; Dr. J. A. Eagen, of Springfield, Secretary and Executive Officer. Dr. J. C. Sullivan, of Cairo; Dr. L. Adelsberger, of Waterloo; Dr. Florence W. Hunt, of Chicago; Dr. P. H. Wessel, of Moline; and Dr. M. Meyerovitz, of Chicago. The Pocket Therapist. A Concise Manual of Modern Treatment for the Physician and Student. Arranged alphabetically for ready reference. By THOS. STRETCH DAWSE, M.D., Fellow of the Rɔyal College of Physicians of Edinburgh; Late Physician Superintendent Central London Sick Asylum; Late President North London Medical Society; Late Member of Council and Secretary for Foreign Correspon. dence, Medical Society of London; Formerly Physi cian to the North London Hospital for Consumption and Diseases of the Chest, to the North West London Hospital, and to the West End Hospital for Epilepsy and Diseases of the Nervous System; Associate Mem ber of the Neurological Society of New York, etc. Price, $1.50 net. [Publisher: William B. Ketcham, New York.] A brief and condensed résumé of the more commonly used remedies in various diseases. It follows almost entirely English methods of treatment and though it contains many therapeutic recommendations that met with favor in this country, the edition is American only in name. Though the preparations and dosage is that of the British Pharmacopeia, the student will find much valuable information in a small space, and a book useful for hasty review. The edition is of pocket size. NOTES AND ITEMS Medicine in France.-Medicine, in France, at Self-Examination for Medical Students. least, says the Pacific Medical Journal, appears to have Three Thousand Questions on; Medical Subjects charms for the old, as well as the young, energetic mind. Arranged for Self Examination. With the Proper It is said that a Frenchman lately became a qualified Reference to Standard Works, in which the correct practitioner at the age of 50 years; that another scienti. replies will be found. Second edition, enlarged. 1899. fically-inclined man at 72 began preparing for the degree Price, 10 cents. [Publishers: P. Blakiston's Son & of B. S. with the view of thereafter taking up medicine; Co., Philadelphia.] while a French maritime surgeon was still faithfully This is a little work that can be very advantageously performing his duties on board ship at the ripe age of used by the medical student who desires to ascertain the amount of knowledge he possesses of medical subjects. It consists of questions solely and is intended only for self-interrogation. It covers all departments of medical study. Every alternate page is left blank for the purpose or writing the answers or making other notes. It is of small size and easily carried in a coat-pocket. 81 years. Dr. Schenck's Discovery. According to a dispatch from Vienna to the Globe Democrat, the Vienna Medical Council is discussing the question whether Professor Schenck's discovery determining the sex of an unborn child is charlatanism or a genuine scientific discovery. This action is being taken by the Council in view of Professor Schenck's submitting his plan to the Emperor of Russia, who is desirous of having the coun cils open. A Text-Book of Mechano-Therapy. (Massage and Medical Gymnastics). Especially prepared for the use of Medical Students and Trained Nurses. By Chicago's Death Rate.-A total of 604 deaths AXEL V. GRAFSTROM, B Sc., M.D, Late Lieutenant in was recorded by the Health Department of Chicago the Royal Swedish Army, Late House Physician, City during the week ending February 18 This is the Hospital, Blackwell's Island, New York. With eleven greatest number for any one week in the history of the pen-and-ink sketches by the Author. 1899. Price, city, the highest previous being 598 for the week end. $1.00 net. [Publisher: W. P. Saunders, Philadelphia.] ing January 21, 1899. The greatest excess was among The profession at large is rather unappreciative of the value of massage as a therapeutic measure, doubtless caused somewhat from lack of definite information as to its indications, etc. In this work the author has very clearly and thoroughly described the conditions in which it is serviceable, its various maneuvers and meth ods of application, the subjects of uterine and ocular massage only being omitted as belonging more properly to the specialist. The book is entertainingly written Magnificent Gift to the Jenner Institute. and nicely illustrated. That it will be well received by-Lord Iveagh has presented the Jenner Institute with the profession we have no doubt. the magnificent gift of £250,000 ($1,250,000) for the endowment of scientific research. those beyond middle life, there having been 145 deaths at over 60 years of age. This number was exceeded only once before, and that during the week already quoted, when there was 158 deaths of this age-period. The principal causes of the increase in deaths were pneumonia, diseases of the nervous system, cousumption, and complications of influenza. St. Louis Mortuary Report.-The weekly mortuary report shows that there were 224 death in St. Louis during the week ending February 18; one less than in the previous week. There were only six deaths from contagious diseases, four from diphtheria, one from whooping cough and one from typhoid fever. There were 188 deaths in the corresponding week in 1898. St. Louis Biological Society.—The prelimin ary organization of the St. Louis Biological Society took place February 20, at the office of Dr. Carl Fisch. Dr. Zahorsky presided. Dr. Fisch read a paper entitled "The Mechanism of the Widal Reaction." The next meeting is to take place Tuesday, March 7. The ob ject of the Society is the discussion of subjects pertaining to those fundamental branches of medicine which form the basis upon which the intelligent prac. Evangelical Lutheran Hospital.-The Gertice of medicine depends. These branches include man Evangelical Lutheran Hospital Association held microscopy, physiology, bacteriology, physiologic and pathologic chemistry, pathology, and botany as far as microscopic structure and biologic processes are concerned. its annual meeting last Monday evening at the Holy Potomac street. The reports of the officers showed that losis; malarial fever, five, and the rest from different in the orphans' home 115 children are being cared for. diseases of non contagious character. Our sanitary conIn the hospital 253 patients of all denominations were dition is improving daily, as shown by the mortality received during the year. The number on hospital days table. Both the civil and military hospitals are now in 10,565, of which 4,098 were gratis, an increase of forty splendid sanitary condition, and perfectly attended. five patients over 1897. A training school for nurses The public now pays more attention to hygiene, and was established and many other improvements in both streets and houses are kept clean. Where disinfection institutions were made. The work of the Association is needed it is immediately practiced. The Establishment of a Medical Library. is greatly assisted by the ladies' societies of the differ ent Lutheran Churches in the city. The financial condition of both institutions has improved, owing to sev-A movement has been made by the physicians of St. eral legacies, which made a decrease of the debt possi ble. The election of officers resulted as follows: Presi dent, Henry F. Mueller; Vice President, C. Kellermann; Cashier, C. F. Auerl; Secretary, Rev. Herman Bartels; Inspector of the Hospital, R. Volberg. "The Annals of Ophthalmology.”—Dr. H. V. Würdemann, of Milwaukee, who has been associate editor of the Annals of Ophthalmology, in charge of the department of German literature, has accepted the position of editor in-chief vice Dr. Casey A. Wood, of Chicago, resigned. Dr. Wood will retain an interest in the Annals of Ophthalmology, and will remain in charge of the department of Italian literature. Resolution of Regret.-The following resolu tion was passed at a recent meeting of the Faculty of the Marion-Sims College of Medicine: Louis to establish a medical library in this city. A meeting was held at the West End Hotel on Friday evening, February 17, to form a temporary organization. Plans for the establishment of the proposed library were gone into in detail, but it was decided to take no definite action until a permanent organization had been effected. The following officers were elected by the temporary organization: President, Dr. S. Pollak; Vice-President, Dr. Bruce Carson; Secretary, Dr. John H. Duncan; Treasurer, Dr. A. R. Kieffer; Trustees, Drs. Latz, Oatten, Lewis, Vaughan, Alt, and French. Membership blanks are being circulated in order to increase the membership before the library work is actively under. taken. Some years ago the physicians and surgeons of this city had a fair library, which was turned over to the Public Library upon certain conditions. The arrange Inasmuch as Dr. H. C. Dalton has tendered his resig. ment did not prove satisfactory, and now it is proposed nation as Professor of Abdominal Surgery in the Ma to open a library of their own. A site will be chosen in rion-Sims College of Medicine, all the members of the on Grand Avenue or some other accessible locality and faculty herewith offer to their late colleague their in addition to equipping the library with a complete thanks for good and faithful services in his department, assortment of medical works it is the intention to keep and express their regret that he has found it necessary to sever his connection with the institution. on file all of the medical journals so that reference may be had to them at any time. Society of German Physicians.-At a meet Cuban Sanitary Report.-Surgeon-General Wyman has received most encouraging reports on saning of the Society of German Physicians, of St. Louis, itary conditions in Havana and Santiago. Mortality held February 17, Dr Geo. Richter read a paper entitled has decreased to a rate which has not been known be. "The Physiology of Digestion." fore in two years. From Havana, Inspector Brunner has sent the following information: Two weeks have elapsed since a death from yellow fever was recorded, and I do not know that there is a case now existing in the city. The mortality has stead ily decreased for the past few weeks until it makes the present week's death rate the lowest for over a year, possibly for over two years. Under the present conditions it can not go much lower before it rises again. The decreased death rate is due to the presence of Americans and food to a large extent, but the diminu. tion of material must enter largely into the decreasing death rate. Inspector Cammera at Santiago writes: I have the honor to inform you that no deaths from either infectious or contagious diseases have been re St. Louis Microscopical Society.-The fol stain. DR Ross: Demonstration of Specimen of Dysmenor rhoea Membranacea. DR. JESSE S. MYERS, Secretary. Weekly Sanitary Report.-The weekly sani. tary report shows that there were 24 cases of diphtheria, 16 cases of scarlatina, 2 cases of typhoid fever, 9 cases of cerebrospinal fever, two cases of measles, and 4 cases of whooping cough. There were 195 births. ported during the week. The total number of deaths Medical Review Visiting List for 1899 has been fifty-four, of which ten were from tubercu- now ready. Price, 75c. postpaid. Send for it. MEDICAL REVIEW VOL. XXXIX. A Weekly Journal of Medicine and Surgery. ST. LOUIS, MO., MARCH 4, 1899. ORIGINAL ARTICLES Report of a Case of Suppurative Puerperal BY ROBERT M. FUNKHOUSER, M D., 8T. LOUIS. The following report may be of some interest, as it demonstrates, that no matter how desperate and unpromising a case may be, in spite of the most unfavor able prognosis, still a chance remains which should be taken, especially when non interference offers a certain NO. 9. found abundant albumin, granular and epithelial casts, leucocytes, and a diminution of urea in the urine passed in twenty-four hours. Evidently she was afflicted with. nephritis, whether or not contracted before pregnancy, I am unable to state; close questioning elicited the presence of no symptoms prior to that state, though I suspect it developed after. Whether the nephritis of pregnancy is due to congestion caused by pressure of the enlarged womb upon the kidneys and their blood-vessels, or to anemia, due to interference with the free passage of the urine from compression of the ureters by the gravid uterus, or to spasm of the renal arteries, or otherwise, it is noticea ble, this affection is present most often in primaparæ, the older the patient the more likely, and in twin preg nancy, and it is reasonable to infer in this case, had the March 14, 1897, I was requested by Dr. Nichols to take patient not aborted, other grave complications would have ensued later on, such as eclampsia, etc. charge of a case he had seen for the first time several Premature separation and expulsion of the placenta, days before, but owing to illness, was unable further to attend. He stated, the patient, Mrs. B., 26 years old, a as in this case, are reported in renal affections of preg primapara, had miscarried of twins at three and one-nancy, before the manifestatation of convulsions. fatal issue. half months, with the membranes intact. I saw her for the first time about one week after the miscar. riage. I found her suffering from general anasarca, every tissue in the body apparently infiltrated. There was excessive ascites, the abdomen being exceedingly swollen and tense; the limbs and feet very much enlarged, the vulva greatly distended, even the walls of the va. gina being highly edematous. Upon examination, the uterus was found empty and contracted, the discharge scanty with only a slight odor, normally puerperal. She, however mentioned that at irregular intervals she noticed a disagreeable watery discharge from the vagina, which I inferred came from the abdominal cavity, through the Fallopian tubes, which was subsequently verified. The pulse was 100; the temperature, 100.6°F., and irregularly varied a degree above up to April 1. She complained of intense pain in the epigastric region which, no doubt, was due to the excessive press. ure of the abdominal fluid. From time to time she experienced chilly sensations. Upon examination of the urine, which was much diminished and of high specific gravity, there were 1Read before the St. Louis Medical Society, Saturday Evening, January 28, 1899. I informed the family that it would be necessary to tap her if medicine failed to give relief. Meeting with indifferent success by medicine, though successful in producing copious diuresis, and abundant watery stools, on March 17, after proper preparation, I drew from her abdomen, by a Dieulafoy aspirator, about two and one half gallons of a slightly cloudy whitish liquid, the color more marked in the latter portion. The patient was very much relieved for several days, but the abdomen filled rapidly, and a second aspiration was deemed advisable, the quantity withdrawn April 1 being much less than before, but bearing unmistakable evidence of suppuration. The temperature was 102°F. The relief was but slight, and as the symptoms became urgent, the temperature rising, pulse rapid, chills, etc., it was deemed imperative to perform celiotomy. She finally agreed, and was removed to the Baptist Hospital on April 5, where the operation was performed on April 7. The abdomen was opened and contained a large quantity of fetid pus. The contents were matted together, intestine to intestine, intestine to stomach, intestine to liver, intestine to parietes, omentum to intest ine and parietes; in fact, the entire abdominal and pelvic cavities were implicated in the inflammatory process, with adhesions everywhere. These were broken up whenever safe and possible. I detached layers of lymph and pus of varying sizes, from |