and rheumatism, suggests the idea that these diseases have something in common, either causal or concomitant, which the preparations of salicin antagonize.

The clinical observations which support the idea of a correlation of gout, diabetes, rheumatism and certain definite structural changes in the kidneys and blood vessels, namely, the frequency of hereditary transmission in the same family and their occasional co-existence in the same individual, the common idiosyncrasy of a diminished capacity for the complete conversion of the carbo-hydrates, and finally the common reactions which they exhibit to the same remedies, are, of course, open to criticism, but they nevertheless excite a reasonable suspicion that these diseases have at least certain common features which, in all probability, proceed from similar derangements of physiological functions.

This much it seems to me may be acknowledged even in the absence of any adequate pathological evidence that these diseases are attended with any common structural lesions or specific functional disturbances.

There are many unsolved problems in the pathology of gout, diabetes and rheumatism, and the working hypotheses of the clinical ob servers in this field are being constantly unsettled by the revelation of the physiological laboratory. It would seem, therefore, that the only conclusion we are at present justified in making as to the correlation of the diseases in question, is this: clinically, they are often associated by hereditary transmission, by coexistence and alternation in the same individual, by presenting similar idiosyncracies in regard to the power of converting the carbo-hydrates, and by being more or less successfully controlled by the same remedies. Pathologically, they must still be regarded in the absence of any demonstrable common determining cause either functional or structural, as more or less distinct and specific dis

eases.

DISCUSSION.

DR. E. G. JANEWAY, New York. In taking up the question of history, we have to be careful in reading English writers. The English people all through are gouty. Any rheumatic tendency except in such individuals will not hold in other countries. We do not I think, find the same correlation in America. A point which has struck me strongly is the fact that, while the Hebrew race is very subject to diabetes, members of this race do not Lave gout and rheumatism in the same proportion.

With reference to the presence of albumen

DR. A. L. LOOMIS, New York. I should like to relate briefly the histories of some illustrative cases. The first is the case of a man of 63, who, at the age of 42, had his first attack of gout. These attacks recurred until the age of 60. The urine was frequently examined during this period and with nega tive results, presenting only a high specific gravity and nearly always an abundance of urates. In his sixtieth year after a prolonged attack of gout, sugar appeared in the urine. From that time to the present, he has not had an attack of gout. Sugar was present until six months ago when it disappeared, and now I find albumen. This change could not be accounted for by changes in habits or in diet. Two analogous cases were also reported. These cases are not unusual. It seems to me that they compel us to take the position that while in their clinical phenomena they differ very markedly, still in their origin and development they seem to have many things in common; in other words, their correlation seems to be complete.

DR. H. C. WOOD, Philadelphia. My experience has led me to conclude that gout and rheumatism are the same thing. I am utterly unable to make the diagnosis between them.

DR. WILLIAM PEPPER, Philadelphia.-The clinical evidences of the correlation of these diseases, seems to me to be so great that we cannot safely disregard it. In considering such common diseases, we must, of course, exclude mere coincidence. In regard to Dr. Janeway's remarks in regard to the frequency of diabetes in the Jewish race, I can agree, but I have also found such persons very subject to lithemia. In all these cases, the importance which a diminution of vital resistance of any particular part plays in the development of the local manifestation must be remembered.

DR.DANA. In regard to treatment, I could give evidence in favor of the salicylic acid treatment in certain groups of diabetics. These have been cases of the milder type associated with rheumatoid and arthritic phenomena. In onecase the diabetes has been apparently cured the patient having returned to the use of the carbo-hydrates. In this case albumen still persists.

The explanation of Dr. Janeway as to the cause of the albuminuria, I think does not hold good in many of these cases. The disappearance of the sugar is not always accom

panied by a corresponding decrease in the quantity of albumen.

DR. JACOBY-In regard to the connection between diabetes and gout, there are several forms of diabetes. The form particularly connected with gout, is that due to disturbances of the nutritive processes, particularly that of the liver. This is the form in which the salicylates do good. Its action has seemed to

me

to be due to the influence of this drug over the liver in increasing the quantity of bile and in liquifying it. It is therefore, a powerful agent in diminishing the tendency to the formation of gall stones. The forms of glycosuria which come and go,are usually benefitted by salicylate of sodium. This form of diabetes is generally found in anemic persons, often very fat and not infrequently among women of the Jewish race.

In reference to Bright's disease. This is quite common at the age of forty or fifty years when atheroma of the small arteries appears. At that time, gout is also common and the co-existence of the two does not necessarily indicate a common causation.

SPASM OF THE GLOTTIS IN RICKETS.

BY JAMES T. WHITTAKER, M. D., CINCINNATI, 0. The author emphasized the fact that this accident belongs almost exclusively to rickets, and dwelt upon the value of recognition of this fact because rickets is, generally speak ing, a curable disease, and the spasm of the glottis disappears with the successful treatment of its cause, while treatment addressed to the larynx directly remains without effect. The speaker next quoted from a number of authorities to show that this relation between the two affections is not so universally recognized in this country and England as in Germany and France. The two latest authors of text books in Germany, Strimpell and Sichorst, declare, one, that two-thirds, and the other that nine-tenths of all cases of spasm of the glottis depend upon rickets.

Spasm of the glottis is often the first sign to unmask rickets, for the other evidences of the disease are often attributed to other causes. Thus general malaise is attributed to dentition, intestinal catarrh to errors in diet, fever and sweating to malaria, bone deformities to premature efforts upon the feet,

.etc.

Spasm of the larynx indicates the stage rather than the degree of rickets, in that it occurs mostly in cases of rapid advance of the disease and does not appear in cases of slow progress. So in the spring and fall, when rickets advances in leaps, spasm of the glottis has occurred in epidemic form.

The essayist discussed next the various theories of rickets which continue to elude investigation to a degree characterized as exasperating. But facts accumulate which go to give it place among the chronic infections. The exemption of hot climates and mountains, Iceland, the Faroe islands, the complete immunity of Davos, notwithstanding the improper hygiene of sucklings at these places, show that faults in diet can not be the cause of it, and the symptomotology of it fits better among the chronic infections produced by specific causes.

Spasm of the glottis in the absence of any constant lesion falls among the neuroses. The question as to the reflex or direct character of the irritation producing it was decided after a review of the evidence in favor of the latter, and since Rosenbach has demonstrated the micro organism of tetanus which often begins with and may go no further than trismus, the maintainance of a mycotic theory for the laryngospasm of rickets may be adopted as the best provisional explanation. The mode of on-set and character of the accident were next detailed and the symptomatology illustrated with a typical case.

The inefficacy of anesthetics and all direct means of treatment, as by intubation, tracheotomy, etc., were mentioned next, and douches, flagellations, electricity, cold air, direct appeals to the skin on the first appearance of attack, were described as the best means of combating and more especially of preventing the attack. Cod liver oil, and more especially phosphorous which might be looked upon almost in the light of a specific were considered the best means of speedily relieving the rickets, and thus removing the cause of the laryngeal spasm. It has the most favorable prognosis of all kinds of laryngospasm, as Monte lost but eight of 329 cases. DISCUSSION.

DR. A. JACOBI, New York. This is a subject in which I am much interested. As has been said, this is almost always due to rickets. When the rickets disappears the spasm of the glottis also disappears. The disease may be primary or secondary. In forty-nine out of fifty cases of spasm of the larynx the cause is rickets, and in forty-eight of these it is rickets of the cranium and of the meringes of the brain. When the cranium is opened we find congestion. Cranio-tabes need not be developed to any marked extent. Where we have a succulent cranium we have a succulent meninges and a succulent brain. There is meninges hyperemia and meningeal effusion in such cases. In regard to prognosis. If you have six weeks during which to carry out

proper treatment, you may be sure that the child will lose its laryngismus stridulus, but during that time the child may die in an attack.

DR. WILLIAM PEPPER, Philadelphia. In a case of spasm of the glottis in whooping congh seen recently, the attacks were So severe that on several occasions the child apparently died. Nitrate of amyl was succesfully used for the relief of these attacks. It was found that a combination of one part of nitrite of amyl with nine of sulphuric ether gave the best results.

[TO BE CONTINUED.]

BALTIMORE GYNECOLOGICAL AND

OBSTETRICAL SOCIETY.

Regular meeting, held May 11, 1886. The President, Dr. Geo. W. Miltenberger, in the chair-Dr. Wm. E. Mosley, Secretary.

DR. ROBERT T. WILSON read a paper entitled:

HYSTERECTOMY FOR REMOVAL OF A FIBRO

CYSTIC TUMOR. (Vide p. 7.)

DISCUSSION.

DR. THOMAS OPIE said he would like to ask Dr. Wilson whether he had ever had signs of poisoning or local irritation from the use of so strong a solution of bichloride of mercury as 1-2000. Judging from his experience with corrosive sublimate in obstetrical practice, one part in two thousand was much too strong. In one of his cases, it had caused a severe metritis. He called attention to statements recently published that biniodide had proved to be quite as effective as the bichloride, and can be safely used as a germicide, the strength of 1-4000.

DR. W. E. MOSELY, in regard to washing out the abdominal cavity with so strong a solution as that advocated by Dr. Wilson, would merely repeat the remarks he made at a previous meeting. He considered that in placing such a solution in contact with so extensive an absorbing surface as that presented by the peritoneum and abdominal contents, there was great danger of general poisoning, and also of local irritation. He believed that all the requirements would be met by the free use of freshly boiled water used directly from the vessels in which it was boiled.

DR. W. P. CHUNN asked how soon the fluid removed from the larger or main tumor coagulated, and what its appearance was.

DR. R. T. WILSON answered that, as he had stated in his paper, the fluid was strawcolored and coagulated within two hours.

DR. H. P. C. WILSON stated that he had repeatedly used the bichloride solution in the manner and strength advocated in the paper read, and had never seen any bad effects follow. Dr. Thornton and other English surgeons, use the same solution freely.

DR. T. A. ASHBY remarked that Dr. Hofmeier of Berlin, had reported in the American Journal of Obstetrics, as far back as May, 1884, several cases of poisoning from the use of weak solutions of corrosive sublimate, in the puerperium. Bodleteur has observed that sublimate solutions of 1-4000 for vaginal injections will produce some irritability, and in view of this fact, he thought solutions of 1-10,000 were sufficiently active for vaginal injections. What is true in this respect, of vaginal injections, is applicable to the use of the bichloride solution in abdominal surgery. The peritoneal membrane is a far better absorbent surface than the vaginal or uterine mucosa. When it is considered that the strength of the sublimate solution of 1-2000 is equal to 3 grs. of the bichloride of mercury to the pint of water, and that frequently the abdominal cavity is irrigated with from one quart to one gallon of this antiseptic wash, an idea may be had of the danger of absorption from the 10, 15 or 20 grains of bichloride in this manner used. In abdominal surgery, the strength of the bichloride solution should be feeble. Dr Ashby thought a solution of 1-10,000 amply sufficient when employed in this manner, and that the stronger solutions were dangerous in proportion to their strength.

He

DR. A. H. ERICH thoroughly agreed with the view expressed that for douching the abdominal cavity, freshly boiled water would meet all the requirements. If there were any suspicious points, they could be touched with a sponge wet in the bichloride solution. had nearly lost a patient from carbolic acid poisoning and it had put him on his guard against the too free use of corrosive sublimate. He thought a great deal depended upon the condition of the peritoneum, and that we ought always to be on our guard, lest free absorption and poisoning should take place.

[TO BE CONTINUED]

HEIDELBERG UNIVERSITY SOCIETY.

During the past week a meeting of resident. Heidelberg students was called for the purpose of preliminary work in the direction of proper celebration of this, the 500th anniversary of the ancient and honorable seat of

learning. The gathering was quite large, it appearing that nearly fifty former students now engaged in the various callings of medicine, law, journalism and commerce, all occupying positions of eminence, are resident in this city.

Dr. Adolf Alt was elected president of the Society, and Dr. Otto Greiner, secretary.

All who have ever been students at the university are requested to send their names to either Dr. Alt or Dr. Greiner. Heidelberg may well feel proud of her flock in St. Louis, as the flock has good reason for pride in its

alma mater.

The Southern Illinois Medical Association held its twelfth annual session at Desberger's Opera House, Murphysboro, Ills., commencing June 17th, 1886. The meeting was called to order at 1 P. M., by the president, Dr. Beattie, of Red Bud.

After the opening exercises, Drs. Wm. Porter, W. L. Barrett and A. B. Shaw, of St. Louis, Bently, of Marion, and Rauch, of Springfield, Illinois, were made members by invitation.

The Secretary read communications from absent members.

Dr. Shaw, of St. Louis, read a very inter

esting and instructive paper on "Masked Epilepsy."

Dr. Wetmore, of Waterloo, read a well prepared paper on "Nutrition." He takes issue with physiologists on the theories commonly advanced by them on this subject.

Dr. Rauch, Secretary of the State Board of Health, delivered an address in the interest of a higher standard of medical education. In order to accomplish this, he says, it is necessary to take the licensing power away from the faculties of medical colleges. Colleges in this country are private institutions, and are conducted for profit. He urged upon the members present, the importance of accurate vital statistics, and their duty to the State Board of Health in regard to the returns of births and deaths.

water or steam.

Dr. Guthrie, of Sparta, read a highly interesting paper on "School Hygiene," in which he advocated heating school rooms with hot He objects to white walls, preferring neutral tints. He discussed, in his paper, tuberculosis, favoring the opinion of numerous authors, that it is of a contagious nature, and cautioned school directors of the danger in employing teachers affected with the disease.

The Association adjourned at 6 o'clock to meet again at 7:30 for an evening session. At this session Prof. A. B. Garrett delivered the address of welcome on behalf of the citizens, and Dr. Ormsby on behalf of the local profession.

Dr. Wetmore, of Waterloo, responded in behalf of the Association.

The Association was called to order by the president at 8 o'clock, on the morning of the second day.

Dr. Booth read a paper on "Fractures"" in which he stated his objections to permanent dressings at first.

Dr. Ferrell read a paper on "The Forward

Dislocation of the Head of the Radius."

Dr. McIntyre read a paper on "Circulation."

Dr. Hale introduced a case with purpura hemorrhagica, which was examined and commented upon by the members.

Dr. Huntsinger exhibited a very interesting case of multiple fibroma molluscum, and read a paper on the subject, in which he advocated Cohnheim's embryonic cell theory as the origin, and inflammation and nervous influence as the exciting causes.

Dr. Thompson read a well prepared paper on Physiology."

66

Dr. Hallam read a short. but interesting