Part 4

I said that there was often doubt as to the condition in the abdomen in these cases. Now, there can be no doubt that the two main points in the diagnosis of a localized abscess are tumor and an aggravation of the symptoms present. But this case exemplified the fact that there may be cases where there is no aggravation of symptoms, and in a great many cases it may be impossible to feel the tumor until it has become very large, owing to its situation, viz., post caecal. Even in this case, from which a great quantity of pus was evacuated, there was no absolute certainty of finding pus on opening the abdomen, although it was suspected strongly.

I have seen a patient walk into the hospital on Sunday with a temperature of 100 and a pulse of 99, and when the abdomen was opened on Monday morning a most virulent form of general streptococcus peritonitis was found, from which the patient died the next day. It is said that it is much better to depend on the pulse and its variations than on the temperature.

I would like to call attention to several points in the treatment of this case also.

First, the place of incision was, as I said, well up towards the iliac crest, and not in the time-honored McBurney point. The wisdom of this is self-evident.

Second, the care used in not breaking up the wall of the abscess formed by the peritoneum.

Also, the fact that the appendix was carefully dissected up and tied off and allowed to heal by itself, obviating, as much as possible, the danger of a faecal fistula. The older books advised evacuating the abscess and leaving the appendix to slough off, and, while I have seen seven cases where this method was used and not a single faecal fistula, yet it seems to me the more rational treatment to remove the offender, as I have also assisted in three operations where the appendix was removed at the second operation. That is, an operation supposedly an appendectomy was done, and later, at a subsequent period, the diseased appendix was found still causing the same old trouble.

Again, the use of the lumbar puncture, so as to drain the abscess cavity from its very bottom. I wonder this is not done oftener, as it appeals to me as being a most sensible thing.

Then the abscess cavity was sponged out with gauze, and not washed out with the antiseptic fluid that books advise, thus spreading bacteria all over the peritoneal cavity, and really doing no good. Nature was allowed to throw off such things as she deemed necessary, an avenue of escape having been provided.

And, lastly, the omentum was found and brought down, covering in the cavity as much as possible, and thus aiding in the walling off process.

DIRECT LARYNGOSCOPY.

BY RICHARD H. JOHNSTON, M. D.

_Read Before the Baltimore City Medical Society, Section on Medicine and Surgery, February, 1909._

Direct laryngoscopy, as the name implies, is the inspection of the larynx through a hollow tube without the use of a mirror. The examination is made with the patient in the sitting position, under local anesthesia, or in the prone position, under general anesthesia. To examine the larynx in the sitting position it is practically always necessary to give a hypodermic injection of morphia and atropia a half hour beforehand, to relax the muscles and to prevent excessive secretion. The patient is seated upon a low stool with the head extended and supported by an assistant. With curved forceps 20% cocaine or 25% alypin solution is quickly passed into the throat, anesthetizing pharynx, tongue and epiglottis. Jackson's slide speculum is then introduced and the base of the tongue, with the epiglottis, gently pulled forward. At this point it is usually necessary to use more cocaine directly in the larynx, which is introduced by means of special cotton carriers. In a few minutes anesthetization is complete, and the examination can be made at leisure. It will be found easier to inspect the different parts of the larynx if the head is held about halfway between the erect position and complete extension. In some patients with short, thick necks and large middle incisor teeth the slide will have to be removed from the speculum to enable one to see well. The examination in the prone position under general anesthesia is made with the patient's head over the end of the table supported by an assistant. The speculum is introduced and the base of the tongue and the epiglottis pulled upward forcibly. In this position direct laryngoscopy, even in children, is unsatisfactory, and operative procedures are well-nigh impossible on account of the muscular rigidity. The force required to lift the tissues is so great and the position of the arm is so cramped that it is difficult to get a clear view of the field. The difficulty has impressed all who have worked in this particular line. It remained for Dr. H. P. Mosher, of Boston, to discover a method of direct laryngoscopy which makes it as simple under ether anesthesia as in the sitting position. In April, 1908, he described in the _Boston Medical and Surgical Journal_ the "left lateral position" for examining the larynx and the upper end of the esophagus. He designed certain instruments which I believe are too cumbersome to meet with popular favor. In Mosher's position the patient lies on the table with the head turned toward the left until the cheek almost rests on the table; the chin is flexed on the chest. In our work at the Presbyterian Hospital we have found a modified Mosher's position and Jackson's child speculum the ideal combination for the examination in the prone patient. In children the procedure is carried out with or without anesthesia. Without anesthesia the head, hands and feet are held, the chin is flexed on the chest in a normal position by placing a pillow under the head, the speculum is introduced and the larynx inspected. In adults under anesthesia the same procedure is used, and will be found much simpler than the extended position. In adults, after the speculum is in position, if the anterior part of the larynx is not seen, gentle pressure on the thyroid cartilage will bring the anterior commissure into view. Operations can be done through the tube satisfactorily. With the different methods of direct laryngoscopy it is possible to remove any growth from the larynx.

919 N. Charles Street.

ITEMS.

The Board of Trustees of the Permanent Endowment Fund of the University held its annual meeting on January 11. Judge Stockbridge was re-elected president and Mr. J. Harry Tregoe secretary-treasurer, and, with Dr. Samuel C. Chew and Judge Sams, constitute the executive committee for the year 1909. The funds and securities in hand total the gross sum of $18,635.74.

A special meeting of the Washington Branch of the General Alumni Association was held at the office of the president, Dr. Monte Griffith, March 11, 1909, to consider the advisability of petitioning the Board of Regents to establish a Board of Alumni Counsellors, a paid president and a Board of Trustees, independent of the teaching faculties. Resolutions in favor of these measures were adopted.

Dr. Louis W. Knight, class of 1866, of Baltimore, has presented to Loyola College a valuable collection of papal medals.

Drs. H. O. and J. N. Reik have removed their offices to 506 Cathedral street.

Drs. W. D. Scott and W. E. Wiegand attended the banquet of the Virginia Military Institute Alumni Association of Baltimore, held at the New Howard House, March 2, 1909. Dr. W. D. Scott responded to the toast "The Younger Generation and the Splendid Work of the Virginia Military Institute Today."

Major William F. Lewis, class of 1893, U. S. A. Medical Corps, has been relieved from duty at Fort Thomas and ordered to sail on June 5, 1909, for the Philippine Islands, via San Francisco, for duty.

Dr. Hugh A. Maughlin, class of 1864, of 121 North Broadway, an official in the United States Custom Service, who was assistant surgeon in the Sixth Maryland Regiment during the Civil War, is dangerously ill of pleurisy at his home. Dr. Maughlin is a member of Wilson Post, G. A. R.

Dr. James A. Nydegger, class of 1892, past assistant surgeon, United States Public Health and Marine Hospital Service, has been promoted to the rank of surgeon.

Dr. Eugene H. Mullan, class of 1903, assistant surgeon, United States Public Health and Marine Hospital Service, has been commissioned a past assistant surgeon, to rank as such from February 2, 1909.

Dr. Samuel T. Earle, Jr., of Baltimore, Md., records the case of Mrs. F. H. D., who, the latter part of August, 1907, while eating ham, swallowed a plate with two false teeth. Ten days later she had a violent attack of pain in the abdomen, followed by a chill and fever. There was no recurrence of this for one and a half months. Since then they have recurred from time to time, but not as severe, nor have they been attended with chill and fever. A diagram taken of the lower abdominal and pelvic regions showed the plate in the sigmoid flexure of the colon, on a level with the promontory of the sacrum. Examination through the sigmoidoscope brought it into view at the point shown by the X-ray. There was considerable tenesmus, and the passage of a good deal of mucous, also a tendency to constipation. Under the influence of two hypodermics of morphine, gr. 1-4, hyoscine hydrobromate, gr. gr. L-100, and cactina, which produced satisfactory anesthesia, Dr. Earle was able to grasp the plate through the sigmoidoscope with a pair of long alligator forceps, and withdraw it immediately behind the sigmoidoscope.

At the Conference on Medical Legislation, held in Washington, D. C., January 18-20, 1909, resolutions were adopted providing for a committee composed of one member each from the medical departments of the Army and the Navy, one from the Public Health and Marine Hospital Service, one member from the District of Columbia and one member from the Council on Medical Legislation, to present to the medical profession the conditions under which the widow of Major James Carroll is now placed, and to devise such plans as might seem advisable for her relief. The following committee was appointed: Major M. W. Ireland, U. S. A.; Surgeon W. H. Bell. U. S. N.; Dr. John F. Anderson, U. S. Public Health and Marine Hospital Service; Dr. John D. Thomas, Washington, D. C., and Dr. A. S. Von Mansfelde, of Ashland, Nebraska.

Mrs. Carroll has been granted a pension of $125 a month on which to support herself, seven young children and the aged mother of her husband. The house, which Major Carroll had partly paid for, is mortgaged for $5,000. Since the conference adjourned the medical officers of the Army have raised enough to pay the taxes on the house, one monthly note of $50 and the overdue interest on the first mortgage, amounting to $125. Believing that the members of the medical profession will wish to contribute toward a fund for the purpose of paying the balance due on the house, the committee requests contributions of any amount. They may be sent to Major M. W. Ireland, United States Army, Washington, D. C. The editors of THE BULLETIN sincerely hope our alumni will honor the memory of our most distinguished alumnus by contributing liberally to this most worthy cause.

At the last regular meeting of the University of Maryland Medical Association, held in the amphitheatre of the University Hospital, Tuesday, March 16, 1909, the program was as follows: 1, "The General Practitioner: His Relation to His Patients, to His Fellow Practitioners and to the Community in Which He Lives," Dr. Guy Steele, Cambridge, Md.; 2, "Medical Ethics," Dr. Samuel C. Chew. Dr. A. M. Shipley, the president, was in the chair, and called the meeting to order promptly at 8.30 P. M. The attendance was large and appreciative, and listened to two remarkably able addresses. Those who had the privilege and pleasure of listening to the words of wisdom and advice both of Dr. Chew and Dr. Steele went away with a clearer conception of their duties to their professional brethren and the public.

Immediately after the adjournment of the Medical Association the Adjunct Faculty, with its president, Dr. Joseph W. Holland, in the chair, held a very important meeting, the gist of which is as follows: Resolved by the Adjunct Faculty of the Medical Department of the University of Maryland that the Board of Regents be implored to effect such changes in the charter as to make possible the election of a president with a fixed salary, and with the duties usually associated with that office in standard universities, and a Board of Administrators independent of teaching faculties. The Adjunct Faculty also endorsed tentative plans looking towards the formation of an advisory board of alumni counsellors.

At the meeting of the Section on Ophthalmology and Otology, Thursday, March 11, 1909, at the Faculty Hall, the following of our alumni read papers: "Rodent Ulcer of the Cornea (Ulcus Rodens Mooren), with Exhibition of the Case," Dr. R. L. Randolph; "Purulent Otitis Media of Infancy and Childhood," Dr. H. O. Reik.

At the meeting of the Section on Neurology and Psychiatry, Friday, March 12, 1909, the following participated:

"History and Forms of Chorea," Dr. N. M. Owensby;

"Etiology of Chorea, Dr. H. D. McCarty;

"Treatment of Chorea," Dr. W. S. Carswell.

The Baltimore _Star_ of March 27th, 1909, has this to say concerning Prof. Randolph Winslow: "Prof. Randolph Winslow, head of the Department of Surgery of the University of Maryland, is one of the best-known lecturers and demonstrators in the East. He is a close student, and has the faculty of impressing the young men of the University with the force of and practicability of his knowledge. Professor Winslow stands high in medical and surgical circles of the country, and ranks with the best surgeons." Under the caption of the leading men of Maryland _The Star_ also included a photograph of Professor Winslow. By honoring Dr. Winslow _The Star_ also honors the University of Maryland, whose authorities feel a natural pride in the eminent position held by its professors.

Dr. Fitz Randolph Winslow, class of 1906, a former resident physician in the University Hospital, and a resident of Baltimore, has located at Hinton, Virginia.

The Phi Sigma Kappa Fraternity had an at-home Saturday, March 27, 1909.

About sixty members of the Theta Nu Epsilon Fraternity, University of Maryland, attended a banquet at the Belvedere recently. It was served in the main hall, and the tables, which formed a semicircle, were beautifully decorated with trailing asparagus and cut flowers. During the meal a string orchestra rendered popular selections. Dr. Arthur M. Shipley, toastmaster, introduced Mr. Frederick W. Rankin, who made the address of welcome. Mr. Rankin was followed by Dr. C. H. Richards, who responded to the toast "Past and Present;" Dr. W. D. Scott had as his subject "The Fraternity Man;" Dr. R. Dorsey Coale, "The Undergraduate;" Dr. Randolph Winslow, "The Near Doctor;" Dr. John C. Hemmeter, "Our University," and Mr. C. B. Mathews, "The Ladies." The reception committee in charge of the arrangements was as follows: Frederick W. Rankin, chairman; Ross S. McElwee; John W. Robertson, John S. Mandigo, Arthur L. Fehsenfeld, J. F. Anderson.

DEATHS.

Dr. Joseph R. Owens, class of 1859, mayor of Hyattsville, Md., and treasurer of the Maryland Agricultural College, died at his home, in Hyattsville, March 15, 1909, after a lingering illness of six months. Death came peacefully, and at the bedside were his wife, who was Miss Gertrude E. Councilman, of Worthington Valley, Baltimore county, Md.; his daughter, Mrs. Geo. B. Luckey, and his son, Charles C. Owens, of New York. Besides these he is survived by his mother, Mrs. Percilla Owens, 90 years of age; a son, Mr. L. Owens, of New York, and a daughter, Mrs. A. A. Turbeyne, of England.

Dr. Owens was born in Baltimore, February 20, 1839, and was 70 years old. His parents removed to West River when he was seven years of age. When he was ten years old he entered Newton Academy, Baltimore, and in 1859 was graduated from the Medical Department of the University of Maryland. Immediately after leaving the University he was appointed resident physician at the Baltimore City Almshouse, and served in this capacity to 1861, when he returned to Anne Arundel county and began farming on West River. In 1885 he removed to Hyattsville and accepted the position of clerk of the Claims Division of the Treasury Department, Washington. He held this office until 1890, when he was named as treasurer of the Maryland Agricultural College, which position he filled until death. For several years Dr. Owens was collector of taxes in Anne Arundel county. When the municipal government of Hyattsville was changed from a board of commissioners to a mayor and common council, Dr. Owens was elected councilman from the Third ward, and served with marked ability until May, 1906, when he was elected mayor.

He was elected for three consecutive terms without opposition, and was foremost in every move tending to the advancement of the town. As treasurer of the Maryland Agricultural College he became acquainted with many of the leading men of the State, by whom he was held in the highest esteem. He was secretary of the Vansville Farmers' Club for many years, a director of the First National Bank of Hyattsville. Interment was in the cemetery adjoining Old St. James' Protestant Episcopal Church, near West River, Anne Arundel county. The coffin was borne from his late residence, Hill Top Lodge, by seven cadets of the Agricultural College--Cadet-Major Mayor, Captains Burrough and Jassell, Lieutenant Jarrell and Sergeants Freere, Saunders and Cole. A squad of 25 cadets, five from each class of the College, under command of Captain Gorsuch, escorted the body to Pinkey Memorial Church, where the Episcopal burial service was read by Rev. Henry Thomas, rector of St. Matthew's Parish, of which Dr. Owens had been registrar and a member of the vestry for several years. The body, preceded by the college cadets, was taken to the Chesapeake Beach Railway Station and shipped to Lyons Creek, and thence to St. James' Church. Rev. Henry Thomas officiated at the grave. The pall-bearers were: Messrs. Wirt Harrison, Harry W. Dorsey, E. B. Owens, O. H. Carr, T. Sellman Hall and E. A. Fuller. A special meeting of the Mayor and Common Council was held in Heptasophs' Hall March 22, 1909, to take action upon the death of Dr. Joseph R. Owens, late Mayor of Hyattsville. Acting Mayor John Fainter Jr., was chairman and Town Clerk G. H. Carr was secretary. Former Mayor Dr. C. A. Wells eulogized the late Mayor, both as a public official and a private citizen. Dr. Joseph A. Mudd, W. P. Magruder, R. E. White, J. W. Aman and Edward Devlin, all members of the Council who served with Dr. Owens, and R. W. Wells, M. J. Smith and S. J. Kelly, the last named as members of the present Council, also made appropriate addresses. It was resolved that in the passing away of Dr. Joseph R. Owens, Mayor of Hyattsville, we have lost a conscientious official, a valued associate and a personal friend, and the citizens of Hyattsville at large, as well as his official associates, have experienced a bereavement, the effects of which they will ever feel.

Dr. Asa S. Linthicum, class of 1852, a former member of the Board of County Commissioners of Anne Arundel county, died at his home, in Jessup, Md., Sunday, March 28, 1909, from apoplexy, aged 78. About 25 years ago Dr. Linthicum retired from the active practice of medicine to engage in iron ore mining.

Dr. Linthicum's wife, who died about five years ago, was Miss Nettie Crane, of Clifton Springs, N. J. Interment was in Loudon Park Cemetery, Baltimore.

Dr. John Bailey Mullins, class of 1887, of Washington, D. C., a member of the American Medical Association and the American Society of Laryngology and Otology, formerly of Norfolk, Va., died at his home, in Washington, D. C., from cerebral hemorrhage, February 11, 1909, aged 42.

Resolutions on the death of Dr. John Bailey Mullins:

WHEREAS, It has been God's purpose to suddenly call hence one of our most useful and beloved members; be it

_Resolved_, By the Washington Branch of the General Alumni Association of the University of Maryland, that we are deeply grieved by the premature death of our honored associate. By his death the public, especially those worthy of charity, whom he was ever ready to serve, have lost a most useful citizen, the medical profession a skilled and painstaking physician and surgeon, and the University of Maryland an able and active worker. And be it further

_Resolved_, That the sympathy of this Association be extended to his daughter, whom he loved before all else on earth, and to whom he was ever a dutiful father. And be it further

_Resolved_, That these resolutions be spread upon the minutes of our Association and a copy of the same be sent to the parent Alumni Association in Baltimore.

Committee--I. S. Stone, William L. Robbins, Harry Hurtt, Monte Griffith, president; W. M. Simpkins, secretary.

Dr. Samuel Groome Fisher, class of 1854, of Port Deposit, Md., died at the home of his son, in Port Deposit, February 22, 1909, aged 77. For more than 50 years Dr. Fisher was a practitioner of Chestertown, Md.

Dr. Charles Brewer, class of 1855, of Vineland, N. J., died at his home, in Vineland, March 3, 1909, aged 76. From 1858 to the outbreak of the Civil War he was a member of the Medical Corps of the Army, and during the war a surgeon in the Confederate States service. Under President Cleveland he was postmaster at Vineland, N. J., and resident physician at the State Prison, Trenton, from 1891 to 1896.

Dr. William F. Chenault, class of 1888, of Cleveland, N. C., a member of the Medical Society of the State of North Carolina, died at his home, in Cleveland, N. C., February 24, 1909, from cerebral hemorrhage, aged 46.

Dr. James B. R. Purnell, class of 1850, of Snow Hill, Maryland, died at his home, in Snow Hill, March 7, 1909, from senile debility, aged 80. He was vice-president of the Medical and Chirurgical Faculty of Maryland in 1900-1901, formerly physician to the county almshouse and health officer of Worcester county.

Dr. Benjamin Franklin Laughlin, class of 1904, of Kingwood, West Virginia, died at the home of his father, in Deer Park, Md., from paralysis, March 9, 1909, aged 31.

=IN PNEUMONIA= the inspired air should be rich in oxygen and comparatively cool, while the surface of the body, especially the thorax, should be kept warm, lest, becoming chilled, the action of the phagocytes in their battle with the pneumococci be inhibited.

_Antiphlogistine_

(_Inflammation's Antidote_)

applied to the chest wall, front, sides and back, hot and thick, stimulates the action of the phagocytes and often turns the scale in favor of recovery.

=Croup.=--Instead of depending on an emetic for quick action in croup, the physician will do well to apply Antiphlogistine hot and thick from ear to ear and down over the interclavicular space. The results of such treatment are usually prompt and gratifying.

Antiphlogistine hot and thick is also indicated in Bronchitis and Pleurisy

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Certain as it is that a single acting cause can bring about any one of the several anomalies of menstruation, just so certain is it that a single remedial agent--if properly administered--can effect the relief of any one of those anomalies.