sitiveness of nerve terminals. We placed her again upon the table, started saline transfusion and removed the uterus and its appendages per vaginam. Notwithstanding the utmost care I passed my finger through the posterior bladder wall, in separating the organs, because of pressure necrosis. I closed this opening with a purse-string suture and inserted a self-retaining catheter. The patient began to improve at once. The bowels moved, the tympanites gradually diminished, the pulse improved and the vomiting ceased. She retained liquid nourishment, and when I left her at 9 o'clock Sunday night I thought she would recover. She died suddenly the next morning.

PRACTICE OF JAMES A. MACMILLAN, M. D., DETROIT.

APPENDICITIS, WITH OPERATION.

A MAN, aged twenty-eight years, teamster, was taken with a severe pain near McBurney's point on March 16, 1901. I saw him on Monday, the 18th. His temperature then was 102° and pulse 110. There was tenderness in the region of the appendix, and he could not retain food. I had him removed to Harper Hospital Monday afternoon, and operated Wednesday morning. Just before the operation his temperature was 98° and pulse 72. I found a large amount of extraperitoneal inflammatory exudate, the peripheral niche of the appendix entirely sloughed off, and encapsulated in a fold of the omentum, a large part of the muscular and fibrous coat of the appendix entirely sloughed away, but the peritoneum sufficiently intact to prevent the liberation of numerous concretions which fill the proximal portion of the appendix. There was a large patch of necrosis on the small intestine. The amputated portion was lying in a pus cavity. I report the case on account of the following features: (1) The existence of a condition so grave with comparatively mild symptoms. (2) The large amount of retroperitoneal inflammation. (3) The thin covering of peritoneal membrane persistent after the destruction of the underlying coats of the appendix. (4) The retention of the concretions in the presence of so much distruction of the appendicular tissue.

PRACTICE OF EMIL AMBERG, M. D., DETROIT.

A SMALL PERFORATION OF THE DRUM MEMBRANE CLOSED BY TRICHLORACETIC ACID APPLICATION.

A LAD, fifteen years old, received a blow on the ear. This was followed by pain. The next day, July 29, in the morning, he went swimming. While swimming, he had pain for about five minutes and felt as if drunk. When he came out of the water he felt dizzy and noticed humming noise. Before dinner he had pain again which lasted until he came to my office at about 2 P. M. Twice his ear was syringed at home. Examination: Left ear contained small perforation in upper posterior half, with reddish reflex. A watch, which is normally heard at a distance of about one hundred or one hundred and fifty inches, is heard only at a distance of twelve inches. Treatment: Insufflation of boric acid and aristol powder. After a few days I noticed that the ear was dry, but that a perforation about the size of a pin-head persisted. In order to close up the perforation a concentrated trichlor-acetic acid solution was applied with the necessary precaution. When seen a few days later the perforation had closed up. August 26, the same watch was heard at eight and one-half feet. The

history of the case and appearances indicate the traumatic origin of the perforation. The fact that the patient reported quickly for treatment and that maltreatment was prevented, insured success. Furthermore, a single application of trichlor-acetic acid proved equal to the task on account of the smallness of the perforation.

EDITORIAL ARTICLES.

A COURT DECISION ON THE RELATION OF DOCTORS TO PATIENTS.

As a rule doctors need no formal interpretation of the law to hold them to assumed obligations. Patients may usually depend upon the moral sense, inseparable from a worthy member of the profession, as a sufficient guaranty of fair dealing. Experience, however, teaches the public the necessity of the law in respect to certain individuals, and it is owing to those derelicts that odium is brought upon the whole profession. Such a one was a San Francisco surgeon, who, as the Christian Advocate relates, decided that a patient whom he was called to attend must submit to an operation. Her violent screaming angered him and he said "if she did not quit he would quit." Despite her suffering and the request of the husband to remain he left. It was an hour before another surgeon could be obtained.

The husband and wife brought suit against him in the Superior Court and were allowed a verdict of two thousand dollars. The doctor appealed the case but the Supreme Court sustained the verdict and laid down the following opinion: "A physician may choose whether or not he will give his services to a case; the law protects him in refusing any case, but having accepted the employment and begun the treatment he must devote to the patient his best skill and attention, and cannot legally abandon the case except under one of two conditions: If the employer wishes to terminate the contract he can do it at once and the physician has no redress; but if the physician wishes to terminate it, it can be done only after due notice and an ample opportunity afforded to secure the presence of other medical attendants."

CRYOSCOPY.

CRYOSCOPY is one of the advance methods of urinalysis. It consists in determining the molecular constitution of urine by finding its freezingpoint. Its value rests upon Raoult's law, which is that the freezing-point of a solution is proportional to the number of molecules dissolved in the unit of volume of the liquid. The number of molecules of dissolved material is taken to represent the value of any urine as an excrementitious product. Of two urines, then, the one whose freezing-point is lower will have greater excretory value.

This means of diagnosis, for which we are indebted to PROFESSOR KORANYI, of Buda-Pesth, has other practical applications, brought to our notice by WALSH, in "International Clinics." The eminent discoverer

has shown that in the urine of cardiac cases certain changes take place which suggest approaching circulatory failure.

The number of molecules dissolved in the urine indicates to an extent the permeability of the kidney. The lowering of the freezing point of the urine in renal cases prognosticates good. Its approach to that of water indicates the retention of toxic material in the blood. However, as both the blood and the condition of the kidneys affect the character of the urine cryoscopy is expected to show up new relations between these two fluids.

ANNOTATIONS.

SYPHILIS IN PRIVATE AND IN DISPENSARY PRACTICE.

UNDER the title of "Syphilis in the Well-to-do," McDONALD gives, in the Medical Record, a pithy contrast between syphilis in the poor and in the well-to-do. This disease he is convinced, when it occurs in private practice, is not only, in the average case, a mild affection, but subjects its victims to less pain, mutilation and loss of time than many a trivial complaint. In a series of one hundred and fifty cases in private practice, of which ninety-seven per cent. were acquired, sixty-five per cent. showed only trivial lesions that left no trace behind, six per cent. suffered severely from laryngitis, alopecia and the like but recovered completely, and twenty per cent. suffered from gummata, which left scars, but healed readily and satisfactorily. In comparison with these the author presents one hundred and fifty consecutive cases, occurring in the dermatologic clinic of the New Haven Free Dispensary during about the same period. Of these one hundred and forty were acquired. Of the acquired cases thirty three per cent. had mild transitory lesions, fifty-one per cent. had destructive lesions, and ten other cases of paralysis, iritis, onychia and periostitis were bad. The author regards the seed, the soil, and the environment all as operating to cause the great difference in the two classes of cases. Verbum sat sapienti.

GAYLORD'S CANCER PROTOZOON.

ANOTHER microorganism of the animal variety, a protozoon, has been announced and published widely as the cause of cancer. The alleged discoverer of this germ is DoCTOR HARVEY R. GAYLORD, Director of the New York State Pathological Laboratory of the University of Buffalo, His publication appeared in the May number of the American Journal of the Medical Sciences. The author has not succeeded in making a very clear presentation of the matter, which will militate greatly against a ready acceptance of his findings. The parasites are described as small spherical bodies closely resembling fat, but not responding to tests for fat. By incubating hanging-drop preparations of fresh scrapings from cancer these bodies, according to the writer's account, grow in size and finally become granulated, and, if kept upon a warm stage, ultimately throw out pseudopodia, develop a nucleus, and end by turning into a sac containing the spores of the organism. It is stated further that "all the organs, including the blood taken from all regions of all cases dying of

cancer, including sarcoma and epithelioma, contain large numbers of the organisms." The observation was made also that in all cases of carcinoma and sarcoma that he examined in which cachexia was well marked the organisms, especially the younger forms, could be detected in the peripheral blood. With such blood it is asserted that animals may be infected and in their peripheral blood the younger forms of the organism may likewise be found.

THE PHYSIOLOGIC EFFECTS OF CHLORETONE.

CHLORETONE, a derivative of chloroform and acetone, was introduced into this country several years ago by PROFESSOR ABEL, of Johns Hopkins Medical School, who used it in physiologic experimentation upon animals. Combining as it does slightly anesthetic with marked narcotic properties animals may be kept quiet for a remarkably long time. transference to human therapeutics has been rapid and quite general. It is less irritating than chloral hydrate and has been supposed to be also much safer, but recently attention has been called to its physiologic effects. The American Journal of Insanity gives a word of warning as to its use as a hypnotic and quotes the following conclusions by DOCTOR E. IMPENS: In warm-blooded animals chloretone is two and one-half times more toxic than hydrate of chloral. A medium dose of chloretone reduces the total volume of air inspired per minute seventy per cent., the volume of individual inspirations sixty per cent., the frequency forty per cent., thereby considerably diminishing the pulmonary aeration. It produces a fall in the blood-pressure of forty-three per cent. In efficacious doses its paralyzing effect upon the heart equals that of chloral hydrate. Chloretone narcosis is accompanied by lowering of the temperature to below 94.1° Fahrenheit in the rabbit, in the smallest effectual dose. restricts the combustion of oxygen more than fifty per cent. and produces a marasmic condition in animals that persists a long time after waking. For these reasons it states that chloretone is a much more dangerous narcotic than chloral hydrate.

MEDICAL NEWS.

It

DETROIT'S NEW HEALTH OFFICER.

DOCTOR GUY L. KIEFER has been appointed health officer of Detroit, his incumbency to date from July 1, 1901. The doctor is a native of the City of the Straits, where he made his début in the drama of life in 1867. He is a graduate of the Detroit High School and obtained the degrees of A. B., A. M. and M. D., at the University of Michigan, the latter in 1891. After pursuing postgraduate studies in Berlin and Vienna he began the practice of medicine in the city of his birth. He has served a term as city physician, and at present enjoys a connection with the Detroit College of Medicine and Harper Hospital Polyclinic. For the sixteen subordinate positions at his disposal he has already been besieged by over six hundred applicants.

THE ROCKEFELLER INSTITUTE FOR MEDICAL RESEARCH.

MR. JOHN D. ROCKEFELLER has made a gift of $200,000 to found an institute for medical research, which shall bear his name. The trustees of the institution, which was incorporated June 13, at Albany, are as follows: Doctor William H. Welch, of Johns Hopkins University; Doctor T. Mitchell Prudden, of Columbia College; Doctor L. Emmet Holt, of Columbia College; Doctor C. A. Herter, of New York University and Bellevue Medical College; Doctor Theobald Smith, of Harvard; Doctor H. M. Biggs, of the New York City Board of Health, and Doctor Simon Flexner, of the University of Pennsylvania. The purpose of the corporation is to facilitate scientific investigation in medical and surgical channels, especially in the direction of prevention and treatment. Instead of immediately erecting a laboratory to pursue this work, however, the board intends to utilize the armamentaria of the medical colleges in New York city until the development of the enterprise necessitates more commodious quarters.

THE JOHNS HOPKINS PRESIDENCY.

DOCTOR IRA REMSEN, who has been professor of chemistry in Johns Hopkins University since the founding of that institution, has recently been elevated to its presidency vice Doctor Daniel C. Gilman, who determined to retire. Doctor Remsen was born in New York in 1846, and graduated from the College of the City of New York in 1865. He is an M. D. from the College of Physicians and Surgeons of his native city; a Ph. D. from the University of Göttingen; and an LL. D. from both Columbia and Princeton. In 1876 the doctor was called to the chair of chemistry in Johns Hopkins University, whereupon he resigned a similar professorship at Williams College, which he filled during the four years immediately preceding. He will assume the duties of the position at the advent of the next collegiate year, in September. He had been associated with Doctor Gilman for twenty-five years in developing the university, and often served in the capacity of acting president during the absence of the chief executive. He is fifty-five years of age.

THE NATIONAL MEDICAL MEETING.

THE fifty-second annual meeting of the American Medical Association, which convened at Saint Paul on the 4th instant enjoyed the attendance of 1806 members. The sections were likewise well represented, some of them attracting gatherings of seven hundred at some of their sessions. The report of the committee on reorganization was adopted. This action relegates the legislative affairs of the association to a house of delegates that is limited to one hundred and fifty, and in which, under the present apportionment of one for five hundred members or fraction thereof, the Michigan State Medical Society is entitled to a representation of only two. It behooves the organized medical fraternity in this state to bestir itself in the direction of increasing its ranks and thereby insuring the society a greater degree of influence in the conduct of the national body. Under the new régime the general meeting will not be held after the first day and consequently more time will be allowed for