Richard C. Cabot

CLINICAL EXAMINATION OF THE UBINE.A CRITICAL STUDY OF THE COMMONER METHODS.

ACUTE DEGENERATION. In the 93 cases of this condition which I have studied, the diagnosis was correctly made in all but three. What I desire to point out here is: 1. That the urine may vary very greatly in composition in different cases, despite identical postmortem findings. 2. That in a few cases the diagnosis of something more serious than fever urine might have been made by any one accustomed to take his urinary analysis very seriously. I will take up this latter point first. Among the cases in which only acute degeneration was discovered postmortem, there were two called acute nephritis before death, and one called chronic nephritis. Besides these there was a case of puerperal eclampsia in which a nephritis of some type was assumed to be present, and in a case in which the patient died in convulsions suspected to be of uremie origin. It is a significant

The Pay Consultation Clinic at the Massachusetts General Hospital

To the Editor —Two reasons led to the establishment of the pay consultation clinic which was opened at the Massachusetts General Hospital, Jan. 25, 1916: One was the desire to make the facilities and staff of a large general hospital available to the practitioner in his care of patients of moderate means. The other was to enable this group of patients to obtain the benefits of a complete range of skilled advice and expensive equipment at a fee within their reach. It is intended that both the family physician and his patient shall be benefited. If not accompanied by his physician the patient is required to bring a letter from him, which is a guarantee that the person to be admitted belongs in the group for which this clinic is intended. Experience with the 700 patients so far received shows that the family physician is making legitimate use of the

CAUSES, TYPES AND TREATMENT OF DIARRHEA IN ADULT LIFE

We have undertaken a fresh study of this ancient problem, beginning with the necropsy records of Bellevue Hospital in New York and the Massachusetts General Hospital in Boston. In each of these institutions we examined three thousand necropsy records, searching for lesions ordinarily supposed to produce diarrhea. We then traced the cases showing these lesions back to the clinical records, trying to ascertain first whether the lesions actually produced diarrhea, and if so, in what proportion of cases; secondly, whether any special type of symptoms or of discharges was associated with any special lesion of the intestine, the endeavor being to mark out clinical types so far as this was possible. Finally, we reviewed the results of treatment both in necropsy cases and in a considerable series of cases which did not come to necropsy, and endeavored to estimate the value of the different methods used. For various reasons we have excluded from this study certain

OUT-PATIENT WORK: THE MOST IMPORTANT AND MOST NEGLECTED PART OF MEDICAL SERVICE

If a patient in a hospital ward should have pneumonia you would not think of filling up the other beds in that ward with members of the patients family who may be going to come down with pneumonia. But when one phthisical patient applies for treatment at any up-to-date dispensary it is obviously the duty of the dispensary to send for the rest of the family exposed to infection and have them examined, and, if need be, treated. One case of rickets is the symptom of more rickets in that family, present or to come—the single rachitic seen at the dispensary is but a single symptom of the rachitic forces at home. Physicians never like to treat symptoms; they want to get down to the roots of things. One case of lead-poisoning means more cases in that shop; one case of vulvovaginitis means a nest of them in

The Medical Profession and the Emmanuel Movement

To the Editor: —In view of the widespread interest in the so-called Emmanuel movement and because of our appreciation of the value of that work, we, the undersigned, have agreed to serve as an advisory board to the clergy of Emmanuel Church, in Boston, and make the following statement of the manner in which the work is conducted: We believe the Emmanuel movement is sound in its fundamental principle, namely, that the effective cooperation of physician and minister is of value to many sick persons. Since character is an important factor in the cure of many diseased conditions, especially of the nervous system, we believe that any one who can help to guide, strengthen and enlighten the patient by the influence of moral and religious teaching will be of genuine assistance to the patient and to the physician in charge of the case. In rendering such assistance at the physicians

TWO POSSIBLE CAUSES OF EMACIATION NOT GENERALLY RECOGNIZED.

Some physicians and many laymen are in the habit of thinking and speaking as if the bulk of the human body could be increased or diminished as simply as we load and unload a vessel: Pour in the cargo and the displacement increases; hoist it out and she rides light on the water. But to feed a patient up or to starve him down is not nearly so simple. Our state of nutrition depends on the number, the contents and the activities of our body cells; but these cells are not buckets to be filled or emptied at our pleasure. They multiply or atrophy, take up food or reject it, burn fuel or refuse to do so according to their own laws. Without food they can no more do their work than a miner can dig coal or a composer produce sonatas. But no one supposes that you can get

CEREBELLAR TUMOR OR MASTURBATION

H. R., 15 years old, a native of New Brunswick, entered the Massachusetts General Hospital, Sept. 14, 1893. His family history showed a decided tubercular taint; two brothers had died of phthisis, one of meningitis, and one in infancy from unknown cause. Two members of his mothers family and three members of his fathers also died of phthisis. His parents, five brothers and two sisters are living and well. Until the present illness, he had always been well and had had no childrens diseases. A year and a half ago a weakness and awkwardness with the right hand were noticed; six months later, frontal headaches began to trouble him at school, and he seemed weak and nervous. He was taken out of school, but without relief to the headaches; cold and draughts seemed to increase the pain; the headaches now came on about once a week and lasted a day.