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1609 - being restored in three. No unpleasant symptom occurred during the operation, and the dose was 7 c.c. stovaine (Billon). In contrast to the above experience it is only fair to add that neuralgic pains in both lower limbs and in the head <(frontal region) were severe for three days, intermittent in type, relieved by aspirin, and had cleared up at the end of a week. Most of the varicose veins recently in my left leg are shown in the accompanying illustration. I am, Sir, yours faithfully, May 9th,_1911. M.B. LOND., M.R.C.S. ERRATUM.-Our attention has been drawn to a misprint in a letter from Dr. E. C. B. Ibotson on "Extraordinary Injuries," which appeared in THE LANCET of June 3fd. In iine 12 the word " lower" should read" liver." M.B. LOND., M.R.C.S. THE GERMAN CONGRESS ON INTERNAL MEDICINE. THE Twenty-eighth German Congress on Internal Medicine was held in Wiesbaden from April 19th to April 22nd, ,Professor KREHL being in the chair. Communication of Varioecs Infeations by the Tonsils. Dr. P&Auml;SSLER (Dresden) said that the condition of the tonsils did not receive sufficient attention from medical men. He examined the tonsils of every patient, and in a great ’number of cases found a permanent source of infection con- sisting in the presence of an abnormal secretion and the formation of plugs within the cavities of the tonsils. These symptoms seldom occurred alone, but were usually followed by some secondary infection, especially by acute articular ’rheumatism, with its complications chorea minor, endo. carditis, and myocarditis ; other sequel&aelig; of tonsillar disease ’were nephritis, cyclic albuminuria. and septic&aelig;mia; there was also probably a connexion between appendicitis and ,tonsillar infections. Removal of the tonsils put an end to the risk of their contributing to the development of the above diseases, but radical extirpation was necessary, and success was, of course, obtained only when no other point of infection existed in the teeth, the prostate, or the female genitals. Professor KREHL said that he concurred with Dr. Passler’s opinion as to a connexion between anomalies of the tonsils and such diseases as rheumatism and endocarditis, but he did not think that removal of the tonsils was necessary. Abnormal Peristaltic Movements of the Stomach. Dr. SICK (Stuttgart) said that in stenosis of the pylorus strong peristaltic movements of the pyloric antrum became visible on the radiographic screen ; after some time the move- ment ceased but began again in a few minutes. There was no antiperistaltic movement in stenosis of the pylorus, and the statements which had been made to the effect that such movements existed were erroneous. Professor VON TABORA (Strasburg) explained that acid, when passing from the stomach into the duodenum, produced a reflex occlusion of the pylorus, and that the presence of fat considerably retarded the evacuation of the stomach. Clinical observation showed that hyperacidity and the use of fatty food increased the amount of residual material in the stomach. Professor von Tabora has found by radiography that the addition of acid to a bismuth emulsion produced very strong peristaltic movements, so that the evacuation of the stomach became retarded by the contraction of the pylorus. The administration of oil, on the other hand, stopped the peristalsis, so that the chyme left the stomach very quickly through the open pylorus. The paresis of the stomach lasted for two or three hours. By repeated adminis- tration of oil the movements might be stopped for several days, and gastric ulcers might be absolutely immobilised in that way. Professor KLEMPERER (Berlin) said that, in his opinion, a complete paresis of the peristaltic movements of the stomach was not produced by oil. When 100 c.c. of oil were administered to a healthy person and the stomach was evacuated two hours later, only 25 c.c. were discharged, 75 c.c. having passed the pylorus. The results of the treat- ment by oil in cases of gastric ulcer were not superior to other methods. Professor VON TABORA said that the paresis of the peri- staltic movement was absolutely proved by radiography. Dr. SINGER (Vienna) read a paper on the Action of the Biliary Acids on the Peristaltic Movements. He said that an enema containing bile caused immediate defalcation in dogs. The active agent was cholic acid, which directly stimulated the colon, as was ascertained by clinical observa- tion and by rectoscopy showing contractions of the colon after the administration of suppositories of cholic acid. In the human subject it was proved by radioscopy that after an injection containing biliary acids there was an immediate forward movement of the faeces. The indications for the administration of biliary acid, either by the mouth or by the rectum, were habitual constipation, paralytic ileus, and post-operative paresis of the intestines. Dr. HOLZKNECHT (Vienna) reported experiments on the action of morphine on the movements of the stomach. In those experiments healthy persons swallowed on a certain day a certain quantity of carbonate of bismuth, and on the next day the same with the addition of 0-01 grm. of morphine, and he found that the time required for the evacuation of the stomach, which was normally from three to three and a quarter hours, became three or four times longer. The cause was neither a paresis of the muscles nor an increase of acidity, but a primary spasm of the pylorus, because the administration of atropine together with morphine made the spasm and the troubles of motility disappear. Experiments on Radium. Professor LAZARUS (Berlin) said that emanation of, radium administered by the mouth penetrated through the walls of the gastro-intestinal canal; and that inhaled emana- tion was partly discharged by the skin. There was a definite relationship between the amount of inhaled emanation and the amount of emanation dissolved in the blood and eliminated by the lungs, the kidneys, and the skin. In its physical relation to the blood the emanation resembled a gas; its coefficient of absorption was, however, ten times greater than that of oxygen. Emanation administered by.

THE GERMAN CONGRESS ON INTERNAL MEDICINE

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1609

- being restored in three. No unpleasant symptom occurredduring the operation, and the dose was 7 c.c. stovaine

(Billon).

In contrast to the above experience it is only fair to addthat neuralgic pains in both lower limbs and in the head<(frontal region) were severe for three days, intermittent intype, relieved by aspirin, and had cleared up at the end of aweek. Most of the varicose veins recently in my left leg areshown in the accompanying illustration._

I am, Sir, yours faithfully,May 9th,_1911. M.B. LOND., M.R.C.S.

ERRATUM.-Our attention has been drawn to a misprint ina letter from Dr. E. C. B. Ibotson on "ExtraordinaryInjuries," which appeared in THE LANCET of June 3fd. Iniine 12 the word " lower" should read" liver."

M.B. LOND., M.R.C.S.

THE GERMAN CONGRESS ON INTERNALMEDICINE.

THE Twenty-eighth German Congress on Internal Medicinewas held in Wiesbaden from April 19th to April 22nd,,Professor KREHL being in the chair.

Communication of Varioecs Infeations by the Tonsils.Dr. P&Auml;SSLER (Dresden) said that the condition of the

tonsils did not receive sufficient attention from medical men.He examined the tonsils of every patient, and in a great’number of cases found a permanent source of infection con-sisting in the presence of an abnormal secretion and theformation of plugs within the cavities of the tonsils. Thesesymptoms seldom occurred alone, but were usually followedby some secondary infection, especially by acute articular’rheumatism, with its complications chorea minor, endo.carditis, and myocarditis ; other sequel&aelig; of tonsillar disease’were nephritis, cyclic albuminuria. and septic&aelig;mia; therewas also probably a connexion between appendicitis and,tonsillar infections. Removal of the tonsils put an end to

the risk of their contributing to the development of the abovediseases, but radical extirpation was necessary, and successwas, of course, obtained only when no other point ofinfection existed in the teeth, the prostate, or the femalegenitals.

Professor KREHL said that he concurred with Dr. Passler’sopinion as to a connexion between anomalies of the tonsilsand such diseases as rheumatism and endocarditis, but hedid not think that removal of the tonsils was necessary.

Abnormal Peristaltic Movements of the Stomach.Dr. SICK (Stuttgart) said that in stenosis of the pylorus

strong peristaltic movements of the pyloric antrum becamevisible on the radiographic screen ; after some time the move-ment ceased but began again in a few minutes. There wasno antiperistaltic movement in stenosis of the pylorus, andthe statements which had been made to the effect that suchmovements existed were erroneous.

Professor VON TABORA (Strasburg) explained that acid, whenpassing from the stomach into the duodenum, produced areflex occlusion of the pylorus, and that the presence of fatconsiderably retarded the evacuation of the stomach.Clinical observation showed that hyperacidity and the useof fatty food increased the amount of residual material inthe stomach. Professor von Tabora has found by radiographythat the addition of acid to a bismuth emulsion producedvery strong peristaltic movements, so that the evacuationof the stomach became retarded by the contraction of thepylorus. The administration of oil, on the other hand,stopped the peristalsis, so that the chyme left the stomachvery quickly through the open pylorus. The paresis of thestomach lasted for two or three hours. By repeated adminis-tration of oil the movements might be stopped for severaldays, and gastric ulcers might be absolutely immobilised inthat way.

Professor KLEMPERER (Berlin) said that, in his opinion, acomplete paresis of the peristaltic movements of the stomachwas not produced by oil. When 100 c.c. of oil were

administered to a healthy person and the stomach wasevacuated two hours later, only 25 c.c. were discharged,75 c.c. having passed the pylorus. The results of the treat-

ment by oil in cases of gastric ulcer were not superior toother methods.

Professor VON TABORA said that the paresis of the peri-staltic movement was absolutely proved by radiography.

Dr. SINGER (Vienna) read a paper on the Action of theBiliary Acids on the Peristaltic Movements. He said thatan enema containing bile caused immediate defalcation indogs. The active agent was cholic acid, which directlystimulated the colon, as was ascertained by clinical observa-tion and by rectoscopy showing contractions of the colonafter the administration of suppositories of cholic acid. Inthe human subject it was proved by radioscopy that after aninjection containing biliary acids there was an immediateforward movement of the faeces. The indications for theadministration of biliary acid, either by the mouth or bythe rectum, were habitual constipation, paralytic ileus, andpost-operative paresis of the intestines.

Dr. HOLZKNECHT (Vienna) reported experiments on theaction of morphine on the movements of the stomach. Inthose experiments healthy persons swallowed on a certainday a certain quantity of carbonate of bismuth, and on thenext day the same with the addition of 0-01 grm. of

morphine, and he found that the time required for theevacuation of the stomach, which was normally from threeto three and a quarter hours, became three or four timeslonger. The cause was neither a paresis of the muscles noran increase of acidity, but a primary spasm of the pylorus,because the administration of atropine together with

morphine made the spasm and the troubles of motilitydisappear.

Experiments on Radium.Professor LAZARUS (Berlin) said that emanation of,

radium administered by the mouth penetrated through thewalls of the gastro-intestinal canal; and that inhaled emana-tion was partly discharged by the skin. There was a

definite relationship between the amount of inhaled emanationand the amount of emanation dissolved in the blood andeliminated by the lungs, the kidneys, and the skin. In its

physical relation to the blood the emanation resembled agas; its coefficient of absorption was, however, ten timesgreater than that of oxygen. Emanation administered by.

1610

inhalation made the arterial blood more radio-active,whereas when it was given by the mouth the effect was

principally seen in the venous blood ; the radio-activity ofthe serum was greater than that of the clot. To conveya sufficient quantity into the blood an adequate dosewas necessary ; the dose of two units in a litre of airusually employed in the inhalation rooms was not strongenough. Professor Lazarus described a method of makingrespirable gas radio-active by introducing a constant radiumsalt into a reservoir of oxygen ; in this way the dose might beregulated from the smallest to the greatest quantity ofradium emanation. An accumulation of emanation in theblood up to 500 units was quite harmless. The emanationmight be concentrated in one of the limbs by means of eitheractive or passive hyperasmia. By charging the radiumreceptacle with positive electricity, the positive electricalproducts of the radium might be discharged and mixedwith the gas introduced into the body.

Dr. EICHHOLZ (Kreuznach) spoke in favour of theadministration of the emanation by the mouth. He saidthat the absorption of the emanation was retarded whenthe stomach was full and the quantity of water too small,but accelerated when the stomach was empty and the

quantity of water considerable (500 cubic centimetres). Byobserving the latter precaution it was possible to charge theblood for hours with emanation. The quantity of emanationconsumed in an emanatorium by each person was four timesas great as the quantity consumed by administration inwater. The clinical effects were the same whether radiumwas administered in water or by inhalation, and the dosemight be increased without difficulty. It has been said thatthe emanation administered in water did not penetrate intothe circulation, but experiments made by Dr.’Eichholzshowed that the arterial blood of animals which had drunkwater charged with emanation was strongly radio-active.

Residual 2Vttrogen in Ur&aelig;mia.

Dr. HOHLWEG (Giessen) said that it was supposed thatur&aelig;mia was caused by the retention of products of the decom-position of albumin termed "Reststickstoff "-i.e., residualnitrogen. He had examined 47 cases of uraemia with refer-ence to this pathological process. He found that personswith healthy kidneys had from 41 to 63 milligrammes ofresidual nitrogen ; in Bright’s disease the quantity was from63 to 96 milligrammes ; in 3 cases of urasmia where an

improvement ensued it was from 66 to 97 milligrammes. Infatal cases of urasmia a constant increase of the residualnitrogen up to 340 milligrammes was observed accompanyingand having a relation to the progressive deterioration of the

patient’s state. The retention of nitrogenous substances inthe blood indicated renal insufficiency ; excessive retentionwas characteristic of uraemia, and by examination of theurine the activity of the function of the kidney might beascertained.

In the discussion Dr. VOLHARD (Mannheim) said thatthere was a difference between eclamptic ursemia andurasmia caused by anuria. In the latter category only aretention of nitrogen was observed ; eclamptic ur&aelig;mia wascaused by acute cedema of the brain, and lumbar puncturewas therefore very successful in those cases.

Dr. BRUGSCH (Berlin) pointed out that a considerableamount of residual nitrogen was present in cases of Bright’sdisease without the occurrence of urasmia, and especially inchronic poisoning by corrosive sublimate.

Aetion of Adrenalin.Fraulein Dr. RAHEL HIRSCH (Berlin) reported that the

injection of adrenalin into the liver, the pancreas, the

kidneys, and the suprarenal glands of animals produceda (rapid fall of temperature, and it therefore appearedthat adrenalin had an immediate influence on the pro-duction of animal heat. Injection of adrenalin intothe pancreas caused glycosuria; the kidney was theonly organ which showed pathological alterations afterthe injection.

The Influence of the Spleen on the Digestion.Dr. PRYM (Bonn) said that experiments which he had made

on animals showed that extirpation of the spleen had noinfluence on the digestion, and that no pepsin was present inthe spleen. It was, however, observed that during digestionthe spleen became swollen, and that animals whose spleen

had been removed had a voracious appetite. An exactmeasure of the spleen before, during, and after food couldnot be given. (To be continued.)(To be continned.)

BRISTOL AND THE WESTERN COUNTIES.(FROM OUR OWN CORRESPONDENT.)

Winsley Sanatorium.THERE is much that is of interest in the sixth annual

report of this sanatorium. Allusion has already been madein these columns to the satisfactory financial position ; thecommittee has in hand a balance of Z2122 to form thenucleus of an extension fund. During 1910 there were 249admissions, the largest number so far. The percentage ofhopeful cases also continues to rise, being 60, as against47 last year. Of the 256 patients discharged 48 per cent.were fit for some work. Dr. L. Crossley, the resident medicalofficer, has compiled an interesting table of results, as far asthe Bristol patients are concerned, showing how many ofthose discharged in previous years are still alive and atwork. Of the 34 discharged in 1905, 10 are known to be alive,and of these 8 are at work. Similar data are given for subse-quent years. There are some useful remarks as to the value oftuberculin as an adjunct to sanatorium treatment. Dr.Crossley began with oral administration, but this has beenabandoned, and the bacillary emulsion is now being givensubcutaneously in doses increasing from 1-1000 mgr, to1-10 mgr., twice a week, apparently with benefit. He claimsthat the only fair test of the value of tuberculin lies in itsapplication to patients whose sputa contain bauilli, as in suchcases there is some definite index of ’’ cure."

The Study of the Historical Side of Medicine.A small society of an informal character has been estab.

lished in Bristol for the study of the historical and philo-sophic aspects of medicine. It happens that several medicalmen, in Clifton particularly, are interested in these subjectsto the extent of original research and thorough study, and itwas at their invitation that Professor Osler presided over avery informal meeting by way of founding a society for thefurtherance of these objects.

The Children’s Convalescent Home, Weston- super-Mape.At the annual meeting of this institution it was stated that

358 patients had been admitted during 1910. Of these,122 were sent by the masters and mistresses of the publicprimary and secondary schools, 104 by subscribers anddonors, and 116 by the Bristol Children’s Hospital, in con-nexion with which the home was first ; established. The

expenditure for the year was &pound;493 ; this had been exactlymet by the income, thanks to a balancing contribution fromthe Bristol Children’s Hospital.

Charge against a Medical Man.At the Salisbury Assizes, held on May 30th, before Mr.

Justice Coleridge, James Farquhar, M.D., C. M. Aberd., ofBurbage, Wilts, pleaded guilty to: having committed perjuryat Marlborough police court on March 28th last. The casearose out of a charge against a servant girl for havingmurdered her illegitimate son at Burbage in June, 1907.Dr. Farquhar was a witness for the Crown, and in givingevidence referred to some notes to refresh his memory. Onbeing challenged as to whether these were the original notes,he replied in the negative, and was then asked to producethem. He brought a book into court the following day andswore that the entries in it were made by him in 1908. It

eventually transpired that the notebook in which thesealleged notes were written was not published until1910. A charge of perjury was then made againstDr. Farquhar, and he made a most ample and fullapology. Mr. Justice Coleridge, in passing sentence,mentioned that Dr. Farquhar had passed the meridianof life (he graduated in 1867), and said that thecourse of justice had not been disturbed by his attitude.Mr. Justice Coleridge further remarked that what hadoccurred was a shaking of the confidence which the courtreposes in the statements of medical men in regard to theauthority of their notes, and added that the motive whichprompted this deception of the public court was Dr.Farquhar’s desire to prevent the court from knowing that