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The Importance of Urinalysis in Diagnosis

case

By Dr. A. B. Walker of Canton, Ohio. As urinalysis requires but a few moments of time, and as the results from it are so positive, the author feels that no opinion of a of any importance should be given without there having been made a careful examination of the urine. He thinks many a case of Bright's disease might be prevented if, when the first symptoms of the disease manifest themselves, a careful examination of the urine be made and the proper treatment and diet prescribed. An interesting case was cited in point.

The author is surprised that all life insurance companies do not require an examination of the urine even for their small risks. He believes the time is not far distant when they will not only see the necessity of it, but demand it in all cases.

Dr. A. M. Owen, of Evansville, Indiana, read a paper in which he reported gratifying results from the administration of gold as a therapeutic agent.

Second Day-Afternoon Session—
Dr. Starling Loving, of Columbus,
Ohio, read a paper entitled:
Physicians' Prescriptions-

com

He alluded to the many difficulties which young practitioners encounter when they essay their first prescription. He said we seldom read of mishaps from defectively written prescriptions in England, Germany or France, where prescription writing is and more extensively systematically taught. Sufficient attention is not always given in this country to patibilities, chemical and therapeutic, to solubilities, the influences of light, temperature, air, and of other circumstances affecting the condition of drugs and chemicals. Many failures in treatment and many accidents, some rious in character, result from carelessness or want of accuracy in the direction given nurses and patients for the administration of medicines after they have been brought ready for use. Dr. William F. Barclay, of Pittsburg, followed with a paper on:

Toxics

se

After defining the poison, the author stated that it may seem strange that almost all toxics were innocent until they reached the circulation of the blood. Their slow and rapid absorption largely determined their deleterious effects upon the system. Toxics enter the circulation of the blood and their action on the normal cells produces toxines, and the multiplication of these products brings on pathological conditions. Nothing is more easily demonstrated than that the emunctories throw off toxics. We observe at once upon the entrance of a toxic into the circulation that all the functions of the body are impaired to a greater or less degree, and that definite poisons are quickly formed, such as ptomaines, leucomaines and others, which is nothmore nor less than an altered nuitrltion. The vital forces are at once dis

turbed or arrested. Primarily the circulation, and secondarily, the nervous system are impaired, and shock is superinduced. In the state of shock nature seems intent upon relieving herself of all effete matter by the discharge of the contents of each viscus of the body. All such efforts should be assisted by artificial means in restoring a healthy condition. Vigorous strength are maintained by proper food, perfect digestion and healthful environment.

Quinine in the Treatment of Chorea

By Drs. Frank R. Fry and M. A. Bliss of St. Louis.

The writers briefly reviewed Prof. H. C. Wood's theory of the causation of chorea as set forth in a paper on "The Choreaic Movement," which was published in the Journal of Nervous and Mental Diseases, April, 1893. He therein advanced the suggestion that chorea is due to disturbances in the spinal inhibitory apparatus, which he supported by a highly scientific argument. He made the further practical suggestion that inasmuch as quinine had been found physiologically to stimulate spinal inhibition in animals, the drug be given to dogs, and the human subject affected with chorea. In this direction he had made a few trials with gratifying results. Although his opportunities for observation had not been many at the time he published his communication, they were of such a nature as to encourage others to use quinine in treating chorea. The writers recited a number of their own cases from clinic and private practice in the treatment of which they have been using quinine, and their results confirm those of Dr. Wood and others. They called attention to the fact that they have not used as large doses as others, yet had very satisfactory results. They suggest that this drug has a decided value in the treatment of certain infectious diseases, in which class, according to the opinion of some authorities, chorea belongs. They further suggested that drawbacks may be found in giving quinine in large doses to choreic patients, inasmuch as it sometimes produces unpleasant nervous phenomena, and especially in nervous or neurotic individuals. They met with no inconveniences of this kind so far in the choreic patient, to whom they administered it. In fact, they stated they could confirm an observation made by others to the effect that these patients are not apparently easily cinchonized. While they have witnessed decided and, as a rule, only beneficial effects from the drug in these

44

cases, they conclude that more data must be collected before its final status can be determined. With this end in view, they have been keeping and would continue to keep, careful notes of all their cases to which quinine was given.

An interesting item of the paper was the citation of a severe case of chorea which after resisting other remedies, promptly recovered on full doses of quinine.

Laparotomy for Pelvic Diseases no Longer a Necessity

(4)

This paper was contributed by Dr. R. Stansbury Sutton, of Pittsburg. The asertion found in the text of the paper was founded upon the following argument: (1) We have a substitute for laparotomy for total extirpation of the uterus and appendages by the vagina, either with or without morcellement. (2) The operation has already been proven to be effectual and successful by Pean, Segond, Jacobs, and others in Europe, and Henrotin, Engelmann, Sutton, Edebohls, and others in the United States. (3) Total extirpation of the uterus in and appendages per vaginam gives a lower mortality than laparotomy for the removal of similar tumors. These operations by the vagina shorten the convalescence of patients who are out of bed on the seventh day. (5) In all cases of gonorrhoeal, tubercular, or other infectuous type of endometritis with chronic salpingitis and chronic ovaritis, a cure is not effected save by total extirpation of the uterus and appendages. The vaginal route is the best. (6) In all cases of fibroid tumors of the uterus, not reaching above or quite to the umbilicus, when the uterus must be sacrificed, total extirpation of the organ, tumor and appendages by morcellement and puncture be removed through the vault of the vagina,leaving the uterus and opposite ovary and tube intact. (8) In all cases of pyosalpinx or of multiple pus centers with coexisting solidification of the pelvic roof, total extirpation by morcellement per vaginam is the only feasible operation, and it cures the patient. (9) Total extirpation per vaginum is followed by a cure in the greatest majority of cases as compared with laparotomy. (10) The following sequelae after laparotomies do not occur after total extirpation by the vagina; Cancer of the uterus, adenoma of the uterus, tuberculosis of the uterus, gonorrhoeal infection, hemorrhages of the uterus, filthy catarrhal discharges from the uterus, ventral

hernia, fecal and other fistulas, the mark of a wound on the abdomen. The nerve storms subsequent to total extirpation are not as great as after laparotomy. The patient is restored to perfect health. This is not the case in more than fifty per cent of laparotomies for pelvic diseases. (11) The bacteriology of infectious diseases demands removal of the uterus with the appendages. (12) Total extirpation by the vagina is in strict conformity to anatomical relations. (13) The physiological results following total extirpation are free from jarrings, and the patient is functionally a smoothly running mechanism. (14) Laparotomy for these diseases is followed by all manner of physiological disturbances whcih affect the vascular, muscular, nervous and digestive systems. (15) In the face of this argument, laparotomy for pelvic disease is no longer a necessity, but in the author's opinion should be abandoned excepting in very rare instances indeed.

Reflex Irritation as a Cause of Dis

ease

By Dr. Edwin Walker, of Evansville, Indiana. The essayist said that no error in modern times has held such tenacious hold on the professional mind as that of reflex irritation as a cause of nervous disease. The reflex theory dates back many years. Early in this century it was offered as an explanation for certain neurotic phenomena, but its prominence in the medical mind of today is due to the lectures of Brown Sequard on the "Physiology and Pathology of the Nervous Centers," delivered in London in 1858. The essayist then alluded to the contributions of several other prominent writers on this subject, and said that for a great many years he had thought much of the question, his attention being first called to the articles of Sayre. He followed his advice and did many circumcisions, and later mainly through the teachings of Emmet, did operations on the cervix and vagina, and has observed many cases of neuroses in women presenting various lesions of the genital tract, and states that he has never seen a case of epilepsy, insanity, catalepsy, hysteria, or grave neurasthenia, nor any organic disease of the nervous system cured or even permanently benefited by either operation on the genital tract either done by himself or any one else.

Dr. Harold N. Moyer, of Chicago, read an interesting paper entitled,

45

Accidents and Injuries From Electric Currents of High Potential.

Third Day-Morning Session

Dr. Frank P. Norbury, Jacksonville, Ill., read a paper entitled: The Mental Symptoms of Cerebral Syphilis; a Clinical Study

He drew the following conclusions: 1. Somnambulism and allied states; lapses of intelligent conceptions with asociated loss of memory are mental symptoms of cerebral syphilis.

2. Sudden comnolence with ocular spasm or paralysis points to syphilis, when preceded with headache and monoplegia is almost pathognomonic. Headache, quasi-periodical, as defined by Gray with marked insomnia, suddenly ceasing and followed by psychical disturbance is due to syphilis.

3. Melancholia or mania when following periodical headaches, insomnia, and somnolence (a) with ocular spasm or other form of monoplegia of heterogeneous paralysis is due to syphilis. (b) Pseudo-paranoia. By this he means cases presenting all symptoms of paranoia, systematized delusions depending on hallucinations of sight, hearing, taste or smell, with slight impairment of general mental functions is due to syphilis, as we know that syphilis causes isolated local losses of power, and it is noteworthy when the special senses are involved that mental derangement usually results. (c) Pseudo paresis, characterized by fibrillary tremor of tongue, indistinct speech (partial or complete aphasia), uncertain and trembling gait, with delusion of grandeur, and occasional outbursts of maniacal excitement, pupillary involvement, all characteristic symptoms of paresis, but which yielded readily to antisyphilitic treatment, we can say it was due to syphilis.

4. Class four have had epileptiform and apoplectiform attacks. We find cases in which treatment was undertaken too late. The symptoms are those of terminal dementia, only occurring in patients of previous sound mental condition and with no special hereditary history.

Dr. Geo. N. Lowe, of Randall, Kan., read a paper, entitled: Traumatic Lesions of Cranium and Brain

In which he reported four interesting cases. The first case was one of depressed comminuted fracture of the right parietal bone at the junction of the temporal bone, caused by the kick

of a horse. There was also a contused lacerated wound of all the soft tissues along the entire ramus of the left inferior maxillary. In this case the author trephined and elevated the depressed comminuted bone fragments. Recovery.

Dr. B. Merrill Ricketts, of Cincinnati, read a paper entitled

(A) Castration for Hypertrophied Prostate; (B) Removal of Head of Femur for Dislocation Into Lesser Sciatic Notch; (C) Trephining For Pressure as a Result of Fluid in Acute Cerebral Meningitis.

In the case of castration for hypertrophied prostate, the author said he was inclined at first to make suprapubic operation, possibly combining the supra-pubic and perineal. After thoroughly considering the matter and explaining to the patient the probable results of the various operations, he decided to remove the testicles. The arteries were tortioned, the wound closed and integment coapted with a continuous silkworm gut suture. The patient rallied well from the chloroform and suffered no inconvenience or pain thereafter. The wound was examined on the fourth day and primary union was found to have taken place. The patient left Dr. Rickett's private hospital at the end of the sixth day. On the second day after the operation the patient told him that he could urinate with greatest ease, and that the pain was slight; that he could sleep four hours at a time during the night, weheas formerly he had been getting up once every hour. This condition continued to improve during the patient's stay in the doctor's hospital.

Dr. A. H. Meisenbach, of St. Louis, read a paper entitled: Resection of the Knee for Separa

tion of the Lower Epiphysis of the Femur—

The case was of two years' standing, in a patient thirteen years of age. The author said separation of the epiphysis is a condition that may occur either on account of trauma or disease. There seems to be a difference of opinion by writers as to the frequency of its occurrence, especially as the result of trauma. As the result of disease of the bones-osteomylitis, it is considered a not infrequent accident. Traumatic separation of the lower end of the femur occurs in about from one-fifth to one-third of all the reported cases, and in the majority of instances previous to the sixteenth year, seldom later.

46

The forces that are necessary to produce this separation are various. Thus during childbirth traction may produce it. Volkmann states that he has produced it when the hip is diseased, when making rotation in seeking for crepitation, or extension in the application of plaster of Paris dressings. Other forces are indirect external violence, usually of a twisting character, or lateral or at right angles to the axis of the limb. The readiness with which the dislocation of the separated diaphysis into the popliteal space occurs can be explained. (1) on account of the anatomical structures of the surrounding parts; (2) the force and position of the patient, the popiteal space being in the direction of least resistance, while on the anterior aspect we have the quadriceps tendon, the patella, and the ligamentum patella. The Ocurrence of pathological separation of the epiphyses is regarded by the latest writers on surgical pathology and diseases of the bones as a not infrequent accident in diseases of the bones and joints. It is noted in osteomylitis of the long bones.

Third Day-Afternoon Session

Dr. J. H. Kellogg, of Battle Creek, Michigan, demonstrated by diagrams and illustrations the deformities of American women resulting from neglect of physical exercise and the conventional mode of dress.

The Neatest Circumcision

Dr. Bransford Lewis, of St. Louis, read a paper before the recent meeting of the Mississippi Valley Medical Association, in which he detailed a method of doing that operation for which he claimed many advantages in celerity, ease and exactitude of performance, and rapidity of healing. The operation was done with the assistance of two instruments, presented by the author, a clamp and prepuce-tractor, which enabled the operator to carry out the following steps of procedure: 1. After cleansing the penis and encircling it with a small rubber band, the prepuce is drawn strongly forward, the traction being applied to its inner surface by means of the serrated tractor, mentioned. 2. The glans penis being repressed, the curved, fenestrated clamp is applied. 3. With these as a support and guide, ten per cent cocaine solution is injected between the two layers of foreskin, anterior to the clamp-no danger of cocaine poisoning occurring, since both clamp and rubber constrictor lie between it and the general circulation. 4. After effective anesthesia has been secured, six double length (ten inch)