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his wife that he had an incurable disease, and probably would live two or three years. They continued him on the police force. Finally he was put into a wagon, as he was so weak that he could not perform the duties of a police officer, and fell into the hands of another physician for a short time, who said the case was curable; that he had been in this condition himself. He gave the man calomel and other medicines, with some little improvement, as the man thought, but when I saw him on the street occasionally he was gradually becoming more bronze in appearance, and he lived about three years and died in collapse, having been perfectly worn out.

Dr. E. B. Block, of Atlanta: I have been very much interested in Dr. Lyle's paper. It is worthy of careful study. I wish to say that lesions have not been found in the suprarenal glands in all cases of Addison's disease. We know that the sympathetic nervous system has a decided influence over the pigmentation of the skin, and in many cases of Addison's disease lesions have been found in the semilunar ganglia.

I have personally observed a case of pigmentation of the skin confined strictly to the distribution of the cervical sympathetic, that is, taking in exactly one-half of the face, upper portion of the chest on one side and the right arm. This was confined to the exact distribution of the cervical sympathetic, and I believe the sympathetic nervous system has a decided control over pigmentation. It is probable that the disease of the semilunar ganglia has had its effect upon Addison's disease by influence upon the suprarenal gland. Everybody is uniform in the belief that the suprarenal glands are associated intimately with Addison's disease. A very common lesion of the suprarenals is tuberculosis, of which I have seen several


The first case, to my knowledge, that was treated witn the suprarenal substance was one I treated in 1895. I made glycerine extract from a pig's adrenal glands and gave it to a young woman, twenty-one years of age, but she died in about three weeks after this treatment was begun. There was really no improvement from the administration of suprarenal gland.

Since suprarenalin has been put on the market I have seen several cases that were treated by the refined products, without any apparent benefit. Of course, the stimulating effect of adrenalin is of some value, as it tends to overcome the extreme asthenia, which is the most marked symptom of this disease.



Abscess of the liver is seen only occasionally in this section of the country, but when occurring as a complication of typhoid fever, it is exceedingly rare, and for that reason I am sure that the report of the following case will be of interest to the members of this Association.

A. S., male, white, age thirty-nine; family history: Both parents living and in good health; two of his brothers have had severe attacks of typhoid fever in recent years. Personal history: He has always enjoyed the best of health until eight years ago, when he had a chronic diarrhea of such severity that he was unable to attend to his business for nearly three years. During the past five years, however, his health has been good and he has experienced no bowel trouble.

He was first seen on August 20, 1905, when he felt badly for at least two weeks, although he did not take to his bed. On examination, the following symptoms

were noted:

Temperature, 102.8° F.; pulse, 94; headache, tongue dry and furred, a slight cough, abdomen somewhat tympanitic, tenderness in the right iliac region, five or six rose-colored spots on the abdomen, constipation. Diagnosis, typhoid fever.

To confirm the diagnosis, Russo's test was used. This test has been suggested as a substitute for Ehrlich's diazo reaction. It is much simpler and seems to be equally reliable. As it may be unfamiliar to some of you, a description of the test may not be out of place here.

In typhoid fever it affords more information than the diazo test, as it indicates the exact phase of the disease. The reagent used is a 1-1000 aqueous solution of methylene blue. To a drachm of urine in a test tube, add four drops of the methylene blue solution, and if the reaction is positive, the fluid turns to a mint or emerald green color. A light green or bluish green represents a negative reaction. This reaction can be seen as early as the second or third day of the disease. As the fever reaches its height the dark green color becomes more marked, gradually turning to a light green, and finally a blue as convalescence is established or the emerald color persists until death. The reaction was positive in eleven out of twelve cases seen by me.

To return to the patient. On the twentieth day of treatment, the temperature returned to the normal and remained so for six days, when a relapse occurred which lasted two weeks. Just about this time he complained of a dull pain in the region of the liver, but a careful examination showed no enlargement. In the course of four or five days, the pain became quite intense, the tempera.ture was normal each morning, but at night rose to 103, followed by a profuse perspiration. Gradually an enlargement of the liver was noticed with a marked bulging of the intercostal spaces. Abscess of the liver was diagnosed and Dr. H. F. Harris called in consultation and the diagnosis confirmed by him. On aspiration pus was found. It was examined microscopically by Dr. Harris

but with a negative result. Immediate operation was advised and on the following day Dr. F. W. McRae made an incision in the ninth intercostal space and a large quantity of pus was evacuated. No rib resected. The cavity was not irrigated, but large drainage tubes inserted. For several days the patient was in a critical condition, then rallied, and in a short time made a complete recovery. At the present time he is in the best of health and weighs more than ever before.

16 mt

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