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2. Chronic catarrh. Vasomotor weakness predisposes the nasal membrane to catarrhal congestion, which process may extend to the throat and to the ear.

3. Local lesions. Such as hypertrophies of the turbinates, deflections and spurs of the septum, nasal polypi, atrophic rhinitis, empyema of the sinuses, adenoids, hypertrophied tonsils and swellings at the base of the tongue; in the ear-impacted cerumen, catarrh of the Eustachian tube and middle ear, disease of the internal ear.

These three factors reacting upon one another may produce symptoms and pathological changes out of all proportion to the size of the original local defect, and treatment, to be successful, must be directed against all three.

Tuberculoma of the Larynx.

S. Bentzen, at the 1901 meeting of the Danish Society of Otology and Laryngology (Revue hebdom., de Laryg., d' Otol., et de Rhin., vol. 23, no. 31) read an interesting paper on this subject. Tuberculomas of the larynx are distinctly circumscribed, covered with smooth and nonulcerated mucous membrane and enclose giant cells. When these are primary they may give rise to errors of diagnosis. The author reported the following case :

A man, 26 years of age, has been hoarse for three years, and is now being treated for pulmonary phthisis, which has been much ameliorated by treatment. The larynx is red and hyperemic, especially at the surface of the vestibule; there is very little swelling of the arytenoid and interarytenoid regions. The anterior portion of the right cord is covered by a tumor of the size of a pea, with a smooth surface inserted along the left ventricular band, and is movable during respiration. This was ablated with the double curette of Landgraf. The voice still remains slightly harsh, and the hyperemia of the vocal cords persists. Microscopical examination gave the following results:

The epithelium which covers the tumor is wanting in several places, but where it exists it is altogether normal. The submucous tissue is infiltrated with round cells; some vessels are engorged with polynuclear cells; there are several heaps of giant cells.

According to Dr. Claudius, who examined the sections, the absence of epithelium did not indicate a beginning ulceration, but was due to the maneuvres of extraction.

GYNECOLOGY AND OBSTETRICS.

UNDER CHARGE OF T. J. Crofford, M.D.

Professor of Gynecology, Memphis Hospital Medical College,

AND

W. D. HAGGARD, M.D.

NASHVILLE, TENN.

Professor of Gynecology and Abdominal Surgery in University of the South (Sewanee) · Gynecologist to the Nashville City Hospital; Professor of Gynecology,

University of Tennessee.

Pelvic Deformity in New York.

J. C. Edgar (Med. Rec., vol. 62, no. 7) has made a study of pelvic deformity as found in a series of 1200 consecutive labors. His conclusions are both interesting and instructive. He says:

1. Of our 1200 consecutive cases measured, 499, or 41.58 per cent., were American born women; 215, or 17.91 per cent., Irish; 130, or 10.83 per cent., Russian; 105, or 8.75 per cent., German; 30, or 2.50 per cent., 'black, etc.

2. Contracted pelves occurred in 44 cases, once in 27 cases, or in 3.66 per cent. Generally, contracted pelves occurred in 30 cases, once in 40 cases, or 2.50 per cent. Flattened pelves occurred in 14 cases, once in 85.71 cases, or 1.16 per cent.

3. Twenty, or 45.45 per cent. of our cases of pelvic contraction were among American born women, and deformity occurred once in 24.95 of these cases, or in 4 per cent.

4. Three, or 6.81 per cent., of the contracted pelves were among black women, and deformity occurred once in 10 of these cases, or in 10 per cent.

5. Our material gives a frequency of contracted pelves (1200 cases, 3.66 per cent.) midway between the conclusions of Williams (Baltimore, 1000 cases, 13.1 per cent.; Crossen (St. Louis, 800 cases, 7 per cent.); Reynolds (Boston, 2127 cases, 1.13 per cent.), and Flint (New York, 10,223 cases, 1.42 per cent.)

6. Our statistics, 3.66 per cent. of contractions in 1200 cases, differ from those of England (F. Barnes of London, 38,065 cases, 0.5 per cent.); of France, 5 to 21.11 per cent.; Germany, 9 to 9 per cent.; Switzerland, 8 to 16 per cent.; Austria-Hungary, 2.44 to 7.8 per cent.; Russia, 1.2 to 5.1 per cent., Italy, 18.13 per cent.; Holland, 3.51 per cent.

7. Special or irregular forms of pelvic contractions, as oste

omalacia, obliquely contracted coxalgic, double coxalgic, spondylolisthetic and kyphotic, fractured pelvis, are infrequent in this country.

8. The generally contracted pelvis is the most frequent deformity met with in New York. I found twice as many generally contracted as flattened pelves in my material (30.14.) Williams found practically the same condition in Baltimore (79.45).

9. Records kept of private and consultation cases in New York over a period of ten years show a somewhat higher percentage than the results obtained from the 1200 hospital cases, namely about 5 per cent. for all deformities; the generally contracted pelvis being twice as frequent as the flattened.

Post-Operative Crural Thrombosis.

B. R. Schenck (N. Y. Med. Jour., vol. 76, no. 10) after a study of 48 cases arrives at the conclusion that:

Thrombosis of the crural veins is more common after pelvic operations than is generally recognized.

It occurs more frequently in those cases in which large tumors, springing from the pelvic organs, have been removed. It rarely follows extra-pelvic operations.

In this series it has been infrequent after infected cases. The anemia and cachexia in consequence of new growths seem to be factors in its causation.

Constipation and the use of enemata play a doubtful part in the etiology.

Traumatism at the time of the operation should be borne. in mind and deep retractors used with extreme care.

Infection is undoubtedly of great importance, but its frequency is difficult to decide.

This complication often occurs when least expected and usually late in convalescence.

Albumin in the urine is more frequent in these cases than in those running an uninterrupted course.

The pulse curve of Singer does not always occur.

The results of rest and elevation for the full length of time are excellent. When time is lessened, swelling and pain persist, and the danger of pulmonary embolus is increased.

When and Why Does Labor Begin?

G. P. Shears (Med. Rec., vol. 62, no. 8) says:

The statement made in many text-books that the cervix maintains its entire length during pregnancy is incorrect.

The statement sometimes made that the canal of the cervix remains closed until the beginning of labor is also incorrect. Usually in multiparæ, and occasionally in primaparæ, the canal including the internal os is dilated to the extent of admitting one or two fingers two or three weeks before labor begins. Dilatation of the external or internal os or of the cervical canal is not per se an indication of beginning labor.

Dilatation of the clinical internal os or ring of Müller in such a manner that it begins to form part of the uterine cavity is at once the anatomical commencement and the diagnostic sign of true labor.

Dilatation at this point is the final result of uterine distention and consequent cervical eversion.

Dilatation at this point, owing to the greater resistance offered, by its effect upon the cervical ganglion, and the consequent reflex awakening of effectual uterine contractions, is the physiological cause of labor.

Myomectomy vs. Hysterectomy.

A. J. McCosh (Med. News, vol. 81, no. 13) says:

1. In young women with uterine fibroids demanding removal, myomectomy should always be the operation of choice. 2. Myomectomy is possible and advisable in the great majority of cases of fibroid tumors in young women.

3. For the safe performance of myomectomy the strictest asepsis is needed, otherwise it becomes a most dangerous oper-. ation.

4. In the operation of myomectomy fear of hemorrhage should be cast aside and bold and rapid methods should be adopted.

5. The operation is attended by the same danger to life as is hysterectomy.

6. The ultimate results as regards menstruation, pain and pregnancy are satisfactory.

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.

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THE HEALTH OF MEMPHIS.

WITH a mortality rate among the white population of but a fraction over 13 to the 1000, the citizens of Memphis have every reason to feel proud over the triumph of sanitation and modern medicine as applied in raising their city from practically the lowest position in the health records of the cities of the United States to, when the mortality among the colored inhabitants is eliminated, the very first position in this list.

What a remarkable change has been wrought! Emerging from the yellow fever epidemics of '78 and '79, Memphis, desolated in population and reeking with disease germs, was looked upon by the entire country as a veritable charnel house. But the confidence of her citizens in the Bluff City could not be shaken, and despite the gloomy forebodings justified by her past history, they returned to faithfully struggle in the upbuilding of a city that was destined through their efforts to earn its present title of "Queen City of the Mississippi Valley." Barring one or two yellow fever scares since the last epidemic of '79, the progress of Memphis toward health and prosperity has been uninterrupted, and the extraordinary increase in the population of this city during the last ten or fifteen years has been so phenomenal that it is attracting the attention of the entire country. In keeping with this rapid expansion of our population, it became necessary to sewer VOL. XXII-40

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