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for the gastric juice to fail to promptly very recently by J. Darwin Nagel (New re-establish the patient's appetite, which York), all of whom have reported their sometimes becomes enormous, and to cor- results to me. At the time (1904) when rect at once the painful slowness of the I was made the object of severe criticism digestion; it has happened repeatedly un- in Germany, on account of the composition der such circumstances, that thanks to this of my gastric juice, I requested Professor powerful arousing of the appetite, I have Litten (Berlin) and he consented, to exsucceeded in obtaining the actual and per- periment with this juice upon his tubermanent cure of the disease.
culous patients, and he had the kindness Unfortunately the effect is not so con- to notify me by letter that the results obstant when fever is present, the tuber- tained from it were most remarkable. culous poison then seems to inhibit the Infantile Gastro-Enteritis :— The above gastric glands, rendering them less ac- outlined indication for the gastric juice, cessible, or even insensible, to their natural although very satisfactory, is less so in my stimulus; and it is then preferable to wait opinion than its indication in infantile gasfor a quiescent period, with freedom from tro-enteritis. As a matter of fact, we do fever, when the remedy will recover its not possess any really efficient medicinal virtues and permit a return to over feeding. agents against the latter, whereas, definite Even in the terminal stages of the disease, triumphs are accomplished by means of I have observed an unfortunately transitory the gastric juice. The gastric juice here resumption of the gastric functions, due acts after an elective, in some manner a to the employment of the gastric juice, or specific fashion, first by assisting the surat any rate an arrest of the vomiting and vival of premature infants and those weaka noteworthy subsidence of the pains, even ened through an insufficiency of digestive in patients who are past all hope of re- secretion; next, by permitting the return covery.
to nourishment, in the course and at the The gastric juice represents accordingly termination of acute gastro-enteritis and a valuable adjuvant in the dietetic treat- finally, by counteracting chronic gastroment of the tuberculous patients, if not a enteritic conditions. curative agent. It must be stated however, Two conditions only are required for its that while it is highly efficient as an anti- action; the gastro-enteritis must not be diarrhoeal agent in general it does not serve due to intestinal tuberculosis; and the diat all for the control of the diarrhoea which gestive glands must not
be entirely indicates the invasion of the intestine by destroyed by the infection. the tubercle bacillus.
The action of the gastric juice in premaSuch is my personal experience. I would turely born and weak infants was investinot dwell upon it, had it not been supported gated by Professor Guerin and Dr. D'Gausby a considerable number of physiologists. sel, of Montpellier. Although no larger Gouel, physician to the hospital for Tu- doses were prescribed than 12, 15 or 20 berculous, in Villepinte, G. Petit, Legry, drops at each nursing, the effect was a physician of the Tenon Hospital, Surmont, remarkable one. The child who had no Thumbert, Nienhaus, von Muralt (Davos), appetite and remained indifferent to all Meyer (Leysin), Lips (Wehrewald), and stimulation takes the breast more
Series, Vol. V.. No. 10
ceases to vomit, and its assimilation is fluid, but these cadavers still had gasshown by its weight, which begins to in- tric glands and intestinal glands. crease after a fall or a prolonged stoppage. Diarrhoeas—Dysentery:- The remark
The favorable action of opotherapy, in able therapeutic action of the gastric juice infantile gastro-enteritis, has formed the in infantile enteritis, takes place likewise subject of numerous contributions; the in the diarrhoeas of adults, whether resulttheses of Drs. Edhem and Malakiano ing from gastric insufficiency or depending (Montpellier) and of Dr. Nicolas (Paris) upon the influence of the season. It is poscarried out in the services and under the sible that the gastric juice in these cases, direction of Prof. Mery, of the Hôspital by arousing the gastric secretion which des Enfants-Malades.
has been weakened by the infection, cures This favorable action of the gastric juice, the intestine by pouring into it an acid sein the gastro-intestinal affections of child- cretion which stimulates the arrested or hood, had been reported to me, since the diminished pancreatic and intestinal secrebeginning of my investigations, by Profes- tion. sor Sabrezes of Bordeaux, to whom as the At any rate this action is very evident, translator of Pawlow, I had offered some and it led me to study the influence which of the first phials of my product. It was the gastric juice may exert in dysentery. confirmed later on by Messrs. Barbier, I have no personal experience in this conGuixiou, Terrien, all pediatricians, and by nection, but the observation of Professor countless colleagues, I might say by the Surmont, Dr. Fontoynout and Dr. Rigand unanimous verdict of those who have tried of Madagascar, Dr. Challies of Vias, Proit, among them Professor Martinez Vargas fessor Hobbs of Cairo; and a general of Barcelona, who has published an article summary of Dr. Le Feunteun, naval surdealing with this question. All are agreed geon in Brest, cause me to believe that that the pig's gastric juice acts in doses gastric opotherapy has a very favorable acof half to one teaspoonful, administered tion in chronic dysentery. Dr. Le Feunbefore each partaking of food, in acute teun writes me that he is inclined to congastro-enteritis. In children who suffer sider my gastric juice as a true specific from persistent diarrhoeas. and are con against chronic amoebic dysentery, which stantly losing in weight it re-creates the
is not influenced at all by serum treatment.
Such are the indications of the opogastric secretion, instead of supplementing
therapy with the gastric juice of pigs, as
obtained by me. Besides the indications, These remarks are equally applicable to
I shall briefly outline the contra-indicachronic gastro-enteritis, as long as the
tions. athrepsia (malnutrition) is not absolute
Contra-indications: The action of the and the digestive glands remain capable
gastric juice is not always certain in the of reacting to a stimulus. I have suc
psychic or organic nervous gastropathies, ceeded, as well as many others with me, nor in muco-membranous enterocolitis and in bringing back to life little cadavers it is nil in tuberculous enteritis with diarwhich refused to absorb a mouthful of rhoea. On the other hand, it is not infre
. New Series, Vol. V., No.
quently favorable in allaying the pains of
DERMOIDS. cancer of the stomach ; Dr. Cettinger, physician of the Broussais-Hospital, spoke to me
JOHN H. LONG, M. D., of his having made about ten favorable ob
Brooklyn, N. Y. servations in this respect. Another in
Clinical Assistant in Surgery, Brooklyn Hosstance was pointed out to me by Professor
pital; Instructor in Surgery Long Island Surmont. Personally I have observed its
College Hospital. effect on a patient suffering from an in
A necessary preliminary in the study of operable gastric tumor, intolerance and se
dermoids is a brief consideration of a few vere pains. In the case of two patients points in embryology. upon whom I performed gastro-enter- The central nervous system is formed ostomy, the gastric juice exerted a very
by infolding of the ectoderm along the favorable effect upon the general condition,
dorsum of the embryo; the formation of one of these patients suffering from neo
the neural canal is completed by fusion of plasm with adhesions to the liver and pan- the lateral ridges of the folds with each creas, is now living, after nearly two years, other, forming the roof. This gives a line and has repeatedly had a return of his ap
of union of ectoderm to ectoderm along petite and strength, thanks to the gastric the dorsum of the embryo from head to juice. This influence is inconstant how
coccyx. The neural canal extends around ever.
the end of the notochord (the future spinal Finally, the gastric juice must be column) and communicates with the encautiously employed in cases of hyper- teric canal. The anus is formed later by chlorhydria. Professor Courmont has fre
the invagination of the ectoderm, at a point quently administered it successfully, in spite anterior to the tip of the notochord (which of the customary treatment, and he found
later becomes the tip of the coccyx) thus that the gastric juice seemed to act direct- leaving a pouch behind the anus which ly upon the irritable mucosa, soothing it communicates at one end with the neural and regulating the secretion, in the same canal, at the other with the rectum. This way as digitalis controls the arythmia is the post-anal gut and is normally obwhile strengthening at the same time the literated; its remains form Luschka's gland. cardiac systole. In certain cases of hyper- The somata-pleura, which form the chlorhydria, on the contrary, it will cause latera walls of the body, extend inward the return or an exacerbation of the pyro- from each side; gradually enclose the sis.
body cavity, and unite in the mid venIn case of ulcer of the stomach, the gas- tral line from perineum to root of neck. tric juice seems to be positively dangerous. From the root of the neck to the point
To summarize: Clinical experience of the chin this line is broken by four fully confirms what one is justified in as- lateral clefts, the branchial or gill clefts. suming from the physiology, the gastric The uppermost one of these becomes the juice is the true remedy for gastric in- tympano-eustachian passage.
The lower sufficiency and its results.
three are obliterated. Thus we have an I rue Magellan, Paris, France.
unbroken line of surface union between
the two halves of the body, extending from After the splitting of the later walls of the vertex to the perineum dorsally, and the embryo into somatapleure and splanchfrom perineum to sternal notch ventrally, nopleure, the Wolffian body, from which and a vertical line broken by four lateral the ovarian follicles are developed, is diflines from sternal notch to chin. The ferentiated from the same group of cells face develops from five processes below which form the intestinal tract with its the cranium, one vertical extending down mucous membrane. The mucous from the cranium, from which develops brane of certain rodents supports tufts of the nose and pre-maxillary bone; two hair. In one kind of bird, the dartos, lateral from which develop the superior •there is a growth of hair in the stomach maxillary border of the face and lower which guards the pyloric opening. margin of the orbit. These two processes The mucous membrane, therefore, deextend inward from each side and coalesce velops some dermal structures. Upon with the nasal process, thus forming lines these facts and the well known powers of of union, one on each side of the median mutability of mucous membrane, J. Bland line, extending from the outer angle of Sutton explains the presence of dermoid the orbit to the inner angle, thence down structures in ovarian dermoid cysts. the side of the nostril, then straight down Sutton defines dermoids as tumors furto margin of lip. These folds meet each nished with skin or mucous membrane ocother in the midline in the palate. The curring in situations where these struclowest pair of processes form the mandible tures are not found under normal conand fuse with each other in the midline. ditions. They only possess tissues which The cranium early consists of skin close- naturally belong to skin or mucous memly adherent to the dura mater, later the brane. bones of the vault develop each from its Dermoids may be arranged in four. own center, between these two structures.
genera: The foetal thyro-lingual duct extends
I. Sequestration dermoids. from the foramen caecum at the base of
2. Tubulo dermoids. the tongue, between the genio-hyoglossus 3. Ovarian dermoids. muscles to the posterior portion of the 4. Dermoid patches. body of the hyoid bone, thence to the pyra- Etiology :-As the first point in the exmid of the thyroid gland. This is lined planation of the causes of dermoids, I will with epithelium.
briefly describe implantation cysts which The infundibulum, which is a prolonga- a subdivision of sequestration dertion from the brain, fuses with the moids. These cysts are acquired, not conpituitary body, which is a glandular de- genital in origin, they are of small size and velopment from the buccal cavity; this occur most frequently on the palmar surnormally recedes into the cranial cavity face of the hands of tailors and seamfollowed by a
diverticulum from the stresses and in the eyeball. They follow pharynx, the pouch of Rathke, which is slight punctured or penetrating wounds obliterated. The auricle of the ear is which carry in a small section of the derformed by the coalescence of six tubercles. mis and plant it in the subcutaneous tissue.
The colony retains its vitality and acts as process during the development of the a skin graft; its sebaceous glands secrete cranial bones, and in the same manner on and its epithelial cells are cast off; if hair the nose during the development of the follicles are carried in, they give rise to nasal bones, so in these two locations they hairs. The secretions, being enclosed, are not limited to the surface coalescence. naturally form a cyst; one or two hairs If the sequestrated nest remains superare frequently found in these cysts. They ficial to the cranial bone the cyst does not seldom acquire any considerable size. This enter the cranial cavity. If the nest is enexplains how the dermal cells behave when tirely separated and is buried under the caught in the subcutaneous tissue.
cranial bone an intra-cranial cyst is the Second point: How and where are result. If the process of the nest is surthese dermal cells isolated when they are rounded by bone instead of being cut off, isolated and give rise to dermoids?
it will give rise to a combined extra-and Slight irregularity or over-lapping in the intra-cranial cyst. The most common lolines of coalescence will bury a group of cations of cranial dermoids are the anterior surface cells more or less deeply. Failure fontanelles and inion. They may attain of obliteration of the embryonic canals the size of cocoanuts. which are lined with dermal derivatives or The most common location for facial mucous membrane accounts for the loca- dermoids is the outer angle of the orbit. tion of the tubulo-dermoids. Inclusion I have seen three within the last year, one and modified development of the embry- of which was attached to the lower margin, onal cells of the Wolffian body, which are the other two to the upper. These all predestined for mucous membrane, explains sented the main part of the cyst on the the occurrence in the ovary.
side of the face, but when dissected out Pathology :- The walls of the cysts are were found to extend an inch or more tocomposed of stratified epithelium, or mu- ward the median line and deeply to the cous membrane, containing sweat glands, bone. These cysts rarely grow larger sebaceous glands and hair follicles in most than a hen's egg, and contain hair, epicases. The contents vary from clear mu- thelial cells and sebaceous material. They cus or oil and cast-off epithelial cells to can be differentiated from sebaceous cysts all the structures developed from the der- by the mobility of the skin over them, bemis, i. e., hair, nails, teeth, and flat bones. ing deep structures, while sebaceous cysts Note that heart, liver, bladder, etc., are
grow from the skin. never found in a true dermoid cyst.
The treatment is complete removal. It The nucleus of the dermoid, excepting is necessary to be prepared to go deeper the implantation cyst, is present at birth.
and wider than the superficial appearance It may or may not be developed at the
would indicate. Two of these cases OCtime. Some develop in infancy; some in advanced life; more commonly at puberty.
curred about puberty, the third in a young Sequestration Dermoids: These adult. The cysts of the branchial clefts the most simple form, they develop along occasionally contain teeth. A dermoid sitthe lines of coalescence as already ex
uated over the sacrum at birth may be misplained, also in the scalp by a pinching off taken for spina bifida.