Columbus Medical Journal: A Magazine of Medicine and Surgery

SALICYLIC ACID A CURE FOR TIC DOULOUREUX.-We frequently meetin our practice cases of tic douloureux, that often so exceedingly painful neuralgia of the fifth nerve, where an operation seems to promise the only radical cure. If we hear of a remedy which is said to have the same effect as the surgical interference, we become doubtful; but if no less reliable an authority than Prof. Nussbaum assures of the fact, our hope increases. Recently a number of such cases had been sent to N. for the purpose of having the operation performed, and, after a number of carefully instituted experiments, this great surgeon recommends a trial with salicylic acid before proceeding to stretching or to resection of the nerve. In all the recently-sent cases he first tried this remedy, and he found it in every one a radical cure; not only a palliative effect, but really an utter disappearance of the painful disease was the result in every case. Especially in cases of rheumatic nature, N. is positive of having discovered in salicylic acid a specific for tic douloureux. He administered the drug in the following manner : R.-Acidi salicylici, gr. 3; sodii salicylatis, gr. 32; M. ft. pulv. Within 24 hours the patient takes from four to six of such powders. Med. and Surg. Reporter.

GASTROSTOMY.-[By an accident the following-which is the conclusion of Dr. Gross' paper, on page 129, of our September issue-was omitted.] Of the forty-five survivors, twenty-seven expired subsequently: two in five weeks, two in seven weeks, eight in two months, two in two and a half, three in three months, two in four months, two in one month, one in six months, one in seven months, one in seven months and a half, two in eight months, and one in ten months. Of the remaining eighteen, three were living at the end of one month, two at forty days, one at seven weeks, three at two months, two at three months and a half, two at four months, one at five months, one at six months, one at seven months, one at twelve months and nine days, and one at thirteen months. The last two cases were under the charge of Mr. Walter Whitehead, of Manchester, England, who was kind enough to write me that the first could not live much longer, while the second was still enjoying excellent health.

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MEDICINE.

BRIGHT'S DISEASE OF MALARIAL ORIGIN.-Dr. I. E. Atkinson, of the University of Maryland, believing that this subject has not attracted the attention it deserves, has been led to study with reference to it all cases of malarial fever coming under his observation during the late sum mer and early fall of the past two years, at Bayview Asylum, and the result he gives in an able and elaborate paper which appears in the July number of the American Journal of the Medical Sciences. The conclusions which he reaches are as follows:

1. Transitory albuminuria is not uncommon in the course of malarial fevers, and is due to the intense visceral congestions characteristic of these affections. It only may endure throughout the height of the congestion, recurring with each return of this, or it may persist in the intervals, in which event a higher grade of congestion is attained, more nearly approaching a condition of acute inflammation.

2.

In a proportion of cases, varying with locality and type of prevailing epidemic, or individual conditions, inflammation of the kidney occurs, accompanied by dropsy and the usual symptoms of nephritis.

3. The usual form of nephritis is the tubal and diffuse variety. In this the inflammmation seems to be most intense in the vicinity of the glomeruli.

4. Contracted kidney may occur as an advanced stage of malarial nephritis either from long-continued or frequently repeated attacks of malarial fever, or from fibrotic changes such as may ultimately occur in ordinary tubal or diffuse nephritis. It is altogether improbable that this form of malarial renal disease ever occurs primarily as purely interstitial nephritis.

5. These changes may be induced by any form of malarial fever, though they more commonly follow chronic intermittent fever.

6. The tendency of malarial inflammation of the kidney is toward recovery. But from the persistence of the impaludism or the intensity of the inflammation, structural changes may be produced that are characteristic of chronic Bright's disease, when the gravity of the affection will be as that from chronic Bright's disease from whatever cause.

7. Treatment should be directed primarily against the malarial intoxication, more especially in recent cases. A correction of this will often

fered with, and thus the joint is not opened. The fragments are then united by platinum or silver wire suture, care being taken not to include the membrane of organized coagulum, but to let it fold upon itself posteriorly toward the joint cavity. Dr. Van der Meulen has operated in this manner in three cases of fractured patella, and has been enabled to obtain excellent and firm union.-Deutsche Medicinal-Zeitung, Record.

CHLOROFORMING.—Mr. Osborn, the chloroformist to St. Thomas' Hospital, London, makes the following points which are important enough to bear frequent quotation:

Dilatation of the pupils is a sign that the anesthetic has been pushed far enough, and its administration should be discontinued.

Flaccidity of the limbs is no sign of cutaneous insensibility.

The inhalation of ether may produce exanthematous patches on the face and thorax. Cases have been removed from/ the operating table under the impression that an outbreak of an eruptive fever had begun, and that the case was unfit for operation.

The origin of this phenomenon is to be found in paralysis of the vasomotor nerves. Moreover, if genuine skin eruption be present, it is by the same cause made more prominent.

A false impression may be conveyed when feeling the pulse, where the patient, lying upon the arm, compresses the main artery.

Chloroform is better for all operations about the mouth, staphylorraphy, excision of tongue, etc., since ether not only excites the flow of saliva and increases vascularity, but the mouth being open, they return sooner to consciousness.-New Eng. Med. Mo.

A PRACTICAL POINT IN THE TREATMENT OF PLEURAL EFFUSIONS.Dr. Broadbent (Lancet) in a clinical lecture, says that when he hears distinct bronchial breathing generally over the chest in cases of pleural effusion, he feels sure that a consolidated lung is immersed in the fluid, and he consequently does not tap unless the symptoms are so urgent as to demand interference. A solidified lung cannot, of course, expand, as does one which is simply collapsed or even compressed, unless it is bound down by adhesions; and experience has shown him that on the resolution of the pneumonia the fluid is usually rapidly absorbed.

He seems to hold the sound views that with grave symptoms a pleural effusion should be withdrawn, whatever the complication; that the course

of moderate effusion may often be shortened by tapping; but that, if the lung be consolidated,-one evidence of which is the persistence of bronchial respiration over the whole or a large part of the chest,—it is better to wait, if the condition of the patient warrants such a course.-Boston M. & S. Jour.

THE MECHANISM OF THE FRICTION SOUND OF PLEURISY.-Moxon, (Lancet) in common with many others, is satisfied that he has often heard pleural friction, so-called, over portions of the chest occupied by fluid, where, consequently, the layers of the membrane, not being in apposition, could not rub. Is the sound, therefore, not produced by creaking of the lymph on the pleura when it is stretched in inspiration ?—Ibid.

THE DIAGNOSIS OF SCIATICA.-A diagnostic point in sciatica is given by De Beurmann which we have never seen alluded to. The patient lying on his back with the muscles of the leg and back relaxed, the affected leg is raised while in complete extension and flexed upon the abdomen. This causes marked pain in the course of the sciatic, especially intense at the sciatic notch, and the movement is resisted. If, then, the limb be lowered, and while the leg is flexed on the thigh the latter is again carried up on to the pelvis, no pain will be felt. This phenomenon depends on the fact, verified by De Beurmann in experiments on the cadaver, that great tension of the sciatic is exerted by flexion of the thigh when the leg is extended, but almost none when the leg is flexed.

In the diagnosis of sciatica from crural neuralgia, affection of the femur, or coxalgia, in all of which diseases the position of the limb and seat of the pain may be similar, this maneuver is of value. If the nerve trunk is free of disease there will be no difference in the amount of pain caused by the extension or relaxation of the nerve by the different positions indicated. In other words, in affections other than sciatica, the movements given to the coxo-femoral articulation will be equally painful whether the leg is extended or flexed on the thigh.—Boston Medical and Surgical Journal.

DR. WILSON, of Louisville, it is said, has used with success the inner membrane of a hen's egg for skin-grafting. One egg will supply an indefinite number of grafts.

A SOLUTION of gutta-percha in chloroform (four to thirty) is useful to protect the skin over projecting bones, and to prevent bed-sores in wasting diseases.

fered with, and thus the joint is not opened. The fragments are then united by platinum or silver wire suture, care being taken not to include the membrane of organized coagulum, but to let it fold upon itself posteriorly toward the joint cavity. Dr. Van der Meulen has operated in this manner in three cases of fractured patella, and has been enabled to obtain excellent and firm union.—Deutsche Medicinal-Zeitung, Record.

CHLOROFORMING.-Mr. Osborn, the chloroformist to St. Thomas' Hospital, London, makes the following points which are important enough to bear frequent quotation: