Diagram of stomach, showing large cyst.

The tumor was somewhat more extensive than is indicated by the drawing. The light area representing cyst is not a true picture in every respect, and is too small.

serum. With the examining finger in the cyst I searched everywhere for the cause of the obstruction, expecting to find a cancer, probably of the pyloric extremity, but I could not get out of the sac or pouch-there was no communication between the stomach proper and the cyst anywhere. After emptying the sac thoroughly it was wiped out and the walls were treated with two ounces of tincture of iodine, packed well with iodoform gauze and then anchored to the abdominal wall.

The patient made a prompt recovery, was never sick at his stomach and began to take food in quantity without discomfort as soon as permitted. He left the hospital with a small

opening leading down to the cyst cavity, which was, to all appearances, rapidly becoming obliterated.

A section of the sac wall was removed and sent to Dr. N. S. Ferry, pathologist, and his report was as follows:

Dr. F. D. Smythe, City:

MEMPHIS, TENN., February 17, 1904.

Dear Doctor-From the specimen taken from the anterior wall of the stomach I can make out nothing more than a simple cyst. The walls are comparatively thick and composed mostly of fibrous tissue. There are no signs of malignant growth anywhere. It certainly is a rare position for such a cyst, and I shall be interested to know of the result of the operation and the ultimate outcome. Very truly yours, N. S. FERRY.

A recent letter from Dr. Feemster states that the patient is doing well, has resumed work and has regained his lost flesh. He was operated upon the 10th day of February, 1904.

This case is reported for the reason that the literature is so scarce-only one case, Schultz's. Tumors of this size in this region in my experience heretofore have always proven upon operation to be malignant.

The question may with propriety be raised, why not attempt to remove the cyst, or portion of the stomach occupied by the cyst? My answer is that such an undertaking would have proven very long and tedious with an extremely doubtful outcome, and I felt reasonably sure that the sac would become obliterated by the treatment employed, and I knew that my patient's life would not be in the least jeopardized by such

treatment.

"A collection of blood in a tumor-like mass is called a hematoma. Sometimes all traces of extravasation of blood in the tissues disappear, but frequently their seat is indicated for a long time by a greater or less amount of pigment or by new formed connective tissue. Occasionally the blood mass in a more or less degenerated condition becomes encapsulated by connective tissue, forming a cyst." Such was the nature of my case. A very good diagram of the stomach with the cyst I am enabled to present through the kindness and skill of Dr. J. E. Johnson.

Porter Building.

TYPHOID FEVER.

ROBERT M. STERRETT, M.D.

NEW YORK, N. Y.

Former Demonstrator of Surgical Pathology, College Physicians and Surgeons, Chicago; former Attending Physician West Side Free Dispensary, Medical Department, Chicago.

TYPHOID fever is one of the most complex and interesting disease dramas in our nosological list. To speak of any line of specific treatment covering the various phases of the disease, is manifestly improper, since the symptoms at different stages of the complaint may be modified and relieved pro re nata. This does not, however, preclude the idea of successfully attacking the principal lesion-or rather its cause-the bacillary infection of the small intestine. While some authorities declare this disease can not be aborted or modified in its course that it must run the regular, classical gamut described in the standard text-books-there are a large number of thoughtful, well educated, capable clinicians who are convinced that they have been successful in shortening the time of typhoid fever, and of greatly ameliorating its behavior. They are convinced that the dangerous elements-the softening of the heart muscle, perforation of the intestine, etc.—may be avoided by proper treatment, prior to the time in the classic course of the disease when such untoward conditions are wont to occur.

That the small intestine is the locale of the infectious propagation, is agreed by all schools of physicians. This same intestinal tract, as we all know, swarms with bacilli under even ordinary conditions of health. It is the source of a vast amount of systemic distúrbance even at best, for it is simply (the lower part, or colon) a receptacle of sewage of which the majority of persons are not properly relieved, and hence the resulting accumulation of toxins of various degrees of potency. That the usual bacilli and their products assist the typhoid bacilli in their destructive work, is pretty well established— there is no doubt of it.

Now, if the infection has its incipiency in the intestinal tract the place to begin treatment is there, and the sooner the better for the patient, although the chances are the regular

typhoid fever performance with its four long acts, will be shortened to an insignificant, possibly nondescript entertainment in one act-at most two.

It may be remarked, in the way of criticism, that typhoid fever is a serious affair, and not a subject for light metaphor. It is undoubtedly a serious affair if the family physician, whether he be the author of a text-book on practice or only a former pupil of the author, calls regularly once or twice daily to see how the beautiful picture of typhoid fever is being wrought out; or feels impelled to exert himself, even at the risk of being considered erratic, and so attempt to curtail, abort, modify, abridge, or whatever term you care to use, the bacillary infection in the intestinal tract.

Many things have been brought forward with which to do this, but so far as the writer can learn from unprejudiced sources, and from his own experience, the sulpho-carbolates of lime, sodium and zinc are by far the best, safest and the cheapest. These salts must be pure. When they are pure, they may be given in daily dosage of from 40 to 100 grains-according to requirements. The thing to be attained is as near a condition of asepsis or antisepsis, as the bowel, from the nature of its function, will admit.

The criticism has been made that some of the bacilli of typhoid fever have been found in the blood outside the immediate neighborhood of the intestine. The fact that some of them do get away does not relieve the conscientious physician from doing his duty to his patient, in striving to destroy, or render innocuous, the mass of disease material that does remain at the principal seat of the disease-the intestine.

Moreover, it has been proven time and time again, that the sulpho-carbolates do reduce the virulence of the infection; do reduce the temperature (by the foregoing); do shorten the time and modify favorably, the course of typhoid fever.

So, that, this complex disease drama is greatly simplified and its many dangers warded off by prompt and thorough institution of intestinal asepsis, by the sulpho-carbolates.

521 W. 123rd street.

A FEW JOTTINGS

FROM THE SWAMPS OF SOUTH ARKANSAS.

W. S. ROBINSON, M.D.

FROSTVILLE, ARK.

QUININ is indicated in every phase of malaria, but it is not the whole treatment-it must be given with due regard to its indications. Especially in malarial hematuria do not give quinin until elimination is well under way.

Now for drug addiction. With something over one hundred cases that I have cured satisfactorily without a single failure with hyoscine hydrobromate, I am convinced that it is a complete antidote and will permanently rid the system of all craving or desire for the drug in from three to five days. I take them all ages and conditions and cure them, have them ready to return home in eight days from the time they land here. And I use nothing except hyoscine hydrobromate.

In my acute rheumatism cases with dry, hot skin, pulse full and strong, kidney action deficient, patient restless and uneasy, I give pilocarpin. In uremic poisoning it is the sheet anchor as an eliminant..

VERATRUM VIRIDE IN PUERPERAL CONVULSIONS. There is a peculiar tolerance of veratrum viride in this disease; the usual dose has no effect upon puerperal convulsions. The state of the pulse is the guide in the treatment. The pulse may be brought down to fifty without any general depression.

In my appendicitis cases, if the patient has had more than one acute attack previously, even though the appendix is found on palpation to be pretty nearly normal, I advise operation in the interval. Those who oppose the idea of immediate operation in appendicitis overlook the fact that in any case of progressing appendicitis an operation is at that moment being done by the bacteria, which are engaged in a more or less complete removal of the tissues of the appendix without regard to the interest of the patient.

In my perineal laceration cases I do not have to heal by granulation because they are slight. A single stitch put in at once, while the tissues are still numb, will usually secure union by first intention.