James Tyson

APPENDICITIS FROM A PHYSICIAN'S STANDPOINT.

Eleven years have elapsed since the first operation for appendicitis was done for me by an eminent surgeon of Philadelphia. The patient was a lad eleven years of age, who had had at least two previous attacks, and the operation may be said to have been done after recovery from the second attack. It was successful and the boy recovered without a bad symptom. Since then I have lost no opportunity to study the disease from a physicians standpoint and sought to gather some information whose application might save some of the lives which are still unfortunately lost by this disease. In the course of my observation I have noted the following: First, that there occur a certain number of cases so evident and decided that no one questions the propriety of operation. These cases are all characterized by the cardinal symptoms of sudden and severe pain, great tenderness in

IRREGULAR OR ATYPICAL GOUT—HOW SHALL WE KNOW IT?

It has always seemed to me that if the department of medicine as contrasted with surgery is to make advances, it must be by the application of accurate methods. This is equally true of nomenclature as of clinical investigation. In no subject in medicine has there been greater looseness in the application of terms than in that of gout, and in some recent studies of this interesting subject I have been so impressed with this fact that it occurred to me it might be worth while to attempt to formulate, briefly, criteria by which to judge of the presence of gout in its more irregular forms, with regard to which alone as contrasted with regular or typical gout the confusion really exists. While many theories have been advanced and many experiments performed with a view to explaining the method of its accumulation, all pathologists agree that the fundamental condition of