Page images
PDF
EPUB

ture left to take care of the appendix. (3) In the interval, after all symptoms of inflammation have subsided, the appendix should be removed. The writer declares that the operation ought not to be done in the intermediary period when there is fever and distention of the abdomen, because the danger from operation at this period is greater than the risk of the case becoming fulminating, or the abscess bursting into the abdominal cavity. The writer has always found his method successful.-Medical Record, October 6, 1906.

SYPHILITIC NECROSIS OF MASTOID AND PETROUS PORTIONS OF TEMPORAL BONE.

Harmon Smith, New York (N. Y. Medical Journal, March 17, 1906) reports a case of syphilitic necrosis of the mastoid and petrous portions of the temporal bone, complicated with double optic neuritis, facial paralysis, glosso-pharyngeal paralysis, vertigo and staggering gait. Smith did a radical mastoid operation, following the necrosis through the semicircular canals and cochlea to the tip of the pars petrosa and backward to the edge of the foramen magnum. Infection was so deep and widespread that the patient died about six months after he first came under observation, notwithstanding active antisyphilitic treatment. The autopsy notes on the brain are given in detail.

SUPRAPUBIC PROSTATIC ENUCLEATION.

E. Hurry Fenwick, London, England (Journal A. M. A., October 13), thinks that our present technic in suprapublic prostatic enucleation tends (1) to the destruction of the vesical orificial ring; (2) to the wholesale destruction of the prostatic urethra with its afferent seminal ducts; (3) to the rough handling of the membranous urethra. No matter, he says, how the operation is carried out, the original vesical orifice must be left intact and covered with its own mucous membrane. A neglect of this rule in a certain proportion of cases will leave the patient with a warped or narrowed vesical orifice and its attendant evils. Unless

there is enough intravesical projection to afford spare mucous membrane to replace that destroyed, such will be the case. avoid this he has successfully grafted in portions of a sheep's urethra and reports a case in which this was done. He suggests that if a medium or large projecting lateral lobe is present, that it be separately enucleated by an antero-posterior incision, and that the rest of the prostate be removed by an operation described by him in 1904, in which he starts the separation from the prostatic urethra. The forefinger is inserted into the prostatic urethra up to the first joint, the point of the finger is then bent and plunged sideways through the mucous membrane, which in the soft elastic prostate gives readily before the pressure. At once the finger finds itself between the tough capsule of the prostate and the contained adenomatous masses; traveling on without much opposition, the entire lobe is enucleated and generally stripped off the urethra. Great care is taken to keep the floor of the urethra intact and attached to its bed. Usually the adhesions of the lateral walls of the urethra and the lateral lobe are very dense; that part of the canal comes away with the lobe, but the floor is preserved. The lobe is now gently detached from the triangular ligament, so as not to tear or bruise the membranous urethra, and being free, it is pushed or pulled into the bladder; the opposite lobe is treated in a similar way. The finger finally smooths down the mucous membrane in the prostatic urethra, leaving the vesical opening clear and free from projecting tags. It heals by the structure being lined with part of the original prostatic urethra. Fenwick emphasizes the importance of not destroying the ejaculatory ducts, and also of not injuring the membranous urethra in separating the anterior face of the prostate from the face of the triangular ligament. As this is the future true sphincter of the bladder after prostatic enucleation, it should be very gently and cautiously handled. The article is illustrated.

SHOCK.

Lucy Waite states that the phenomena of shock manifest themselves through the tripod of vital forces, the nervous, circulatory

and respiratory systems, and principally in those organs most highly supplied by the sympathetic system. The intensity of physical shock is influenced by the extent of the injury, the nearness of the traumatism to the solar plexus, the character of the injury, and the severity of pain produced. The diagnosis of shock is the recognition of the clinical phenomena. Practically the only difficulty lies in differentiating this condition from syncope, caused by severe hemorrhage. The physician should never be content with a diagnosis of shock until every possibility of hemorrhage has been excluded. As to prognosis, temperature is in general the best guide. A persistence of 96 degrees or below for several hours warrants an unfavorable prognosis. The writer concludes by discussing the treatment of shock.-Medical Record, September 8, 1906.

IODINE AS AN ANTISEPTIC.

Nicholas Senn, professor of surgery in Rush Medical College, Chicago, concludes a scholarly study of iodine in surgery, with special reference to its use as an antiseptic, with the following summary:

1. Iodine is the safest and most potent of all known antiseptics.

2. Iodine in proper dilution to serve its purposes as an antiseptic does not damage the tissues; on the contrary, it acts the part of a useful tissue stimulant, producing an active phagocytosis, a process so desirable in the treatment of acute and chronic inflammatory affections.

3. In the treatment of simple hyperplastic goiter, acinomycosis and blastomycosis, the local use of iodine is made more effective by cataphoresis.-Ex.

MEDICAL

A CONTRIBUTION TO THE HISTOPATHOLOGY OF SOMe Drug

ERUPTIONS.

BY DRS. M. F. ENGMAN AND W. H. MOORE, OF ST. LOUIS.

The observations contained in this paper were based upon a study of the iodine and bromine eruptions, and the following conclusions were offered: (1) The local eruptive phenomena were prone to occur at points of previous inflammation; about comedones, acne lesions, seborrhoic lesions, scars, traumata, scratches, etc. (2) Traumata, pressure or rapid temperature changes might precipitate an eruption in tissues charged with the drug. (3) Idiosyncracy or susceptibility were factors here, as in other toxic conditions. (4) The glands or follicles of the skin took no active part in the production of the lesions, and when they were involved, it was secondary and passive to inflammatory changes about the vessels and in the connective tissue. (5) The gross histological changes in the skin consisted in different degrees of inflammation, from slight changes about the vessels to destructive abscess formation and progressive death of tissue. In their further conclusions, Drs. Engman and Moore described the minute histological changes that led to the formation of these lesions, and stated that this theory might be termed the "rational theory," as it explained all the symptoms of ioderma and bromoderma in a purely rational, chemical and mechanical manner, and did not depend in its elucidation upon the mysterious and purely theoretical action of the vaso-motor system.-The Boston Medical and Surgical Journal.

EXAMINATION OF THE FECES OF TWENTY-FIVE STARCH-FED INFANTS, WITH A FEW CLINICAL OBSERVATIONS.

Joseph H. Lopez tested the digestion of these infants, who were fed in five classes. The feedings were wheat gruel, arrow root gruel, wheat and barley water, home-modified cow's milk,

and highly saccharated food containing converted starch. Fifteen of the infants at the beginning of these observations had perfectly normal digestion, while ten had intestinal indigestion. The digestion of the infants in the first three classes was not impaired by this diet, while those who had not been well improved in health. Disturbances of digestion were noted in the last two classes. The writer is convinced from his work that young infants do healthfully digest starch.-Medical Record, September 29, 1906.

ONE HUNDRED AND THREE CASES OF EPILEPSY.

William L. Stowell gives the summary of his notes upon one hundred and three cases of epilepsy in private, dispensary and hospital practice. The young are most frequently affected. The disease has little tendency to shorten life or to be readily cured. The children of unhealthy or neurotic parents are more liable to become epileptic than are those of vigorous ancestry. Many of the hospital cases originate in a class of people used ot poverty, overcrowding and abuse of alcohol. Palsies appear in twentytwo of the writer's cases. The aura is most common in cases of eccentric origin-Jacksonian. Insanity and epilepsy are closely related or allied. In the treatment of these cases an attempt is made to improve general nutrition and to quiet the nerve cells. A vegetable diet is advised, together with the observance of the general laws of hygiene. The writer approves of the use of the bromides with general tonics.-Medical Record, September 29, 1906.

THE EFFECT OF BLOWING UPON WIND MUSICAL INSTRUMENTS, WITH SPECIAL REFERENCE TO TUBERCULOSIS.

J. Frederick Rogers, in speaking of the physiological effects of blowing upon wind instruments, states that the outflow of lymph is hastened, especially from the lung tissue; the heart sounds and beats are not materially altered except by extreme pressure; the gaseous interchange in the lungs must be facilitated

« PreviousContinue »