fall from large doses of alcohol, probably because of the greater narcosis the combination produces.

Aside from considerable quickening during the first hour or two, alcohol had little effect on the respiration; caffein alone had little effect on respiration except for a slight quickening with large doses. Caffein in any dose exerted little influence on alcohol in any dose. The combination of a moderate dose (4) cubic centimeters) of alcohol with a large quantity of caffein results in a somewhat greater quickening. Large doses of alcohol show less quickening when caffein is added. In the former experiments on dogs, caffein caused considerable increase in the rate and depth of respiration and experiments in the literature show a greater respiratory response to caffein than was obtained. in this series and it would seem that the respiratory response of cats to caffein is less than that of other animals.

If one may deduce a practical application from this work it would seem to be the following: In severe acute alcoholic intoxication little is to be expected from caffein. In somewhat severe intoxication large therapeutic doses of caffein (5 to 15 grains) may lessen the narcosis and hasten recovery. In still more severe intoxications caffein does not lessen the narcosis and may increase it, and, further, the danger in alcoholic poisoning lies in the vascular paralysis and subsequent loss of heat which caffein in no way lessens, but may increase.

The work was done with Professor Torald Sollman, to whom I gratefully acknowledge my indebtedness.

Clinical-Pathological Note.

EDITOR'S NOTE: Under this read it is hoped to publish from time to time, brief summaries of cases of more than usual interest, cases in which the clinical and pathological findings help to elucidate each other.

Complete Amyloid Infiltration of Both Adrenals Associated with Addison's Disease.

M. K., a Pole, aged 25 years, was admitted to the City Hospital on July 13 with a diagnosis of tuberculous peritonitis. He had entered the Lakeside Hospital on May 29, complaining of pain in the abdomen which had been present for four months; swelling of the legs and loss of weight. His family and personal history were negative. The notes of the physical examination made at the time of admission to the Lakeside Hospital state that the skin was normal, although one of the Resident Staff has since called attention to the fact that there was a suggestion of discoloration, which was supposed to be of the type sometimes found associated with

tuberculosis. The abdomen was greatly distended, the border of the liver was at the costal margin and the spleen could not be felt because of the abdominal distension and tenderness.

During his stay at the Lakeside Hospital the patient was tapped three times, large amounts of cloudy, yellowish fluid termed chylous being removed from the pleural and peritoneal cavities. After his removal to the City Hospital he was repeatedly tapped. The red blood corpuscles numbered 3,000,000, the white corpuscles 27,500. The urine contained 2.3% of albumin and many casts of all kinds. The temperature was variable while at the City Hospital, running from subnormal to 103° shortly before death.

Although the clinical diagnosis which appears upon the City Hospital records of the case is tuberculous peritonitis the diagnosis of Addison's disease was also considered. In favor of this were such bronzing of the skin as was present, a small area of pigmentation upon the lower lip, the marked asthenia and emaciation and the poor circulation without organic heart disease. The patient died on November 3, the duration of his illness having been, therefore, nine months.

At autopsy, the serous membranes showed nothing which would account for the effusions which had been present. In the liver there were numerous gummata, most of them subcapsular, a few calcified. The liver lobules were outlined by an increase in interlobular stroma which was not marked enough, however, to cause deformity or a hobnailed surface. The liver weighed 1,300 grams. The spleen weighed 800 grams. It was very firm, the cut surface showing a peculiar, uniform, dark, reddishbrown appearance, leading to the belief that the chief cause of the increase in size was a diffuse stroma proliferation. The adrenals were of the so-called paper type, very thin, with an unusually large surface area. There was the normal differentiation between cortex and medulla and in the absence of any gummata or necrosis an adrenal insufficiency was considered improbable.

Microscopically, the interlobular inflammation in the liver is found to be quite active, the connective tissue being young and richly infiltrated with lymphocytes. Lymphocytes are also present within the lobules. The change in the liver reminds one more of congenital syphilis than of the dense fibrosis which is usually associated with the gummata of tertiary lues. The spleen is almost wholly transformed into amyloid. About some of the smaller arterioles a few of the lymphoid cells of the original Malpighian bodies still remain. The normal cellular pulp has disappeared entirely, being replaced by the homogeneous amyloid material through which run the distended venous sinuses. Both adrenals have also undergone practically complete amyloid transformation. Only the shadows and outlines of the alveoli of the original parenchyma are seen, separated from each other rather more widely than normal by amyloid. The parenchyma cells have almost entirely disappeared. Such as can still be recognized are shrunken, granular, with very small pyknotic nuclei.

Addison's disease due to syphilis is not an exceedingly uncommon condition. In the cases reported, however, the adrenal destruction has been due to the localization of the active specific inflammatory process in the glands; the caseation consequent upon gumma formation may involve the structures to such a degree as to produce an adrenal insufficiency. In this case the insufficiency was not due to an actual destructive syphilitic process, but to the nonspecific amyloid infiltration which occurs so frequently in other organs in tertiary lues. Although primarily

due to syphilis the insufficiency in this case cannot be considered due to syphilis of the adrenals. The same unusual complication might follow any of the processes other than syphilis in which long continued destruction of the tissues of certain organs leads to amyloid infiltration of other organs.

O. T. SCHULTZ.

Wound Surgery in 1569.

I found him in a high fever, his eyes deep sunken, with a moribund and yellowish face, his tongue dry and parched, and the whole body much wasted and lean, the voice low, as of a man very near death; and I found his thigh much inflamed, suppurating, and ulcerated, discharging a greenish and very offensive sanies. I probed it with a silver probe, wherewith I found a large cavity in the middle of the thigh, and others round the knee, sanious and cuniculate; also several scales of bone, some loose, others' not. The leg was greatly swelled and imbued with pituitous humor and bent and drawn back. It seemed

to me there was little hope he would escape death.

After dinner, we began our consultation, all the physicians and surgeons together.

The consultation ended, we went back to the patient, and I made three openings in his thigh. Soon after he asked

to sleep; which he did for near four hours; and everybody in the house began to feel happy.

The following days, I made injections into the depth and cavities of the ulcers of Egyptiacum dissolved sometimes in eau-de-vie, other times in wine. I applied compresses to the bottom of the sinuous tracks to cleanse and dry the soft spongy flesh, and hollow leaden tents, that the sanies might always have a way out; and above them a large plaster of Diacalcitheos dissolved in wine. And I bandaged him so skillfully that he had no pain; and when the pain was gone the fever began at once to abate. And all that we agreed in consultation was done in due time and order; and so soon as his pains and fever ceased he began steadily to mend. He dismissed two of his surgeons and one of his physicians, so that we were but three with him.— Ambroise Paré, "Journeys in Diverse Places"; The Journey to Flanders, 1569.

CONTINUING THE CLEVELAND MEDICAL GAZette and

THE CLEVELAND JOURNAL OF MEDICINE

MONTHLY

THE OFFICIAL ORGAN OF THE ACADEMY OF MEDICINE OF CLEVELAND EDITOR, OSCAR T. SCHULTZ, M. D.

Entered March 7, 1902, as Second-Class Matter, Post-Office at Cleveland, Ohio, under Act of Congress of March 3, 1879.

Reprints of articles will be furnished authors at a reasonable price.

All remittances to the Journal should be made payable to The Cleveland Medical Journal

Short notes upon clinical experiences or reports of interesting cases will be welcomed by the editors.

Original articles are accepted for publication by this Journal only with the distinct understanding that they are contributed solely to this Journal and will not be published elsewhere as original.

EDITORIAL

Valedictory.

With this issue it becomes necessary to pronounce a benediction and to announce the retirement, because of the pressure of other duties, of Doctor William H. Weir from the editorship of THE JOURNAL. In the five years during which he was helmsman of the ship of fate of THE CLEVELAND MEDICAL JOURNAL the latter was transformed from a publication which was more or less frankly commercial into a journal which is clean, which tries to seek such light as the medical horizon may yield and which is, it is hoped, of some slight value other than as shaving paper. In this transformation Doctor Weir had an important part and he gave unreservedly of his energy and un

stintedly of his time. Only those who have had the interests of THE JOURNAL most at heart can realize how freely he gave of himself and how uncomplainingly he bore a too heavy burden under often vexatious conditions. Much as Doctor Weir's departure from the field that he has tilled so well is to be regretted, it must be admitted that his rest is well earned and that such surcease from editorial pangs and pains as he may be able to obtain is fully deserved. What we might say of him would do him but poor justice His reward must continue to lie in the knowledge that those who know best how and how hard he has worked in the interests of THE JOURNAL appreciate most fully his services.

By way of salutation little enough is to be said. The present policy in regard to advertising is to be continued. Of definite editorial policies we have as yet none, except the wish to maintain THE JOURNAL at its present standard. The editor, however god-like he may appear to any except the printer's devil, is, after all, only the humble servant of those that THE JOURNAL seeks to serve. More important, in the determination of the value of a publication, than the editor and those more actively associated with him, is the nature of the publication's clientele. Our own feeling is that if the medical profession of Cleveland deserves a journal it deserves a good one or none at all. Our hope is not so much that THE CLEVELAND MEDICAL JOURNAL may be worthy of the Cleveland medical profession as that the profession may be worthy of a good journal. Given the latter condition and the journal must inevitably follow. THE CLEVELAND MEDICAL JOURNAL can be very little better than the work of the local profession, its tone can be but very little higher than that which the physicians of Cleveland, as a body, express in their professional activities, it can do little more than reflect the glories or mirror the defects which the profession may show. As editor we shall, therefore, be most humble in the acceptance of such help as may be offered and most willing in the receipt of such suggestions as may be made with the purpose of improving THE JOURNAL.

O. T. S.

Money Before Health.

An interesting commentary on the modern point of view may be taken from the editorial page of a recent number of the