THE a lower appraisement, and getting down Cincinnati Lancet-Clinic: to actual necessities. Enterprises that A WEEKLY JOURNAL OF MEDICINE AND SURGERY. ISSUED EVERY SATURDAY. are inflated and conducted on credit are sometimes obliged to close up. This is hard on many, but such inflations result in over-productions, and thereby greatly J. C. CULBERTSON, M.D., Editor and Publisher. impair others who have actual capital Physicians, like other people, are interested in the kind of times in which they live. When the country is prosperous they share in the prosperity; when dullness reigns in the commercial world, and the cogs of commerce go unoiled, physicians suffer as much from frictions as any other class of peopleperhaps more than most. Those who are wage-earners and receive regular salaries are better off than those who are not so favorably situated, but, strange as it may seem, those very people complain of the effects of dullness of business, and are correspondingly slow in paying their just debts. The Presidential election has been made the scapegoat for a vast amount of grumbling over the hard times. A fact is, hard times are actually necessary, and should come for the good of a majority of the people at stated intervals. Such periods cause a cessation of many extravagances and limitation of luxuries. There is a taking of stock on invested, Physicians suffer in resources because there is not much money in circulation, and when times are called hard people who pay their doctor are very slow about sending for a physician, and indulge in domestic remedies. In many such cases there is a natural tendency to recovery, and the physician thereby loses a considerable part of his income. When times are hard an increased number of people patronize the dispensaries and hospitals, and in that manner the aggregate income of the medical profession is lessened, and particularly among those who can least afford a shortage. A few days ago a physician in this city, who has been in practice ten or twelve years, stated to the writer that he had been obliged to borrow money on his watch in order to obtain food for his family. This man is reputable in his profession, and, so far as known to the writer, has no extravagant or bibulous habits. Money due him for ser vices rendered could not be collected, and he was in hard lines. It may be taken that this was an exceptional instance, but the collection of money honestly earned by physicians has been unusually difficult during the year 1896. One trouble in the, medical proression is that physicians do not make out their statements of account either as soon as service is rendered or at the end of every month. Mechanics do better; their work is not dry until pay for it is demanded, or, if working by the week, they expect and get their wages or work is stopped. A new deal is on all around, and physicians should take advantage of the occasion, and determine to collect so soon as service is rendered or at the end of every month. GONORRHEA. This is an affection that not so very long ago was regarded by the typical young man about town as little if any worse in its effects than a bad cold, some even going so far as to regard it as a necessary part of their education, and a condition to be proud of rather than otherwise; while pox was looked upon by the same young men as a much more horrible malady, but the serious constitutional nature of which was not by any means appreciated. When Noegerath, some twenty years ago, drew attention to the dire effects of gonorrhea upon the female, his assertions were received by the medical profession with downright skepticism. However, he made his statements so frequently and with such vehemence that one after another was induced to make a study of inflammatory conditions found within the female pelvis, and one after another began to affirm his statements of the dire effects of the gonococcus poison when once it found a lodgement in any part of the female genital organs. Pus-tubes, ovarian cysts, metritis, vaginitis, peritonitis, nephritis, ureteritis and phlebitis are now believed to be caused by the gonococcus microbe. Recently special attention is being directed to the effects of gonorrhea upon the male. A score and more of years ago the writer often wondered why it was that cases of gonorrhea which found their way to his office were so very intractable to treat, and that the disease under his hands was a good deal worse than the typical bad cold. Nearly every case proved so slow of recovery that he came to a conclusion that as a curer of a bad cold located in the penile member he was not a success. His cases did not in any instance get well in from three to five days, as often reported by others. Recently attention has been directed to the unusual number of medical journal articles published on this subject, and to the number of remedies indicated as useful in its treatment, which has led to a conclusion that there were some other physicians besides himself who do not succeed in curing the disease within the usual three to five days' time. Several cases of gonorrheal rheumatism in both sexes have directed special attention to this condition, and it is now believed that there are very many more cases of rheumatism which are primarily due to this affection than is generally supposed. In some cases the manifestations are not particularly observable until several months after the primary attack of the disease. In one case, that of a woman, there is at this time an arthritis, which has been quite acute in character, followed by a partial anchylosis in several joints, which it is thought will have to be relieved by surgical measures. Some cases which may hardly be looked upon as of gonorrheic origin will bear investigation, and in long time since supposably cured gonorrhea cases the gonococcus will be found to furnish the etiological reasons for an existing malady that has been attributed to something else. DR. GILLES DE LA TOURETTE has been appointed physician-in-chief to the Paris Exposition, to be held in 1900. There will be an exhibit of objects per taining to medicine and surgery. Total..... I 21 Correspondence. PUDENDAL HEMATOCELE. LUCASVILLE, O., October 28, 1896. Editor LANCET-CLINIC: In the LANCET-CLINIC of October Cases. Deaths. 17, 1896, I noticed an article from Dr. M. A. Tate, of Cincinnati, on "Puden3 dal Hematocele." This article was of much interest to me, from the fact that 10 I had just experienced my first case, 1 October 9, 1896, after a practice of thirty-seven years. 7 12 4 46 .. 2 16 The mortality report for the week Diphtheria Other Zymotic Diseases. Cancer... 2 3 2 4 10 Was called to see Mrs. M., a married lady, non-pregnant, who, two weeks prior to my visit, had attempted to climb upon a chair to arrange a picture on the wall. The chair upset, she falling astride of the back and struck herself on the left vulva. A hematocele devel7-15 oped instantly, so states the lady. In company with Dr. J. H. Stover, of 2-16 North Dakota, we visited the patient, and found upon examination a pudendal hematocele about as large as a goose egg, very hard, and of a dark bluish color. There was considerable tenderness, and the patient had suffered from sharp, shooting pains. Temperature 99°, circulation 92. Patient very ner nous. We deemed it best to operate, 90 not leave for absorption, for fear of 13.37 sepsis. We made a long free incision 7 5 2 2 2 13 19-50 6 3 14 106 over the tumor from above downwards and turned out a large firm blood-clot. 110 There was no hemorrhage following 109 the operation, as the interval from time 109 of accident to the day of operation (some fourteen days) had given the ruptured vessel time to close. Patient doing nicely. ACADEMY OF MEDICINE.-Monday evening, November 9: "Hydronephrosis" (with exhibition of patient), Dr. E. W. Walker; "Pathology of Corneal Ulceration," Dr. Louis Stricker. DR. H. D. HINCKLEY has removed his office to No. 20 W. Ninth Street. Hours, 1 to 3 P.M. Telephone 1889. A TEMPERATURE persistently above 100° and without apparent cause is suggestive of a tubercular trouble. My only reason for reporting the case is that they are not often met with, or physicians do not report them. We irrigated with hot bichloride solution. J. B. WARWICK, M.D. MEDICAL REGISTRATION. COLUMBUS, O., October 29, 1896. Editor LANCET-CLINIC: In looking over the records of the Probate Judges in a number of the counties of this State I find that a number of physicians who have received certificates from the State Board of Medical Registration and Examination have failed to record the same with the Probate Judge. There seems to be some misunderstanding in regard to this final act of registration. Would you kindly, in your next issue, call the attention of the profession throughout the State to that portion of the law which says: "The person receiving a certificate to practice medicine or surgery under Section 4403c, shall, before entering upon the practice, leave his certificate with the Probate Judge in the county in which he resides for record." This is the final act of registration, and no physician can consider himself legally qualified to practice medicine in the State of Ohio without first recording this certificate with the Probate Judge in the county in which he resides. Up to date, from reports from all the counties in the State, I find that there are less than sixty physicians in the State who have failed to make application for registration; a number of these are men who are not engaged in the practice of medicine at the present time. Respectfully yours, FRANK WINDERS, Secretary. Therapeutic Uses Of Suspension. Worotynski (Deut. Zeit. f. neuen Heilkunde) concludes as follows respecting the therapeutic value of suspension: 1. Suspension is worthy of being employed as a therapeutic measure in nervous diseases. 2. It is impossible, as yet, to establish clearly the indications and contraindications of this method of treatment. 3. Suspension gives excellent results in the second stage of tabes, and very good results in neurasthenia and other neuroses as a symptomatic measure which may be recommended in vertebral caries of tubercular origin and in other lesions of rachitis. 4. Suspension exerts favorable action upon visual disorders in patients suffering from atrophy of the optic nerve. 5. Suspension is not an indifferent means, and must be employed with caution.-Modern Medicine. Selections. FROM CURRENT MEDICAL LITERATURE. Fatty Heart and Obesity. Dr. Kirsch, a consultant at one of the large watering places, has published an interesting article on the subject of the condition of the heart in persons suffering from obesity. According to him, there exist three periods in the heart trouble provoked by the excess of fat around the organ. In the first period the cardiac symptoms are but slightly pronounced. When the heart of these patients is examined only a slight increase in the dullness and a certain degree of weakness of the physiological sounds of the organ, as well as of the cardiac shock at the apex, is found. Ordinarily the pulse preserves its normal tension; sometimes, however, it is small, the result frequently of a layer of fat over the radial artery. The progressive increase of the obesity produces a parallel increase of fat around the heart, and then cardiac affection enters on the second period. The first change to take place is a dilatation of the left ventricle, and if the compensation be not sufficient the right ventricle becomes enlarged in its turn. It is at this point that the patients complain of palpitations, vertigo, and an increasing dyspnea. Frequently also chronic bronchitis supervenes, which under the slightest causes presents acute exacerbations, and the dyspnea becomes more and more pronounced. Direct examination of the heart reveals little more than an exaggeration of the symptoms of the first period; however, the existence of short systolic souffle is frequently found at the apex, and the shock seems to be diffused over a large surface. The number of the cardiac beats vary considerably, according to the moment of examination; at one time the pulse is rapid, at another it will be found slow. The researches of M. Kirsch, confirming those of Dr. Huchard, show that arterio-sclerosis is very frequently met with in fat individuals, and when that is so, the symptoms of this affection, added to those dependent on the fatty envelepe, increase considerably the troubles of the patient. It is worthy of remark, however, that during his second period the morbid symptoms are less pronounced in women than in men and in muscular persons than in those of weaker build. The third period is characterized by the fact that the excess of fat around the organ becomes transformed into fatty degeneration. An active proliferation of fat takes place between the bundles of the muscular fibres of the heart on one hand, and the fibres themselves undergo the fatty transformation on the other. Hyposystole and asystole are the forced consequences of this anatomical condition of the myocardia. At this stage the patients develop all the symptoms of cardiac asthma, and frequently phenomena of angina pectoris are witnessed, producing fear of impending death. of fat in the organism, that is to say, rich in albuminates, but from which sugar and fat should be banished.-Paris Cor. Med. Press and Circular. The Treatment of Locomotor Ataxia. Erb (Sammlung klin. Vorträge, No. 150, April, 1896) gives a very detailed dissertation concerning the treatment of locomotor ataxia, of which here but the conclusion, as briefly as possible, and necessarily, therefore, imperfectly, can be given. 1. In the very earliest stage of the disease, when the indication thereto exists, an anti-syphilitic treatment should be instituted. This indication is present in all very fresh cases, in which the occurrence of the syphilitic infection does not antedate by too great a length of time the development of the initial symptoms of the tabes; in all cases in which there are still present symptoms of active syphilis of the skin, The physical signs at this period are mucous membrane, bones, etc., or in important; the cardiac dullness is per- which symptoms of cerebral or meninceived over a much larger surface, the geal syphilis exist; in those cases which shock is hardly felt, the bruits are faint, earlier were subject to an insufficient but frequently the second bruit at the treatment of the syphilis. The treataortic orifice is well pronounced. Under ment is to be carried out carefully, these conditions, the pulse is small, de- but energetically; not continuously, but pressible and often irregular and even rather intermittently, whereby operated intermittent. periods of anti-syphilitic treatment alterAt the two first periods, the prog-nate with others during which tonics, nosis is ordinarily favorable; but it is far from being so at the third stage of the malady, for a fatal denouement can take place, either suddenly or in a gradual manner common to heart diseases. In the first case, the sudden death may be the consequence of an embolus, of acute congestion of the lungs, or from paralysis of the heart, or from cerebral hemorrhage, especially where the affection is complicated by arterio-sclerosis. As regards the treatment, which can only hope to succeed in the two first periods, it is that of obesity, that is to say, that it should be essentially dietetic and hygienic. It consists in the systematic use of mineral water (sulphate of soda) acting as a laxative and a diuretic; in hydrotherapy, hot or cold, according to circumstances; in physical exercise and, above all, in an appropriate alimentary régime, tending to diminish the quantity electricity, etc., should be employed. The most serviceable specific treatment consists in the employment of inunctions of from four to six grammes of mercurial ointment daily until thirty or forty, or, in some instances, even fifty or sixty inunctions have been made. Due attention must be given to personal cleanliness, the care of the mouth, etc. There should occur then intermissions of the mercurial exhibition of from four to twelve months, during which iodide of potassium, in doses of from one and a half to four grammes or more daily should be given. The iodide of potas sium is especially recommended in cases complicated with tertiary manifestations, affecting the skin, mucous mem brane, bones, brain, etc.; likewise in cases with severe lightning pains, in cases with rapid and progressive increase in the severity of the symptoms, in cases |