NORTHWESTERN WISCONSIN MEDICAL ASSOCIATION.

The meeting of the Northwestern Wisconsin Medical Association held at Stevens Point, April 12th, was not only a most profitable one, but by far the best attended meeting of the year, members being present from Milwaukee, Oshkosh, Wausau, Merrill, Marshfield, Colby, Stevens Point and other smaller places. The following papers were read and discussed:

"Some Rare Forms of Fractures and Dislocations of the Leg," Dr. C. O. Thienhaus, Milwaukee.

"Ulcer of the Bladder," Dr. Karl Doege, Marshfield.

"Vaginal-uretero-plasty," Dr. Michael Ravn, Merrill.

"Treatment of Typhoid Fever," Dr. C. von Neupert, Jr., Stevens Point. President's Address-"The Relation of the General Practitioner to the Specialist," Dr. D. Sauerhering, Wausau.

The following places were selected for the coming meetings-- July at Waupaca, October at Marshfield, January at Wausau, and April, the annual meeting, at Stevens Point. It was also decided to make the social feature quite prominent during the coming year, combining business and pleasure. The evening following each meeting will therefore be devoted to a social session and smoker, the entertainment to be arranged by the local members of the society where the meeting is held, the expenses to be paid from the funds of the society.

This being the annual meeting the reports of the Secretary and Treasurer were read and accepted. The report shows the financial condition to be good.

A committee, consisting of Drs. Steele, Doege and Gregory, was appointed to draft resolutions on the death of our late member Dr. W. M. Graham of Auburndale, copy to be sent to the family and entered on the records.

By unanimous vote the old officers were re-elected as follows: President, Dr. D. Sauerhering, Wausau; vice-presidents, Drs. F. A. Southwick, Stevens Point, L. H. Pelton, Waupaca, Karl Doege, Marshfield; secretary and treasurer, C. von Neupert, Jr., Stevens Point; censors, Drs. C. H. Frost, Plainfield, L. H. Pelton, Waupaca, W. W. Gregory, Stevens Point.

C. VON NEUPERT, JR., M. D., Secretary.

TENTH DISTRICT MEDICAL ASSOCIATION.

The Tenth District Medical Society organized at Rhinelander, April 8th, 1904, with Dr. I. D. Steffen, of Antigo, as President and Dr. D. H. Lando, of Hurley, as Secretary and Treasurer.

The following committees were appointed: Committee on Constitution and By-Laws, Drs. T. B. McIndoe, J. M. Dodd and F. E. Winneman; Committee on Programme, Drs. W. T. Rhinehardt, H. L. Garner, H. A. Lathrop, M. Ravn, and Dr. Rosenberry.

The attendance was very good and all those present were agreeably entertained. A visit to the newly erected paper mill was very much enjoyed by all. A very sumptuous banquet was tendered us in the evening by the Rhinelander physicians, for which our entertainers have our best thanks.

Our next meeting will be held at Ashland, September 15th, 1904, and we look forward to a large attendance.

D. H. LANDO, M. D., Secretary.

WILLS' HOSPITAL OPHTHALMIC SOCIETY OF PHILADELPHIA.

A stated meeting of the society was held at the Hospital on the fourteenth of March, 1904.

THE CHAIRMAN, DR. WILLIAM ZENTMAYER, announced that there would be an informal discussion upon glaucoma.

DR. FRANK FISHER, in order to open the subject, cited the histories of two diametrically opposed types of such cases which had recently come under his observation. He desired to know under what conditions an iridectomy should be performed; when should enucleation of a glaucomatous blind eye be done; and if enucleation be done, what effect would the procedure have upon the fellow eye. He was uncertain as to the character of the visual fields serving as a guide to the value of an iridectomy, they being so unstable and uncertain. His experience had led him to ignore the usefulness of the degree or the grade of visual acuity as offering itself as a therapeutic guide. In some eyes which had become blinded from glaucoma processes, he had found that eserine failed to produce pupillary contraction. He had been interested in studying a series of cases of glaucoma, in which there had not been any consanguineous marriages; he gave the detailed history of one such family, and had more or less knowledge of some others. He inquired what had been the experience of members of the society in regard to the ophthalmoscopic appearances of the eyeground and media after the performance of posterior sclerotomy. He asked this question as he had seen two cases in which he could locate the position of the internal traumatism by a localized rupture of the chorioid. He would ocular tension in cases in which posterior sclerotomy had been done. He asked the question whether vitreous elements were reformed or not. He would like to know if any members of the society had, like himself, seen recession of optic nerve head cupping after successful iridectomy.

The chairman stated that he enucleated the offending eye in absolute glaucoma, with a possible previous attempt at iridectomy. He performed an iridectomy if possible, in acute inflammatory glaucoma. His studies with the visual fields in chronic glaucoma, had taught him that the character of decreases and the peculiarities of lessened areas were not in any way characteristic or typical.

DR. CONRAD BERENS believed that enucleation tended towards the conservation of the energies of the other eye; his experience being that vision and intraocular tension of the remaining eye are preserved for much longer periods of time. His experience had taught him that the earlier an enucleation is done-particularly in a painful eye-the safer it is for the other one. If possible, he preferred an early iridectomy in all appropriate cases. In some cases of systemic type he eschewed all forms of operative procedure and preferred to wait for some acute condition necessitating radical measures, watching and guarding over the general system, and directing his main therapy towards the general dyscrasia at hand. He had found good results from the ingestion of large doses of iodide of potassium in association with the salicylates. He had found that the more he had to deal with the condition, the more he depended upon remedial measures, reserving as a rule operative interference for cases of the fulminating type. He had observed the effects of climate

upon such cases, and spoke of the effects of psychological processes upon the condition of the patient. He mentioned his experiences with the results that he had obtained in some of his chronic cases by the employment of varying strengths of synoidal currents.

DR. MCCLUNEY RADCLIFFE showed a case under his care in the hospital in which by enucleation of the blind eye, in combination with appropriate local and general treatment, the ordinarily seen progressive and disastrous symptoms, he felt sure, were rapidly and painlessly disappearing in the fellow eye. DR. CHARLES A. OLIVER said that no fast and hard law could be laid down In any particular case; each one, and even the same case at different times, demanding what might be aptly termed "symptomatic treatment." After a large experience with various operative measures, in association with carefully graded local and general therapy, and above all, hygiene with well reguIated cheerful surroundings, and early treatment directed towards the removal of any possible offending dyscrasia, he had in many cases, ceased to be disturbed as to the probability of ultimate failure; in other words, he made it an unalterable rule to exercise constant vigilance against the general and special inroads of any causative factor with the prompt removal of the disturbing local conditions in the easiest and the most conformable way possible in each case. Whenever possible, he enucleated an eye which had become blinded from glaucoma, as he had learned from experience that it was the safest and the most certain of all of the radical procedures in certain types of cases for the good of the fellow eye; in fact, he was certain that it undoubtedly seemed to have a beneficial influence upon the fellow organ, whether it was injured or not. The question of the performance of an iridectomy he reserved to cases in all stages, more particularly the incipient and practically unadvanced ones in which he felt that there was either a present necessity or an advantage in the future to be gained by opening as much as possible of an imperfectly acting filtration angle. In some cases of coarse severity, he repeated the iridectomy and even had successfully and usefully removed the crystalline lens. He uniformly reserved his operative procedures to the individual organ in question. He spoke of having seen some cases in the hands of some of his colleagues apparently do well by the employment of cyclotomy, and believed that the measure, if not too disturbing in its immediate traumatism, possibly did good by destruction of some of the lymph-making glands. He asserted his disbelief in a proper regeneration of the vitreal elements, believing the vitreous to be like the crystalline lens, an organized body, which once removed or destroyed, was replaced with ordinary lymph; in consequence, he doubted the efficacy of all procedures in which loss of the vitreous body constituted a part. He denounced the term "liquid or fluid vitreous", and said that the replacement of the vitreous humor by ordinary lymph in which there were loose vitreal elements with uveal debris, merely tended to provoke glandular action with consequent increase of the intraocular fluids. He spoke of the classical experiments of Uribe Troncoso upon the effects of altitude upon the density of the intraocular fluids, as well as the morphological conditions of the fluids themselves. As one of the results of a return of intraocular pressure to normal, he had more than once seen temporary lessening and even disappearance of shallow pathological cuppings in the optic nerve head, particularly in the temporally placed finer fibres.

DR. S. LEWIS ZIEGLER spoke of the advantages and the good results he had personally obtained in certain varieties of cases by the performance of posterior sclerotomy. He made the procedure by a quick plunge with a von Graefe knife, with its back directed towards the ciliary body some six or eight millimeters back of the ciliary region, between the muscular attachments, and parallel with the radiating vessels. He rotated the knife at right angles to the first incision, allowed a few beads of vitreous to escape, and withdrew the instrument, thus making a T incision. He had found that there is immediate hypotension and there is never any reaction. His experiences had coincided closely with those given by Dr. Oliver. In the blind eyes of some such types he had had useful recourse to opticociliary neurotomy, having, he remembers in more than one instance, kept a functionless eyeball intact and free from pain and harmful influences for a period of nine years. He mentioned several interesting examples of the various conditions, showing the multiplicity and variability of the symptom-complex in cases which had come under his immediate observation; distinctly proving the efficacy of certain procedures in some cases, and the inefficiencies of many authoritative measures that had been strictly applied, in others. The more extended his experience had become in such an enormous mass of material as was almost daily given him in such a large service as in the outpatient department of the hospital, the broader and the more conservative had become his views in regard to therapeutic measures. He was daily waiting for opportunity, and was more than willing to apply any plan of therapy which offered in the least a greater chance for the patient's welfare. Upon being asked whether he would do an iridectomy at the time of the appearance of the earliest signs and symptoms of the disease, he answered that he would in appropriate cases. He had never had any intraocular complications of inflammatory type to arise after the performance of posterior sclerotomy. In a number of painful cases in which immediate operative procedure could not be done, he had most useful recourse to a formula containing hyoscine hydrobromate, morphine, strychnine and pilocarpine; a combination which not only subdued pain, but which both stimulated and controlled lymph circulation. In support of his claim for the value of these therapeutic agents, he cited three most interesting confirmative cases which he had seen at the hospital several years previously. In the use of electricity he had had considerable experience, finding a most curious paradoxical result that pain and tension are reduced when the negative electrode is applied to the eyeball. In his hands, pneumo-massage had given but moderate effects in some cases of chronic glaucoma.

Pathogenesis of Scoliosis in Children- DEUTSCHLANDER (Ztschr. f. orthopäd. Chir., XI, 2, 1902) agrees with v. Recklinghausen in that this is caused by infantile osteomalacia. It is distinguished from rachitis in being a pure degeneration. The anemia so often present in habitual scoliosis can also be referred to the diseased skeleton, the influence of bones on blood building being well known. The accompanying flatfoot, genu valgum, etc., also speak for infantile osteomalacia as the causative factor. (G. P. B.)

BOOK REVIEWS.

Physiological and Pathological Chemistry.— PROF. DR. E. SAIKOWSKI. Translated by R. E. Orndorff. (Published by John Wiley and Sons, New York.)

The appearance of Orndorff's translation of Salkowski's "Practicum der Physiologischen und Pathologischen Chemie" will be hailed with delight by those who either as teachers of this branch or as progressive practitioners desirious of doing scientific work, have long felt an urgent need of just such a publication. While a number of writers, American and English, have given us a result of their work along this line, and many of them detailed their methods, but one or two, so far as we know-and these teachers of the subject-have written with the purpose of furnishing a laboratory manual which could be used alike by student and practitioner with advantage. In some of these the non-essential and theoretical problems have occupied too large a portion of the text, making the work incomprehensible to the beginner and too complicated for adoption in the office of the average physician. In others the methods given have not extended to those factors and processes which are of great clinical significance, and hence should have been considered.

The subject of physiological and pathological chemistry has for some years been conceded to be one of the most important of the foundation studies of a medical education, and within the last few years nearly every reputable college in this country has established a course, largely laboratory, for instruction and demonstration in this important branch. As a result of this, there has been a general demand for a laboratory manual of such content and scope that it could be used as the basis of a course of instruction in this department of chemistry.

To meet the requirements it should not be so extensive as to demand too much time, nor so intensive as to be beyond the ability of the student to comprehend. Nor should it demand for the performance of the experiments given, a greater amount or more complicated apparatus than is to be found in the average well-equipped laboratories of our colleges.

Orndorff's manual meets all these conditions. The work outlined, while comprehensive, is not more than can be performed with profit by the medical student, and while quite detailed is still so clearly described and directions are so explicitly given that with the apparatus usually at hand, the average student or any physician, with a few brief instructions, can readily perform any of the experiments outlined. The chapters which will probably be of the greatest interest to physicians because of their bearing on clinical diagnosis, are those treating of milk, gastric contents, pathological transudates and cystic fluids, the analysis of biliary and urinary calculi and of the urine and the faeces.

The author has omitted special consideration of what constitutes a large portion of most of the books on physiological chemistry, viz., the discussions and analyses of the various compounds constituting the food stuffs. There are no chapters devoted especially to carbohydrates or fats or proteids, but instead he has fully and in detail considered the analysis of bread, meat and muscle tissue, egg and adipose tissue, and thus incidentally given the known facts concerning, and the analytical methods employed in the detection, isola