lesion in the mouth to account for the pain, a general examination of the system was instituted, when it was discovered that the inner surface of the fundus of the uterus was ulcerated. Its cure was soon followed by a disappearance of the toothache. Dr. Storer relates two cases of neuralgia of the dental and gingival nerves occurring during the preg

nant state.

That thrombi, tumors, inflammatory processes, etc., at the base of the brain, within its substance, or about the cortex, may produce odontalgia is a proposition which finds but little support in the records of clinical cases. Nevertheless, such instances exist. Coleman mentions the Coleman mentions the case of an insane lady who repeatedly troubled him and other practitioners "to remove her sound teeth on account of the uncomfortable sensations which she referred to them." Dr. Stellwagon also states that he gave great offence to a military officer by refusing to extract some perfectly sound teeth which were the seat of severe odontalgic pain. The patient shortly after began to exhibit symptoms of softening of the brain. Rosenthal states that he has "seen old men, sixty to seventy years of age, suffering from melancholia complicated with neuralgia of the dental branches; these cases must be attributed to senile changes in the tissues (osseous canals or arteries)."

It is quite certain that hysteria frequently gives rise to or is associated with odontalgia. Dr. Richardson has stated that it is more common than generally supposed, and relates a case in illustration of his view that the toothache of pregnancy is frequently, if not always, connected with hysteria.

It has long been known that the various systemic conditions caused by the poisons of malaria, gout, syphilis, etc., while having no special and remarkable. tendency to produce pain which the patient localizes in the teeth, are yet frequently provocative of severe and obstinate forms of odontalgia. There can be no doubt that these kinds of reflexes exist, as noteworthy cases illustrate. In malarial districts toothaches of a distinctly periodical character are observed. In the gouty and rheumatic diathesis the pain

which usually localizes itself in the joints not infrequently selects one or more teeth for its local expression. In such cases the pain assumes the specific character of these diseases.

Dr. Flagg reports a case of odontalgia of malarial origin in which the patient had been under treatment for pain in her face for eighteen months. Dr. Latimer mentions a case of odontalgia of gouty origin in which a violent toothache was suddenly exchanged for a gouty pain in one of the great toes; and Dr. Harris reports a case in which a victim of gout for fifteen years went to him for odontalgia. An example of odontalgia of specific origin is given by Dr. Pierce of a young lady who had been suffering for several days from severe pain in all the teeth, though they were apparently free from disease. A few days later the trouble entirely disappeared upon the appearance of the eruption of measles.

Why the irritation from morbid conditions of the teeth should in one case result in wry-neck or facial spasm, and in another in blindness, in deafness, in chorea, in dyspepsia, in epilepsy, or in mania, is an inquiry beyond the purpose of this paper. But in this connection there is one thing beyond question: the cases presented leave no room for doubt that morbid conditions of the teeth may be, in other organs far removed, the fruitful sources of troubles whose real origin was hardly to be suspected.

Society Reports.

BALTIMORE MEDICAL AND SURGICAL ASSOCIATION.

MEETING HELD MAY 23, 1898.

DR. JOHN I. PENNINGTON, president, in the chair. Drs. Cary B. Gamble, Jr., and Thomas H. Brayshaw were elected to membership.

Dr. Randolph Winslow exhibited a patient who had been injured in a crowd. His physician, Dr. E. G. Welch, found a large swelling in the right flank and pust appeared in the urine. He had considerable pain. Dr. Winslow saw him in He was consultation with Dr. Welch.

admitted to the University Hospital. Nephrotomy was performed. He appeared to progress well until symptoms of suppuration again manifested themselves. The kidney was then removed. Considerable shock followed, from which he rallied. The patient now weighs more than he ever did before. Dr. Winslow's assistant removed a calculus from one of the calices of the kidney. The crush in the crowd probably caused this to set up inflammation and suppuration. There were six distinct abscess cavities found in the kidney.

Dr. John T. King: He has at present a similar case. The left kidney was affected. This was removed. The case had at first been diagnosed as one of simple cystitis. The urine, however, was acid, showing that the trouble was in the kidney. After the removal of the left kidney the right ceased to act. Uremic poisoning was manifest and an unfavorable prognosis was given. He, however, recovered.

Dr. James E. Gibbons read a paper on "The Therapeutics of Summer Complaint of Children."

Dr. A. K. Bond: Victor C. Vaughan makes four classes of infantile diarrheas, viz., acute and chronic intestinal indigestion and acute and chronic milk infection. For the milk infection the first thing is absolute withdrawal of the milk, even breast milk, for a week or so. Feed the child on boiled water, barley water, starches, grain preparations, egg, meat preparations. It would be better for the child to be starved for a day or two than to be poisoned. A nervous element is often present. This is the case in cholera infantum. He believes that morphia hypodermically, very cautiously given, would be beneficial in children. He thinks that the injection of water under the skin would be helpful, just as the injection of saline solution in post-partum hemorrhage does good.

He

Dr. J. T. King: Every year he gives less and less of drugs in these cases. Cleanse the intestinal tract; then employ hygienic measures. He gives opium very sparingly and watches the cases carefully. Diet is all important. Avoid giving cow's milk or any other food for mother's milk. There is too great a ten

dency for mothers to refuse to nurse their children.

Dr. John I. Pennington appreciates fully what Dr. Bond has said about milk poisoning. Another difficulty about cow's milk is that we do not know on what the cows are fed. Another trouble about the mother is that women know nothing about surgical cleanliness.

Dr. Morris C. Robins: Dr. Bond has made a good point in regard to the classification of infantile diarrheas. Mother's milk is often at fault. An analysis would reveal the defect. Numbers of children are killed with paregoric. He questions if it is ever wise to use opium. He recommends calomel.

Dr. Bond: The hypodermic of morphia. that he spoke of was in connection with cholera infantum. In the ordinary gastro-intestinal catarrh we would go too far in stopping the use of opium, but use it cautiously. In regard to mother's milk, many mothers are not in proper condition to nurse the baby. Some infantile diarrheas are due to heat-stroke.

Dr. M. C. Robins: Antiseptics will check diarrhea almost as quickly as opium.

Dr. J. E. Gibbons would not care to have Dr. Bond try a hypodermic of morphia on his very young infant. Calomel is the sheet-anchor. There is a danger of not giving enough drugs when we pay so much attention to diet. Mother's milk is frequently at fault.

Dr. Wirt A. Duvall read a paper on "Lateral Curvature of the Spine, and the Corset," in which he claimed that the corset is responsible for the majority of cases of that trouble occurring in the female.

Dr. Randolph Winslow thinks that a woman needs the corset to support the breasts.

Dr. A. K. Bond: When women leave off the corset something should take its place to supply the proper amount of warmth.

Dr. Duvall wished more particularly to call attention to young girls growing up. Bags and straps from the shoulders would support the breasts.

The association then adjourned until the second Monday in October.

EUGENE LEE CRUTCHFIELD, M.D.,
Secretary.

Medical Progress.

PREGNANCY FOLLOWING VENTROFIXATION WITH IMPROVEMENTS IN TECHNIQUE.—Author's abstract of paper read before American Gynecological Society at Boston, May 24, 1898, by A. Laphorn Smith, M.D., M.R.C.S., England; Fellow of the American Gynecological Society; Professor of Clinical Gynecology, Bishop's University, Montreal; Gynecologist to the Montreal Dispensary; Surgeon-in-Chief of the Samaritan Hospital for Women; Surgeon to the Western General Hospital.

His conclusions were based upon about 2500 cases by forty-one operators, including III cases of his own, reported in reply to a circular-letter of inquiry.

1. That as far as curing retrodisplacements is concerned, whether retroflexion, retroversion, anteflexion with retroversion, and also prolapse of the uterus, ventrofixation with two buried silk stitches passing through peritoneum and fascia. gives the most reliable results. Failures are unknown when the operation is performed in this way.

2. Ventrofixation should be reserved for cases in which abdominal section is necessary for other reasons, such as detaching of adhesions and the removal of the diseased tubes which caused the adhesions. When it is expected that pregnancy may follow, some other operation should be chosen, because—

3. Although pregnancy only followed in 148 cases out of about 2500, still in 30 per cent. of these, or thirty-six, there was pain, miscarriage or difficult labor requiring obstetrical operations.

4. When suspensio uteri was performed, that is, the uterus attached to the peritoneum, only a few relapses occurred; but on the other hand the patients were free from pain during pregnancy and the labors were less tedious; neither did they require resort to serious obstetrical operations. The uterus should therefore be suspended rather than fixed to the abdominal wall in all cases in which any part of the ovary is allowed to remain.

5. A third method, it is claimed by some, namely, the intra-abdominal shortening of the round ligaments, is prefer

able to either ventrofixation or suspensio uteri. This may be done either by drawing a loop of the round ligament into the loop which ties off the ovary and tube; or, in cases in which the latter are not removed, simply to detach them from adhesions and shorten the round ligament by drawing up a loop of it and stitching it to itself for a space of about two inches. By this means the round ligament develops as pregnancy advances, and the dragging and pain and other more serious accidents which are present in 30 per cent. of the cases of ventrofixation are certainly avoided.

6. If the uterus is attached to the abdominal wall, the stitches should be kept on the anterior surface, but near the top of the fundus; the complications were more frequent when there was too much anteversion than was the case when the anterior surface of the fundus was attached to the abdominal wall.

7. As large a surface as possible should be made to adhere by scarifying both the anterior surface of the fundus and the corresponding surface of the abdominal peritoneum, in which case one buried silk suture will be sufficient to keep the uterus in good position.

8. Several of my correspondents mentioned incidentally that they knew of many cases of pregnancy after Alexander's operation and that in no case was the pregnancy or labor unfavorably influenced by it. Alexander's operation should, therefore, be preferred whenever the uterus and appendages are free from adhesions.

9. The results of Alexander's operation are so good that even when there are adhesions it might be well to adopt the procedure of freeing the adhesions by at very small median incision and then shortening the round ligaments by Alexander's method, after which the abdomen should be closed. This could be done without adding more than one-half of I per cent. to the mortality, which in Alexander's operation is nil.

Dr.

results of his investigations have been published in the Lancet. The total number of cases collected by him is thirtyeight. Of these, twenty-five were those of children under five years of age. The paralytic seizure occurred in most cases during the ascendency of the disease, but in some during its decline. It was associated with severe types and sometimes with various complications, such as scarlet fever, broncho-pneumonia, etc. Leroux classifies the resulting lesions. under four chief headings. 1. Cerebral paralysis. This is commonly hemiplegia, though two cases of monoplegia, both of the right arm, are also recorded, as well as cases of aphasia and cases of disturbance of special senses. 2. Of spinal paralysis two cases with paraplegia of the legs are quoted. 3. There are also four cases which appear to depend upon peripheral disorders, different groups of muscles being involved in each case. An example of disseminated sclerosis, though possibly existent before the cough began, appeared to be distinctly aggravated by its development.

4.

Dr. Leroux draws attention to the question of prognosis. He finds the mortality to be six cases out of the thirtyeight, and he directs attention to the fact that very young children are particularly liable not only to die, but where this result is prevented, to retain a degree of permanent paralysis. As the age of the child increases the prospect of complete recovery from a seizure improves. The pathology of these various conditions, though more or less obscure in many cases, is decipherable with tolerable clearness by the light obtained from a limited number of necropsies. It comprises congestions,

hemorrhages-submeningeal, meningeal and cerebral-and patches of inflammatory softening. In discussing this part of his subject Dr. Leroux notes the fact that the cough paroxysm alone does not account for the nerve paralyses, as these have occurred repeatedly during the decline of the disease. He is disposed rather to regard whooping-cough as exercising a damaging influence on the coats of blood vessels in the nervous tissues, very much in the same way as other infections have been shown to do.

Whether this theory be entirely justified or not, it is at least instructive to be reminded of a complication which, though rare, has long been recognized among the less regular characteristics of whooping-cough. Its bearing on treatment is obvious. In this connection much is apt to be left to nature, but the cases above mentioned ought to impress the fact that there is a very real purpose in the maintenance of effectual sedative measures. The common practice of exposing children out-of-doors in all weathers is much to be reprobated as tending to induce those pulmonary troubles which are liable to induce convulsions and thus easily lead to other and dangerous forms of brain disturbance.

SEDENTARY EMPLOYMENTS.-Very little observation will suffice to convince anyone of the difference which exists between those who follow sedentary and those engaged in outdoor occupations, as far as their physical appearance goes. The city clerk, the employes in shops, and those who follow sedentary occupations, whether male or female, do not, says the Lancet, usually present anything like the healthy appearance, nor have they the coloring, the healthy facial expression, or the robust aspect and upstanding carriage of those who live in the country or at the seaside, or of those who follow an out-of-doors life and take sufficient physical exercise. But making every allowance for the depressing effect of sedentary habits and occupations in these respects, how much of it is avoidable and attributable to the unhygien:c conditions, personal and otherwise, under which such occupations are carried on? It will be frequently found that the offices. rooms and places of business in which clerks and others are employed for the greater part of the day are small, badly lighted, ventilated and warmed; that the air is more or less stagnant and foul, owing to complicated or bad structural arrangements, with probably narrow, tortuous, dark passages; that the water closets are improperly placed, and that a good deal of overcrowding exists. Now although a sedentary life is not, of course, the healthiest kind of life, it is,

nevertheless, more or less healthy in proportion as the local conditions are healthy or otherwise. Clerks and city employes are not generally robust folk; they usually possess a feeble circulation; their work is nerve-exhausting, entailing, as it does, various degrees of mental tension and strain of eyesight, and sedentary work is, moreover, cold work. Those employed are liable from the nature of their duties and the closeness of the atmosphere in which they have to pursue them to headaches and a feeling of exhaustion which probably induces many of them to have recourse to "nips" of alcohol. The necessary remedies obviously are fresh air and light, together with warmth; the incoming air requires to be warmed during the greater part of the year in this climate. Business people in the city, even to put the matter on merely economical grounds, do not practically get the best attainable out of those in their

employ for want of proper care and attention to these details, to say nothing of the inconvenience and pecuniary loss arising from frequent absences from temGreat imporary causes of ill-health. provement has no doubt taken place of late years, and most of the banks and large city offices are well provided in these respects, but there still remains much to be done which could be effected if enlightened views about the laws of health and hygiene were more generally recognized than they are.

MOVABLE KIDNEY.-Dr. John A. Lechty, in making a report of cases of movable kidney in the Philadelphia Medical Journal, concludes as follows:

1. Movable kidney may be easily overlooked.

2. Unless due to some disease in the organ itself, movable kidney is consequent to a peculiar fault in nutrition, and is always accompanied by some nervous symptoms.

3. The treatment of movable kidney, not due to any pathologic change within itself, must always be directed towards the correction of the faulty nutrition, and a regaining of at least the normal bodyweight.

4. If the symptoms do not disappear after this is accomplished, fit a supporting bandage.

5. If the symptoms disappear with a bandage, and if later it seems necessary to wear this continually, give the patient a choice between the bandage and a surgical operation.

6. If the symptoms do not disappear after the normal body-weight is gained, or after a thorougn trial of the bandage, operate, fixing the kidney permanently.

7. I movable kidney is due to disease in the kidney itself, remove the kidney early if at all allowable.

METHYLENE BLUE IN DIABETES MELLITUS.-A case reported in the TheraA man of peutic Gazette is of interest. fifty-three years, suffering from headache and general malaise and other evidences of diabetes mellitus, including glycosuria and albuminuria, received five to eight grains of methylene blue, and under these circumstances the albumen materially diminished and the sugar markedly decreased in quantity. The quantity of urine was also decreased. In a second case the results were equally satisfactory. In this instance four pills of methylene blue to the amount of two grains each were administered each day with marked benefit. One advantage of this treatment is that it tends to relieve any neuralgic pains from which the patient may be suffering.

TRACHEOTOMY AFTER THE USE OF ANTITOXINE.-Noccioli (British Medical Journal) contributes some statistics as to the results of tracheotomy in diphtheria after the use of serum. His tracheotomies number fifteen in all; of these, seven died and eight were cured. But for various reasons four of the deaths can be excluded, which brings the mortality down to 25 per cent., a great improvement on the statistics of the operation before the use of antitoxine. The author never used an anesthetic; in all cases except one he performed the high operation. No inconvenience followed the removal of the tracheotomy tube, usually on the eighth or tenth day after the operation.