the

It is a woeful waste of time, these idle bickerings about methods and precedence of discovery or adoption and the comparative merits of this or that ephemeral line of professional achievements. I am charitable enough to believe that great majority of physicians, of whatever individual opinion, are manfully and conscientiously endeavoring to assist Nature in the alleviation of human suffering and that in the pursuit of so high a calling, which involves at times the utmost limits of self sacrifice, they are actuated by a zeal no less intrepid and an enthusiasm no less vital than inspired the good Terentian verse:

Homo sum: humani nihil a me alienum puto.

We live in an epoch of unprecedented medical and surgical activity. The amount of medical literature is well nigh overwhelming. Amid such a wealth of resources it seems fatuous to dogmatize and dispute, the attitude of the doctrinaire being never a high minded and

charitable one. Yet arbitrary statements are too often made by those high in authority regarding the value or futility of certain method of treatment. In the contentions arising from these truly progressive stages of development, we should be careful to give full credit to the sincerity of purpose from which they emanate. Do we alone, forsooth, possess the golden thread of knowledge which is to guide us through the labyrinthine mazes of science? Shall we monopolize truth, to the exclusion of those whose ardor and capacity are commensurate with our own? Can we, in a word, be sure of anything, save our own liability to error? Arago dared to assert that "nothing is absolutely certain outside the realm of pure mathematics."

Not long ago, the author heard an able, earnest, country doctor read a paper on the treatment of erysipelas with a certain plant found in the locality where he resided, whereupon a certain surgeon, who knew nothing whatever about the treatment the doctor recommended, proceeded to "roast" the reader of the paper and ridicule the method as being absurd and unscientific. We cannot afford to belittle the results of such observation and experience.

In the struggle for progress, medicine has often turned from its great masters to the patient toilers in rural districts whose work, when it was finished, remained to afford a foothold to those who came after. And in this, lie the present greatness and the hope of every true science.

The very man whose theories we deride to-day may to-morrow prove to have been far wiser than we. When Ericsson, the inventor of the twin screw, offered his discovery to the British board of admiralty, they laughed him to scorn, declaring that it would be hopeless to attempt to steer a vessel while such an apparatus was attached to it. But a short time after the screw was

adopted, a great ocean liner, having lost her helm, was triumphantly guided into port by her twin screws!

In this age of invention and marvelous discoveries in medicine and science, it need scarcely be said that it behooves us all to maintain an attitude of the widest toleration. Let us be liberal, with our minds open to conviction. If our opponent is wise we should hesitate to impugn his talents and earnestness, even though they mitigate against some pet conceit of our own. If he is ignorant, he may yet be sincere. And who of us has not at some period been guilty of the grossest incapacity? Thackeray said "a man who has reached the age of thirty and never made a fool of himself is a fool."

No thoughtful physician can fail to see the immense advantage of a liberal mind in the pursuit of truth. It is to the honor of the scientific world that its most distinguished savants have been characterized by a noteworthy freedom from illiberality. Wallace undoubtedly discovered the general theory of natural selection which Darwin SO brilliantly elaborated. How noble is the spectacle of these two men vying with one another in their desire to accord, each to his friend, the praise of that transcendent intuition! What a lesson of humility and love of truth! It is of signal importance that the physician should not only welcome every advancement, especially in therapeutics, but he should at all times be willing to put the broadest construction upon opinions conflicting with his own.

BAD RESULTS OF PARAFFIN INJECTIONS.

Robert Abbé presented a case to the Practitioners Society of New York to illustrate the detrimental effects of the use of paraffine to remedy facial deformity. The patient was a stenographer who had suffered in early youth a hemiatrophy of the lower jaw with depressed

cicatrix on one side, due to bone necrosis following caries of molar teeth. To remedy this facial deformity she visited an able surgeon in this city, who injected paraffine on both sides with apparently excellent cosmetic effect satisfactory to the patient and himself for more than two years. The paraffin had been injected at a temperature of 110° F., and to overcome the depression in the cheek a rather large injection was given in that part, which puffed out the cheek. This was well placed and raised the scar, but it also made a mass which later extended across the lip. During the past year there had been a progressive settling of the paraffin into the chin, giving it a very dark color in the daytime. Now the entire breadth of the chin was of dusky violet hue and adamantine quality due to the setting of the paraffine into areolar and cutaneous structures, leaving but a thin layer of skin stretched over all, with a long crease below the chin, which opened spontaneously and oozed lymph. The patient was present in the hope of eliciting some idea of method of correction. One thought suggesting itself as a possible remedy was the use of heat sufficient to raise the temperature of the imbedded paraffin to model it into better shape, but this was a delicate procedure. Personally the speaker did not feel inclined to touch it. If some temperature change was brought about it might make it plastic and modeling possible. This might be done, but where it had now come to the surface he doubted if this could be done with safety. Dr. Abbe said that he had never used paraffin injection, for he had never thought that it was a safe procedure. Since it was in vogue, however, he presented this patient so that by observation the possibility of ill effects from its use might be seen. He had seen three cases in which women's faces had been badly marked, although the intention in each case was good. He recalled cases of two other ladies who had submitted to this treat

ment for obliteration of furrows in both cheeks, where the paraffin made two masses of yellowish white as broad as the finger on both sides of the face. The ladies wore veils and gave up society because of this deformity. His purpose in presenting the case was to illustrate what may happen from what may at first seem a good procedure.

TREATMENT OF AMEBIC DYSEN-
TERY.

The Journal of the A. M. A. states that in just what way the ipecac produces its beneficial effect has not been determined, but it seems probable that either it, or some product resulting from its decomposition, inhibits the development of the ameba.

It is sometimes advisable to administer a laxative with the idea of removing the amebas from the intestinal canal. Castor oil has been recommended for this, but probably one of the salines, either the sulphate of magnesium or sulphate of sodium, is preferable. A good combination is the following:

.20

or

3v.

Olei theobromatis. Fac suppositoria 20. Sig. Use one suppository every four hours, if needed.

But far more important than these internal laxatives, astringents, and sedatives is the local treatment. This consists of enemata given with the idea of washing out the rectum and irrigating and cleansing the entire colon. The use of a simple salt solution, distinctly stronger than physiologic saline (which is about 0.7 per cent.) is recommended by many for washing out the rectum and colon, and is believed to have some destructive effect on the amebas. This destructive action is greatly increased f the enema is administered at the low temperature of 70° F., at which temperature the ameba finds it difficult to continue life. Water of this temperature may be used in the rectum, but should not be used in the colon.

Sulphate of quinin is believed by many to be specific in its destructive action on the ameba, and is much used for irrigating the rectum and colon. It should be used in a 1 to 5,000 to 1 to 1,000 solution. Cures are believed to have been effected by such irrigations in many

cases.

If, in spite of the remedies which have been enumerated, the case still continues rebellious, resort to surgical interference may be deemed advisable, and appendicostomy may be performed, and irrigation of the colon by means of the insertion of an irrigation tube through the appendix may be practiced.

Great care and patience are required in the treatment of this disease, and the treatment should be long continued, and after the patient is apparently cured, he should be kept under observation for months in order that, if a relapse occurs, treatment may be promptly instituted.

re

were

LABYRINTHINE SUPPURATION. The correspondent of the Medical Record reports that new observations on labyrinthine suppuration have been ported by Prof. Adam Politzer before the Practitioners' Society. Eighteen fatal cases of otitic complications that had been carefully studied during life, showed at autoposy in ten cases marked anatomical changes in the labyrinth, while in eight cases, in spite of profound changes in the middle ear, no demonstrable changes in the labyrinth were found. The following lesions found: 1. Perforation of both fenestra of the labyrinth, with penetration of the pus into the interior of the labyrinth. 2. Fistulous openings in the semicircular canals and on the inner wall of the tympanum. 3. Destruction of the epithelial framework of the labyrinth, and of the organ of Corti. 4. Disappearance of the bony wall of the labyrinth and of the modiolus of the cochlea with perforation into the inner auditory canal. 5. Inflammatory changes in the latter and suppurative infiltration of the auditory nerve. 6. Connective tissue and osseous neoplastic formation in the cochlea as the result of an old inflammatory process that had run its course in the labyrinth. As otitic complications with lethal outcome there were evident meningitis, extradural abscess, cerebellar abscess, temperosphnoidal abscess, and sinus throbbosis. According to the statistics Politzer's clinic, the fatal outcome in more than half of the cases was due to a meningitis resulting from an infection by way of the labyrinth. Politzer has shown that this complication proceeds preferably through the cochlea. He rejects those operative methods that are confined to a breaking down of the semicircular canals and an opening up .of the vestibule, and lays down the postulate that the operative clearing out of the cochlea, and, therefore, the eradication of the dangerous focus of suppura

of

tion in the labyrinth, are necessary. In the presence of extradural abscess and of intracranial complications, the method of Jansen-Neumann is indicated, namely, the removal of the posterior pyramidal wall and the opening up of the labyrinth from the median side. On the other hand, in the case of labyrinthine suppurations without cerebal complications, Politzer recommends the removal of the wall of the promontory and the wide opening up of the vestibule and cochlea, which are to be thoroughly cleared out. The advantage of this method is the impossibility thereby of wounding the facial

nerve.

DIAGNOSIS OF DISEASES OF THE
LIVER.

The Medical Record cites an important series of investigations on this subject have been carried out in the medical clinics of Basle, by W. Frey, who contributes the results of his observations in the Zeitschrift für Klinsche Medizin. He finds that urobilinuria is a frequent manifestation of affections of the liver, denoting a functionally impaired organ if one can exclude, on the one hand, the occurrence of a diminution of the fecal urobilin, and on the other hand, an increased formation of urobilin, as by the destruction of red bloodcells. The administration of levulose is an important means of testing the functional capacity of the liver. In healthy individuals, alimentary levulosuria curs in 10 per cent. of the cases, while in those suffering from hepatic disorders alimentary levulosuria occurs in 50 per cent. of the cases. Among these cases instances of cirrhosis are largely represented, although the symptoms may occasionally fail. The employment of galactose is of inferior value in this test. The determination of urea in the urine furnishes no criterion of any existing disease of the liver. The excretion of ammonia, however, is increased in hepatic disorders, and is exceptionally high in the cirrhoses. The diagnostic value

OC

of this sign is compromised by the existence of similar figures in the case of excessive meat diet, fever, and various diseases that lead to acidosis.

The determination of the amino-acids furnishes an important diagnostic criterion. These acids are regularly increased (above 0.5 gram N.) in the cirrhoses. The significance of this sign is all the greater in view of the fact that Frey observed this abnormality only in one case of amyloid liver, and in one case of marked congestion of the liver, among a large nnumber of cases he had investigated. Among diseases of other organs, hyperacidaminuria was noted in pneumonia, typhoid fever, and pancreatic diabetes. The diseased liver is capable of disposing of ingested animo-acids as well as the healthy organ.

It is hoped that the development of these, as well as of other methods of diagnosis, will render possible the early recognition and differentiation of heptatic disease with a faccility equal to that of the urinary diagnosis of diseases of the kidney.

A NEW PHYSICAL SIGN.

Textbooks on physical diagnosis says the New York Medical Journal usually state that the upper limit of the absolute liver dullness begins posteriorly at midline and only anteriorly crosses the middle of the abdomen. Any dullness posterior to the left of the midspinal line is not accounted for, as a rule, by any increase or transposition of the liver limits. Yet Grocco, who has already pointed out a neglected physical sign, the so-called Grocco's paravertebral triangle, in cases of pleurisy with effusion, again takes issue with the textbook descriptions. Careful physical examinations of patients, combined with the observation of anatomical and pathological material, have shown to him. that even the normal limits of absolute liver dullness pass beyond the midspinal line and extend for from 3 1-2 to 5 cm.

to the left. In cases of enlargement of the liver the posterior boundary is, of course, moved still further to the left, sometimes reaching as far as 12 cm. to the left of the midline. Grocco has examined over three hundred normal and abnormal persons in reference to this point and gives in the Wiener klinische Wochenschrift for May 11, 1911, detailed directions for demonstrating his new physical sign. Of course, the determination of the left boundary of the liver posteriorly should prove of interest in cases where enlargement of the left lobe is suspected. Whether such determination will prove of much clinical value, remains to be seen. Grocco himself thinks that in the future this new physical sign will be elicited as an important. part of the routine physical examination of the thorax and abdomen.

HOT AIR DOUCHES IN NEURITIS.

In

Leopold Stieghtz, in the Medical Record, says the main principles of the actual cure of the disease can be summed up in two words: Rest and heat. the severer cases little or no headway will be made until the patient is put to bed and kept there till he is well on the way toward recovery, and then the return to active life should be gradual and cautious; a premature use of the affected limb is punished almost invariably by a setback. The beneficial effect of rest is indirect, inasmuch as it protects the inflamed nerve trunk from the innumerable small traumatisms active use of the limb would entail, traumatisms which aggravate the condition as indicated by the pain they create. Although rest is a sine qua non in the severe cases, rest alone will not cure this form neuritis, owing, as stated above, to the very slight tendency toward spontaneous recovery of an inflamed nerve trunk. This failure to heal of its own accord is accounted for by the poor blood supply provided for the nutrition of the peripheral nerve trunks, and in general it may be said that the more poorly tissues

of