1787

GERMAN CONGRESS OF INTERNALMEDICINE.

(FROM OUR BERLIN CORRESPONDENT.)(Concluded from p. 1708.)

Therapeutical Applications of Thorium and -Radium.Dr. W. FALTA (Vienna), in the course of a paper which he

read on the action of thorium, said that when thorium Xwas subcutaneously administered only 24 per cent. were

discharged by the faaces and 4 per cent. by the urine duringthe first four days. He was in the habit of giving from50,000 to 100,000 Mache units to be taken daily as a

beverage, or from 15,000 to 80,000 Mache units administeredby intramuscular or subcutaneous injection. Thorium waterdrunk in quantities larger than above mentioned producednausea, vomiting, or diarrhoea. Of 12 cases of chronic rheu-matism treated in this way three showed a striking ameliora-tion, and in two patients suffering from tabes an alleviationof the lancinating pains was observed. Leukasmia was

greatly benefited by this treatment ; in six cases the numberof leucocytes became nearly normal, the number of erythro-cytes increased considerably, the spleen became smaller andsofter, the enlarged glands disappeared, and the patient’sgeneral state improved. Whether this improvement wouldbe of long duration could not yet be stated. Cancer wasnot influenced at all ; in one case of lymphosarcoma a clusterof enlarged glards became smaller.

Dr. KARCZAG (Berlin), describing the action of radio-activecompounds, as observed by himself and Dr. Plesch, said thatafter an intravenous injection of thorium X only 20 per cent.were discharged by the faeces and urine within 40 hours, andthat about 80 per cent. remained within the organism.Thorium X had a beneficial influence on the cardiac actionand decreased the blood pressure. He had seen the sameeffect in leukaemia as Dr. Falta had mentioned. Intra-venous injection was preferable to subcutaneous injection,because the latter produced necrosis of the skin. Gastritis,which sometimes resulted from the action of the rays,could be avoided by dietetic precautions and by the use ofpurgatives.

Uf. F. GUDZENT (Berlin) said that he had observed a like-ness between the action of thorium and radium two yearsago. He had tried a thorium compress in a case of

pleurisy, and had employed thorium rays in cancer

and affections of the skin. For internal administrationhe had made use of two forms of inhalation apparatus,of which one produced 500, and the other 9000 Macheunits per second. Of the patients treated in that timeabout 25 per cent. were improved. By the injection of smalldoses of radium an increase of leucocytes up to 18,000 percubic millimetre was obtained. Small doses of thorium hadthe same effect. Very high doses up to 3 millions of Macheunits produced progressive leucopenia, accompanied bysevere general symptoms. In a patient subject to gout dueto lead poisoning the administration of 4 millions of Macheunits brought on an attack of gout, the blood pressure sinkingfrom 160 to 125 millimetres of mercury. In a case of leuco-sarcomatosis the number of leucocytes decreased to 1000 percubic millimetre after two injections-one of 4 millions andanother of 2 millions of Mache units. Therapeutical effectscould only be obtained by very high doses, but owingto the harm which might be done great caution wasnecessary.

Professor P. LAZARUS (Berlin), speaking of the character-istic properties of radio-active substances, expressed theopinion that bactericidal power, intensification of the actionof ferments, and capability of increasing metabolism anddestroying cells were not characteristic properties, becauseother chemical rays, especially the ultra-violet rays, had asimilar biological action, whether they came from a Finsenlamp, from a Roentgen tube, or from some other source ofradiant energy. He considered that the action of radiumwas only a temporary one, and not well suited forpractical use, because of the high doses which were

required.Dr. GLAESSGEN (Munster am Stein) recommended a com-

bination of natural radium baths with inhalation in an-emanatorium for the treatment of rheumatic diseases,

myalgia, sciatica, and neuralgia. He was opposed to the useof artificial radium baths in myocarditis, neurosis of theheart, and arteriosclerosis, conditions in which natural radiumbaths were efficacious, provided that the temperature of thewater was low and the duration of the bath did not exceed40 minutes.

-Diseases of the Lungs.Dr. ALBERT FRÄNKEL (Badenweiler), in recommending

surgical intervention in certain cases of tuberculosis of thelungs, said that the best operative proceeding was the onedevised by Professor Wilms of Heidelberg, who commencedby resecting portions of the ribs from the first to the eighthnear the vertebras, and after some time operated similarly onthe anterior part near the sternum. The operation was there-fore performed in two stages. Sometimes the resection ofthe posterior parts of the ribs was sufficient to produce thedesired collapse of the lung. The operation was indicatedin cirrhotic cavernous conditions when they involved onlyone apex, and when the patients were still in a goodstate of nutrition. The results hitherto obtained wereencouraging.

Professor WILMS (Heidelberg) said that his operation hadseveral advantages : it could be performed under local anæs-thesia, it might be divided into two stages with an intervalof several months if required so as to allow the lung tocontract, and it did not disfigure the patient, because, not-withstanding well-marked retraction of the thoracic wall,the shoulder-girdle was left unaltered. Operation was indi-cated in the following circumstances : in cases of unilateralaffections, especially with well-marked retraction ; in casesof relapsing hæmorrhage; in cases where the sputum wasgradually increasing ; and, finally, when a pneumothorax hadbeen formed but the upper flap was not compressed by itbecause of adhesions. Professor Wilms had up to the presenttime operated in this way in 12 cases without a deathattributable to the operation.

Dr. KISSLING (Hamburg), in reporting the results of 20operations performed by the late Professor Lenhartz, saidthat only one of them was successful, because of the 20patients 19 had died. Professor Lenhartz resected largepieces of the ribs under general anaesthesia, a fact whichmight have been the cause of the high mortality. Perhapsthe milder method of Professor Wilms might give betterresults.

Dr. CURSCHMANN (Mainz) reported his experiences withRosenbach’s tuberculin, which he said was 10 times morediluted and 100 times less toxic than the old tuberculin. Itwas produced by a symbiosis of trichophyta with tuberclebacilli. He had obtained good results in pulmonary tuber-culosis in the first and second stage, the amount of sputumdiminishing, the bacilli becoming less numerous, and thepatient’s weight increasing, sometimes by as much as 30lb.It was an advantage of this preparation that it could beadministered in fairly large doses from the beginning, andcould be increased. Rise of temperature was seldomobserved. This tuberculin might be useful for diagnosticinjections, as 90 per cent. of the cases reacted after the firstinjection of two decigrammes, but it was not adapted forobtaining the ophthalmic reaction because of its smallreactive power.

Dr. WOLFF (Reiboldsgrun), in discussing the subject ofpredisposition to tuberculosis, said that aspiration of tuber-culous material into healthy parts of a lung produced aninfection only when an atelectasis had been previouslyformed. Tuberculosis developed especially in places oflessened resistance. Lupus was produced by a mechanicalirritation of the skin, as, for instance, by the friction of thecuffs of the patient’s shirt ; tuberculous caries of the sternumby prolonged leaning against a writing desk, and tuberculosisof the testicles by pre-existing orchitis. The inhalation ofdust produced a lessened power of resistance in the lung,and thus a liability to tuberculosis. A point of lessenedresistance might also be hereditary, as was proved in the caseof two girls in whom tuberculosis developed in the same

place and at the same time as had been the case 20 yearsbefore in their mother.

Dr. MENZER (Halle), discussing the treatment of psoriasisby antistreptococcic serum and the vaccine of small-pox,said that he had observed a rapid desquamation after injec-tions of the above substances ; injections of tuberculin pro-duced first a spread of the disease, but afterwards, when the

1788

treatment was continued, an improvement occurred. He was-of opinion that psoriasis was caused by a mixed infection ofthe skin by tubercle bacilli and streptococci.

Dr. LIEBERNEISTER (Dufen) said that active and inactivetuberculosis could not be distinguished by the presence oftubercle bacilli in the blood. He always found tuberclebacilli in the blood in " open

" tuberculosis and in 10 out of12 cases of "closed " tuberculosis. In the blood of 68 patientspresenting no clinical symptom of tuberculosis he foundacid-fast bacilli by the antiformin method. The same wasthe case in 5 cases of scrofulosis, in 10 cases of acute andsubacute arthritis, in 7 cases of pleurisy, in 3 cases ofperitonitis, and in 8 cases of recurrent endocarditis,as well as in chorea, erythema nodosum, sciatica, cirrhosisof the liver, and albuminuria. Six of the animalswhich had been inoculated with these bacilli becametuberculous.

Dr. MEINERTZ (Rostock) said that an animal in whosekidney the circulation was retarded became liable to tuber-culosis. The same was the case in a lung when an

atelectasis had formed. The cause was probably theformation of a thrombus in the capillary vessels.

Diseases of the Heart and Blood-vessels,

Dr. MAX STERNBERG (Vienna), speaking on the diagnosisof chronic aneurysm of the heart, said that the majority ofthe cases of chronic aneurysm were produced by thrombosisof a branch of the coronary arteries with myomalacia.The anatomical conditions of many instances of thedisease were well known, but its clinical diagnosis hadhitherto been difficult. Dr. Sternberg, by comparing thesymptoms of cases with the results of dissection, had castfresh light on the pathology of the disease, and had foundthat in its progressive development there were four stages-namely, (1) a stage of stenocardiac attacks ; (2) a stage ofstenocardiac pericarditis ; (3) a stage of latency or apparentrecovery ; and (4) a stage of serious deterioration of the heartmuscle. He had been able to diagnose cases from the abovesymptoms and to confirm the diagnosis afterwards bynecropsy.

Dr. MÜNZER (Prague) said that he had measured thevelocity of propagation of the pulse wave. In healthy personshe found a velocity varying from 9 to 12 metres per second ;ansemia and plethora did not exercise any influence on thevelocity. In a case of severe anæmia and bradycardia astriking retardation of the wave was observed. In arterio-sclerosis the velocity varied between 15 and 23 metres persecond. The velocity depended not on the blood pressurebut on the elasticity of the walls of the vessels.

Diseases of the Kidneys.Dr. SCHLAYER (Tiibingen) read a paper on Fatigue of the

Function of the Kidneys. He said that in some cases of

Bright’s disease, especially in chronic parenchymatous andcontracted kidney, the indiscriminate administration ofdiuretics and of chloride of sodium produced a state ofexhaustion of the kidneys, leading to anuria. In suchcases large doses of diuretics were very injurious, whilstunder a continued acministration of small doses the diuresis

might again become active.Dr. HEDINGER (Baden-Baden) stated that in healthy

kidneys the quantity and the concentration of the urineunderwent alteration after meals. In pathological condi-tions there were differences as to the influence of meals.Sometimes no reaction at all occurred after a meal ; insevere cases of Graves’s disease the excretion of urine mighteither be retarded or there might be no reaction to meals at all.

Influence of Adrenalin and Pituitrinum on the RespiratoryMetabolism.

Dr. BERNSTEIN and Dr. W. FALTA (Vienna) described theinfluence of adrenalin and of infundibular and glandularpituitrinum on the respiratory metabolism. They statedthat injections of adrenalin in healthy persons produced anincrease of the consumption of oxygen and of the productionof carbonic acid, together with an increase of the respiratoryquotient. After an injection of infundibular pituitrinum theconsumption of oxygen and the production of carbonic acidrapidly increased, but not the respiratory quotient. Glandularpituitrinum produced a decrease of the consumption ofoxygen and of the production of carbonic acid.

MEETING OF THE ASSOCIATION OFAMERICAN PHYSICIANS AT

ATLANTIC CITY.

(FROM OUR OWN CORRESPONDENT.)

THE twenty-seventh meeting of the Association ofAmerican Physicians was held at Atlantic City on May 14thand 15th under the presidency of Dr. George Adami,professor of pathology at McGill University, Montreal.The meeting in question was perhaps the most successfulfrom all standpoints which ever took place under theauspices of this association. As is usual at most of themedical and surgical meetings held on this side of theAtlantic, the papers presented were numerous. Not in-

frequently this plethora of papers is a decided drawback.On this occasion, however, although the papers read werenumerous, they were of such a uniformly high standard.that it would be a matter for regret if any of themhad been omitted. The President’s address was ex-

cellent, and was followed by papers dealing with thenervous and respiratory systems, the circulatory system,the kidneys, digestive system, infections and metabolism.Of these, perhaps the most noteworthy were those byDr. David L. Edsall, of Philadelphia, " Observations onthe Effects of Various Forms of Respiration " ; by Dr. M. J.Rosenau, of the United States Public Health and MarineHospital Service, on ’’ Organic Matter in the ExpiredBreath and its Significance"; and by Dr. David Reismanand Dr. John A. Kolmar, of Philadelphia, on "An Experi-mental Contribution to the Study of Pneumonia."

Dr. ROSENAU demonstrated in his paper the occurrenceof anaphylactic phenomena in animals that had been exposedin a used atmosphere, and showed that the expired breathcontains volatile protein matter.

Dr. REISMAN and Dr. KOLMAR reported that by employingMeltzer’s method they had obtained constant and extensivelesions in rabbits’ lungs by inoculations of pneumococci.They were doubtful, however, if these lesions should beclassed as those of a lobar or lobular broncho-pneumonia.-In the discussion that followed, ProfessorS. J. MELTZER pointed out that by employing a catheterwith lateral aperture for passage of the cultures into thebronchi they had not obtained the right distribution, and-that in order to obtain a complete picture it was necessary toemploy a catheter with terminal orifice and so completely tofill the bronchus into which it was passed with the fluidculture. The essential characteristic of lobar pneumoniawas the production of some substance that favoured thediffuse formation of fibrin in the inflammatory exudate, incontrast with the pus obtained in other infections.

Dr. E. LIDMAN (New York) presented the results ofstudies of more than 80 cases of subacute endocarditis, show-ing that an organism apparently identical with that ofPoynton and Paine was associated with a particular type oflesion, and that only where this organism was present thekidney and glomerular lesions described by Löhlein werefound. Where the ordinary pyogenic organisms were presentthese renal lesions were absent. He brought forward evidencetending to show that the disease was not necessarily fatal, there-being presumably mild cases which were clinically unrecog-nisable. All the cases recognised by him during life and,confirmed by blood culture had a fatal ending. He woulddistinguish, however, between this condition and acuterheumatic fever.

’

Dr. LEWIS A. CONNER (New York) presented a contribu-tion to the Symptomatology and Early Diagnosis of Thrombo-phlebitis, based on a long series of cases of typhoid fever.He drew attention to the significance of chills in the courseof this disease, as indicating the formation of thrombi in theveins of the calf of the leg and elsewhere.A most active discussion took place over the presentation

of a paper by Dr. MARTIN H. FISCHER (Cincinnati) onhis Colloidal Theory of (Edema and Nephritis and itsTreatment.-Dr. T. C. JANEWAY and Professor MELTZER(New York), Dr. ALONZO TAYLOR (Philadelphia), and otherstook part in the discussion.

Professor OSCAR KLOTZ (Pittsburg) gave an importantcommunication dealing with the Effeet of Acute Rheumatismupon the Arteries. He had found that small’ cell fnfiitratnoms