Enuresis. Bierhoff (Pediatrics) believes that urinary incontinence is simply an advanced stage of "irritable bladder," due to hyperemia or inflammation of the vesical neck, sphincter or deep urethra. He recommends hot sitz-baths, once or twice daily, and restriction of fluids at night. While asleep the child should lie with the head lower than the hips. Local endoscopic treatment is advised for older children. Mustard in Respiratory Affections. The common wayside weed, hedge mustard, says the New York Medical Journal, was in high repute during the 18th century as a remedy for laryngeal catarrh. Messrs. Brissemoret and Harmary have recently revived interest in this and other old drugs that had lapsed from common use. The latter writer claims that hoarseness and even complete aphonia are sometimes completely cured in a single day. In chronic affections of the air passages, M. Brissemoret advises the use of the juice of the plant in daily amounts of one half ounce or an ounce; or an infusion made by macerating one or two ounces of the leaves in a quart of warm water for three quarters of an hour. may be employed. Early Diagnosis of Carcinoma of the Stomach. To make a really early diagnosis, that is, soon enough for operative intervention to be curative, the editor of the Medical Record affirms that we should not wait for a palpable tumor, lactic acid, "coffee-ground" vomit, Oppler-Boas bacilli or carcinomatous tissue shreds. He refers to the age of such patients (usually over 45), and to the suspicious evidence of a history of chronic gastritis or dyspepsia not ameliorating under treatment and with constant diminution of free hydrochloric acid. He also alludes to the diagnostic importance of the epithelial cells in the stomach washings showing atypical and irregular mitoses. He concludes that there is room for a judicious extension of the use of exploratory incisions. Diagnostic Importance of the Meningococcus Intracellularis.—This microorganism was first described by Weichselbaum in 1897. It appears either as a diplococcus or in tetrad arrangement, and is always found within the pus cells. In a paper under the above heading, in Pediatrics, Louis Fischer writes of the prognostic importance of finding this germ in lumbar puncture fluid, the mortality being much less in the epidemic cerebrospinal meningitis due to the meningococcus than in the sporadic form of the disease. caused by streptococci, pneumococci, bacteria coli or influenza bacilli. The meningococcus is easily stained with Ziehl's solution after making a smear from the pure culture. The best method of obtaining a pure culture is to inoculate the surface of agar with fluid aspirated by lumbar puncture. The growth is rapid, and yellowish, shining and slime-like in appearance. Test for Uric Acid in the Blood.-In the latest edition of his striking work, Haig describes a simple quantitative test for this substance. A very small drop of blood on a microscope slide is mixed with three or four times its volume of a 10% sodium carbonate solution and of a 20% ammonium chloride solution. A cover glass is now put on, and the slide is placed in a box or under a glass with some moist blotting paper or cotton wool to prevent evaporation. At the end of a half hour the slide is set under the microscope and the red blood cells and urate granules are counted. The ratio of the latter to the former varies from 1:1 to 1:20 or higher. The more granules, the more uric acid of course. In Bright's disease. there is always a marked excess of these ammonium urate granules. Poisonous Snake-Bites.-The fourfold object of treatment, says G. Langmann (Medical Record, Sept. 15) is to prevent absorption, to destroy or neutralize the poison, to hasten elimination and to meet urgent symptoms. An Esmarch or other bandage is to be applied at once, being loosened at times to prevent gangrene. Excision or destruction of the area with the cautery is preferable to scarification. Probably the best local remedy is a solution of calcium hypochlorite, 1:60. Strychnine and ammonia are of service as general stimulants. The antivenene or antivenomous serum of Calmette and Fraser is an efficient protective, in the dose of 5 to 20 c.c., when injected within one and one-half hours after the bite. Artificial respiration should be employed for hours if necessary, and it is well also to resort to lavage of the stomach. The patient should be encouraged to surmount the attendent fear and deep mental prostration. Etiology and Nature of Puerperal Septicemia. This question was covered by M. Doleris at the International Congress of Medicine. After giving Pasteur credit for the discovery of the true nature of this affection, the author states that the streptococcus pyogenes is the most common pathogenic germ, after which come the staphylococcus aureus, the gonococcus, the bacterium coli commune, etc., all of which are anerobic or of mixed character. The conclusion at present is that certain saprophytes (bacillus putridus, etc.) can so develop as to become really pathogenic, particularly if there is placental retention. The association of different species appears to favor infection. This takes place ordinarily by toxemia, and proves fatal chiefly by subacute peritonitis, nervous inhibition or intestinal obturation. The staphylococcus aureus may cause fatal effects by grave visceral metastases to the pericardium, pleura or kidney. The demonstration of the pathogenic action of certain putrefactive saprophytes remains a question of autogenetic infection. DENVER MEDICAL TIMES VOLUME XX. JANUARY, 1901. NUMBER 7. ORIGINAL COMMUNICATIONS. FOREIGN BODIES IN THE OESOPHAGUS,* By GEO. W. KING, M.D., * The clinical history of a recent case of impaction of a foreign. body in the oesophagus is herewith submitted for the purpose of illustrating in a practical way the principal points to be considered in the diagnosis and treatment of this accident. Girl, aged 6 years, while amusing herself with a penny whistle, inadvertently allowed it to slip backward into the pharynx, and becoming alarmed, she made violent efforts at swallowing, which forced the body onward into the oesophagus and beyond reach of the finger. Several copious draughts of water were taken, but served no useful purpose in accelerating the progress of the whistle downward. She then informed her mother of the accident. Nothing was done, however, until the following day, when she was presented for examination, with the above history. During the night several attacks of vomiting had occurred without effecting dislodgement or expulsion or the foreign body. Fluids. could be swallowed without regurgitation. Some degree of discomfort existed, pain over sternum and cervical region being the most prominent symptom complained of. Respiration appeared to be normal. No information concerning the presence or position of the whistle could be ascertained by palpation or superficial examination. The absence of urgent symptoms suggested the probability that passage downward had been successfully accomplished during the interval. The traumatism produced by the passage of a body of that size would account for the irritation present. Fortunately, we are no longer compelled to remain in doubt when dealing with this class of cases. The fluoroscope and skiagraph Read at the Rocky Mountain Inter-State Medical Association, Butte, Mont., Aug., 190). demonstrate clearly what we desire to know, without subjecting our patients to the annoyance incident to the use of sounds or other instruments, which, after all, are liable to fail in the object for which they are employed. The accompanying skiagraph indicates the utility of this method of examination. The vertical position of the whistle is well shown, but its exact location, when measured by fractions of an inch, is largely a matter of conjecture. The position and distance of the Crook's tube in relation to the object, the diffusibility of the rays must be carefully noted in order to eliminate errors in the interpretation of the shadow. Facility in this respect is acquired by experience in this line of work. In this instance the picture represents the object as slightly below its actual position. This difference was immaterial, inasmuch as the positive assurance that the impaction was in the cervical portion of the oesophagus, and therefore accessible, furnished sufficient data for all practical purposes. The patient was put under an anaesthetic and extraction by the mouth undertaken. It was found to be impossible to locate and grasp the foreign body with suitable instruments; sounds or bougies failed to give evidence of contact, apparently passing by the seat of obstruction without inpinging upon the rim of the whistle. It soon became evident that nothing could be accomplished by this route, and the operation was for the time abandoned. Considerable reaction followed, temperature went up to 102F., with marked symptoms of acute bronchitis, induced in all probability by exposure or traumatism. Appropriate remedies were prescribed and the patient left undisturbed until her condition would justify further operative interference. With the subsidence of the bronchitis a more distressing condition developed, viz: Spasm of the glottis, accompanied by an incessant cough, reflex in character, caused by the presence of the foreign body. Oesophagotomy being the only recourse likely to afford relief, it was performed without incident. The incision was made in the usual location, i. e., upon the left side along the anterior border of the sterno-mastoid muscle; the fascia was divided with due regard to the position of the vessels and nerves lying within the field of operation; the tissues were carefully separated by blunt dissection, until the bodies of the cervical vertebrae could be felt with the finger; the carotid sheath retracted outward and the trachea and thyroid gland rotated in the opposite direction. A sound was now introduced into the oesophagus and two silk sutures placed in appropriate position in its walls and cut long to facilitate control of the part during the subsequent manipulations. The tube was opened over the point of the sound and the latter withdrawn. Forceps were passed downward through the incision to the depth of six inches and upward to nearly the same distance without encountering the foreign body. A metallic bougie a boule was then substituted and being introduced came directly in contact with the whistle, which was imbedded just below the cricoid cartilege. A small instrument was passed under the rim and by a prying motion it was loosened and forced upward and outward, where it could be easily grasped with the forceps and extracted. It is worthy of remark that the same instrument by means of which the whistle was located through the incision had been passed by the mouth in the previous attempt with no beneficial result. The incision in the oesophagus was closed by absorbable suture and the lower angle of the wound external to it loosely packed. The head was fixed by a pasteboard splint extending upward from the dorsal region. No vessel of sufficient size to require a ligature was divided during the operation; hemorrhage therefore limited to slight oozing. No injury to nerves resulted. In the after treatment nothing was given by the mouth until the fifth day, nutrient ennema being used to sustain the patient. The wound remained free from infection and the healing progressed sat |