EDITORIAL ITEMS. State of Spinal Cord in Congenital Absence of a Limb.-From a careful study of the pathologic findings, J. W. Ballantyne, of the University of Edinburg (Interstate Medical Journal, August) concludes that in some cases absence of a limb may be due to (or associated with) defective development of the corresponding part of the spinal cord; in other cases pressure from the amnion may have prevented the outward growth of the limb, or of part of it, without causing any changes in the cord; and yet in other cases (especially absence of one or more digits) the defect may have been due to amputation of the parts by amniotic bands or other changes in utero, and the cord changes may have followed the amputations. Treatment of Hepatic Cirrhosis. In a leading article in the Therapeutic Gazette, Hare reviews Cheadle's Lumleian lecture on this subject and commends its practical nature. Both writers agree that paracentesis is the only remedy that should be employed for the ascites, and that it should be resorted to as soon as there is functional interference with the abdominal organs. Alcohol and rich food should be avoided and, owing to the associated gastric catarrh, the food should be predigested by means of peptonizing tablets and takadiastase. Mercury and potassium iodide are of distinct service in syphilitic cases. Digitalis overcomes the cardiac weakness and palpitation and circulatory stasis, and is of great value when indicated. Gall-Stones.--Norbury (Medical Fortnightly, Sept. 10) alludes to the frequency with which the symptoms of the ball valve variety are mistaken for malaria. The points in diagnosis are jaundice, biliary colic, tenderness over gall-bladder, emaciation and loss of appetite, and enlargement of liver. 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Chronic A very interesting contribution to medRheumatism. ical literature is that by James J. Walsh on the differential diagnosis of chronic rheumatism (Medical News, Sept. 1). The diagnosis of true chronic rheumatism, he says, rests chiefly on a clear history of an attack of rheumatism which has persisted and even become worse by secondary degenerative processes extending over years. When permanent changes have taken place in the joint, they are readily detected on palpation. Many other conditions are mistaken for chronic rheumatism and most of these, like rheumatism, are worse in weather changes and often show some swelling. One common class consists of cases of recurring subacute rheumatism-slight attacks of arthritis, with some swelling and effusion into the joints, that occur at moderate intervals in certain predisposed subjects. Another class is an abarticular rheumatism which recurs again and again as fleeting joint pains, often with slight swelling; or it may be replaced by chorea, recurring tonsillitis, erythema nodosum or peliosa rheumatica. Pseudorheumatic affections comprise a most varied collection of ailments; as flatfoot, occupation and traumatic neuroses and musculoses, varicose veins and meralgia paresthetica. In flatfoot or weak foot there is often calf-tire from overstrain of the muscles. The patient's walk, says the writer, in flatfoot is almost typical. The heel is brought down more forcibly than normally and there is a tendency to eversion of the toes. Placing a wedge of felt on the inner side of the foot, will, with appropriate massage and passive motion, often relieve the symptoms and make sure the diagnosis. A curious occupation neurosis is that of dentists and others who work much with the lathe or dental engine. The condition of discomfort develops in the leg on which the body weight is borne, resulting in disability and spastic neuralgia about the knee. The so called "writer's cramp" is rather a brachyalgia, that is a sore arm with consequent disability, than a muscular cramp. Typical epicondylalgia of the humerus occurs in nervous women after carrying an umbrella on a stormy day or in waitresses from carrying heavy dishes. A similar brachyalgia of wrist and forearm is observed in ladies who have been calling or shopping and holding up their long skirts. A traumatic neurosis is defined by the writer as that condition of sensitiveness to external influences which develops in a joint after an injury, although no trace of the injury remains as far as any ordinary examination can determine. Such cases are often greatly benefited by massage. The deep veins are sometimes markedly dilated and tortuous when there is but little surface varicosity, and the dull, heavy ache which they cause is easily mistaken for rheumatic pains. One of the writer's cases of supposed chronic rheumatism proved to be meralgia paresthetica. Over the large muscles on the outside of this patient's thigh there was a region of lowered sensibility in which he had burning and painful sensations, worse in winter and aggravated by counter irritants. |