Extracts trom Home and Foreign Journals. SURGICAL IMPORTANCE OF EARLY DIAGNOSIS AND OPERATION IN Cancer. J. C. Bloodgood, Baltimore (Journal A. M. A., November 3), says that until the etiology of malignant growths is ascertained and a treatment based on this elaborated, the chief problems are: (1) Early recognition. (2) The method of operating. The public must be educated as to the curability of malignant tumors taken in time, and that their great fatality is due to delay. The responsibility of the general practitioner here is greater than that of the surgeon, the latter has enough to do to fit himself to act rightly when the cases come to him. If the general practitioner does his duty by immediate consultation with the surgeon the surgeon must be prepared to meet the new requirements of diagnosis, and in this connection Bloodgood lays stress on the iml portance of his being able to make a naked eye diagnosis at the time of the operation or of an exploratory incision. As regards the alleged danger of the latter for diagnostic purposes, he thinks it far less than that of delay. The earlier surgical lesions, especially tumors, come to the surgeon for treatment the more frequently will exploratory incision have to be resorted to. He goes over the various types of the malignant growths as regards their relative malignancy, and says that it is of the utmost importance for the general practitioner and the public to be keenly watchful in their attitude to small and apparently innocent warts, nodules, scabs, ulcers and little areas of induration on the mucous membrane of the lower lip, tongue and mouth, skin of face, in an individual over thirty. Congenital pigmented moles should also be watched for and their immediate excision advised. Other growths mentioned and calling for operation are asymmetrical tumors and nodules in or near the thyroid, single tumors in the breast, dubious indurated masses in the stomach wall discovered on exploratory incision. Local pain referred to a bone should also always be regarded as suspicious and as calling for an x-ray examination. The main point of the article is the importance, not only of early recognition of the growth, but also the necessity of the surgeon being able to recognize the nature of the growth and its probable prognosis and to adapt his operation accordingly. ILLUSTRATIVE CASES OF PROSTATIC CARCINOMA. J. Bentley Squier cites the history of several cases in point and emphasizes the futility of the endeavor to do more than palliate the patient's sufferings by operation when he is the victim of prostatic carcinoma. He declares that the whose question resolves itself into one of early diagnosis and operation if any lasting results are to be accomplished. The early recognition of carcinoma in any locality is imperative, and nowhere more so than in the prostate. But the problem is a very difficult one. If the disease is at all advanced, the majority of patients live longer if palliative measures are employed than by extensive radical operation. The writer has found that permanent suprapubic drainage gives great comfort to the patient. When the operation for a hypertrophied condition of the prostate is performed, microscopical examinations of frozen sections should be made.-Medical Record, October 20, 1906. THE OPERATIVE TREATMENT OF ACUTE GONORRHEAL EPIDIDYMITIS. Francis R. Hagner has had excellent results with the open method of treating gonorrheal epididymitis. After describing the details of his operation, he sums up the advantages of this treatment as follows: According to the known pathology, it is a rational procedure. If care be exercised, the danger to the patient is slight. The infiltration of the epididymitis disappears more rapidly under the operative treatment than under any other. The danger of permanent injury to the testicle and epididymis is lessened. The patients are absolutely relieved of pain on re covery from the anesthetic. The systemic symptoms are promptly relieved. Medicinal treatment will usually be followed by relative relief only, and perhaps not by a permanent cure because the infecting agent remains. Therefore the most rational way to do away with this is by incision, irrigation, and drainage.-Medical Record, October 13, 1906. MEDICAL TUBERCULOSIS IN INFANTS AND CHILDREN. According to E. E. Graham, Philadelphia (Journal A. M. A., November 10), tuberculosis is common in children over 4 years of age, and in probably 90 per cent. of the cases infection is through the respiratory tract, bacilli entering the lymphatic ducts and being arrested by the glands of the neck, trachea and larger bronchi. It is important to recollect that tuberculosis of the lymph glands is very characteristic of the disease in early infancy. the disease being sometimes arrested permanently or for a time; in other cases going on to acute inflammation and caseation and much depending on the resisting ability of the child. Tuberculous meningitis may occur, and in the first two years of life the principal seats of the disease are the lungs, bronchial glands and brain. After the third year the mesenteric glands, peritoneum and intestines are more likely to be involved than during infancy, but throughout the whole period of childhood the lungs are almost always involved in all moderately advanced cases. The most common type is a double tuberculous bronchopneumonia, more rapid in its course in infants than in older children. The clinical picture often presents many curious features, rendering diagnosis difficult or well-nigh impossible. Graham describes chronic, subacute and acute forms, the former running a slow course and after the eighth year of life closely resembling the adult type. The subacute cases generally last from two to six months, and the lung month or six weeks, the cough being slight and spasmodic. Later, the pulmonary symptoms are more noticeable. In the acute cases there are tuberculous deposits and miliary tubercles in the lung, and, in addition, a simple bronchial pneumonia. The symptoms closely resemble those of ordinary non-tuberculous bronchopneumonia, but their rapid progression and the increasing weakness and possibly a tuberculous meningitis, carry the child off. Cases illustrating the difficulty of diagnosis are given. When bronchopneumonia tends to persist beyond the usual period tuberculosis should be suspected. The situation of pneumonia may assist in the diagnosis. In simple bronchopneumonia the inflammation is apt to be in the lower posterior part of the lung; in the tuberculous form it is more likely to be in the upper portion. Leucocytosis is usually absent in tuberculosis unless there is a mixed infection and leucopenia is commonly present. If the diseases in which the number of white cells is diminished, such as malaria and typhoid, can be excluded, the diagnosis may be aided by this symptom. Chlorosis may closely simulate tuberculosis, but the finding of the bacilli and history of the case will confirm the diagnosis. Inoculation experiments with glandular substance may decide in chronic cases. The failure of young children to expectorate makes sputum examination hard to get, but a rubber tube passed down the throat and examination of the mucous scrapings will overcome the difficulty. Lumbar puncture is mentioned as of possible value. HEADACHE FROM AURAL DISEASE. P. Hommand, Boston (Journal A. M. A., November 10), says that headache from aural derangement is more likely to be misunderstood as to its cause than that from ocular trouble, notwithstanding its possible severity, because it is not so directly associated with conscious functional defect of the special sense, especially the chronic forms of aural headache. Yet it is fairly common, the more so because of the intimate relations of the innervation of the ear and the central nervous system. In young children, as Gradle has shown, a continuous heahache is likely to occur from slight obstruction of the Eustachian tubes which is at once temporarily relieved by inflation of the middle ear. For permanent relief, steps should be taken to remove any adenoids or other causes of obstruction of the Eustachian tubes. In the more chronic adhesive processes in the internal ear, absolute pain is seldom felt, but there may be a feeling of fulness or of pressure in the brain. When headache is due to acute middle-ear inflammation it is usually relieved by paracentesis. Politzer thinks that some of the most severe cases are due to hyperemia transmitted |