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THIRST AFTER Celiotomy.—Dr. William H. Humiston of Cleveland, Ohio, reports in the American Journal of Obstetrics his method of preventing thirst after celiotomy, which is as follows:

The patient should have the usual preparation for celiotomy - i. e., diet, daily baths, cathartics, etc. For three days prior to operation, order the patient to drink one pint of hot water an hour before each meal and on retiring, thus drinking two quarts of water each twentyfour hours, the last pint to be taken three hours before the time set for operating. Do not omit to give the water the day previous to the operation, while the patient is restricted to a limited amount of liquid nourishment and the bowels are being unloaded. We thus restore to the system the large loss of fluid occasioned by the free catharsis, and we have the great satisfaction of seeing our patient pass through the trying ordeal of the first thirty-six hours after operation in comparative comfort, with no thirst, a moist tongue, and an active renal function, represented by an excretion of from twenty-eight to fifty fluidounces of urine during the first twenty-four hours, catheterization being seldom necessary. This is in keeping This is in keeping with the full character of the pulse noted.

The application of this law is subject to certain modifications due to the anatomical and architectonic peculiarities of the skull, its coverings and contents, and to certain exceptions due to the amount and velocity of the force applied as well as to the coming into play of peculiar counter-forces.

The above detail I have recently carried out in twelve cases. To eleven chloroform was administered, to one ether. The time required to complete operation varied from ten to fifty-five minutes. Whether the case was one of sclerotic ovaries or a pus case with universal adhesions of all the pelvic structures, the result has been uniform and highly satisfactory, thirst being allayed and excretion stimulated (a very essential condition to prompt recovery).

I believe this method will prove to be efficient in the hands of abdominal surgeons generally, and I publish it early with all confidence that the twelve cases I have had will soon be fortified by the reports of many hundreds, and that by it we may avoid a condition that is and has been distressing alike to patient, surgeon and nurse.

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URINE FILTRATION. - In the Boston Medical and Surgical Journal, Dr. L. F. Bishop gives a quick method for filtering small quantities of urine. A small quantity of the cloudy urine is placed in a test-tube, the mouth of the testtube plugged with cotton with a moderate degree of firmness. A second testtube is placed with its mouth to the first. The position of the tubes is now reversed so that the one with the urine is bottom upward. The upper tube is now carefully and gently heated over the flame of a Bunsen burner or alcohol flame, and the expansion of the air above the urine immediately forces it through the cotton plug, and the filtered urine collects in the lower tube. In this we imitate to a degree the rapidfiltering apparatus of laboratories, but use pressure above the fluid to be filtered instead of an air-exhaust below.

SOCIETY REPORTS.

THE CLINICO-PATHOLOGICAL

SOCIETY OF WASHINGTON, D. C.

MEETING HELD MAY 7, 1895.

At the meeting of the Clinico-Pathological Society, held May 7, 1895, at the office of Dr. Holden, the following pathological specimens were presented by Dr. Kelley: Large stone taken from the bladder through the abdomen. A case of acute peritonitis, in which was found a fibroid tumor of the uterus, an ovarian cyst, a pelvic abscess, and appendicitis. Dr. Wellington read a paper entitled CROUPOUS PNEUMONIA IN CHILDREN. (See page 305.)

Dr. Stone opened the discussion. He said: It is sadly lacking in taste, to say the least, to open any discussion with an excuse or apology, but here I think I am justified in so doing for the scope of the evening's paper is far without my bailiwick and again, as my library only contains works (on general subjects) which the advance of time have relegated to the past, any criticism I may possibly advance would be in the nature of (if I may be pardoned the use of slang) "back-numbers."

It has always appeared to me that the treatment of children with their many disorders required a little more than the usual care and ability. In the adult undoubtedly, we are dealing with intellect and reason which will suggest and aid the physician in diagnosing, but in the infant it is different. I have heard physicians say they preferred the treatment of childreu for the reason that they (the children) never or seldom ever lied. This is very true for it is more natural for a child to be up and bright enjoying its play, than the adult, who may wish a few lazy days in bed. Still, in the infant one must absolutely be certain as a diagnostician and keen observer to gain the coveted reward of success. I shall in nowise attempt to discuss the entire paper, but only here and there. Although in well managed cases all authorities agree in the favorable prognosis, still Loomis in the prognosis says:

"The prognosis in pneumonia depends more upon the age of the patient than upon any other single element; occurring in the young child, or in a very old Again, as regards the limit of temperaperson, it is almost certainly fatal." ture, the same author says: "A temperature of 104° F. must be regarded as the limit in a mild case of pneumonia." Loomis says in his introduction of treatment that "perhaps there is no disease, the treatment of which has been so bitterly and earnestly discussed, as the one now under discussion. It has been the battlefield of the advocates of heroic measures on the one hand and of the advocates of expectant plan of treatment on the other."

Dr. Wellington refers in treatment to reduction of temperature by "sponging, wet-packs or even the plunge bath (cold)." Of course, heroic diseases and symptoms require heroic measures but it appears to me that this should be a dernier ressort even if ever used. I do not believe the children of the rich and better classes could nor would stand such severe measures. Loomis is quoted in this connection as saying: "The Germans believe that in pneumonia the temperature can be reduced by the application to the chest of cold compresses; a cloth of some thickness is to be wrung from cold water and applied every five or ten minutes to the affected side. It is claimed for this measure, that not only does it relieve local symptoms but it lowers the body temperature and hastens the day of crisis. There can be no doubt that the pain in the side and the dyspnea will be relieved in this way; but it is also certain that the reduction of temperature and relief of local symptoms are only temporary. My own experience (Loomis) would lead me to believe that pneumonia treated in this way is more liable to extend; besides, unless great care is exercised in the application of the compress, the patient is quite likely to be chilled, and as the measure is only temporary he does not regard it as a safe measure."

Again, in treatment Dr. Wellington prefers antipyrine. I do not know what experience he may have had with

the drug, but am almost certain that it will be but a matter of time before he will meet his Waterloo. Some years ago during an attack of typhoid my wife's temperature being 103° and the doctor desiring reduction, resorted to this drug for its accomplishment. Only five grains were given. There was dangerous heart failure and at the same time a reduction of temperature subnormal in less than two hours. At that time, strange as it may seem, the drug was more universally used in the west and southwest than here in the east. I agree most heartily with him in that frequent and careful watching is absolutely necessary. I regret most sincerely that I am unable to discuss the paper as it deserves, but I am fully aware that abler hands than mine will open all avenues and the subject and paper will receive the praise and interest it most justly demands.

Dr. Glazebrook said that in regard to croupous being more prevalent than catarrhal pneumonia in children he was of the opinion that it was just the reverse.

Dr. Wellington said that about onethird of all cases of pneumonia are croupous. As to differential diagnosis, a large majority of the cases of croupous pneumonia brought to the Children's Hospital, say 90 per cent., were previously diagnosed as cases of meningitis; the movements of the alae nasi muscles clinched the diagnosis of pneumonia. The cold pack and bath are to be preferred to antipyretics in the treatment of this disease; this was the preferred treatment at the Children's Hospital.

Dr. Frank Leech said that he had some experience with croupous pneumonia in the Children's Hospital but did not see so many cases as those of catarrhal pneumonia. After leaving the hospital and engaging in private practice the order of things seemed to be reversed. The oiled silk jacket is a valuable adjunct to the treatment of this disease. He prefers the application of cold to the use of antipyretics.

Dr. Sprigg said he was glad to hear the oiled silk jacket recommended in the treatment of pneumonia.

Dr. Snyder said that the oiled silk

jacket used to be considered a pathognomonic sign'of pneumonia. He thinks there is considerable difficulty in making the differential diagnosis between capillary bronchitis and this disease; it is certainly more difficult than one imagines it to be. The cold bath and pack is not so rational as it seems at first sight.

Dr. Glazebrook said the relief following the use of the cold pack or bath was marvelous.

Dr. Stone asked if the cold pack is used in private practice as much as it is used in the hospitals.

Dr. Olin Leech said that the oiled silk vest and cold pack and sponging are favorite remedies of his. He also thought well of the practice of mixing quinine with vaseline and rubbing it in the skin; he does not use antipyretics or expectorants, the latter working more harm to the stomach than benefit to the patient.

Dr. Tompkins said that the principal question under discussion was whether cold packing or hot applications to the chest should be used. If he had pneumonia he would prefer hot applications to the chest.

Dr. Mackall said that the old flaxseed meal poultices should not be altogether discarded. The cold plunge and pack are valuable, but no routine treatment ought to be recommended.

Dr. Glazebrook said that the cold pack and sponging are to reduce the temperature. Sometimes the hot applications agree with patients better than cold.

Dr. Tompkins said that the applications to the chest are to promote resolution and not to affect body temperature.

Dr. Olin Leech said that the cold acts as a stimulant to the circulation, as well as to the nervous system. He uses flaxseed meal poultices; sometimes they did not have time to remove the oiled silk jacket.

Dr. Deale said that if it is a specific disease the local applications should not affect it at all. The oiled silk jacket offers more of a protection than any curative power. Unless the temperature is excessive it is better to let it alone,

as it has been shown that the pneumococci cannot exist at a temperature above 104°-105° F. Sponging, or cold pack if it is allowed, is the better remedy for reducing temperature. As to antipyretics; antipyrine is by far the most depressing; phenacetine is to be preferred-if followed by quinine it is quite efficacious. Diagnosis is sometimes quite difficult. Mortality is considerable, somewhat greater than he imagined, according to Dr. Wellington's paper. Treatment: Nitroglycerine is a valuable remedy.

Dr. Clark said that in the treatment of cases, baths would not be used in children who are weak or exhausted. He agrees with Dr. Mackall about routine treatment, and with Dr. D. O. Leech as to using as little medicine as possible. Aconite in incipient pneumonia is the most valuable drug for reducing temperature. Quinine is valuable after the temperature has been reduced by aconite. It should not be used by the mouth, but rubbed in with lanolin or in suppository. A great deal of the treatment depends on the stage at which you see the patient. The shock to most children of the wet sheet is considerable. The bath at about body temperature is to be preferred, and we can gradually lower the temperature of the water. If shock ensues, brandy or other stimulants are indicated. Poultices are not to be discarded, in properly selected cases; if the nursing is good, and the patient a strong child, improvement will follow their use. In weak children the poultices by their weight do harm.

Dr. Muncaster wished to mention one point in the examination of the heart in pneumonia; it is found that the radial pulse will not indicate the exact action of the heart. The examination of the right side of the heart, and the use of trinitrin, is important.

Dr. Wellington in closing said that Dr. Stone quoted Dr. Loomis, who is at variance with most authors in treatment and prognosis of croupous pneumonia. He regards cold as valuable; he uses both the sponging and pack. As to frequency his experience is that it is a comparatively infrequent disease, but

eminent authorities declare that it forms one-third of all cases. He advocates cold pack, and sometimes poultices. Quinine in his experience has little effect in pneumonia.

Dr. Tompkins read a paper entitled CEREBRAL HEMORRHAGE, with specimens, the discussion of which was postponed until the next meeting.

R. T. HOLDEN, M. D., Secretary.

PHILADELPHIA ACADEMY OF

SURGERY.

STATED MEETING, JUNE 3, 1895.

Dr. Thomas G. Morton, the President, in the chair.

Dr. Charles W. Dulles read a paper on FRACTURES OF THE SKULL. (See page 308.)

The President: Has the alteration in the conformation of the skull, I mean the shortening of the axis in the direction of the applied force and the lengthening of the transverse axes, been accurately determined by measurement ?

Dr. Dulles: Yes; the alteration has been carefully measured and there is an appreciable difference, the amount of which is mentioned in my former paper.

Dr. Hewson: In connection with the remarks upon the fractures of the clinoid processes, have you taken into consideration the fact of the difference in the height of the free concave margin and anterior attached extremities to the posterior clinoid process? Owing to this, the portion of the tentorium open for the passage of the nervous substance is triangular, with curved sides, and this is much higher than its attached anterior extremities to the posterior clinoid processes. The direction of the free margin of the tentorium is pointed upward over the superior vermiform process of the cerebellum, this margin being higher than its anterior attachment. I only wish to ask if the direction of the traction upon the posterior clinoid processes contribute anything to the fracture? The point I wish to ask is, have you observed any laceration of the margins of this opening?

Dr. Dulles: Whether or not the posterior clinoid processes are higher than

the arch of the tentorium depends much on the way in which the skull is held. I should think that under ordinary circumstances, when the head is held erect, they are about on the same level.

Dr. Hewson: The tentorium arches upward.

Dr. Dulles: I have not overlooked this fact in my study of fractures of the skull. Under ordinary circumstances the curve of the tentorium would supply an amount of slack material which would prevent any pull on the clinoid processes. But it must be remembered that the tentorium rests upon the cerebellum and is held tense by the cerebrum above the cerebellum, and is so attached that the latter occupies a closed, unyielding case. The brain-substance is so largely made up of water that it is almost as incompressible as water (which is practically entirely incompressible) and the cerebellum will hold up the tentorium almost as effectually as if it were made of marble, and so cause a pull at its posterior part to be transmitted to its anterior attachments. This I say only by way of suggested explanation of fractures of the processes; I have no demonstration of the theory to offer.

MEDICAL PROGRESS.

RENNET-ZYMOGEN

AND STOMACH

DISEASES. Dr. Julius Friedenwald of Baltimore has made a very exhaustive study in the Medical News of the quantitative estimation of the rennet-zymogen and its diagnostic value in certain. diseases of the stomach, from which he sums up the following conclusions :

1. Under normal conditions the milkcurdling ferment may be present in dilutions up to 6, the zymogen up to 1.

2. In those cases in which there is a normal or diminished percentage of free hydrochloric acid, the milk-curdling ferment and its zymogen may be present in normal quantities or may be markedly diminished. Their estimation, therefore, in these cases is of little value.

3. The estimation of the milk-curdling ferment and its zymogen is of great

diagnostic as well as prognostic importance in those cases of gastric disorder accompanied by an entire absence of free hydrochloric acid. In these cases (chronic gastritis or carcinoma) there is marked diminution of the zymogen (4-0), depending upon the severity and extent of the disease. In cases of nervous dyspepsia, as well as in secondary catarrh, the zymogen is present in normal proportions in dilutions of from to We can, therefore, readily determine whether there is actual disease of the gastric mucous membrane or simply a nervous or congestive condition.

4. In those cases in which there is an absence of free hydrochloric acid, and in which the labzymogen falls between

and, it is impossible to determine at once whether there is a catarrhal condition or nervous dyspepsia present. Several examinations must be made to determine whether the labzymogen ranges above or below.

5. In cases of chronic gastritis the examination for the labzymogen is of considerable prognostic importance. In those cases in which the labzymogen is diminished from too there is no chance of recovery; in those in which it is diminished from to there is a possibility that judicious treatment may result in recovery.

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DIET IN PREGNANCY.- Dr. Eichholz of Kreuznach, in the British Medical Journal, maintains that a large proportion of the discomforts and difficulties preceding, attending and following parturition might be avoided by a rigid adherence to some simple dietetic rules. Excess of albumen and of water are, he considers, the errors against which pregnant women should be warned, as tending respectively to excessive development of the fetus and secretion of amniotic fluid. His rules are: Meat only once a day, and that in small quantity and rarely if ever salted; green vegetables, salad, potatoes, bread and butter, but avoiding as far as possible eggs, peas and beans, as being too rich in albumen. Thirst to be quenched by milk or water in moderate quantities, and cocoa in preference to tea and coffee.

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