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THE SANITARIUM:: Battle Creek, Michigan,

Incorporated 1867.

The largest, most thoroughly equipped and one of the most favorably located in the United States. It is under strictly regular management. Eight physicians, well trained and of large experience. A quiet home-like place where trained nurses," "rest cure," "massage," "faradization," "galvanization," "static electrization," "Swedish movements," "dieting," baths," "physical training," and all that pertains to modern rational medical treatment can be had in perfection at reasonable prices. A special Hospital Building (150 beds) for surgical cases with finest hospital facilities and appliances. Large fan for Winter and Summer ventilation, absolutely devoid of usual Hospital Odors. Delightful Surroundings, Lake-side Resort. Pleasure Grounds, Steamers, Sail-boats, etc, Trained nurses, either sex, furnished at reasonable rates. J. H. KELLOGG, M. D., Sup', Battle Creek, Mich.


The undersigned have for several years been manufacturing a pure gluten for a few physicians. We are now prepared to furnish to the medical profession the one pure gluten biscuit manufactured in America. For samples and prices, address, Sanitarium Health-Food Co., Battle Creek, Mich.

Time-tried and Approved

Animal Extracts

Fairchild's Essence of Pepsine-made by direct maceration from the fresh lining glands of the calf rennet and pig stomach, in an aromatic, antiseptic solvent, especially devised for the extraction and preservation of all the soluble gastric principles. It is immensely superior to elixirs and cordials of pepsin, made by dissolving precipitated or peptone pepsins in elixirs.

Glycerinum Pepticum-a pure glycerin extract from the fresh

glands of the pig stomach, free from acid, alcohol or sugar.

Extractum Pancreatis-containing all the active principles and constituents of the fresh gland; will digest every form of alimentary substance.

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To contributors of Original Articles, a liberal number of copies of the HERALD will be given (or mailed free of expense if addresses are furnished), and the publishers will furnish reprints at cost, application for same to be made when copy is forwarded.

Illustrations will be furnished FREE for all articles requiring same, if drawings are furnished. Original Articles, Clinical Reports, Society Proceedings, Correspondence and News invited. Address all articles for publication, books for review and exchanges to the EDITOR. Address all correspondence relating to subscriptions and advertisements to MEDICAL HERALD CO., Sixth and Charles Streets. (See Publishers Bureau.)

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Professor of Gynecology, Post-Graduate Medical School; Gynecologist to Woman's Hospital, to Charity Hospital, and to Post-Graduate Hospital.

COR ten years I have followed with interest, gynecology and abdominal


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on forever. An autopsy is of interest when it reveals some useful object, be it anatomic, physiologic or pathologic. Autopsic revelations are generally limited to anatomic and pathologic matters. The autopsy indicates what the nature of the disease was and its exact locality. The highest interest in an autopsy lies in the fact that some physician who treated the living. patient should at least be present at the post-mortem. But in our country this is generally not possible. So that the autopsy reveals general interests without distinct regard to modes of individual treatment. The next highest interest in autopsies is that specialists should perform that part to which they have devoted their life's efforts. The future interests in autopsies lies in specialists doing their own. I have performed about two hundred autopsies, but the chief interest to me lies in the abdomen, so that my lessons will be from that cavity. By autopsies one learns, also, the use of organs.


As one opens the abdomen it may be observed that the omentum-the surgeon's friend, the man-of-war-tends to the left, that it seldom covers the caecum, that it is fixed to any old adhesions where inflammation has arisen. It may be seen that the omentum has checked peritonitis in various quarters of the abdominal cavity and, in short, has frequently saved life by burying the infectious invaders in old exudates forever. Finally the omentum prevents the invasion of infection from any part by peritonitis. We will quickly see that peritonitis is a life-saving process, while it is infection that kills. Peritonitis is nature's method of repair. That the omentum assumes a great and useful role in the animal economy which is chiefly found out by observing its condition in post-mortem. How are we to learn. visceral pathology? It must be chiefly studied by autopsies through the peritoneum. In looking into the abdomen of a dead subject we become impressed with the locality of disease, the organs it attacks and its nature. We see the shape, outline and locality of organs. We can observe, as on a map, the mountains of exudates or the hill of pathology in various districts of the abdomen. There are great and small regions where disease is apt to They must be discussed by noting where peritonitis is liable to arise. For peritonitis leaves its traces through the years. First, to generalize, we will note the three great districts where inflammation or peritonitis arises. These are:

(a) The pelvis, i. e., the infection invades the pelvic peritoneum through the ends of the Fallopian tubes. Pelvic peritonitis can be observed in at least 50 per cent of women which I have examined. Besides it may be noted that when the adhesions are at the mouth of one tube the mouth of the other tube is not generally free from peritonitis. The adhesions are of all kinds and degrees, from the spider-web kind to the dense bands of solid white connective tissue. It is of interest to practice cleavage in its various forms in the dead body, for in the living I know of three cases where holes were torn in the gut and the patients died. Good pelvic surgery depends on a surgeon's skill in accomplishing cleavage. Cleavage means the distinct and definite separation of peritonal layers which have adhered together from inflammation. The place to learn it is in the deadhouse, with female subjects having pelvic peritonitis. Pelvic peritonitis seldom kills because the inflammation is limited. The limitation of inflam-' mation is due to the force of gravity, the pendent pelvis, non-peristalsis and the definite bony surrounding. Also the pelvic peritoneum has learned through the ages, to resist inflammation in the female.

(b) Another great region of peritonitis is the appendicular and cecal. Four times as much peritonitis occurs around the appendix in man as in


woman. The reason is that women's Gerlach's valve-mouth of the appendix-is much wider than man's. If a foreign body fall into a woman's appendix it can easily fall out, but if it fall into a man's appendix it irritates and aids in closing the mouth of the appendix by edema of the mucous membrane. Again, in the region of the cecum there is a kind of inflammation produced by the contraction and relaxation of the psoas and iliac muscles. This same kind of inflammation arises over the psoa just under the sigmoid as it comes over it. This observation of peritonitis induced by the contraction and relaxation of the psoas and iliac muscles is an original view which came to me while pursuing autopsic work.

(c) The next general locality of peritonitis is the gall-bladder. Modern abdominal surgery has made its great progress in these three great regions of peritonitis, viz: pelvic, ceco-appendicular and gall-bladder. The abdominal surgeon soon maps out these districts when called to patients suffering with visceral disease. The minor regions of peritonitis are the sphincters-(a) pylorus, (b) ilio-cecal, (c) anus. Besides the flexures (d) the hepatic, (e) the splenic, (f) the sigmoid. Now visceral disease and consequently peritonitis is apt to arise in the above regions. A sphincter is a weak point, as it has a high function, a complicated nerve-apparatus, a periodic blood supply and a large lymphatic system. Malignancy and cicatrical tissue is apt to arise in a sphincter, both of which may induce peritonitis. Also, the colonic flexures may give rise to disease from trauma or irritation. The solid feces containing sharp, rough foreign bodies may wound the mucous membrane as they pass around its acute angle and with a wounded mucous membrane the way lies open for infectious invasion into the gut-wall or peritoneum. Outside of the peritoneum one learns the size and dimension of organs. One soon learns the various positions of organs and their wonderful variation. In the exact measurements of thirteen autopsies the colon averaged twenty-three inches. The shortest colon was thirteen inches and the longest forty-two inches. The difference was twenty-nine inches. The ascending colon averaged seven and one-half inches. It varied two inches in length. The longest descending colon was nearly ten inches; the shortest was six. It varied four inches. The small intestine measured twenty-eight feet; the shortest, thirteen feet. It varied fifteen feet. The average was nineteen feet. The sigmoid averaged twenty-three inches. The shortest was eight inches and the longest twenty-six inches. It varied eleven inches. These figures were taken from seventeen autopsies. So far as regards the abdominal viscera they vary within wide limits as to dimensions and position. A notable feature in the abdominal viscera is prolapse. The whole viscera falls toward the


pelvis. The mesenteries and supports elongate. In nearly every one of the seventeen autopsies the loops of the small intestine would pass through the hernial orifices artificially produced. In one case the ilium entered the ascending colon from behind and to the external side. In one case the caecum was arrested immediately under the liver and did not descend to its home in the iliac fossa. In four cases out of the seventeen the cecum hung in the pelvis. In each of these cases the cecum would herniate through the hernial rings. The cecum was so free that it would touch almost every organ in the body. In these four cases the peritoneum did not leave the posterior surface of the ascending colon for two or three inches above the entrance of the ilium. The ascending colon varies more than any portion of the large bowel, in position and dimension.

CLEVELAND, OHIO, Jan. 16, 1895.

MY DEAR DOCTOR:-The Cleveland Medical Society held its annual election at its quarters in the Chamber of Commerce rooms, on Friday evening, January 11, 1895. The following officers were elected: President, Wm. E. Wirt; First Vice-President, Aug. F. House; Second Vice-President, Henry S. Upson; Recording Secretary, W. F. Brokaw; Corresponding Secretary, Frank S. Clark; Treasurer, N. Stone Scott; Librarian, William E. Bruner; Censors, M. Rosenwasser, Howard S. Straight, L. B. Tuckerman, A. J. Cook, W. J. Scott; Pathologist, A. P. Ohlmacher; Trustees, H. G. Sherman, C. H. Gentsch and C. F. Dutton.

Immediately after the election the Society adjourned to the Hollenden Hotel, where the annual banquet was held.

The retiring president, Dr. W, H. Harriston stated in his address, that the society has 291 members; that the average attendance for the year was 135, being in this regard, second to no society of its kind in the United States, as shown by reports he had received from other societies. The society meets every two weeks. W. F. BROKAW, Secretary.

Sewer Gas and Throat Disease.-Dr. Beverley Robinson, of New York, (Provincial Medical Journal) has written an able article on this question and arrives at the following conclusions: "The influence of sewer gas upon diseases of the throat can be summarized as follows: 1. Given a patient with a so-called weak throat, subject to frequent attacks of quinsy, etc., expose him to sewer gas, he will probably develop amygdalitis. 2. Given a patient in good health, with a throat containing Klebs-Löeffler bacilli, expose him for any time to sewer-gas, and he will probably develop diphtheria; or, 3. Given a mild case of diphtheria, expose him to sewer gas, and the disease will assume a more malignant type. Therefore, although sewer gas plays an important part in the etiology of some throat diseases, it can by no means be held responsible as the primary all-efficient cause.”

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