son who has been passing only a little sugar, brings a specimen which contains a large quantity of sugar. Under such circumstances we must look for some error in the preceding meal. In one case this proved to be blancmange which had been made with corn flour. Blanc-mange for the diabetic should be made with cream and gelatine or isinglass. In another case a patient had been passing very little sugar, when suddenly the quantity increased. Careful questioning revealed no error in diet, until it was learned that the patient had substituted for the bran biscuits which he had been using others said to be "just as good," which examination showed to be made of the whole meal. I refer to these cases to show the value of the quantitative analysis. In the treatment of these cases, the exclusion of the carbohydrate elements of the food should be as complete as possible. In the case of a person in the middle period of life, I first put the patient upon a strict diet. Very often the sugar for a time lingers in the urine. It is materially diminished, but has not disappeared. I may also say that I have, in addition, recourse to opium, codeia, or morphia, for I believe that these drugs have an important influence in controlling the disease-or, to put it in other words, they restore the assimilative power. Certain it is that under the influence of these drugs and strict diet, sugar after a time disappears from the urine; and after the urine is kept free from sugar for a few months, I find that the individual has a certain amount of assimilative power over the starch of bread. I test this by giving him a couple of ounces of bread. Frequently there is no reappearance of sugar. If there is no return after this has been continued two or three weeks, I increase the quantity to three ounces per diem. Then, if there is no return, to four and one-half ounces; and, finally, to six ounces. Then the person is in the position of a small bread eater. I recommend patients to be content with that. They can very well give up potatoes and sugar, but to give up bread is a serious matter with many people. When a person can take six ounces of bread per diem, he is not in an unfavorable condition. Many of these persons can continue to take this quantity of bread with no return of sugar in the urine. If, however, they go further and resume their ordinary diet, there will be a reappearance of sugar. The urine must be taken as the guide. Treating the case in this way, my experience is that, after the middle period of life, these patients do exceedingly well. I must apologize, Mr. President, for the crudeness of these remarks, for I have had no time for preparation. I thank you most heartily for the attention which you have given to me. I cannot close without thanking you and your countrymen for the cordial reception given to myself and my confréres by everyone with whom we have come in contact. PECULIAR SEQUELÆ OF MEASLES. BY DR. JAMES COLLINS. Read before the Philadelphia County Medical Society. September 28, 1887. Measles is usually considered a very simple affection. The respiratory organs and eyes are usually watched. This being accomplished, and care that aural catarrh is not developed being exercised, measles is considered as having been properly treated. During the recent epidemic I witnessed some sequelæ from measles in which the nervous system seemed to be especially involved. CASE I. A girl of eight years. The fever, eruption, and desquamation followed the usual course; and not until several days after the skin had resumed its normal color, and the bronchitis had disappeared, did the symptoms of chorea develop. This child was a blonde, of Irish parentage. The invasion of the nervous symptoms was gradual, but they developed to a violent degree. During the second week the agitation of the child was so great that she could not remain upon a sofa without being guarded or tied. She was unable to feed herself, and was constantly laughing and giggling, as well as twitching. Cimicifuga, tonics, and applications to the spine were used. The child recovered, and was well at the sixth week. CASE II.—A girl of eleven years, of German parentage, a dark blonde, also developed chorea, but in a less violent degree. Similar treatment was pursued, and recovery was complete in the fourth week. The marked nervous element in these cases causes them to be worthy of note. CASE III.-Kate A., aged three and a half years-the second case of measles in the house. Eruption appeared at a normal period, and followed the usual course. Catarrhal symptoms not more marked than usual. Temperature not above 103°, pulse 110 at highest point. On the third day of the eruption she exhibited a peculiar irregular kick while in bed. Examination revealed that the reflexes of the ankle and knee were exaggerated, while the ability to stand was greatly impaired, and the coördination of the movements of the lower extremities was imperfect. On the following day she was unable to sit up in bed, the arms kept in irregular motion, while the power of grasp was almost lost for small objects. By the fourth day, hearing was impaired, and by the seventh day eyesight was lost, and action of the sphincters became uncertain. Blind, deaf, and powerless for self-help, this poor child for five weeks kept up an idiotic cry, with irregular swinging and aimless motion of arms and legs. The special senses gave some objective evidences of such a grave condition. The eye-ground showed the arteries tortuous, veins full, choroid congested; disk seemed to be choked in either eye. weeks commenced to walk and see; hearing was slow to return. The reflexes of bladder and rectum also became normal. Yet the child continued nervous, irritable, howling with raucous voice when disturbed or denied any of her wishes. During the summer she has gradually improved; now walks with gait somewhat wabbling. She eats well, and nourishes well. Her temper is irascible; she drags the right foot, and falls easily. The motion and use of the upper extremities appear to be normal. Hearing nearly normal. Eye-ground shows evidences of some structural changes; vessels still small and tortuous, some choroiditis remains. Vision has improved so that she can distinguish objects, but my last attempt to test it accurately resulted in ignominious failure. Urine has shown neither albumen nor sugar. Specimens examined were of normal specific gravity, and deposited phosphates on standing. The following case presents some peculiar conditions: CASE IV.-Edward L., aged nine years, had measles in March, 1886. The attack was severe for four days; and in spite of treatment the recovery was slow. He complained of severe headache, and of seeing double at times. During the spring and summer he seemed to be tolerably well, excepting headache, from which he suffered frequently. In July, 1886,his headaches increased. At times his head seemed to be drawn either backward or to one side, the paroxysms lasting four or five minutes, after which he would complain of seeing double. On closing the left eye, vision improved; at times vomited his food with glairy mucus. The lad improved under treatment. Spells of headache became less frequent. As he complained of his eyes, examination showed hypermetropia of 1 D. left eye, with astigmatism in left eye. The optic disk of left eye swollen, right less so. Glasses given in November improved vision, but headache was still persistent at intervals. He got along tolerably well until February, 1887, when headache returned with increasing violence; his gait became unsteady, and double vision increased, becoming almost constant. In April he was taken to a specialist, who added prisms to his glasses, which, for a time, improved his vision. In May his headaches became violent again; he suffered from attacks of nausea: his gait became more uncertain; he stiffened his feet in walking, and staggered with uncertain movements, frequently falling, but seemed in good spirits; temperature subnormal. Urine pale, passed in large quantities, but neither sugar nor albumen detected. Since July the lad has lost flesh; loses his food by vomiting frequently; often the mat ters vomited are undigested food with glairy mucus, of yellowish tinge. Pain in head always present before vomiting; head thrown backward; belches, often has hiccough. Temperature subnormal; hands and feet usually cold. Generally sleeps well. The condition of his eyes as I have seen them, and confirmed by Dr. Isett, who is practised in the use of the ophthalmoscope, shows both disks swollen, the arteries small and tortuous, veins large, tortuous, choroid congested. Dr. Isett adds, "no doubt there is pressure on the brain somewhere." The treatment of this laȧ has been tonic, alterative, and dietetic. The case presents a peculiar outcome from measles. I report these to elicit further reports of such cases, and for the sake of calling attention to the effects of measles on the nervous system, which, in these cases, seems to have suffered severely. "AERO-URETHROSCOPE.” WEEKLY MEDICAL REVIEW, EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION. Contributions for publication should be sent to Dr. B. J. Primm, 3136 Olive Street. All remittances and communications pertaining to Advertise ments or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST STREET, St. Louis, Mo. SATURDAY, OCTOBER 15, 1887. SANITATION AND DRESS-REFORM. Not only in the present day has the subject of dress reform engaged the attention of sporadic enthusiasts, who, with an eye to the public good, the female portion of it more particularly, inveigh strenuously against the apparel as adopted and worn by the modern fashionable belle, but back through preceding centuries, following each other at comparatively regular intervals, there appeared pioneers of what they considered to be a good cause, advocating the expulsion of the ther fashionable attire, and extolling the virtues of the garb proposed by themselves. But the adherence of the female mind to the fashion is adamantine and immovable, and unfortunately for the innovators, their efforts toward the accomplishment of the general good failed to meet with that recognition to which they thought they were entitled, and women continued to reject pants,and clung to their stays with true feminine pertinacity. Despite the repeated warnings of physicians and the obviously apparent injuries to health produced by our modern dress, the female of to-day clings to her costume with all the oldtime vigor, and when the teachings of Dr. Mary Walker and Dr. Jessop prevail, we feel that an end of all things will have arrived. Either that, or the relative position of man will have changed, and the attempt to captivate by personal attractions will be the man's part, and not the woman's. Throughout the animal kingdom, one sex is always found to be seeking the admiration of the opposite by parading their physical at and woman The opening of the urethral canal is closed air-tight by this apparatus. The as sistant, by pressing the balloon, distends the canal, and by means of pressure upon the perineum, or from a finger introduced into the rectum, the air cannot escape into the bladder. tractions, adorned by whatever means are at their command, before it. The peacock struts about,in plumed and colored magnificence, and would not think for a moment of exchanging his plumage for a pair of pants because they happened to be conducive to health. No more would one of our modern females cast off the garb which gives her, as dress now stands, a chance to appear well, and not ridiculous before her mate. There is no cloud without its silver lining, but the fact that every rose has its thorn is just as true, and if the evil of modern dress was done away with by the adoption of a more masculine attire, some thorn would creep in with it, and we might perhaps find that we had substituted a greater for a lesser evil. As is shown by an editorial in the Brit. Med. Jour., dress is the result of evolution, the various details of the costume of to day, many of which appear to our eyes useless, being the remnants of what was once a useful part, as for instance the two buttons on the back of a man's coat. As re gards dress, we are unquestionably passing through one of those evolutionary stages, and in accordance with the rule, "the survival of the fittest," the best attire in every sense of the word will gain its day and be the fashion of the future. But we can not expect to arrive at it by forcible innovations; evolution is a slow process, and all unfeelingly but surely works out its own end, in dress as in all other things. SOME FACTS. It is such an exceedingly simple matter to detect medical colleges in the act of not complying with the requirements of their catalogues,that it is a wonder to see with what cool audacity some of them make their announcements, and then deliberately put them aside without a moment's consideration, when the question of the dollar comes up. Nearly all medical colleges of to-day, state on paper, that such and such branches must be passed before the applicant will be admitted to the course; but whether they adhere to their requirements or not is seen from the facts given Dr. in an editorial in the Med. Standard. Gerrish, of Portland, Maine, being desirous of knowing to what extent the printed requirements of the various colleges were adhered to by their officers, made use of an eight year old girl for the purpose, whose handwriting demonstrated her immaturity. She made written application for admission to the various colleges under an assumed name, and in each application confessed her absolute ignorance of some special study, proficiency in which is supposed to be necessary to a comprehension of medical science. One-half the replies received by the child informed her that she could not enter the course prescribed until she was able to pass the preliminary examination, including the studies in which she confessed her ignorance. The other half,however, evinced a willingness to take the fee of the applicant, and promised to make a doctor of her in spite of her confessed inability to pass the examination prescribed in their prospectuses as necessary to gain admission to their halls. One college wrote encouragingly: "Our examination is not difficult; no one has yet failed to pass." Another kindly wrote: "Natural philosophy is not required, except as a suggestion in the line of a liberal educa[tion." A third, bent on quieting all anxiety on the part of the applicant, wrote: "The preliminary examinations are not difficult, and no deserving applicant is rejected on account of not being able to pass them. Call and see us when you are in the city, and I will fix it so that you can enter." Such facts as the above, only add to what is already a certainty, that the dollar is the all-important item to many of our medical institutions. Fortunately, the various state boards are awaking to the necessities of the matter, and the time is not far distant when colleges guilty of such conduct as the above, will be obliged to step down and out. INFLUENCE OF THEORIES ON PRACTICE. Despite the fact, made certain by the experiences of the past two or three decades, that pathological theories are constantly changing-are continually shifting ground, the practice of medicine just as constantly varies to meet its fickle demands. The desire for support must be the chief reason for these ephemeral methods of practice, for the practice of medicine at its best is uncertain in result, and the physician needs the backing of an authority from which there is no appeal by those who might attach blame to his methods. The authority of pathological anatomy, backed up by the microscope and retort, is the unassailable fortress from which we of the present day receive our orders as to how to cure, and the sacred refuge for us when our remedies fail to accomplish what we expected of them. It seems to satisfy all parties when it can be said that, according to the latest pathological theory, this is the medicine to give; the result might be bad, worse than with an old remedy, but then what mat ters that, so long as it was in accord with the revelations of the microscope. With these facts in view, it behooves path ological anatomists to examine with care,to conclude with deliberation and caution,and not to advance the theory upon which a new practice is to be based, without being certain in the highest degree possible, that that theory is correct. PROFESSIONAL REPUTATION. send for a physician, but they wish to be cured pleasantly, safely, and quickly, as the old Latin saw runs. Now, he who cures thus is certain of numerous clients; he may have to wait for them, but they are coming as sure as fate. Let him beware of exciting any per sonal hostilities or begetting any professional antagonisms, for success is a plant which thrives best, grows strongest and largest amid calm and sunshine, not in darkness and storms. Even if Z. makes a correct diagnosis after several of all of the preceding capitals of the alphabet have failed, and cures the patient, that is glory enough without depreciating the character of his professional associates; the time has been when he himself made similar failure, and such time is coming again. Charity for the errors of others and a consciousness of his own fallibility, furnish a condition of mind which every physician should have. The reputation built upon the ruins of that of another has a very insecure foundation, and is liable at any time to fall. "The young physician should beware of making the secular press his ally. The better class of the profession shrink from newspaper notices, and are naturally suspicious of the ability or moral character of those whose names are frequently found in connection with patients attended or operations performed by them; newspaper doctors are, as a rule, quack doctors. Our great cities are not without The difficulty of securing that bubble, pro- some who thus endeavor to herald their professional reputation, frequently leads the fessional exploits, but they are not recognized youthful practitioner of medicine to adopt as the gentlemen of the profession, nor do methods which are far from redounding to his they deserve success; sometimes this yearncredit. To him who is willing to work and ing for publicity arises from an overweening wait, the remarks on this subject in the Med. vanity, whose possessor is never happy unless News will offer much encouragement. It gives people are talking about him; or from a dein a recent issue, as is its custom, sound ad-sire to impart new life to a dying fame, just vice, which, if followed, will redound to the as the woman whose charms of face the years success of worthy and ambitious young doc- have taken away, endeavors by enameling and tors. The News says: "The reputation coloring to hide the wrinkles of age and resought by the young doctor is usually first store the beauty of youth. among the people and next with fellow practitioners. To secure the first, honest, wise, and faithful work at sick beds is the only le gitimate way. Sick people care little about individuals or places of education, when they "But no matter where or by whom done, the reputation thus gained is very liable to be short lived. On the other hand, the reputatation founded in the grateful hearts of those whom he has relieved by his skill and com |