seems that association and the spur of competition are most important incentives in scientific work. Take this away and the average man relapses into indolence. Some have tried to find an explanation, in the fact that men in institutions were paid fixed salaries, and, therefore, the question of a livelihood did not present itself so imminently as it did to those in general practice. That this is not the case, is shown by the fact that many who receive fixed salaries, as teachers in our colleges or connected with hospitals in our large cities, frequently show a striking capacity for scientific research and a very earnest spirit in original investigation. We believe that the explanation of the indifference of institution workers is found in the lack of scientific association. It is true as well of the army and navy medical service, as with those engaged in asylum work. There are perhaps no class of men from whom more could be expected in a scientific way than the army and navy physicians. The question of livelihood fully provided for, and abundant resources and an excellent education, would seem to furnish the ideal conditions for scientific work. That the result has been disappointing, scarcely any one will deny. The explanation, we think, is found in the lack of scientific association. Any professional man set apart from his fellows almost certainly deteriorates in his scientific work. He needs the stimulus of competition and sympathetic association to develop his best efforts. THE INFREQUENCE OF GASTRIC VERTIGO. The practitioner usually thinks of the stomach. when a case of vertigo comes under his observation. The older writers, notably Watson, said that this symptom was sometimes the result of disease within the head, sometimes an indirect consequence of disorder of the stomach, or of mere debility and an approach of syncope. He did not attach the highest degree of importance to this sympton as a sign of gastric disturbance. Notwithstanding the frequency with which the diagnosis of gastric vertigo is made, this symptom having its origin in the stomach is one. of great rarity. Ulcer, cancer, inflammation, as well. as dilatation with stagnation of the stomach, are of frequent occurrence, but the writer does not recall a single instance in which these disorders were accompanied by well marked and frequently recurring attacks of vertigo. The reverse, however, is true; vertiginous attacks are very often accompanied by nausea and vomiting, and we suppose it is this latter relation of vertigo and gastric disturbance, in which the vomiting and nausea are secondary and accompanying phenomena, which has led the profession into the belief that gastric disorders were a frequent cause of vertigo. THE CAUSES OF SUDDEN DEATH. Not long since, the writer of this editorial asked twenty physicians what were the causes of sudden death. Thirteen of these named apoplexy and heart disease, placing apoplexy first. By apoplexy they understood a cerebral hemorrhage. Six stated that heart disease was the most frequent cause, and apoplexy next. One, a pathologist in a large hospital, stated that cerebral hemorrhage was a very infrequent cause of sudden death, and that most of the cases where death resulted immediately, as a person falling on the street and picked up dead, or in which death took place within an hour or less, were almost invariably due to heart disease or associated circulatory phenomena, as pulmonary embolism, rupture of an aneurism, etc. It is difficult to learn just how the view that apoplexy is a frequent cause of sudden death has become current in the profession, but it has probably been handed down from early times, before the word apoplexy had lost its original significance and had become accepted as a synonym for cerebral hemorrhage. hemorrhage. In the older sense, the term apopleia, meaning literally to strike down," would have applied quite as well to sudden deaths due to failure of the heart or accident to the circulation as it would to attacks of cerebral hemorrhage. There is no warrant in the literature for the assertion that cerebral hemorrhage is, except in the rarest instances, a cause of sudden death; only in cases of hemorrhage into the medulla would death be immediate. It is possible, also, that quite large hemor. rhages below the tentorium might also result in such an increase of pressure in the posterior fossa as at once to suspend respiration. Hemorrhages in this situation, however, are very rare, the vast majority occurring in the cerebrum. In this situation death never results under a few hours, and it is rather rare to have it occur in less than a day or two. THE BUBONIC PLAGUE. In the June 3 issue of the MEDICAL REVIEW we called editorial attention to the disturbing rumors of the advance of the plague. According to the Medical and Surgical Review of Reviews, May, 1899, the plague in India is declining. It is officially estimated that over a quarter of a million have perished during the epidemic. In Bombay the ravages have been exceptionally severe, and the death-rate sometimes exceeded 250 per day. With the advance of hot weather in the latter city the mortality rate has lessened. Hong Kong is threatened with a repetition of the outbreak of last year; the disease is raging, and it is feared that with the return of the pilgrims from Mecca to Constantinople it may be brought into Europe. The Bulgarian authorities have decided to place a quarantine of ten days on the frontier, and to submit all articles of clothing and all luggage to thorough disinfection. It has further been decided to keep all travelers in quarantine for five days. REINFECTION BY SYPHILIS. The profession is generally of the belief that reinfection of syphilis is practically impossible. In view, however, of the well-attested cases which have been reported, such a view can no longer be maintained, though it is unquestionable that reinfection is exceedingly rare. Fournier, in his boundless experience, stated that to establish the presence of a second infection from this disease it would be necssary to have two primary sores, separated at wide intervals, each followed by a secondary eruption and the usual sequelæ. Such a case he had never seen; but its possibility he was not prepared to deny. There is still some question, even among experts, as to the possibility of reinfection. However, a sufficient number of cases have now been gathered to show, beyond reasonable doubt, the possibility of such an occurrence. Reasoning from analogy, there can be nothing said against the possibility of reinfection, but it must be admitted that it is among the rarest of observed phenomena. Most of the infectious disorders confer some degree of immunity-much less in some than in others. Small-pox, measles, scarlet fever present a striking degree of immunity, while erysipelas confers practically none, one attack seeming to predispose to others. In a disease having the distinctly contagious character of syphilis it would not be surprising to have a reinfection, because there is no doubt that recovery takes place after this disease. THE MANIA FOR OPERATING. The necessity of a young surgeon "making a record" leads to some queer efforts on their part to obtain patients. The writer not long since had occasion to see a patient in one of the public clinics whose condition was most distressing. The mental faculties were much obtunded, and there was extreme THE EXERCISE TEST FOR PULMONARY PROF. PENZOLDT has recently introduced a new test for pulmonary tuberculosis. He says that active exercise, meaning by this a fairly rapid walk of from two to four miles upon a level road, increases the bodily temperature to some extent, even in health. In convalescence, anemia, chloroses and other constitutional states, temperature may reach as high as 100.5 F. A temperature above this is almost always indicative of tuberculosis. All suspected cases in which active exercise was followed by a temperature above this, were invariably found to be tubercular. His experiments were conducted with great care and with especial reference to the condition of weather and other circumstances. So far as his comparatively few observations would show, it would seem that this is a differential test of some value in distinguishing between chronic bronchitis and tuberculosis. PETER PHELAN is described as a tea inebriate. When forty years old he was admitted to the Bellevue Hospital in a state bordering on collapse. In spite of treatment, at the end of two weeks he died. The patient suffered from anemia and a severe catarrhal inflammation of the stomach. In the history it was stated that he had been addicted to the excessive use of tea from childhood, and that prior to his entrance to the hospital the daily quantum had reached thirty cups of strong tea. Society Proceedings MEDICAL SOCIETY OF CITY HOSPITAL ALUMNI. STATED MEETING, THURSDAY EVENING, MARCH 2. THE PRESIDENT, DR. GEO. HOMAN, IN THE CHAIR. Dr. R. B. H. GRADWOHL read a paper entitled Cerebral Hemorrhage with Temporary Glycosuria. DISCUSSION. DR. ARMAND RAVOLD said that the essayist had apparently left nothing undone to make his report complete. His clinical observations were acute and carefully recorded; the post-mortem findings were surprising, but nevertheless in accordance with the clinical observations; the chemic, physiologic, anatomic and pathologic knowledge displayed showed a wide and accurate acquaintance with the technique, methods and literature of these subjects, and the literature of the whole subject seems to have been carefully and extensively studied. DR. E. S. SMITH said that he agreed with Dr. Ravold. He did not see that the essayist had left anything to be said. He had been much interested in the specimen presented at the last meeting. THE PRESIDENT said one of the interesting points in the paper was the corroboration afforded by Dr. Gradwohl, in this case, of Dr. Bremer's researches in the examination of blood. Dr. Bremer, the speaker said, first presented that subject to this Society, and it seems clearly to be based on good scientific foundations. DR. F. REDER said that aneurysmal dilation of cerebral arterioles was interesting because it was the principal cause of many brain lesions. In cerebral hemorrhage, besides the blood pressure, there must be something else, and it is here that the pathology of aneurysm of cerebral arterioles must come in, i. e., a diseased condition of the investing sheath of the arteriole must exist. For instance, there is at first a periarteritis beginning in the perivascular lymph sheaths; this inflammation extends to the tunica adventitia, the muscular coat of the artery dilates, causing an aneurysm. After dilatation of the muscular coat has occurred, the subsequent blood pressure which exists in the arterioles, and which might be caused by a mechanical stimulus, such as violent exercise, or by a medicinal stimulus, may cause rupture to take place. The blood need not confine itself to the place whence it escaped, but may find its way to the surface or into one of the ventricles, and pass by the iter from the third to the fourth ventricle. The essayist had ably demonstrated the morbid process called glycosuria. Grape sugar and glycogen are both formed in the healthy organism, but an examination of the secretions of the healthy body does not disclose to us either grape sugar or glycogen; therefore, when we find sugar in the urine we look for a diseased condition somewhere in the brain, possibly somewhere in or near the medulla oblongata. We expect this diseased condition to cause irritation or pressure upon brain tissue. This irritation acts as a stimulus to the nerve filaments emanating from the medulla. These filaments find their way down along the cord, as the essayist has informed us, to the upper dorsal vertebræ, then to join the gangliated sympathetic, and so ultimately to reach the liver. The disturbed equilibrium, an alteration of nerve influence, causes the sugar to appear in the urine. In some forms of cerebral hemorrhage the cause of death is glycosuria; in other forms the cause is pneumonia. It is of interest to note how this irritation or pressure upon the brain is brought about by the blood clot. The fibrin collects in the center or at the periphery of the clot, the corpuscles crowd together and adhere, the serum is pressed out and finds its way into the neighboring cerebral matter. A limited inflammation takes place, and if the blood clot is near or in the medulla the irritation is sufficient to cause the appearance of sugar. The speaker said some attention was paid to the pupil during the time he was at the City Hospital. Autopsies revealed that in minutely contracted pupils the hemorrhage was most generally into the pons. In other cases, where the pupils were unequal, one largely dilated, they found that the clot was into the lateral ventricle. When there were seizures of an epiliptiform character it was usually found that hemorrhage was very extensive. DR. M. A. BLISS said, speaking of the theory that pressure in the fourth ventricle caused glycosuria, that it seemed to him such an effect may come from internal hydrocephalus. He was not sure that this observation had been made. The pressure in these cases was very extensive. He spoke of it merely as a point to be considered, whether glycosuria does not occur at certain times in internal hydrocephalus. DR. E. S. SMITH said he did not understand why albumin should appear in the urine. DR. GRADWOHL said there was only a trace. DR. SMITH Said albumin was often found in cases of cerebral hemorrhage, but he had never heard it attributed definitely to the hemorrhage; for instance, as glycosuria following hemorrhage of the fourth ventricle. Albuminuria was a part and parcel of general sclerosis; as a rule, it is found in cerebral hemorrhage, and this general sclerosis extends to the kidney, predisposing to interstitial conditions which give albuminuria. DR. BENNO BRIBACH said he thought that the essayist had brought clinical proof to bear out his assertions. The speaker said he was not aware of anything published from direct clinical observations to prove that the theory was correct, and he believed that it would go down in the text-books of that disease as a classical piece of information. He desired to make a motion, at this point, that the thanks of the Society be extended to Dr. Gradwohl for this excellent paper. DR. GRADWOHL, in closing, thanked the Society for the many honors showered upon him and hoped he would continue to merit them. In regard to glycosuria causing death, the speaker said he failed to see how glycosuria, per se, could cause death; he supposed that Dr. Reder meant that this was a concomitant symptom of an apoplectic condition, serious enough to produce death. In regard to hydrocephalus causing glycosuria, he said he thought there was a case mentioned where glycosuria was caused by this affection. Editorial Comment. THE May issue of the Medical and Surgical Review of Reviews devotes a number of pages to editorial comment upon the signal triumph of Dr. Wood as military governor of Santiago. The energy which transformed what was described as a cesspool and a charnel-house combined, into a city of fair sanitary arrangements, and in which the death-rate is not more than sixteen in a thousand, is one of the triumphs of medical science and modern sanitation. Governor Wood is spoken of as the "Paladin of the dust-cart," and his career as military governor is said to furnish an example of the fitness for administrative work developed by a medical training. SAVAGE peoples are not as ignorant of medicine and surgery as many people suppose. The descriptions which travelers give are always of the incantations and weird proceedings of the Medicine Man, and they sometimes omit references to the well directed use of a knife; the application of the omnipotent poultice; heat, cold, water, etc. In many cases the practice of medicine among the barbarians, stripped of its incantations, which are for the purpose of exorcising the evil spirit, is found to contain much that is of value, which exercises a useful purpose among a primitive people. The incantations are not even believed by the operators themselves to be efficacious, but they are part of the means resorted to by the Medicine Man to maintain his prestige, increase his clientage, and enlarge the fees. It is a sort of hocus pocus that seems to have been handed down from these primitive times, as part and parcel of the practice of medicine. Its counterpart can be found in the advertising columns of every daily newspaper, and exact reproductions are seen in the practices of the faith healers, Christian scientists, osteopaths, magnetic healers, etc. THE ninth annual report of the State Board of Medical Examiners of Tennessee has just been published by the secretary, Dr. T. J. Happel. He calls attention to a prediction in a previous report, that the law regarding examinations would be early attacked in the legislature. Within ten days after the assembling of the last legislature, five bills relating to medical practice were introduced. One of them proposed the repeal of the entire act and the others a practical abrogation of its usefulness by various amendments, among which were those especially directed toward recognizing the college diploma as an evidence of sufficient acquirements to admit of regis tration. It seems that Chicago is rapidly achieving an unenviable notoriety in the development of diploma mills. As Dr. Happel refers to having received a letter from the Dutton Medical College, this institution seems to have been organized for the purpose of imitating as closely as possible the name of the Dunham Medical College, an institution happily defunct. The Board of Health of Illinois no sooner gets after one of these institutions and revokes its charter than it is immediately reorganized under a new name. It is currently reported that one man has at least twenty different charters for medical institutions, and as soon as one is suppressed another name is employed, and the wretched business goes on. THE effect of the new law in New York placing the regulation of free dispensaries and hospitals under the care of the Department of Public Charities, has borne fruit. An ill-starred venture in the establishment of a cancer hospital in the lower part of New York City has been nipped in the bud. Application was made by Miss Rose Hawthorne Lathrop for articles of incorporation and the matter was referred by the Board to Dr. Stephen Smith, who reported adversely upon the establishment of such an institution upon the following grounds: While the respectability and motive of the people asking for the article are not questioned, such an institution is not needed in the locality it which it is situated. The patients can be accommodated and better cared for in the hospitals of the Department of Public Charities, with their efficient corps of trained nurses and skillful attending and resident physicians. Moreover, the institution is inadequately provided with medical attendants, its location is unhealthy, and its financial resources too uncertain and precarious to warrant a belief in their permanency." New York has been showing a splendid record of late years in medical legislation, and not the least important of the laws which it has passed relates to the control of the organization of dispensaries and hospitals. The profession has shown an indifference to the development of such institutions that is phenomenal, and we look to see the action of New York copied by many other states. The evil is greatest in those sections of the country where large cities are located, but the disease seems to be spreading rapidly to the larger towns and villages. Current Medical Literature A Buried Suture That Can be Removed.—A most ingenious method is that proposed by DR. MINERVINI, but one to whose complete understanding two neat cuts are necessary. He uses a heavy silk thread, a French needle and slender stiff body (wire or straight needle). Loops of his sutures from both sides of the incision are caught by having the stiff slender body drawn through them, the skin being sewn together over the whole, leaving one end of the thread and the slender body projecting from the wound. The whole can be readily removed by drawing out the slender body, thus leaving the separate loops no hold and withdrawing the thread entire. It is especially recommended in radical hernia operations. The Polyadenomata of the Large Intestine.†These may affect the entire gut, but are very uncommon, the most frequent seat being low down. They look like grapes, being attached by small pedicles to the apex of a fold of mucous membrane. In size they vary from the invisible to a pigeon egg, and are covered with mucous membrane. Microscopically, they consist of connective tissue and hypertrophied intestinal glands, with cylindrical epithelium and goblet cells. The larger adenomata frequently undergo cancerous transformation after they are several years old. The mean age at which polyadenomata develop is 31; they are more frequent in men. There are three principal symptoms: diarrhea, hemorrhage, and abdominal pains. Treatment is in these cases of two varieties, as the adenomata are simple or secondarily cancerous. In these latter conditions resections have been made, some successful, others not so on account of diarrhea continuing. In non-malignant cases, most surgeons have dilated the rectum and removed the separate tumors. Relief is in all cases only temporary, recurrence in situ or higher having occurred with hemorrhage and diarrhea. Landry's Paralysis.-W. H. HAYNES gives a summary of the etiology, pathology, symptomatology and course of this disease as far as at present determined. In diagnosis it may be confounded with multiple neuritis, transverse myelitis, disseminated myelitis, meningomyelitis, anterior poliomyelitis, and polioencephalitis; from these it is differentiated by the difference in history, onset, course, and limit of the parts affected, in involvement of sensibility and sphincters, and in results. Landry's paralysis lasts from a few days to fourteen weeks, its typical condition is one of flaccid paralysis of all the extremities, *Centralblatt für Chirurgie, May 20, 1899. + Revue de Chirurgie, April 10, 1899. N. Y. Med. Jour., May 27, 1899. with loss of reflexes, little disturbance of sensibility, normal electrical reaction, sphincters uninvolved, and it is universally fatal. As a method of treatment, the use of antistreptococcic serum of Marmorek is suggested, though it has so far been unsuccessful. The Possibility of Preventing Thrombosis of Veins in the Lower Extremities after Operations Requiring Long-Continued Rest in Bed.-Thrombosis, according to LENNANDER, bosis, according to LENNANDER,* has been noticed after aseptic operations when a dressing pressed upon the femoral vein or when an over-filled large intestine compressed the iliac. The same has been considered of infectious nature in a case of chronic colitis. Ziegler gives two reasons for thrombus formation in flowing blood: (1) slowing of the stream; (2) local change in the vein wall. Heart muscle changes and pressure on the iliac veins favor the first mentioned factor. Endophlebitis and fatty metamorphosis of the endothelium commonly come under the second head. The author attained most satisfactory results by elevating the foot of the bed after operation, and in very weak patients by subcutaneous saline injection, this assistance to the venous return of blood being sufcient to prevent thrombus formation. A Little Point of Great Importance in Transfusion.-L. J. Y. GENELLA† describes this method to prevent the introduction of air in transfusion: three ligatures are passed around the vein; the one farthest from the heart is tied; the second is not tied, but the third, passed three-quarters of an inch above the second, is tied, but as a slipknot. Make the incision between the second and third ligatures and introduce the needle with the saline solution running, so that it will pass through the second ligature; as the third ligature is tied, the fluid will flow out around the sides of the incision washing out any air which may have got into the vein; while the fluid is still running the second ligature is tied around the needle and the third ligature is removed, so opening the venous channel without danger of letting in any air. Changes in the Large Pyramidal Cells Following Lesions in the Internal Capsule.-M. MARINESCO examined the paracentral lobule, the frontal convolutions and the ascending parietal in six cases of old lesions of the internal capsule with a view of studying the changes in the large pyramidal cells of the cortex. These large pyramidal cells are situated deep in the cortex, and are characterized, normally, by their great size, by their numerous dendrites and by their chromophilic quality. The changes found in the cells bear a certain relation to the age of the lesion. The following pathologic changes were noted: Disappearance of the chromophilic elements *Centralblatt für Chirurgie, May 13, 1899. |