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the discovery of a body. .
This article is submitted to the medical profession for more general investigation and study.
possible to demonstrate that the shadow under discussion has moved in some direction or other. while the kidney has remained unaltered, the shadow must be outside the kidney. Once having diagnosed the presence of a stone in the kidney its correct position in the organ itself can be given, and a rough estimate made as to its size. Scott considers this method of localization invaluable where the shadow is extremely indefinite and doubt is felt as to its nature.
A Method of Approximating the Time of Death-Vaughan in a communication to the Journal of the American Medical Association (Feb. 26, 1921), calls attention to the fact that medicolegal volumes fail to reveal any method whereby one can determine even approximately how long a body has been dead. When a dead body is discovered the police naturally turn to the physician for information as to the probable time of death. We are, therefore, confronted by the problem of discovering some method that can be relied on to give fairly accurate information on this subject.
Vaughan has found that, taking advantage of the fact that those portions of the body farthest from the heart-namely, the extremi. ties—are the first to cool, it is possible, by dividing the lower extremities into ten parts, to determine the approximate time of death with a fair degree of accuracy. The method is as follows:
Divide the leg from ankle to knee into three imaginary parts, take the region of the kneepan as the fourth part and divide the thigh into six parts, making ten parts in all, and make allowance of one hour for each division; then by sense of touch note the difference in temperature in each section. Allowing one hour for each section and starting with section 1 (section 1 being the lowest third of the leg above the ankle), if section 1 is found to be frankly cold as compared with section 2 (middle third of the leg above the ankle), one may state that the body has been dead about one hour. If in section 2 one finds frank coldness as compared to section 3, the body has been dead about two hours, and so on up the leg and thigh until one is able to state approximately how long a body has been dead, if death has occurred within ten hours.
This method has been proved to be fairly accurate in more than a hundred examinations conducted by Assistant Medical Examiners Martin and Boettiger, of Kings County, and by Drs. Hala and Atchley of Kings County Hospital, together with the author. The tests have been conducted only where the prevailing atmospheric temperature ranged from 40 to 80 F.
This method is so simple that every person connected with a hospital or with the police force can determine the approximate time of death to his own satisfaction, and in my opinion it should be of material aid to the ambulance surgeon, who is likely to be the first whose opinion is asked at the scene of
Indications for Tonsillectomy.-T. L. Deavor in the International Journal of Surgery (Jan., 1921) declares that constitutional symptoms, in many instances, should be taken more seriously than the degree of hypertrophy. Most of the tonsil, when diseased, is out of sight, even tho there is marked projection into the pharynx. Both tonsils should always be removed, tho the toxic element may reside in only one. The larger of the two is often quiescent. As the tonsil hypertrophies, the pillars are put upon the stretch, intermittent tinuous. The result of tension so produced is to force the infective material into the lymphatic circulation. Prima donnas and public speakers have acquired disfavor toward removal of the tonsils-largely because much damage has, at times, been done to surrounding tissues, limiting the usual flexibility of the anterior and posterior pillars. Greatly enlarged tonsils may seem otherwise innocent, yet, during removal, fluid resembling pus can frequently be expressed from them which was not discovered on examination. Thru tonsillectomy, patients are relieved of lassitude, earache, erratic pains, headache, rheumatic tendencies, cervical adenitis and cardiovascular depression. Not a few individuals gain in weight. If results are good, but not wholly satisfactory, an associated lesion will always be found. Look for nasal obstruction, necrosis of bone. sinusitis, or defective teeth. A diseased tonsil may be secondary to any of the above condi. tions. In case of cervical adenitis, especially the fluctuating type, the tonsil should be dealt with first. In this way one limits the number of unsightly scars about the neck. Again, if the tonsil is the primary focus and is left, enlarged glands, when removed, are soon replaced by others. It is along these lines that more concerted action is needed on the part of three men, the surgeon, the physician and the dentist.
Artificial Impregnation.—Dickinson takes up in detail the problem and technic of artificial impregnation and gives the following as obstacles which may interfere with its success:
1. The possibility of infection of the tube and peritoneum.
2. Old tubal disease may be lighted up anew. It may, for a tubouterine orifice never closes.
For the present, at least such cases should be calcium phosphate. Very little if any benefit avoided.
can be looked for secondary, congenital or sta3. It is possible that all that injection of tionary cataract. The best results are obtained semen accomplishes is to open the tube, in when the lens is first beginning to show a which case other fluids would do as well, and tendency to opacity, especially incipient diaantiseptics be safer as used by Stone and betes. The lens may still be transparent, but Bovee. Only tests can tell.
changes in refraction show disturbance in the 4. One can have no assurance that coitus molecular imbibition of the hydrogel of the subsequent to the treatment was not the real lens, and conditions may be restored to normal agent in procuring conception. This may be by the local iodide treatment. The widest field true and this is the reason that the veterinary for its application is incipient senile cataract surgeon can offer proofs which we cannot. of the subcapsular, cortical type, which may be
5. It fails with semen which is not vigorous. regarded as a manifestation of dyscrasia. The It was devised for just such cases and it has diathesis or dyscrasia should be combated at not helped so far.
the same time. Dor asserts that of every ten 6. The field is very limited because patients patients with incipient cataract, eight can have revolt at the idea, or give it one trial instead the process arrested, one can be cured and only of half a dozen. They prefer laparotomy. All the tenth finds his condition not modified. this is exact, but it does not relieve us of Others are less enthusiastic, but Scalinci rethe responsibility of preventing the patient
marks in conclusion that this local iodide treattaking the greater risk should there be a sim ment is well worth a trial. pler way, did we but have the will to face the distastefulness of working it out.
Dickinson summarizes as follows: In women presenting histories or pelvic findings pointing
The Benzyl Treatment of Persistent Hicto the sealed tube following milder types of cough.—Macht, of Johns Hopkins University salpingitis, entirely quiescent, injection into has done more than any one else to establish the uterine cavity of active semen produced
the field of the therapeutic application of benno results in twelve instances. Strong pres zyl benzoate. Some time ago, he called attensure was not deemed warranted.
tion to its value as an antispasmodic and anoIn women with no gonorrheal histories or dyne in the painful and distressing conditions findings, free from cervical inflammations and arising from spasms of the smooth-muscle tisevident uterine, tubal or ovarian lesions or sues, such as dysmenorrhea, renal colic, dys. abnormalities, living semen of the poorer entery and asthma. Many drugs, which often grades produced no results in nineteen pa
are announced in high notes of enthusiasm, tients. No infection followed except in one
prove disappointing in practice; scores could possible instance and that of mild type. Sev
be named. This does not seem to be true of eral of these received three trials.
benzyl benzoate. Reports indicate that it is With fairly normal pelvic organs and semen
generally coming up to the recommendations of good quality, five pregnancies followed and of its sponsor in his earlier writings. are believed to have been due to tubal insemina
Pursuing his investigations, Macht has found tion. The knee-chest posture, the curved pipette
other uses for the ester. fitting the internal os and carried nearly to
In the Medical Record (New York), he has the fundus, injection into the tubes, horizontal
recently shown its application in the treatrest, and repetition three to six times-these ment of persistent hiccoughs in both adults and are considered important. Trial of this method
children. Not only is it useful in the ordinary may well precede resort to operation--save forms so common to infants, but also in the those done for external obstructions.
severer form that lasts some days and threatens , to kill the patient by exhaustion.
The drug acts best, says Macht, in 20 per
cent. alcoholic solution; of this, he directs the Medical Treatment of Incipient Cataract.
patient to take from 20 to 40 drops in water Scalinci (Riforma Medica, Sept. 11, 1920) lays
or milk. This dose should be repeated, at stress on the fact that cataract is especially
hourly or half-hourly intervals, as required for prone to develop in persons with a special
effect. diathesis or dyscrasia. He recalls that an
Several cases are reviewed in this paper in iodide solution undoubtedly passes into the in.
which benzyl benzoate was so used, in all with terior of the eye and may restore the local good results. metabolism to approximately normal and thus arrest the tendency to opacity. Good results have been reported from electrolytic introduc The Induction of Premature Labor.-The tion of iodide salts, but this, like subconjunc- induction of labor for the preservation of tival injections, must be reserved for excep maternal and fetal life is carefully considered
ses. However, bathing the eye with by Phillips (Lancet, Oct. 9, 1920) with some iodide solution is a simple and easy procedure. enthusiasm of laminaria tents which if kept The solution should not be stronger than 0.25 in alcoholic solution 1 to 1000 remain aseptic or 0.5 per cent. at first. Smarting usually over a long period. In the afternoon the indicates that impurities are present. He ad- laminaria tents are introduced into the cervix, vises a 1 per cent. solution of sodium iodide from one to three of the long variety, fresh or rubidium iodide with addition of a trace of from the solution, and within 18 hours are
removed, when the cervix will be found to careful investigations. The close similarity of admit a finger, also quite soft and dilatable, the symptoms of bronchopulmonary spirochetoenabling one to insert, after a little digital sis to influenza, and especially to pulmonary dilatation under an anesthetic, a small de Ribes tuberculosis, should constantly be borne in bag.
mind, and as a conclusive differential test from He gives an analysis of his results in 161 tuberculosis we would recommend an iniculacases, recording seven deaths of mothers and tion of the suspected sputum into a guinea pig. twenty-four of children. His maternal deaths were due to acute bronchitis (1), multiple fibroid with twins (1), contracted pelvis and Treatment of Displacements of the Uterus. acute yellow atrophy (1), ventrofixation and Bland, writing in the N. Y. Med. Jour. (Novembilobing of uterus (1), placenta previa (1), ber 6, 1920), gives the following summary of acute albuminuria and eclampsia (2).
his views on this subject: 1. Therapeutically With regard to the maternal deaths, none there is a distinct need for a specific line of of them can be attributed to the actual induc division between medical and surgical malposition, as a fatal result would, in all probability, tions. 2. The symptomatology of uterine dishave occurred without the operation; induction placements, in general, as taught today is erroof labor may, therefore, be looked upon as a neous. This is confirmed by the small percentprocedure which, per se, should be unattended age of so-called cures following operation. 3. by any mortality.
Uncomplicated malpositions should be treated The writer believes that in cases in which by medical and mechanical means. Operative rapid delivery in a primigravida is necessary, measures should be applied to those associated such as in puerperal convulsions and complete with distinct surgical complications. 4. Operaplacenta previa, it would perhaps be preferable tive intervention should not be utilized in the to perform Cesarean section, but should the case simple malpositions of virgins or young marbe that of a multipara digital dilatation and ried women. 5. The infantile uterus never rea de Ribes bag would be the best course to quires, nor is the condition benefited by surgery. pursue. If there is no urgency and the case Endocrine dysfunction as an etiologic factor can be taken deliberately, bougies, followed by should be remembered. This condition should digital dilatation or a de Ribes bag, is the be treated and not the uterus. 6. Nerve and preferable course.
muscle relaxation (backache) should be regared as a causative factor and not the result
of uterine malposition. 7. Restoration of nerve Bronchopulmonary Spirochetosis (Castel.
and muscle power should be restored in all cases lani),-Levy, in the New York Medical Journal, and is best accomplished by rest and generous January 29, 1921, says: The attention of the
feeding. 8. In no case of retroflexion or retroprofession was recently directed to the numer version will the patient recover in the presence ous cases of Castellani's bronchitis being re
of obstinate constipation or bladder overdisported from various parts of the world, and to tention. Overcome constipation and malposithe probability of like infections occurring in tions will largely disappear. 9. The prolapsus this country. That this was most probable was of old women with low surgical resistance is suggested as a result of the close association of best treated mechanically by the Menge pessary. the American troops in France, Germany, and Italy, with groups from areas which were known to have been infected with the spiro
The symptoms in acute cases usually disappear after a few days' rest in bed. For the rheumatoid pains, salicylates or codeine may be necessary. If hemorrhage is a prominent feature, the usual remedies as employed in other pulmonary disorders are advised, such as morphine, icebag to the chest, calcium lactate, or, in severe cases, blood transfusions. The anemia is combated by the usual tonic remedies, Purification and Sterilization of Drinking of which iron in some form is the basis. In the Water with Lime-Smith (Mededeel. v. d. way of specific treatment arsenic has given Burg. Geneesk. Dienst, Java, Nov. 3, 1920) better results than any other drug used. Re- asserts that his extensive experiments with cently much success has attended the intra- lime have confirmed its sterilizing and clarify. venous use of one of the arsphenamine products. ing power for river water. · He refers to the
The report of these two cases is made with turbid, brown rivers of Java in which the the hope that a more careful study of the spu- amount of dissolved impurities and content of tum of patients suffering from chronic cough ammonia is small. The addition of milk of will reveal other cases of bronchopulmonary lime causes flaking of the colloid particles respirochetosis. In study of seventy-nine cases sponsible for 'the turbidity. Ordinary laboratory of chronic cough, Thompson found the spiro- filter paper retained practically all bacteria chete present in thirty-nine. In view of the when the fluid passed thru it had been renwide distribution of the infection as evidenced dered alkaline. His tabulations show that there by reports the world over, it is our belief that is a possibility of obtaining nearly sterile water more cases will be brought to light by more from turbid and greatly polluted water by mix
ing lime with it for just a few seconds, and passing the mixture thru ordinary coarse filter paper, provided the first 250 C. c. be thrown away. His tests do not prove that the method can be applied on a large scale, with sand instead of paper, but they render it strongly probable. He reiterates that the filtrate only requires neutralization with carbon dioxid, which is harmless, to give a completely reliable, sufficiently soft and palatable water.
Avocado Fat.-Among the fruits that enter into the dietary of man the avocado, or alligator pear, takes an almost unique place because of its richness in fat, says an editorial writer in the Journal of the American Medical Associa. tion (March 27, 1920). A few fruits may furnish a noticeable quota of real nutrients in the form of starch and, particularly, sugars; thus an ordinary sized banana is rated at a food value of 100 calories or more. But for the most part the fruits that enter into the ordinary regimen, however palatable, wholesome and dietetically valuable they may be, can scarcely be rated as significant sources of energy. The part that they play in nutrition must be estimated from other standpoints. Accordingly, an edible fruit that may exhibit as much as 20 per cent. of fat in its make-up is worthy of special consideration. It may prove, for example, to become a valued adjuvant to the dietary of the diabetic, from which the carbohydrate content of many common fruits unfortunately excludes them. The possibilities of the avocado have been fur ther promoted by recent investigations in California and Washington, both of which agree in assigning an excellent utilization to avocado fat, even when as much as 124 gm. (about 412 ounces) a day were consumed. Heretofore the market price of this fruit has prohibited a very widespread use of what now appears to be a nutritious as well as palatable food. The avocado is indigenous to tropical and sub-tropical regions in the western hemisphere; but it is being cultivated to an increasing extent in Florida and California, and may ultimately become available at more reasonable prices in harmony with the history of some other tropical fruits. Dietotherapy will testify that the enrichment of the dietary with a really palatable source of fat will not be unwelcomed in the management of certain nutritive disorders. Ordinary cream rarely exceeds the avocado in available fat content.
vaccine, being a living virus, is easily destroyed by summer temperature.
4. Careful instructions should be given the patient as to the subsequent care of the vaccination, and cleansing or treatment of the vaccinated area is necessary. The patient should be instructed to return in a day or two to the physician for examination.
5. It should be remembered that vaccination is a surgical procedure and a suppurative wound, unless properly looked after, is an excellent culture field for the growth of foreign bacilli.
Unfortunate occurrences can be entirely prevented if the patient is kept under observation of the physician until the vaccinated area is completely healed.
6. Glycerinated virus is the only form of vaccine prepared at the present time. Only fresh vaccine should be employed, and the physician should be sure that the virus has been carried in a refrigerator and not exposed to heat.
7. Glycerinated vaccine is milder and slightly slower in action than other forms—the vesicle usually forming on the eighth day in primary vaccination, possibly as late as the tenth day. The formation of the typical vesicles should be considered as proof of successful vaccination.
Preservation of Vaccine.—Vaccine should be kept on ice until used.
Vaccine not kept at low temperature soon becomes inert and will not "take."
Extensive studies in the Mulford Laboratories show that:
Vaccine kept at 140° F. for five minutes is killed.
Vaccine kept at 98° F. for three or four days is dead. (This body temperature is about the temperature at which the vaccine would be kept if carried in the pocket.)
Vaccine kept at 70° F. for one to three weeks is weakened but not dead.
Vaccine kept at 50° F. for three to six months is still active. (This is about refrigerator temperature.)
Vaccine kept at 10° F. for four years is still active.
The lesson is: Keep vaccine in the refrigerator until used. Don't expect to get "takes" from vaccine that has not been kept at a low temperature.
Vaccinate during the spring and winter months whenever possible.
· Special Points to be Remembered About Vaccination in Smallpox.—Stewart (Western Medical Times, January, 1921) says:
1. Rigid cleanliness should be exercised in preparing the patient for vaccination and in the after-care of the vaccinated area.
2. Deep scarification should be avoided; no blood should be drawn.
3. Vaccination should be preferably in the winter or spring, to get the best results, as the
The Mosaic Unloosed Shoe and Divorce.There is a Mosaic requirement for marriage with a deceased brother's wife, states The Urologic and Cutaneous Review, March, 1921, for not obeying which Onan was slain, which has a strong influence on certain orthodox Jews. Some years ago a widow went from the United States to South Africa to carry out the ceremony of offering to marry her brother-in-law and then having his shoe unloosed. It is really a sur
vival of polyandry. The law as laid down in percentage obtained from the study of a large Deuteronomy XXV, 5-10, is as follows:
group of New England families taken at ran"If brethren dwell together and one of them dom which shows that only one-tenth were die and have no child, the wife of the dead childless. shall not marry without unto a stranger; her 4. More than one-third of the families of husband's brother shall ... take her to him to syphilitics have accidents to pregnancies; namewife and perform the duty of a husband's ly, abortions, miscarriages, or stillbirths. brother unto her. And it shall be that 5. The birth-rate in syphilitic families is 2.05 the first born which she beareth shall suc- per family; whereas the birth-rate in the New ceed in the name of his brother which is dead, England families mentioned above is 3.8 per that his name be not put out of Israel. And if family, or almost twice as great. the man like not to take his brother's wife, then 6. Two-thirds of the families show defects let his brother's wife go up to the gate unto as to children (sterility, accidents to pregnan. the elders and say, My husband's brother re cies, and syphilitic children). fuseth to raise up unto his brother a name in 7. Only one-third of the families show no deIsrael; he will not perform the duty of my hus fect as to children or Wassermann reaction in band's brother. Then the elders of his city spouse. shall call him and speak unto him: and if he 8. About one-fifth of the individuals examstand to it and say, I like not to take her; then ined show a positive Wassermann reaction; shall his brother's wife come unto him in the more of these are spouses than children. presence of the elders and loose his shoe from 9. Between one-fourth and one-third of the off his foot and spit in his face and shall answer spouses examined show syphilitic involvement. and say, So shall it be done unto the man that 10. Between one in twelve and one in six of will not build up his brother's house. And his the children examined show syphilitic involvename shall be called in Israel the house of him ment. that hath his shoe loosed."
11. One-fifth of all children born alive in While Deuteronomy is ascribed to Moses, the syphilitic families were dead at the time the intrinsic evidence is that it was written much families were examined. This does not differ later. In a recent case a Jew asked the Su materially from the general average in the compreme Court of New York to annul a marriage munity. because his wife brought it about by false state 12. One-fifth of the pregnancies are aborments.
tions, miscarriages, or stillbirths, compared with The fraud alleged is that the wife represented less than one-tenth of the pregnancies in nonthat she had “observed, aided by, and gone syphilitic families. thru a certain Jewish orthodox religious prac 13. The average pregnancies per family is tice which requires a widow who has never had 2.58, compared with 3.88, 4.43 and 5.51 in nonchildren, and whose deceased husband has a syphilitic families. brother surviving, to ask said brother of the 14. There are 3.52 stillbirths per 100 live deceased husband to marry her, and if said births in the syphilitic families, as compared brother is either unwilling or unable, the re- with the 3.79 reported by the Massachusetts quired ceremony is for the widow to remove Census, showing that there is no very marked his shoe with a certain ceremony."
difference in this regard. As the parties were married by the orthodox 15. A syphilitic is a syphilitic, whether his Jewish ritual the deceit would be sufficient for disease is general paresis, cerebrospinal syphilis, divorce.
or visceral syphilis without involvement of the central nervous system, and the problems af
fecting his family are the same in any case. The Results of Familial Syphilis.—The fami- The family of every syphilitic patient should lies of syphilitic patients admitted to the Psy be examined, irrespective of the stage of the chopathic Hospital have been examined as a disease or the symptomatology presented by the routine procedure. The patients are all in the patient when first seen. If this is done, cases late stage of the disease and are divided into of conjugal and congenital syphilis will be disthree groups: (1) general paresis, (2) cerebro covered which would otherwise be neglected. spinal syphilis, and (3) late syphilis without in They will often be found at a period when sympvolvement of the nervous system. This division toms are not active, and thus treatment may be is made to determine if the familial problem is instituted before irreparable destructive lesions different in cases of central nervous system in- have occurred. An opportunity is offered to prevolvement from those in which the central vent the development of such disabling condinervous system escapes. The families of 555 tion as general paresis, tabes dorsalis, aneusyphilitic patients were examined and the fol- rysms, and the like. The possibility of bearing lowing findings were obtained:
healthy children may be increased. Every 1. The family of the late syphilitic abounds clinic dealing with syphilitic patients, whether with evidence of syphilitic damage.
it is primarily a syphilitic clinic, a neurological 2. At least one-fifth of the families of syph clinic, a cardiac clinic, or an internal medicine ilitics have one or more syphilitic members in clinic should be equipped with the machinery addition to the original patient.
for bringing the members of the syphilitic's 3. Between one-third and one-fourth of the family to the clinic for examination.-Social families of syphilitics have never given birth to Hygiene quoted in The Urologic and Cutaneous a living child. This is much larger than the Review, March, 1921.