logical. This has been overthrown by Horbaczewski and others. From the various various investigations made, Dr. F. Levison draws the following conclusions: 1. Uric acid is formed in the body by the disintegration of the albuminous substances of its tissues, especially of the nuclein or nucleins. 2. The excretion of uric acid becomes increased or diminished by all factors (diseases, medicines, poisons, etc.) which give rise to a more rapid or slower disintegration of the cellular elements of the body, and especially of the leucocytes. 3. The taking of food, especially flesh food, causes a temporary leucocytosis, probably arising from the nuclein of the food. 4. The amount of uric acid excreted in twenty-four hours is not influenced to a great extent by food. There is, however, this distinction noticeable: The easily digestible animal albumens set up digestive leucocytosis and formation of uric acid much quicker than the vegetable albumens, which are difficult to digest. SYMPTOMS. The symptoms are so closely expressed in the pathology of this disease that it is best to describe them in common. Let me say, however, that we have symptoms of a local and general nature. Those of a local nature are best described as sensitiveness to hot and cold shooting pain upon pressure, looseness of the teeth, discoloration of the gums, swelling, elongation and displacement of the teeth, and, last, pus discharging from the alveolar sockets. The general symptoms are found under the microscope in the variation of the number of white to red corpuscles; in the size, form and cell contents of the red corpuscles; and the kind of white corpuscles, whether neutro-acidi, basophilic; also in the quantity of hemoglobin present. So, likewise, the urinalysis determines the condition of the blood and the secretory and excretory organs. I shall give in brief the local pathology of this affection. The disease shows itself in gingival inflammation, recession of gum, destruction of pericementum, sanguinary calculus (deposits upon the root of the tooth), pus, disappearance of the alveolar wall, and finally loss of the teeth. So far as I have had opportunity to observe its beginnings, it seems to take the form of a simple gingivitis, presenting a reddening of the gingival margins about the teeth attacked; a slight mobility of the teeth is already noticeable. This reddening soon broadens out into a more general reddening of the neighboring gum tissue. After a time the lower margin of the gum will be destroyed here and there, so that the thin blade of an instrument will pass up along the side of the root. The destruction of the tissue of the peridental membrane has begun, and already there is a slight pocket that contains a little pus. This destructive process gradually extends to the apex of the root, and in most cases narrow, deep pockets are formed along side the root. This may occur at only one side or two or three points; as the destructive process extends these pockets widen, and frequently encircle the entire root; the tendency is to the destruction of the entire root membrane. The teeth are generally displaced, moving in a direction from the diseased surface. This disease seems to attack any of the teeth. The margins of the alveolar processes usually disappear as the destruction of the peridental membrane advances. Some dentists claim this precedes the destruction of the mem. brane, but it stands more to reason that it should follow. The complications of this disease are: Deposits of tartar or salivary calculus; displacement of the teeth; gradual infection of the healthy gum tissues; exposure of the roots, making them extremely sensitive to thermal changes. The most trying of all complications is the deposit of sanguinary calculus. These deposits heighten the inflammation and the destructive process. They are very characteristic. They form as small nodules, usually of darkish-gray to brown or black appearance; some very minute, and always flat where they are attached to the surface of the root, and round or pointed on their free surface. They cling to the root with wonderful tenacity, and frequently gather in such quantity as to completely encircle the root. These deposits are scattered at various points over the surface of the roots, reaching from just below the gingival border to the apex of the root. PROGNOSIS. The prognosis will depend upon whether this disease be local or general. If the pyorrhea alveolaris be purely a local disease, with proper treatment the trouble can be readily cured. Not so Not so favorable is the prognosis of that form of pyorrhea resulting from general or constitutional origin. If the disease of which pyorrhea alveolaris is but a local expression be amenable to treatment, such as anemia, rheumatism, gout, etc., then the prognosis will be favorable; but if pyorrhea alveolaris be the resultant of such diseases as tuberculosis, syphilis, Bright's disease, etc., then the prognosis will depend entirely upon the management of the disease. In other words, the prognosis of the general forms of this disease will depend, first, upon the proper diagnosis; and, secondly, upon the management and treat ment of the constitutional trouble. TREATMENT. The treatment is divided into the local and general treatment. The essential part of the first is cleanliness. Not only do I treat my patients at the office, but I expect them to assist me in keeping the gums healthy and the teeth absolutely clean and free from all deposit. How can they accomplish this? For in such cases we most frequently find receding gums, the necks of the teeth exposed, leaving long interdental spaces, pus-pockets, etc., for lodgment of food and tartar; while the elongated and loosened teeth interfere very much with the brush. It is difficult to keep the teeth clean under such circumstances, but by following the method to be outlined this difficulty falls away, even for the most refractory patient. I prescribe two tooth-brushes, one a medium quality, not too soft or If hard, prophylactic brush, which is the most acceptable and efficient tooth-brush made. This should be used upon all the teeth, always brushing in the direction of the length of the tooth and never across, as brushing across only drives food and deposit into the spaces between the teeth, and at the same time it injures the delicate gum margin, whilst brushing in the direction of the lengths of the teeth sweeps everything off of and out of the spaces between the teeth. For the lingual and palatine surface, and especially the lingual surface of the lower eight teeth, and also the wisdom teeth, I recommend a special brush accessible to those parts. A good dentifrice, preferably prepared by the dentist, should accompany the thorough cleansing with the brush. Listerine and waxed floss silk are adjuncts. there be an oozing of pus around the necks of the teeth, then I advise my patients upon rising in the morn, and before brushing their teeth, to atomize their gums and teeth with a 3 per cent. solution of hydrogen dioxide. I here show you the atomizers I employ. This is to remove as much pus as may have formed over night. After breakfast I advise brushing the teeth with powder and listerine, after lunch lightly with listerine, and after the evening meal the same. Where there is considerable pus I have my patients use the atomizer and hydrogen dioxide just before retiring, rinsing the mouth with warm water. The amount of spraying is determined by the severity of the case and the amount of pus present. Patients who, under ordinary circumstances, with long teeth and marked interdental spaces, find difficulty in keeping their teeth clean and free of calculus, manage to do so thoroughly while under treatment. Thorough brushing acts as massage; it is a stimulant to the gums, they loose their red color; the little arteries, veins, lymphatics and nerves become freed from all pressure; normal circulation goes on unimpeded, and as a result the gums, heretofore of a dark purplish-red color, the gingival border thickened, swollen, curled over, so to speak, gradually thin out, become pink, and by means of medicinal applications become adherent to the teeth. Where there is recession of gum and erosion of enamel, I recommend Phillips' Milk of Magnesia to be used after every meal, and at night, before retiring, bathing the teeth and margins of the gum in the same and allowing it to remain. ment. But local treatment will not suffice in all cases; general treatment is necessary, especially in those cases of constitutional origin. The physician's treatment will greatly depend upon the nature of the disease producing pyorrhea. In general, it may be said that proper food, less meat, more cereals and fresh fruit and vegetables, avoiding as much as possible sweets and pastries. Above all things, fresh air, exercise not too violent, such as horse-backing, bicycling, golf, etc., are to be liberally partaken of. Refreshing sleep and tonics are necessary. Avoid all stimulating drinks. In many cases the At the office the first and most important step is to remove all deposit. Above the gum the salivary calculus is easily and quickly removed. For sanguinary calculus, that which deposits below the gum line, and frequently to the very apex of the root, the delicate touch and skill of the operator is necessary. The most efficient work and with least danger to the gums, can be accom-lithiates are prescribed. When there is plished with the downward stroke or pushing motion of the scaler, in preference to the upward, although at times both are employed. It is astonishing what force is sometimes required to dislodge these nodules, which cannot be seen, but must be felt by means of the thin and delicate blade of the instrument striking against them in its downward course along side of the root. Sometimes several sittings are necessary in order to free a root of all deposit. Some teeth are keenly sensitive to this treatment, and many are not. If sensi tive, cataphoresis can be employed. The pus pockets must be washed out with hydrogen dioxide spray or hydrogen dioxide with bichloride of mercury (1:1000). These pockets are then cauterized on their inside with various preparations-chromic acid, silver nitrate, sulphuric acid-but in my hands I have found trichloracetic acid to be the best. It is highly lauded by those who have recently used it, and it must be placed as the most efficient remedy in the list of drugs. Applications of iodide of zinc have proven very beneficial, and frequently a good antiseptic and stimulant mouth wash is prescribed. All loose teeth must be held firm by ligaturing or by some retentive apparatus, and occlusion of the teeth must be made as perfect as possible. All pus-pockets must be thoroughly washed out and made as aseptic as possible. Every instrument should be sterilized. much nervous energy or waste, take plenty of rest. In this age of keen competition and riotous living, and of the constant effort to obtain the impossible, there follows a great loss of nervous energy. The breaking down goes on at a greater pace than the building up of the tissues; the organs of function become impaired, consequently the various tissues suffer, and at last there follows in the path of all this destruction pyorrhea alveolaris. 937 McMillan St., W. H. THE SERUM TEST FOR BY GEO. E. MALSBARY, M.D., CINCINNATI. This evening I have the pleasure of presenting to the Academy of Medicine a microscopic specimen illustrating an effect produced upon a pure culture of the typhoid bacillus by blood from a typhoid patient The bacillus of Eberth is an exceedingly active, motile bacillus, but, when we add to a hanging-drop preparation of this bacillus some blood from a patient affected with typhoid fever, the bacilli gradually become less active, lose their motion and become agglutinated together in small clumps. This is said to be absolutely pathognomonic of typhoid fever, since the blood of patients suffering from dis 1 Read before the Academy of Medicine This, in substance, is the local treat- of Cincinnati, December 21, 1896. eases other than typhoid fever do not give the reaction. The process may be best seen with an oil-immersion lens of high power. It is claimed by some that the grouping causes the mount to assume a peculiar macroscopic appearance, whereby a diagnosis may be made. The test may be made, probably best, by using fresh blood or blood-serum, but it may also be made with dried blood, which retains this characteristic for a long time. In some cases the urine will answer. Of course, the culture of the typhoid bacillus must be secured from some reliable source and kept uncontaminated. The reaction is positive within the first week of typhoid fever, and is supposed to last, in some instances, for years. The test originated through the work of Pfeiffer, and has been elaborated by Widal and others, so that it has now become perfectly practicable. In the specimen before you I have used dried blood, which may be kept between a couple of clean visiting cards. The reaction begins to manifest itself in a few minutes, and may not be complete for half an hour or longer. 546 Woodward Street. Total Extirpation of the Bladder. M. Tuffier, in a communication to the Académie de Médecine de Paris, reports an interesting case of total extirpation of the bladder for a diffused tumor of that organ. It was that of a man, aged forty, suffering from infiltrated tumor of the left wall of the urinary reservoir invading all the mucous membrane of the bas fond. On October 10, the speaker practiced ablation of the organ, the catheterism of the ureters was suppressed on the seventh day and replaced by the hypogastric syphon. The patient left his bed in the first week of December, and for the last fortnight he has recommenced his work, wearing an appropriate apparatus. He does not suffer, has got strong, and has notably regained flesh. The histological examination of the bladder showed that the tumor was malignant. -Paris Cor. Med. Press and Cir cular. Society Reports. ACADEMY OF MEDICINE OF CINCINNATI. OFFICIAL REPORT. Meeting of December 21, 1896. Vice-President ROBERT W. Stewart, M.D., in the Chair. W. EDWARDS SCHENCK, M.D., Secretary. [The attention of members is called to the Nurses' Central Directory, Telephone 2121, No. 210 W. Twelfth St., which is under the supervision of the Academy of Medicine, and is deserving of the members' patronage.] DR. GEO. E. MALSBARY exhibited a microscopic specimen demonstrating the serum test for typhoid fever (see p. 121). DR. A. I. F. BUXBAUM read a paper entitled "Pyorrhea Alveolaris" (see p. 115). DR. HENRY W. BETTMANN demonstrated the shape of the stomach and its pathological variations, with numerous specimens and photographs. Discussion on the Shape of the DR. W. H. CRANE: My share in Dr. Bettmann's work has been confined to the collection and preparation of material, and is so slight that I think I may be permitted to express the pleasure which the paper has given the members of the Academy, and the interest we feel in the facts which he has brought out so clearly. I have been especially interested in the tabulated measurements which the essayist has prepared. They prove beyond question the fact that the fundus exists in the earliest fetal specimens which could be obtained. With regard to the photographs which I have prepared, I may say that they were taken with a small lens which is not adapted for such work, and it was really forced beyond its working limitations. The scale, which in each instance was hung in the focal plane, gives a fair idea of the size of the speci mens. It seems a little strange that no hospital in the city is provided with a long focus lens for scientific photography. Surgical photographs must therefore be taken with lenses only intended for landscape work. The skin cases alone at the City Hospital would amply repay the trouble of photographic reproduction, and in a short time would be a real contribution to the knowledge of the subject. esophagus is inserted in the manner suggested by the essayist, it can readily be seen that the tilting of the organ would cause part of what is spoken of as the posterior wall of the stomach to present anteriorly, especially when the viscus is distended; after its collapse it would be a very difficult matter to find the perforations. I have seen a couple of cases where this condition was present. It may be possible that the essayist has been led into error in his observations regarding the relative size of the fundus, because these observations were made upon inflated organs. As the muscular development is greater at the pyloric end, it must follow that the distention of the cardiac end is more easily accomplished, and, because of the lack of resisting tissue in this locality, distending the organ may lead to incorrect conclusions, because it yields more readily, and hence the proper propor DR. H. M. BROWN: I would like to know if HCl is deficient when we have cancer of remote parts, and if it is, why? DR. S. P. KRAMER: The doctor has given us a purely scientific paper, containing several interesting points. Why is not the stomach digested? We have here a mineral acid, which is dangerous to other tissues, and reminds us of the incident when the student came to the professor and told him he had found the universal solvent, when he remarked, "What do you keep it in?" This secretions are not preserved. tion must be poured out, because it is important in stomach digestion, and when we have free HCl it augurs that there are albuminous foods that are more resisting. Great credit is due Dr. Bettmann upon his observation on the fundus. I do not believe that it exists at birthonly in a modified form-for if you observe the stomach at fifteen months you will note that it is much better de veloped than at earlier periods, so that the truth of the matter is that at birth we have a minimum fundus, but during the milk period it gradually develops and is less of a reservoir. Another important point is the eccentric insertion of the esophagus. May it not be possible that this is due to the drying of the walls of the stomach due to the different contracting power of the walls, so that if this was investigated under water, slightly inflating the stomach, this may be obviated? DR. J. C. OLIVER: The interesting observation relative to the point of insertion of the esophagus into the stomach throws light upon the fact that occasionally we find gun shot wounds of the stomach upon the posterior wall of that organ without corresponding ones upon the anterior wall. If the DR. ALBERT FREIBERG: I don't believe that the drying or the alcohol has influenced the change in the appearance of the stomachs, but rather the procedure of inflation. We know that the cardiac end is less developed, muscularly, than the pyloric, so that the cardiac end will give more, thus giving the appearance of a large fundus. DR. BETTMANN: Regarding the technique employed in preparing the specimens, let me say that Dr. Wm. H. Crane assisted me in the work, and he was the first to notice the eccentric insertion of the esophagus in a fresh stomach, which we had just inflated. and hung up to dry. The eccentricity is just as marked in the fresh specimens as in the dried ones, and it seemed strange to us that this peculiarity is not described in the text-books. If you will examine the fetal stomachs inflated and preserved in alcohol you will notice the same condition. Regarding the fundus, it was one of the objects of the paper to make plain the fact that the fundus is not greater relatively in adult than in infantile or even fetal stomachs. Here is a stomach from a fetus eleven weeks old; the fundus is 40 per cent. of the whole stomach. In nine fetal stomachs it |