From an artery beating quickly and with low ten- Riegel, speaking of the way to recognize these Henoch was not able to satisfy himself that circulatory changes followed scarlatinal nephritis. system, there is usually no difficulty in determining On the 12th there was observable, along with the continuance of the abnormal tension, an increase in the area of the heart's dulness, and in the strength of the apex heat. These signs increased during the remainder of the course of the disease. On the 18th there were convulsions; the pulse became quick. Patient died on the 19th in a general convulsion. On post mortem there was found a hæmorrhagic and glomerulo-nephritis with well-marked dilatation and hypertrophy of the left ventricle. There was already commencing fatty degeneration of the fibres of the ventricle. There was also complete suppression of urine for ten days. In this case all the above extensive heart changes had occurred within a period of ten days as the result of the acute nephritis. Riegel gives an account of six additional cases where the circulatory disturbance was pronounced, although not so great as in the above case. They were all instances of vessel and heart changes, as the result of an acute nephritis. marked increased tension, the secondary being practically, into our vocabulary. We should, I even higher than the primary one. Urine could am sure all will acknowledge, support the right not be obtained for examination, the patient sort of men, without reference to party. The sexstating on being questioned, that he had passed anary of legal gentlemen now forming the governnone from the previous evening. ment of Ontario may be all well enough in their way, politically speaking, but when they come to deal with matters affecting the interests of the profession or the health of the public, what a spectacle they present! That hideous monstrosity known as the "Coroners' Act," and the recent Act relating to public health, may be cited as examples. With reference to the latter, many of the leading physicians in the Province, after a number of meetings, in view of the large amount of preventable sickness, decided to ask the Government for $5,000 with which to pay the expenses of a Board of Health for the Province, deeming this a small sum for the purpose-as small as an efficient board could be worked with. Though the Government readily acknowledged the value and usefulness of preventive medicine, and, be it observed, though they give hundreds of thousands of dollars to less worthy objects, after two or three years of shillyshallying, they throw down the bone of $2,000, with which the medical profession is to "run" a Board of Health for Ontario. A loaf is asked; not half a loaf is given. Many supposed, as did the writer, until the last meeting of the Association, that $5,000, as asked, had been appropriated. I am loath to take up too much of your valuable space; but this is a very important question to which attention is being drawn. I have a proposition to make, in which, however, I shall be as brief as possible. It is now more than a quarter of a century since a medical man occupied the position of a member of the Government of this Province-the Hon. Dr. Rolph. No class of persons know better the wants and needs of the country than do the doctors, chiefly from their constant intercourse with the masses of the people ; and in the interests of the country and of the profession, which are identical, I propose that means be taken by which some competent physician shall be made a member of the next Government. I am not prepared to say at present how this may be best promoted, but, as before stated, it is a very important matter, concerning as it does directly the Governmental affairs of this Provi.ice, and is unquestionably worth the while of the profession to give some time and attention to it. Correspondence. UNITY OF ACTION AMONG PHYSICIANS. To the Editor of THE CANADA LANCET. SIR, You are probably aware that at the last meeting of the Ontario Medical Association a resolution was drafted and generally approved of, asking for a committee to report at the next meeting of the Association some plan by which the individual influence of medical men could be united and exercised for the benefit of the profession and the country. Several reasons prevented the resolution coming up. We hear a good deal about the influence our profession might exercise if united-an influence, doubtless, which would be absolutely irresistible; and probably there never was a time when there were greater reasons for united action amongst us than the present. Almost every physician will admit that we ought not to have any thing to do with politics commonly so-called, and that the words Reformer and Conservative should not enter, The I should like to suggest also, in this connection, treatment pursued in this case is the use of the that we advocate changes, and important ones too, faradic current direct to the atrophied muscles. looking towards the simplification of the public It has not as yet been used sufficiently long to say educational system, which will soon, if not simpli- whether it is going to do any good or not. fied and improved, do irreparable mischief, and send pupils, teachers and parents to the insane asylums. Finally, in view of the agricultural and manufacturing interests of Ontario, would it not be well if there were a practical farmer and a practical manufacturer as members of the Government, and not more than three lawyers at most. There are many who would be glad to learn the opinion of members of the profession on these questions. Yours, etc., M.D. Reports of Societies. HURON MEDICAL ASOCIATION. The last regular quarterly meeting of the Huron Medical Association was held in Clinton, on Tuesday, July 18th, Dr. Holmes, of Brussels, President, in the chair. The following members were present :-Drs. Holmes, Worthington, McLean, Taylor, Hyndman, Young, Sloan, Graham, Williams, Bethune, and Stewart. Dr. Young, of Londesboro', showed a very well marked case of annular malignant stricture of the rectum, in man, aged 51 years. The first symptoms of stricture showed themselves about a year ago. Dr. Taylor presented a man, aged 55, who has mitral stenosis and commencing degeneration of the heart. The organic heart changes in this case, appear to have followed a pneumonia which affected the patient about nine months ago, at least there was no physical evidence of any valvular or mural changes during the progress of his pneumonia. Dr Graham, of Brussels, related the particulars of a remarkable case which he recently saw. patient is a girl, aged 12. During her waking hours she only breathes six or seven times in the minute. With each inspiration the epigastrium sinks in, and the shoulders are drawn forwards and upwards very forcibly. She has been breathing in this manner for six months. Some time previously she is said to have had inflammation of the lungs. She is otherwise perfectly healthy. She is said to breathe naturally during sleep. TORONTO MEDICAL SOCIETY. Ordinary meeting, June 15th, 1882, Dr. A. H. Wright, Vice-President, in the chair. Dr. Bray, President of the Medical Council, and Drs. Rosebrugh, McCargow and Day, members of the Council being present, were cordially welcomed by the Vice-President. Dr. Zimmerman showed a young girl affected with psoriasis guttata and nummularis. The disease began eight weeks ago. Dr. Oldright reported the following case :-A lad, aged 18, overgrown, had pains of a rheumatic nature for some days, when pneumonia developed, followed in a few days by pleurisy. Shortly afterwards a peculiar hissing endocardial murmur became evident. Feet became cedematous, pulse irregular, and temperature varied from 100°-103° Urine gave reaction indicating coloring matter of bile. As these symptoms improved he became dull, morose, not answering when spoken to; refused food and had to be fed with a stomach pump. Dr. Stewart exhibited a man, aged 35, who has Dr. Cameron reported a case of popliteal aneurwell marked atrophy of the left scapular muscles. ism in a man aged 50 under his care at the Toronto The case is one of progressive muscular atrophy General Hospital. The tumor was first noticed commencing in the shoulder muscles. The supra, last December, increasing steadily since; impulse and infra-spinati are almost completely gone. The and bruit distinct. During the last week, treatment disease is of two year's standing. Lately he has by flexion and instrumental compression alternately had considerable pain about the right shoulder, as they could be borne has been tried, but with but up to the present there is no wasting of the only indifferent results. It was then proposed to muscles in its neighbourhood. The atrophied apply an Esmarch bandage up to the hip omitting muscles, and in fact nearly all the voluntary mus- the tumor, but a systolic cardiac murmur contracles of both upper and lower extremities are the indicated anæsthesia. Besides, a second aneurism seat of fibrillary twitchings when percussed. The was discovered in the lower part of the epigastric region which would probably be injured by the increased pressure resulting from the application of the bandage as proposed. Only two alternatives were left, digital compression and ligation of the femoral. Dr. Oldright deprecated such serious means as ligation until digital compression had been tried, and related a case of aneurism of the lower part of the femoral, under his care, cured by this treatment after compression for 18 hours by relays of students. Dr. Zimmerman suggested passing a small trocar through the sac, and introducing a horse hair to be left in situ. Dr. McCargow said the galvanic needle might be tried. Dr. Cameron then showed a cysto-sarcoma of the testicle removed from a man aged 60. The testicle was adherent to the sac at many points, and had to be dissected off. The glands in both groins were enlarged, and the disease extended up the cord, so that it was thought advisable to ligate it en masse in order to remove as much as possible of it. Dr. Rosebrugh, of Hamilton, gave a short account of several cases of ovariotomy occurring in his practice. The Society then adjourned. Ordinary meeting, June 29th, 1882, Dr. George Wright, President, in the chair. Dr. Cameron showed a tumor taken from the side of the neck of a woman aged 70. Three years ago it was as large as a hen's egg, hard and freely moveable. Was supposed to be enchondromatous. It became cystic, and as the cysts ruptured from time to time, considerable hemorrhage occurred. Also uterus and ovaries from a young girl who died from puerperal fever in the Lying-in-Hospital four days after delivery. Labor was natural and tem. perature normal. A few hours afterwards she had a severe chill and temperature rose to 105°. P.M. showed distinct evidence of peritoneal inflammation with considerable sero-purulent fluid. Ovaries much inflamed, left more so than right. Dr. Oldright reported in reference to the boy whose case he had brought to the notice of the Society at last meeting. He began to take food a few days afterwards, spoke a little, but gradually sank and died. No post mortem. Dr. King reported a case of pernicious anæmia in a woman who died after four months illness. Pulse usually over 100, highest temperature 1021⁄2°. Thought the red corpuscles were decreased, but had made no accurate examination of the blood. Dr. Cameron drew attention to the statement of Dr. Fenwick of London, that in many of these cases there was degeneration of the glands of the pyloric end of the stomach, and disease, usually cancerous or tubercular, of the supra-renal capsules. A general conversation on the treatment of anæmia followed, and on the relative merits of the various preparations of iron in these cases. Dr. Riddel reported two cases of death from coma; in one, there was pus in the lateral ventricle and in the other a clot in the right parietal region. Ordinary meeting, July 13th, 1882, Dr. Geo. Wright, President in the chair. Dr. Macdonald in the absence of Dr. Temple showed a uterus in which rupture had occurred during labour. The woman, a primipara, was unmarried, aged 26, healthy. Labor began at 2 p.m. Saturday, July 8th, membranes ruptured shortly afterwards, during, or before removal to the Lyingin-Hospital. Pains moderate. At or during a pain of greater severity than the preceding ones, though not excessive, she felt something give way. The pain ceased, moderate hemorrhage followed, tenderness over uterine tumor. Collapse gradually set in and was marked at 101⁄2 p.m., when first Dr. Temple arrived. Hemorrhage now profuse. On examination a rent was discovered in the anterior wall of the uterus, through which the hand passed easily into the abdominal cavity. Ether and ergot were administered subcutaneously and long forceps applied, but they slipped. Ether was then given, and delivery affected by turning. Child dead. Uterus responded but slightly to all stimuli used. The woman rallied somewhat, but died the following Monday morning, 39 hours after the rupture. A large quantity of fluid extract of ergot, and five drachms of ether and brandy were given subcutaneously. Post-mortem showed a ragged rent in the uterus 7 inches long, extending from the juncture of the neck and body on the left side downwards and to the right, to the os uteri. Dr. Oldright showed a fatty tumor from the head of a woman, aged 65. Also a small fibroid poly pus removed from the uterus on account of persis- was the significance of this murmur? Was it-(1) tent hemorrhage. Dr. McPhedran reported a case of Railway accident to a child aged 9, at Oshawa, in 1876. He saw the case with Dr. Rae. The child was comatose the scalp cut in several places; blood flowed from the mouth, nose and ears, and there was considerable sub-conjunctinal extravasation. Two pieces of brain matter, each as large as a bean, escaped from the left ear. merus and clavicle were broken. covery ultimately took place. The evidence of contracting or sclerotic endocarditis of Rosenstein? was it (2) the result of an olddocarditis? or was it (3) a mere peculiarity, a standing injury, the outcome of a bypast acute ensound produced at the mitral ostium, which has been, and was, and is, and will be without any significance whatever. I am not ashamed to confess that the problem is insoluble to me. The symptoms were quite accounted for by her general condition, for she was bilious and somewhat malnourThe left huished. Any failure of power in her could be perComplete re- fectly accounted for without the hypothesis of contraction of the mitral ostium. There was no thrill the contracting endocarditis of middle age and adaccompanying the murmur; but such is usual in vanced life. There was no irregularity in the heart's rythm. Nor would the presence of irregularity or a thrill have cast the least ray or glimmer of light upon the case, in my opinion. There was the unmistakeable murmur-seat, maximum of intensity, period in time; and a long murmur to boot. The minutiæ of mitral stenosis is not recorded in my Dr. Macdonald next read a long and interesting paper on "Menorrhagia and Metrorrhagia" with their causes and treatment, which was fully discussed. Selected Articles. MITRAL STENOSIS IN A GOUTY HEART. note book. There was no possibility of mistake BY J. MILNER FOTHERGILL, M.D., LONDON. Our knowledge of valvular affections of the heart does not rest on the detection of a murmur, its seat, the point of its maximum intensity, and its precise time in the cardiac cycle. Nor does their treatment consist in the administration of iron and digitalis promiscuously. Such simplicity may be admirably adapted to the requirements of an examination table, but it is perilously inadequate to the wants of actual practice. For the latter some familiarity with the natural history of each form of valvular disease is eminently desirable, which alone will enable the medical practitioner to read his case aright. There is first the individual to be estimated; then the disease to be measured. Then 2 and 2, or the nearest approach to that numeral in each case, have to be put together; and then 4 is the resultant product. But the equation has points of practical difficulty not represented in the mathematical formula. It is not always easy to determine the precise "2" of each factor. For instance, let me adduce the following case :— as to the presence of that murmur which is held to be pathognomonic of stenosis of the mitral ostium. There was the murmur, true; but what was the anatomical condition underlying it? That was the essential question to be asked; and, if possible, answered. The murmur of itself was nothing; but its cause was fraught with the most intense interest. With which of the three conditions spoken of above was it casually connected? I summed up the evidence against its being the outcome of a steady progressive diminution of the mitral ostium due to sclerosing endocarditis, and gave a prognosis accordingly. Whether the diagnosis, and with it the prognosis was correct or not time alone can tell. The case was certainly one where contracting endocarditis might be present; for its associations were there as regards the general conditions ; but the essential features of mitral disease were not sufficiently prominent to establish its presence. From the negative aspect of a case like this, it may be well to go on to describe the positive features of mitral stenosis. Assuming that some of my readers are not thoroughly acquainted with the natural history and features of mitral stenosis in all its varieties, it may be well to point out that such mitral stenosis has very different features from the mitral stenosis of young subjects. Perhaps in the dead-house the features are more alike than they are clinically. In the mitral stenosis of the young, set up by acute endocarditis, there is the weak pulse of a small left ventricle; shortness of breath E. A. W——, aged fifty-four, the mother of a family in a south-western county, came to me a little while ago, because her local medical man had found something amiss with her heart. She had been a very active person, but recently had not felt so equal to effort. Yet she had no shortness of breath on exertion, and only a little palpitation on effort at times. She had some dilatation with hy-on exertion; enlarged right ventricle; tendency to pertrophy of the left ventricle, and beyond that a long mitral stenosis-murmur heard to the right of the left apex ; but over a limited area only. There were no indications of regurgitation. Now, what dropsy in the serous cavities, or the lower limbs. Often there is the "heart cough," of excess of blood in the pulmonic circulation. There is a murmur, presystolic in time, conveyed to the right |