Memphis Medical Monthly Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880 Memphis Lancet, established 1898. LYCEUM BUILDING, MEMPHIS, TENN. Subscription Per Annum, One Dollar in Advance. Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR W. B. ROGERS, M.D. DEPARTMENT EDITORS. A. G. SINCLAIR, M.D. T. J. CROFFORD, M.D. W. D. HAGGARD, M.D., Nashville. B. F. TURNER, M.D. TREATMENT OF CHRONIC SUPPURATIVE OTITIS MEDIA. ONE of the gravest problems confronting the otologist is the proper treatment of his cases of chronic suppurative otitis media. That the operative treatment of this condition is not everything desired in the way of successful results is apparent to any one who has given statistics even the most casual study. These cases are so diverse in their manifestations, and are so uncertain in their course, that the surgeon might well classify them as being in the same category from a therapeutic standpoint as appendicitis. It is pretty generally accepted that the tendency of practically every case of otitis media purulenta, if it does not yield to local treatment in a few weeks, is to chronicity, and chronic suppurating ears are as little amenable to anything other than operative treatment as any condition that is known to the clinician. And yet we are confronted with the fact that operation does not by any means invariably cure in these cases. Every physician of extensive experience in the operative treatment of chronic purulent otitis media is forced to admit. that he has had quite a large proportion comparatively of unsuccessful cases. Dench reports that out of seventeen cases operated on by the Stacke-Schwartze method, which is the accepted one, eleven were cured, four were improved, and in one case the result is unknown. We can perhaps consider that six of these cases were not cured by the operation, a percentage of nearly 33 per cent. An operation that leaves such a large proportion of cases uncured, is certainly not ideal. On the other hand we have to face the probability of a lifelong chronic condition, which continually requires attention, is disgusting to the patient and frequently to his friends, and there is constantly hanging over the victim's head the possibility of developing a cerebral abscess from the purulent condition of the middle ear. Of this latter, the danger to life seems to be very small-there being a mortality of about 3 per cent. ascribable to this source. In operating for the relief of this condition, we are met with the serious proposition in many cases of being compelled to operate upon both ears. Then again, since the StackeSchwartze method involves the destruction of the posterior wall of the external auditory meatus, as well as the mastoid cells involved, it necessarily causes considerable disfigurement. But this consideration is of but minor moment in the long run, and if we could in a larger proportion of cases promise permanent relief from the suppuration, with at the same time no further impairment of the hearing, the operation assuredly would be the thing to urge in every case. Yet take an instance such as the writer has in mind, of a young man with a double chronic purulent otitis existing since childhood, in whom the discharge does not interfere with his pleasure and business, who presents no other evidence of physical impairment, the question presents itself to the surgeon, Shall I advise an operation, which has a strong element of doubtful value, to this patient? The writer answers most emphatically, No. On the other hand we will take an instance in babyhood. A child recovers from an attack of scarlet fever, but is afflicted with a persistent chronic otitis media in both ears. Treatment commonly adopted in these cases benefits this child to a certain extent, but the discharge continues and promises to hold on indefinitely. Should this case be operated upon? This to us places us in a more embarrassing position than the one just outlined, but we certainly should feel more inclined to urge operation in a case of this character than we would when the condition presents itself in an adult. Operation for the cure of chronic purulent otitis media involves a radicalism that is astounding at times in its scope, for in order to remove every portion of diseased bone, without which the operation would be practically worthless, it is frequently necessary to destroy an area of bone so extensive as to appal even the operator of wide experience. The mastoid region demands thorough curettement, the partition between the cells and the middle ear must be broken down, and the middle ear cleared of its contents. The extent of this operation is no doubt one of the chief reasons, if not the chief, for the conservatism of many otologists. The question of operating or not is still an open one, and therefore the responsibility of the aurist becomes all the greater, for he has no positive rules by which he can be guided, but must make every case a separate study and be guided by his own opinion as to the treatment to be adopted. THE DECREASING PREVALENCE OF DIPHTHERIA. It is apparent to general practitioners that there has been a noticeable decrease in the number of cases of diphtheria found in almost every locality of this country. This decrease is not merely apparent, but unquestionably is real. We state this so positively because it has been contended that the early and general use of antitoxin has been instrumental in bringing about this state of affairs. We would not question the claim that antitoxin has diminished the mortality in this disease, but that it has occasioned a decrease in its prevalence we would vigorously dispute. In the early days of antitoxin the opponents of this therapeutic agent claimed that to the fact that diphtheria was becoming less virulent was due the improvement in mortality statistics that had been reported. This would now seem to us to be a stronger argument than it did at that time. In the experience of the writer, there has been during the past five or six years a very noticeable decrease in the number of cases of diphtheria that have come within the scope of his observation. The health reports of the city of Memphis will also bear us out in this statement. We seriously question the claim that antitoxin had anything at all to do with this state of affairs, but believe that the principles of isolation and attention to general hygiene, which are now more commonly invoked are really the chief factors in bringing about this very desirable lessening in prevalence of a very distressing and frequently fatal disease. FRANK A. JONES, M.D. It is not often that the MONTHLY trespasses upon its editorial space to the extent of a biographical notice of any length, but the subject of this sketch has received such considerable honor at the hands of the greatest medical organization in the United States-the American Medical Association-that we feel that local pride should condone this usurpation. Dr. Frank A. Jones was born in Brownsville, Hinds County, Mississippi, July 16, 1867. Receiving his literary education at the Southern University, located at Greensboro, Alabama, he graduated in medicine from the Louisville Medical College in 1890. After practicing at Indianola, Mississippi, for four years, he moved to Memphis in the fall of 1895. Dr. Jones now occupies the position of Chief of Clinic at the East End Dispensary and Lecturer on Clinical Medicine and Demonstrator of Physical Diagnosis in the Memphis Hospital Mediical College. At the St. Paul meeting of the American Medical Association last year, Dr. Jones was elected Chairman of the Section on Practice of Medicine, he being the youngest man ever honored with this office, which is regarded as being next in importance to that of President of the Association. EDITOR'S NOTES. THE ASSOCIATION OF MILITARY SURGEONS OF THE UNITED STATES will meet in Washington, June 5-6-7. THE AMERICAN PROCTOLOGIC SOCIETY will hold its fourth annual meeting at Saratoga Springs, June 10-11. Dr. JOSEPH II. VENN, of Memphis, was married to Mrs. Laura Robertson Hogin, Wednesday evening, May 21, at Memphis. THE KANSAS CITY ACADEMY OF MEDICINE has recently adopted resolutions urging the abolition of the newspaper publication of personal medical advertisements. |