largely in excess, whatever the diet. | are involved: Proper presentation of The first thing to do in elaborating such material by the teacher, and proper al hypothesis is to obtain a general attitude of mind on the part of the agreement as to the facts on which it is pupil. Seldom, if ever, can the latter based, and sufficient time has not yet condition be supplied by the boy or girl elapsed since these ideas were promul- in the midst of the physical and mental gated for this to have been accomplished revolutions and evolutions of pubescence. in respect of the conditions under which uric acid production is modified by diet. It is quite possible, as suggested by one of the speakers during the recent discussion at the Medical Society of London, that there are two distinct conditions which have as a common factor an excessive excretion of uric acid, or in which the over-production is the result of dietetic errors, and is consequently readily amenable to dietetic measures, and a second in which the over-production is due to a hereditary defect in tissue metabolism, and is only modified by a diet to a limited and variable extent. If this be so the term diathesis will have to be restricted to cases coming into the second group.— Med. Press and Circular. Body and Brain Weariness. "The child fatigues much more readily—that is, his organism is more quickly depleted and poisoned-during the periods of most rapid growth. The average boy has his most rapid growth between the ages of fourteen and sixteen. In these two years he increases in weight by as much as he did during the entire six years preceding the age of fourteen. At this period of most rapid growth, the period of pubescence, the brain loses considerable weight, because of the fact that the usual blood supply is lessened by a portion being withdrawn to nourish the viscera and other organs undergoing rapid revolutional changes during this period. While the weight of the brain is but one fortyfifth of that of the whole body, it requires one-eighth of all the blood to nourish it. "At no time in his whole school career is the boy so deserving of sympathy as at the time of most rapid growth. In all learning, two features "The great curse of this age is the demand for rapid education. Parents and teachers crowd the children through a long, hard year's work. Health is sacrificed for promotion. What is learned while a child is fatigued is soon lost, the mind's force being equally dissipated. Vital force is required faster than it is generated. to day is done on to-morrow's credit, and the system of a child is wholly at a loss to protect itself against disease and accident." The work of The Limits of Vaginal, as Compared with Abdominal, Exploratory Section. Coe (Polyclinic, 1896, No. 6), in an able and instructive paper, in which he propounds the following question: What method of exploration shall we adopt which gives the least possible risk, furnishes the best means of approach, and last, but not least, which is best applied in private practice? offers the following solution, so far as his own experience goes: The abdominal method is to be elected in: (1) Neoplasms or obscure enlargements, which are situated in the abdominal cavity, or have risen above the pelvic brim, especially if such be more or less adherent; (2) ascites of doubtful origin, more especially when tuberculous or malignant disease is suspected; (3) disease of the adnexa in which the latter are situated near or above the pelvic brim, as established by bimanual palpation; (4) where the history and symptoms point to general intestinal adhesions, and above all, where appendical complications are suspected; (5) ectopic gestation before rupture, when the sac is high up, at the side or in front of the uterus, instead of in Douglas' pouch; (6) intractable pelvic and abdominal pain of obscure origin, including the so-called neuroses. On the other hand, explorative va It is also well to remember that patients suffering from ear troubles often become hysterical, and that a hasty diagnosis of hysteria, even if the typical symptoms are present, may falsely be made in cerebral abscess of otitic origin. Valvular Lesions of the Heart and ginal section is preferred in: (1) Cases Differential Diagnosis of Abscess of the Brain. In the Fortschrit d. Medecin, November 15, 1896, Oppenheim emphasizes the difficulty of differential diagnosis in traumatic brain abscesses, which may be confounded with traumatic meningitis, apoplexy, encephalitis, tumor, epilepsy, traumatic neuroses, etc. Cases cited prove how easily a one-sided traumatic apoplexy, or hemorrhagic non-purulent encephalitis, may, from symptoms alone, be taken for abscess. Oppenheim mentions a striking case in a boy, in which a wound on the forehead was followed by slow pulse, optic neuritis, rigidity of the neck, etc. A diagnosis of frontal abscess was made, but puncture gave no pus. On the following day the pulse was 144, there was fever and unconsciousness, and rapid death. The autopsy showed a well-developed tubercular meningitis. The boy was ill before the accident. The traumatism merely gave an impulse to the development of the disease. Suppurative meningitis occurring with an abscess is likely to be overlooked. An abscess of the brain is marked by normal or subnormal temperatures; fever is by no means a necessary symptom. If an attack begins with a rise of temperature, it is probably not due to an abscess of the brain -certainly not to an uncomplicated one. A slow pulse is, perhaps, the most reliable single symptom. Pulmonary Tuberculosis. Lannois (Revue de Médecine) calls attention to the infrequency of the association of valvular disease of the heart and pulmonary tuberculosis in the same person, and reports an illustrative case. A blacksmith, thirty-nine years en old, had had an attack of enteric fever at the age of five, followed by convul. sions; at seventeen, an attack of acute articular rheumatism, with pericarditis; at twenty-three, a second attack of rheumatism, with endo pericarditis; three years later, a third attack; and three years later a fourth attack. From the age of eighteen he had had a winter cough. Following the last attack of rheumatism the appetite had failed, strength and flesh had been lost, and albumen had appeared in the urine. The respiratory murmur became feebled below the clavicles; sonorous râles were heard posteriorly and at the bases, while the cough developed sibilant râles. The patient became ill at ease, felt slightly feverish, and took to bed. It was found that the temperature was 105°. Oppression of the chest set in. The sputum became nummular. Sibilant and subcrepitant râles were to be heard. The number of respirations was increased. Dyspnea became marked and aphonia appeared. The patient grew progressively worse and finally succumbed. At the post-mortem examination the right pleural cavity was found obliterated by adhesions. Both lungs were congested. Beneath the pleura numerous gray granulations were visible, while the anterior margins of the lungs were emphysematous. On section, granulations, some of which were caseous, were found throughout both lungs, but in greatest number at the apices. The glands at the hilus of the lung were enlarged, but not caseous. The kidneys contained numerous miliary 1 tubercles. The spleen enlarged, the | bacilli from the thrombi in' the portal liver fatty. The heart was bound to the vein occurs chiefly through the agency pericardium by old adhesions. Neither of leucocytes. Possibly the liver tissue the organ nor its serous sac presented exerts a destructive action upon the evidence of tuberculosis. Both aortic tubercle bacilli. American Medicoand the mitral leaflets were thickened Surgical Bulletin. and the two valves were manifestly incompetent.-Indian Lancet. Histogenesis of Miliary Tubercle. R. Kockel (Virchow's Archiv, Vol. 143, No. 3) summarizes the results of his experiments as follows: After injection of tubercle bacilli into the portal vein, thrombi containing bacilli are originated which are not at all or but poorly vascularized. The necroses of the liver cells developing after the injections are not peculiar (specific) to tuberculosis, since they also occur after injection of grits. The liver necroses are caused by thrombosis of the portal vein. The granulation tissue appearing along Glisson's capsule is to be looked upon as the first specific product of the tubercle bacilli which have entered, since it manifests no disposition to cicatrize, but subsequently caseates. From the ninth day onward the true hepatic miliary tubercles develop. They are of intra-capillary origin and nonvascular from their inception. All tuberculous products in the liver originate exclusively from proliferation of the endothelial and connective tissue cells; a participation of the liver epithelia and leucocytes in the structure of the tuberculous tissue is improbable. The miliary tubercles of the liver frequently begin with the appearance of giant cells. The giant cells may originate in various ways; those in the liver are formed from hyaline capillary thrombi and endothelia. The reticulum of hepatic tubercle is chiefly a product of coagulation called forth by the fixing solutions. The caseation of the tuberculous products is dependent upon the nonformation of blood-vessels brought about by the influence of the tubercle bacilli, and also upon obliteration of existing vessels in consequence of peculiar proliferation of the endothelia. The further extension of the tubercle Tuberculous Ascites. The external application of guaiacol has been recommended for various affections, pneumonia, pleurisy, typhoid fever, etc., with more or less success. M. de Mincis has found that the same drug gives excellent results when addressed to tuberculous ascites, and has published several cases in which he applied it. One case was that of a young girl whose parents were tuberculous. The patient, who had had previously a pleurisy with effusion, presented a considerable amount of liquid in the abdomen, hindering in a notable manner the respiratory movements. Besides, the patient suffered from diarrhea, night sweats, fever, and had lost flesh considerably. There was no doubt about the nature of the case, which was manifestly tuberculous. Once she was tapped but the liquid quickly returned in spite of the various kinds of diuretics prescribed. At this moment, M. de Mincis thought of trying guaiacol as an antithermic, associated with tincture of iodine, as an absorbent. He painted, every afternoon at the hour when the temperature attained its maximum, the abdomen with a mixture of half a drachm of guaiacol and two drachms of tincture of iodine. Almost immediately the temperature fell two degrees, and an abundant perspiration with diuresis followed, while the ab dominal pain was much relieved. After a few days of this treatment, the liquid diminished in the abdomen, and finally disappeared completely, and, more remarkable, the ascites did not return. In three other cases of tuberculous peritonitis, accompanied with ascites, the author tried the same treatment with equal success. Where he found the iodine to irritate the skin too much, he replaced it by oil of sweet almonds, in the proportion of three parts of guaiacol to two of the oil.-Paris Cor. Med. Press and Circular. Obituary. A. E. BELL, M.D. RESOLUTIONS OF RESPECT AND EULOGIES COMMEMORATIVE OF THE LATE FELLOW-PRACTITIONER'S VIRTUES. A special meeting of the Muskingum County. Medical Society was held last week at which time the committee appointed to prepare appropriate resolutions in honor of the late Dr. Bell, made its report, submitting the following memorial, which was read and adopted by the society: IN MEMORIAM. The world recedes; it disappears! Lend, lend your wings! I mount! I fly! O death! Where is thy sting? -Alexander Pope. Such words must comfort us in this hour of grief and sorrow, caused by the death of our beloved member and respected fellow physician, Dr. A. E. Bell. We realize that he has gone to his just reward; that he is at rest, and that the effect of his life is one beautiful lesson to us all. Unpretentious, quiet and reserved in manner; affable and generous in disposition. These qualities, in connection with an active, well-educated professional intellect and his high appreciation of morality stamped him a true and noble physician among his professional associates, and leaves behind that worthy influence which shall live for ages in the memory of those who knew him. Until enfeebled by long illness he was always found at our society meetings; his papers and his discussions were of the highest order, lending much to the society's success by his unpretentious help and quiet influence. We mourn his death, not only because of the great loss in his membership to our society, the loss to the profession at large, and the loss to the community, but for the reason that his life was that of an honest man, and one who was true in all the relations of life. WHEREAS, In the death of our esteemed friend and fellow-practitioner, Dr. A. E. Bell, the profession and especially the Muskingum County Medical Society has lost one of its influential and honored members, Resolved, That we express to the wife of the deceased our sincere and heartfelt sympathies in this, her hour of trial and affliction. Resolved, That a copy of these resolutions be presented to the family of the deceased; that they be published in the columns of our daily papers and also in the columns of the Cincinnati LANCET CLINIC. (J. M. FASSIG, Signed W. A. MELICK, G. WARBURTON. The following eulogy by Dr. J. S. Haldeman was listened to with interest by the members of the society: IN MEMORIAM OF A. E. BELL, M.D. "It is common to bestow eulogies upon the dead, and rightfully so upon the worthy ones. And doing so I am forcibly reminded of these poetic words: ་ Why do we wait till ears are deaf, When not a whisper can be heard? Why do wait till hands are laid And lilies in their flawless grace?' "In Dr. Bell we found most assuredly such a personage as the foregoing lines indicate, whose virtues we could commend when living and moving among us, as well as we now can, that his body is lying cold and helpless in death's and the grave's embrace, and his immortal spirit is grandly basking in the sunshine of celestial bliss and enjoyments of paradisical fruitions. It was a "My first knowledge of Dr. Bell extends back many years ago, as far back, at any rate, as 1851-some fortysix years ago. I distinctly remember the location of his office. small brick building on the northwest corner of North Fifth Street and Fountain Alley. His beginning of the practice of medicine in the city was contemporaneous with Drs. Ball, Culbertson, Holston, Sr., and myself. McElroy had come to this city a year or two prior; Dr. Hildreth some eighteen Dr. years before. He devoted most assiduously all the subsequent years of his practice intervening from that time until his death to the duties of his profession and was singularly successful in mitigating the sufferings of his patients and restoring them to their normal healthy condition. He certainly well deserved the envied soubriquet of beloved physician,' as was given to Luke, the evangelist. "Dr. Bell was also among the first of the Zanesville physicians who adopted the theory of the germ system, as being reliable and truthful, and which is now pretty generally received. He never wavered in his advocacy of it. "He was a member of every medical organization that was formed in the city and took an active part in their transactions of business, and in the discussion of the various medical topics that from time to time were presented. "I will close this sketch by making a quotation from a book entitled The Physicians and Surgeons of the United States,' edited by William B. Atkinson, M.D., published in 1878, by Chas. Robson, Philadelphia, Pa., in which a biographical account occurs of the doctor: "Aurelius Eaty Bell, Zanesville, O., son of Dr. Edward Southwood Bell (deceased), late of Zanesville, O., was born at Middleway, Jefferson County, Va., November 14, 1824. He pursued his medical studies at Jefferson College, graduating M.D. in the spring of 1849, and settling immediately after in Zanesville, in general practice. He is a member of the Ohio State Medical Society and of the Zanesville Academy of Medicine, was its President during 1875. His contributions to medical literature are confined to his local society. For some time during the war he held the office of Post-Surgeon to Camp Goddard, near Zanesville. On June 3, 1852, he married Sarah M., daughter of the late Robert McConnell, Esq., of McConnelsville, O.' After listening to the above several of the members present made short talks in which some sterling traits of the well beloved Dr. Bell were brought out and emphasized. Narrowing of the Pulmonary Artery Considered as a Manifestation of Tubercular Heredity. Commencing with the remark that narrowing of the pulmonary artery is commonly looked upon as a cause of phthisis, Victor Hanot, M.D. (Gazette hebdomadaire de Médecine et de Chirurgie, March 19, 1896), reports three cases that seem to lead to another interpretation. The first was a male of twenty-six years; both parents had died of phthisis, and he had always been delicate, and, in his youth, slightly cyanotic. Examination of the heart revealed a harsh frémissement at the base, and a loud systolic murmur in the second left intercostal space transmitted towards the middle of the left clavicle. The second patient was a female of twentysix years, whose father had died of phthisis, and who had suffered from palpitation upon exertion; at twenty she had had an attack of acute articular rheumatism, and the cardiac phenomena were the same as in the preceding case; aside from a slight temporary bronchitis the lungs were normal. The third was a female of sixteen years, whose father had died of phthisis, and whose mother was suffering from the same disease. Two brothers had died of tubercular meningitis in youth. She had always suffered from palpitation, but never had from articular rheumatism; the lungs were intact; the heart presented the same phenomena as in the preceding case. Hanot discusses the possibility of this form of stenosis being similar to the congenital narrowing of the aorta such as occurs in chlorosis, and whether both are not manifestations of heteromorphous tubercular heredity. He believes that this narrowing may have absorbed the whole or the greater part of the inherited tubercular tendency, and that it acts therefore to a certain extent as an element of immunity against phthisis.International Med. Magazine. |