sure have been keep in all patients in this hospital for the past seven or eight years, but Dr. Lee's paper deals only with cases of 160 m.m. and above, which came to autopsy. About 70 per cent. of these cases showed either chronic nephritis or arteriosclerosis, or both. There were a few cases, some seven or eight, if I remember, due to other conditions; three or four to brain lesions, and three or four to valvular heart disease. It is an interesting fact that in the heart cases there was no record of more than 200 m.m., and most of the cases were considerably below-i. e., from 160 m.m. up to 200. It was also observed that in all these heart cases the aortic valves were involved. In pneumonia there is not much change in blood pressuresometimes during the first few days there is a slight rise above normal, and there is no material drop at crisis, as it might be supposed there would be during convalescence, however, there is apt to be a moderate fall in the reading. Dr. Alexander Lambert reports his observations in forty-eight cases of pneumonia, and found that Gibson's rule relative to the comparative pulse and blood pressure reading, as quoted by the essayist, was, for the most part confirmed. There were a number of exceptions, however, but these were probably due to coexisting arterial or kidney lesion. I believe that what the essayist says regarding the toxaemia of pregnancy is very importaant. We should make early and repeated blood pressure examinations in all cases that are at all suspicious. In fact, I believe it would be good practice to make a test in every case in which we have an opportunity. This should be done during the sixth or seventh months. The sphygmomanometer will often reveal the presence of toxaemia before other symptoms are manifest, and thus put us on our guard, and enable us to anticipate more serious conditions. Concerning the treatment of these conditions of abnormal blood pressure, it may be said that in the chronic forms where the pressure is always high there is very little to be expected from drugs. Careful regulation of the general habits of life— rest-in some cases moderate exercise-diet, etc., are most important. A timely venesection may, in some cases, postpone the evil day. Nitrites and iodides are sometimes useful. In acute conditions, where there is very low tension due to infection-there are certain drugs which probably raise blood pressure and sometimes tide the patient safely over a crisis. Caffein, and camphor hypodermatically, and adrenalin by hypodermoclysis or venous transfusion with salt solution, are agents to be considered. Alcohol reduces blood pressure and is therefore contra-indicated in this condition. INDIVIDUAL SEPTIC HYPERSUSCEPTIBILITY. BY DR. A. G. HINRICHS, PITTSTON, PA. READ JUNE 19, 1912. It seems that there are born into this world, individuals, who, through the absence of certain chemical substances from the blood or lymph, are deprived of a natural protective barrier, and rendered unusually susceptible to infection by septic micro-organisms. Such individuals are constantly threatened with grave dangers through the most trivial injuries. Slight abrasions, the prick of a pin, or cuts from a razor, while shaving or paring corns, have been followed by alarming or even fatal sepsis. Mild infections, which give rise to no symptoms, or at the most, only to those of a very moderate degree, in normal individuals, are followed by marked constitutional disturbances in the susceptible. Surgical operations, conducted with the utmost care and skill, are occasionally followed by septic infection, which may prove fatal, much to the discomfiture of the surgeon who is at a loss to account for the mishap. I believe it is in these hypersusceptible individuals that the passage of a sterile sound or catheter, is followed by the alarming symptoms known as urethral fever, no matter how great the amount of care exercised to render this operation aseptic. I will cite the following case as an example: A few years ago, while surgeon in the transaatlantic service, a member of the crew came to me, suffering from a spasmodic stricture of the urethra, causing complete obstruction to the flow of urine. I succeeded in catheterizing him without much difficulty, but within a few hours this was followed by a severe chill, and elevation in temperature above 103 degrees F. I had the same experience with him on a subsequent voyage, and this happened regardless of the care and precaution with which I undertook the procedure. I have passed sounds and catheters many times, but neither before nor since have I ever met with a case of urethral fever. On the other hand, the careless passing of unclean instruments is, in a large number of cases, followed by no untoward results. Old men with enlarged prostates often carry catheters in their inside pockets and use them when they desire to empty the bladder without the slightest knowledge or even pretense at surgical cleanliness-and yet fatal infection is comparatively rare-some of these men follow this reckless self-catheterization for years. Then, again, when we consider the immense number of pregnant women, attended by ignorant and unskilled midwives, careless or incompetent physicians or criminal abortionists, where dirty hands as well as dirty instruments prevail, the escape from dangerous as well as fatal infection, is nothing short of marvelous. Most of us have attended cases of confinement amid the most unhygienic and filthy surroundings, and our patients have probably had not even a rise in temperature. Puerperal sepsis is fortunately a rare disease, and old fashioned country practitioners of years of obstetric experience, say that they have never met with this dread infection, or perhaps but once in a long life of active practice. And yet you may encounter puerperal sepsis, where every precaution known to obstetric science has been thoroughly carried out to the minutest detail. I can recall the case of a young woman, where the most elaborate preparations for the coming event had been made weeks in advance. A celebrated obstetrician and an expert obstetrical nurse were engaged. The room was stripped of all furnishings, hangings, carpets and rugs-even the plumbing was removed. The walls and floor were thoroughly scrubbed with strong antiseptic solution. A white enameled bedstead, with sterilized mattresses and bed clothes, two chairs and a small table, were the only articles of furniture in the room. Just before the onset of labor, the patient was given a bath in bichloride solution, and arrayed in sterilized stockings and night dress. The bed clothes were replaced by others freshly sterilized. The obstetrician and nurse made all preparations as for a major surgical operation, and the woman was safely delivered. Yet she developed a most virulent case of puerperal sepsis. We know that the severity of an infection depends upon the quantity of the invading micro-organisms. But if the most absolute and thorough asepsis has been strictly enforced, this quantity must necessarily have been reduced to a minimum. We also know that pathogenic micro-organisms are to be found at all times in varying quantity, on body surfaces, as well as in body cavities, but surely with the enforcing of the most rigid asepsis, dangerous infection to any body of normal resistive powers, should be practically nil, yet some of the most malignant cases ensue in spite of all this. Of course, this hyper susceptibility may also be acquired through the existence of some debilitating disease, as seen in the diabetic with his carbuncle formation or wound infection. In the newborn, the capacity for developing opsonins is feeble, consequently it is in a state of hypersusceptibility to infection from pathogenic bacteria, which find easy portals of entry through various ways. But with its growth and development, definite resistive powers become more and more firmly established. It would seem that in some infants, probably only in a very small percentage, this capacity for developing opsonins never becomes established, or only feebly so, or else the phagocytic power of the leucocytes remains at a low standard, so that the child remains in a permanent state of septic hypersusceptibility, and which, if it does not succumb to some form of infantile sepsis, menaces it throughout life. I believe that the infant with grave hemorrhage or icteric disorders, the woman who develops unavoidable puerperal sepsis, the victim of urethral fever, the easily infected from the most trivial injuries, all constitute a distinct type having hypersusceptibility to septic infection, and that when infection takes place, it does so in spite of all prophylactic meas ures. A CONSIDERATION OF THE SURGICAL PATHOLOGY AND TREATMENT OF CHRONIC CONSTIPATION. BY DR. LEVI JAY HAMMOND, PHILADELPHIA, PA. READ SEPTEMBER II, 1912. The surgical problem involved in chornic constipation does not concern itself with those forms growing out from general systemic disturbances which result in temporary intestinal stasis, impairment to the general health, or sedentary habits, but instead with mechanical factors which act either by inducing local organic changes or general disease of the bowel walls. Chronic constipation is not primarily a disease, but merely a local manifestation of disturbance ultimately resulting in disease by directly altering or impairing intestinal function and consequently no effort toward improvement of the general condition or relief of the symptoms can prove successful until the obstruction is removed, while improvement in persons so suffering promptly follows the removal of these obstacles to normal bowel functionation; such as the breaking up of abdominal and pelvic adhesions, replacement of the viscera, etc. CAUSES. Mechanical causes of chronic constipation may be of such a character as to operate either continuously or intermittingly, dependent upon the seat of the obstruction. In other words, chronic constipation is not always due to change in the intestines, at least primarily, but rather to morbid conditions acting from without, that have altered both in shape and position the gastro-intestinal tract; such as the matting together of the limbs of the colon by adhesions, marked kinking of the colon at the hepatic flexure and middle of its transverse portion or an exaggeration of the natural kinking of the splenic flexure, downward displacement or kinking of the pylorus, cholelithiasis, which so often has associated adhesions of the gall bladder to the hepatic flexure and omentum, adhesions of the cae |