DR. F. MAAS, of Detroit, read a paper which was largely a statistical one, in which he pointed out the comparative value of the medical and surgical treatment of appendicitis.

DIAGNOSIS OF HYSTERIA.

By DR. HUGH T. PATRICK, of Chicago.

The writer dwelt particularly upon the peculiarities of hysterical anes thesia, hyperesthesia, and paralyses. The principal peculiarities of the first are its distribution in the form of a glove, sleeve, or stocking, with sharply cut border and in disseminated and irregular patches. Dr. Patrick called attention to a distinguishing trait not yet described, namely, almost instantaneous and normal areas.

This pe

culiar feature applies equally well to hyperesthesia. Among the hyperesthesias was described hysterical joint diseases and hysterical anglina pectoris with differential points of diagnosis between these affections and organic disease. The peculiarities of the hysterical gait were described at some length, and their relation shown to the affection described by Blocq and called by him astasia-abasia. The writer protested against this affection being considered a nosological entity, as it is simply an exaggeration of a common feature in hysterical paralyses. The peculiarities which distinguish an hysterical from an organic paralsis of the upper extremity were also described, and hysterical affections of the special senses were briefly alluded to.

THE DEFLECTED SEPTUM AND ITS

REPAIR.

This paper was read by DR. J. HOMER COULTER, of Chicago. The author first dwelt upon the etiology of the condition. In stenosis of any degree, there is created in each inspiration within the cavity, a more or less complete vacuum. Thus the atmospheric pressure is to that degree increased and is a constant force of no inconsiderable gravity. He holds further that such a course would be more efficient in producing structural changes in the cartilaginous septum than would be a more violent force suddenly applied, because the natural cartilaginous resiliency would more easily recover and throw off the effect of the latter.

The author then gave the points in the operation because in the observance of these lies the success of the operator. Where the deviation is well anterior, or involving merely the alae, it is very much simplified because of convenience in operating, and aftertreatment as well. Until recent years but little attention was paid to the presevation of the mucous membrane, when operating on a deflected septum. A new form of punch was suggested for removing the cartilage and leaving the membrane intact.

DR. W. F. BREAKEY, of Ann Arbor, Mich., read a paper entitled A CASE OF COMMINUTED FRACTURE OF THE ILIUM, WITH SPECIMEN AND PHOTOGRAPH.

No reports show such an extensive fracture of the ilium as this case. It was literally shattered into pieces. The patient fell ten feet on a pile of stones, producing this fracture and also a Colles' fracture with dislocation of ulna. The patient never rallied from the shock of the accident. THE TREATMENT OF CANCER.

By DR. HAL C. WYMAN, of Detroit. The cure of cancer is rare, and unless the treatment is begun early, the disease terminates in death. In the treatment of cancer, there is still an open field. The cure by early removal, while the disease is local, is urged and practiced by all who have opportunity. But the opportunity will not occur with sufficient frequency to stamp out the disease until the people are educated as to the facts.

DR. LEWIS C. CLINE, of Indianapolis, read a paper on LARYNGITIS FROM A RHINOLOGICAL STANDPOINT.

The author adheres to Bosworth's the word it is only to inflammations of a purely catarrhal character, which classification of laryngitis, and applies excludes at once syphilis, tuberculosis, and all other constitutional diseases, as they are more properly called syphilis or tuberculosis of the larynx.

The cases that are least amenable to treatment are the atrophic, but much can be done to comfort and palliate these cases by attention to dress, stimulant and lubricant applications. For stimulating and astringing, he finds nothing equal to nitrate

of silver, from 10 to 40 grains to the ounce, according to indications. For overwork cases, the first law is rest, with occasional mild, stimulating applications with an atomizer. The great majority of cases that had come under his observation had had atrophic or hypertrophic rhinitis to a greater or less degree. Spurs and deflected septum are often associated with these conditions. The lesions most frequently observed are hypertrophies of the posterior ends of the inferior turbinate bodies, and a thickened, lumpy condition of the posterior end of the septum. The drill, saw, snare and galvano-cautery are aids in removing these conditions in the more aggravated forms while the application of silver and various astringents with sprays had served the author in the mild forms.

DR. J. A. WESSINGER, of Ann Arbor, Mich., contributed a paper on THE THERAPEUTICS OF OLEO-CRE

OSOTE, AND CREOSOTE CARBON-
ΑΤΕ.

He summed up his his experience with these remedies in the following conclusions: (1) The dosage is practically unlimited as far as toxicity is concerned, but it is preferable to begin with a small dosage two or three drops after eating, and increase until the result is obtained. (2) To be of value in tuberculosis, a clinical diagnosis must be made early. (3) While these agents are distinctly germicidal, they also serve as tissue builders. (4) Creosote carbonate and oleate have the power of increasing the number of red blood corpuscles, and they also increase the percentage of hemoglobin in the blood.

DR. I. N. LOVE, of St. Louis, read a paper entitled

THE BICYCLE FROM A MEDICAL STANDPOINT.

Bicyclists should understand the importance of going reasonably slow. The wheel brings into play all the muscles, and the maintaining of equipoise has beneficial results. The matter of position is important. The rider should maintain an erect posture and not assume an unsightly stoop in imitation of the hoop-snake, which takes

598

its tail in its mouth and sails through the country. A study of the question of the wheel for women has resulted in an opinion favorable to its moderate use in cases of acute diseases. Specialists have agreed to this. Numerous cases of long standing pelvic diseases have been benefited by a judicious use of the bicycle. Women maintain a better position than men. An hour's wheeling three times a day is ample. The costume is important from the standpoints of health and art. He objected most emphatically to bloomers, which lessened the respect of mankind for womanhood, and blemished the landscape. Leggins and accordion plaited skirts were about the thing. Corsets should be set aside. Skirt and shirt-waist were favored, and even the sweater was approved.

The discussion was opened by DR. C. B. PARKER, of Cleveland, and continued by DR. W. N. WISHARD. of Indianapolis, DR. STERNE, of Indianapolis, DR. WALKER, of Evansville, Ind. They all advocated and advised a moderate use of the wheel for both men and women.

A paper was read by DR. T. 0. SUMMERS, of St. Louis, entitled THE PHYSIOLOGICAL

LEUCOCYTOSIS,

ASPECT

OF

And one by DR. A. GOLDSPOHN, of Chicago, on

THE PROPER INDICATIONS FOR REPAIR OF PATHOLOGICAL LACERATIONS OF THE CERVIX UTERI, AND FOR THE RELIEF OF PATHOLOGICAL ANTEFLEXIONS AND THE PROPER OPERATIONS TO MEET THEM.

DR. K. K. WHEELOCK, of Fort Wayne, Ind., read a paper entitled RHEUMATISM AND GOUT IN ITS RELATION TO THE EYE.

The paper was a thoroughly practical one and presented this somewhat old but nevertheless important subject in an interesting manner. The paper elicited a warm discussion.

DR. G. W. M'CASKEY, of Fort Wayne, Ind., followed with a contribution on

BIO-CHEMISTRY IN ITS RELATION

TO NERVOUS DISEASES.

In this paper the somewhat peculiar and certainly novel attempt was made to establish the general theory of the causation of nervous diseases by chemical poisons, circulating in the blood, and acting by a process of selective affinity upon different parts of the nervous system. The author referred to these poisons under the following groups, the classification being entirely tentative, and based upon their source of origin instead of their ultimate chemical analysis or physiological action. (1) Bacteriological products-ptomaines. (2) Products of per verted tissue metabolism. (3) Defective elimination of excretion. (4) Perverted secretion of glandular organs. (5) Products of imperfect digestion. (6) Chemical compounds probably present in independent blood-states, and of unknown origin.

Many conditions heretofore unknown as to their etiology will be found to be due to one of the above conditions existing in the system.

One of the most popular and practical papers of the Section was that read by DR. J. H. TAYLOR, of Indianapolis, entitled

HOW SHALL WE REAR OUR BA

BIES?

The suggestions and directions were for both physician and mother, and put in so pointed a manner that the paper ought to have a wide circulation. The next paper was by DR. FENTON B. TURCK, of Chicago, which was entitled

DISEASES OF THE MOUTH, NOSE AND THROAT, AS ETIOLOGICAL FACTORS IN CHRONIC GLANDULAR GASTRITIS, WITH BACTERIOLOGIC STUDIES OF THE PHARYNGEAL VAULT.

Bacteriologic study has developed the fact that upon the mocus membrane of the mouth, nose and pharynx, groups of micro-organisms may form which may also be found growing on the mucous membrane of the stomach in gastritis. Under normal conditions, the mucous membrane of the stomach does not favor colonization upon its walls; but let some etiologic factor come into play and microorganisms will develop. The mouth,

nose and throat when in a diseased state, become incubators ready to infect when the conditions of the stomach permit the development of growing micro-organisms upon its walls. The author then referred to the bacteriologic studies of Miller, Wurtz and Lindet. Micro-organisms of the mouth are carried by the food after mastication into the stomach; many of them are again recognized in the stomach and in cases of gastritis are found in colonies growing upon the mucous walls. The author in his clinical and experimental work has presented similar groups of micro-organisms taken from the gums and cavities in the teeth as well as from the material removed by the Gyromele (revolving sound) from the walls of the stomach. In cultures upon the prepared mucous membrane of the pig, he has been able to cultivate some of the micro-organisms and finds the same developing in the stomach that are found in the mouth, but in the control animal, he has not yet found micro-organisms growing in colonies in the stomach.

After reporting several cases, Dr. Turck concluded that clinical observation indicates a marked relation between diseases of the mouth and postnnasal cavity and chronic inflammation in the stomach and intestines; that the invasion of the stomach from the infected mouth and pharynx is supported by the fact that many of the pathogenic micro-organisms present the identical, biological and physical forms in cases of gastritis, the same as those found in diseases of the mouth and post-nasal cavities of the same patients.

DR. TURCK exhibited a chart showing the predominating micro-organisms found in eight cases that were studied bacteriologically.

In the discussion, DR. LARRABEE of Louisville, said that the germ theory had been superceded by germ facts as presented.

DR. FRANK BILLINGS, of Chicago complimented Dr. Turck on his excellent clinical and experimental work, saying that the doctor stands at the head of the profession in the work he has accomplished. He had shown that when there is a lowered vitality of the mucous membrane of the

In which he gave the history of nine sases of this disease, seven of which had been treated with the serum. The patients all improved greatly. One case particularly lost completely all dysphagia, pain in the larynx, cough and night sweats. Other patients showed a much greater improvement than under any other plan of treatment yet tried. The doctor quoted the confirmatory evidence of Maragliano of Genoa, Cole, Semon, Wiggins and Paquin. eH will continue his investigations and present further conclusions at a later date.

In the discussion, DR. PAUL PAQUIN, of St. Louis, explained in detail the treatment which he had instituted He said it was just in its beginning. It will have to be improved as we go along, and it will take years to do so. The best results have been obtained in the acute form of the disease, and not in the chronic. The law underlying serum-therapy is a natural one. It is trying to fight bacteria by using Nature's remedy. He had had failures with serum, but he could mention forty or more cases of recovery. He thought that in some cases it would require other treatment besides serum He had not had good results inside of two or three months, and it frequently required five or six months, or even longer. He had made over 10,000 injections of sérum in tubercular patients and did not recall one which was attended with fatal results. He counseled study of the climate, as well as the patient, before sending a patient away. Tuberculous patients could not live in Colorado or New Mexico. They will die quicker there than anywhere.

THE USE OF DRY HEAT OF HIGH TEMPERATURE IN THE TREATMENT OF JOINT DISEASES.

This paper was read by DR. WILLIAM E. WIRT, of Cleveland, 0. Shortly after reading a description of

this treatment in the medical journals the essayist encountered a case of rheumatoid arthritis, in which he resorted to this method. The treatment was followed by great improvement in the motion of the joint, and in the comfort felt by the patient. He also reported a case of rhematism of a year's standing in which there was more or less fixation. He broke up the adhesions, made use of the high application of heat, and raised the temperature to 290 degrees, which was followed by decided improvement in the ease with which the patient could move the joint and relief from pain. ULCERS OF THE LEG; ALL CAN BE CURED.

This paper was read DR. CARTER S. COLE, of New York. What constitutional conditions obtain that favor morbid states, or that retard a return to a healthy state, such a diathesis receives its proper treatment, whether or not ulcers exist. For systematic purposes, ulcers of the leg were designated by the author according to their appearance as healthy, irritable, indolent, etc. In intractable cases, he is inclined to place foremost thorough washing with soap and water and good scrubbing with a bristle hair brush. If the ulcer be inflamed, iritable or painful, anesthesia may be required for this and subsequent steps. The next step is a thorough cleaning out of all soft granulations, and the base of the ulcer with a sharp curette. The edges of the ulcer are freed from their attachment, and in many cases with a curved sharp bistoury he knicks the circumference at intervals of about one-quarter of an inch. If much hemorrhage follows, a pad of gauze wrung out of a two per cent solution of carbolic acid is placed over the wound, and a firm compression bandage from the toes to the knee applied, the wound having been previously cleansed with the carbolic solution. The dressing, when used, is allowed to remain for 24 or 48 hours. after which he considers the ulcer to have become a simple one, and amenable to treatment as follows: No further lotion is used. The wound is wiped off with dry cotton, and over and completely covering it he places strips of diachylon plaster to protect

the ulcer. Over the surgeon's plaster he applies a pad of sterilized gauze, held in place by strips of rubber adhesive plaster, or often simply by a bandage. He then uses a firm muslin bandage from the toes to the knee, making equal compression. Bandaging should be carefully done. Sometimes he uses two bandages three inches wide and eight yards long. This bandage is not removed unless the discharge comes through, or the leg becomes painful, or the bandage gets loose. When he redresses the ulcer, he again uses simply absorbent cotton to cleanse the wound, and proceeds as before. Often after two or three dressings, the bandages may remain five to seven days without being disturbed. In some cases a thin scum forms on the ulcer, which must be removed by going over the surface lightly with a curette. With this treatment, in ord:nary cases about three weeks will suffice for an ulcer of even a dozen years standing. In extraordinary cases, as much as six weeks may be necessary.

HOW TO DIAGNOSTICATE SEXUAL

DERANGEMENTS IN THE MALE. By DR. EUGENE FULLER, of New York. The author endeavors to impress upon the profession the fact that in the majority of instances, sexual derangements in the male are caused by pathological processes in or about the seminal vesicles, and further, that they accomplish their results by interfering with the mechanism of ejaculation. He calls attention also to the fact that this side of the question has been almost wholly neglected by preceding writers on sexual disorders, who have devoted themselves largely to psychological conditions in this connection, the result being that the great majority of the profession associate sexual disturbances with some radical mental defect. Sexual derangements in the male should be diagnostically arranged in four classes: (1) Those dependent on seminal vesicuitis. (2) Those dependent on neuroses. (3( Those dependent on primary mental diseases or degeneration. (4) Those dependent on general malnutrition and debility. The order of this classification corresponds to the frequency with which these different forms of diseases are encounter

ed in practice. In explanation of the first class of causes, the writer states that it is needless to go into details since he has recently reviewed the subject in his book, just published.

The second class of causes either inhibit or excite the sexual center by means of reflex nervous action.

The third class of causes includes the different form of paraoia, in which the sexual sense exists in a perverted form.

The fourth class of causes is a small one. It includes individuals, generally young or middle-aged, who make complaint that they are capable of little sexual exertion and that feelings of prostration and exhaustion result whenever coitus is attempted.

Dr. Fuller then takes up the clinical examination. In conclusion the writer makes some special remarks on the different appearances that the varying grades of seminal vesiculitis present to the sense of touch, and calls attention to the fact that in cases of extensive perivesiculitis involving both sacs an inexperienced examiner is liable to err in diagnosis, mistaking the condition for hypertrophy or inflammation of the prostate. The author holds that to become perfected in the feel of the seminal vesicles, the finger needs as much practice as does that of the gynecologist in feeling the ovaries and tubes. To obtain the necessary practice, he advises the genito-urinary surgeon to make it customary to examine in this manner every male case coming into the clinic until all normal and pathological conditions can be fully appreciated.

CHRONIC SEMINAL VESICULITIS WITH HEMORRHAGE.

DR. S. P. COLLINGS, of Hot Springs, Ark., read a paper on this subject, in which he said there has apparently been little known of the pathological condition of the seminal vesicles until within recent years. The usual cause of this trouble in the extension of gonorrheal inflammation from the prostatic urethra through the ejaculatory duct into the vesicle itself; at least there usually a history of a former gonorrhea with a deep urethral trouble remaining. The vesicles are sometimes involved in very acute and severe gonorrheal inflamma