Page images
PDF
EPUB

tongue, can be accepted only after a suitable interval of probation has elapsed since the last treatment, and then at higher rates and for a limited period. Given a tendency to the evolution of late symptoms, the personal condition. family history and surroundings of the applicant should be carefully scrutinized.

7. Those in whom syphilis has implicated the viscera, or in whom the mucous membranes (other than the tongue) have been affected in the tertiary period, should be rejected.

THE SENN RECEPTION. The reception tendered Dr. Nicholas Senn by the president and board of trustees of the Newberry Library on December 8, on the

DR. NICHOLAS SENN.

occasion of the formal opening of the Senn room, was marked by the assembling of as large a body of representative medical men and women of all schools of medicine as was ever gathered together in this city. The auditorium of the library was filled to overflowing. President E. W. Blatchford, on behalf of the board of trustees, made an address of welcome, in which he detailed the evolution of the library and especially its medical department, which, thanks to the munificence of Dr. Senn, is now second to none in this country. Dr. Fernand 'Henrotin, President of the Chicago Medical

Society, on behalf of the medical profession, made eulogistic remarks regarding Dr. Senn, his services to humanity, to the medical profession and to the library. "Rare is it," said Dr. Henrotin, "that honor is given a physician or surgeon for his professional worth alone. America has been famed for her surgeons. Men are here to-night whose names are known al! over the globe but Senn is the greatest of them all."

In his reply Dr. Senn narrated the circumstances which led to his gifts of the Baum and the Du Bois Reymond libraries to the institution, expressed his intention of continuing his contributions to the library, and advised others to follow his example. He made the pertinent suggestions that a committee of specialists be appointed to confer and advise with the trustees regarding the conduct of each departinent of the library, and that the name of the park which fronts the library be changed to Newberry Park in honor of the founder of the library. Dr. Senn's remarks and suggestions were received with enthusiasm. A few words of earnest advice from the venerable Dr. N. S. Davis closed the proceedings.

The guests were shown through the various departments of the library and its workings explained to them.

The medical profession of this city does not as a rule, appreciate the advantages offered them by the library, its extent or comprehensiveness. We hope that one result of the reception may be a marked increase in the number of physicians who consult this most valuable reference library.

[graphic]

LAPAROTOMY IN TUBERCULOUS
PERITONITIS.

Von Marchthurn (Wien. Klin. Woch.; Brit. Med. Journ.; Therap. Gaz.) records nineteen further cases of this affection operated on by Chrobak. No patient died directly from the operation, out one succumbed the day after from inanition. Twelve patients recovered entirely from the peritonitis, but two of them died five months and two years respectively after the operation, of pre-existing pulmonary disease. In three cases a second laparotomy was necessary three to seven months after the operation; two of the patients recovered completely; the third died of pulmonary tuberculosis five months later without abdominal recurrence. Two patients had been tapped before the operation; one of these was cured, the other could not be traced. Eleven of the

In

cases were complicated with lung trouble; of these three died, two from the pulmonary affection, the abdominal mischief having healed, the third from exhaustion. All the eight patients with sound lungs recovered. The author is disinclined to follow Spaeth in forbidding operation in patients with lung disease. In six cases there was tuberculosis of the generative organs; in four both sets of appendages were affected, but too tightly bound down by adhesions to be removed. three of these the tumors disappeared after the operation; the fourth patient left the hospital relieved but was then lost sight of. Of the other two patients, one, who died the day after operation, had a tuberculous abscess of the left ovary; the other, a tubo-ovarian cyst, which could not be removed, and which eighteen months later had given rise to no further trouble. Three cases had high temperature before operation; these did perfectly well, and in only one of the others did the thermometer register 100 degrees F. after laparotomy. The diagnosis was invariably verified microscopically. The after-history was unfortunately deficient in six cases. Altogether out of thirtyeight cases treated by Chrobak in the years 1896-97 by simple laparotomy twenty-one, or fifty-five per cent, were completely cured.

The most rational explanation of these cures appears to be stimulation of the peritoneum and the removal of fluid from the abdomen; the former is the more generally applicable, as dry tuberculous peritonitis is equally adapted to the treatment The author concludes by giving Chrobak's opinion that in tuberculous peritonitis medical treatment is useless, and tapping at best but of temporary service; incision, and if necessary, evacuation of the abdominal contents, afford by far the best chances of recovery.

Gatti (Gaz. deg. Osp.) has produced experimentally tuberculous peritonitis and then cured it with laparotomy; gradually the tuberculous cells and the bacilli disappear, the products of degeneration are absorbed, and a process of reorganization ensues, in the course of which the peritoneum becomes normal not only to the eye, but to histological and bacteriological tests also. The process requires six to eight months, and the laparotomy, to succeed, must be performed at the proper moment, neither too soon nor too late; the tubercle fully developed and before the caseous degeneration has begun. As it is difficult in the clinic to determine the exact moment when the operation is needed, Gatti recommends a second laparotomy if the

first proved ineffectual and it was noticed that caseous degeneration had not begun. Burci ascribes the effect of the laparotomy to the combination of trauma, change of temperature, admission of light and air, etc.

SURGICAL TREATMENT OF CANCER OF THE RECTUM.

Dr. Edward H. Taylor of Dublin (Ann. Surg. ; Med. Rec.) gives the following summary of

treatment:

1. Great care should be exercised in the selection of cases for operation. Cancers which have exceeded the limits of the bowel and have acquired adhesions to neighboring parts do better if left alone.

2. The preparatory treatment deserves the utmost attention, having as its object the improvement of the patient's general condition, and as great a degree of intestinal asepsis as it is possible to obtain.

3. Free purgation, intestinal antiseptics, and rectal irrigation cannot have a really useful effect so long as there exists an ulcerating cancerous surface swarming with virulent micro organisms. The use of the curette, whenever possible, followed by irrigation, should accompany the other measures.

4. A preliminary colostomy can hardly be recommended as a matter of routine. It is chiefly indicated when attempts to empty and cleanse the intestine have been either impos sible or attended with difficulty.

5. A certain number of types of rectal cancer should be considered, both as regards their site and extent, with a view to determine the methods best suited for their removal.

6. Three cardinal rules may be suggested as applicable to all cases: (a) Control bleeding as far as possible; (b) let the principles of aseptic surgery be observed as far as the field of operation will permit; (c) avoid rough manipulation in the separation of diseased tissues; let it be effected for the most part by a process of careful dissection.

7. The perineal operation is best employed for ano-rectal cancers; that is, for cancers which involve the sphincteric zone, and extend for some distance above it.

8. If possible the rectum should not be split in its removal, nor should the finger be introduced as a guide in its separation. Elastic ligatures should be applied and sterilized gauze be placed beneath before it is cut.

9. Cancers situated in the suprasphincteric region are better removed by the sacral method.

As contrasted with the perineal, it gives more room, bleeding is more easily controlled, separation of the disease is more easily effected, and it gives the best functional results.

10. Temporary sacral resection should not be entirely disregarded, owing to its manifest advantages over the more extensive mutilation of Kraske and Bardenheuer.

11. If when the cancer is excised, it is found that the upper healthy segment descends easily, it is worth while making an attempt to suture it to the anal margin, having previously removed the mucous membrane from the lower segment.

12. In cases in which the ends of the bowel have been united after removal of the cancerous segment, it is well to close the sacral wound completely, for fear of accidents.

13. For cancers situated high up. as well as for those of wide extent in the rectum, the formation of a sacral anus is often the only means at our disposal. 14. In such cases it appears advisable to follow the method of Gersuny, and give the bowel a twist on its long axis before attaching it to the skin, the object being to establish a modified sphincteric apparatus.

15. The perineo-abdominal and sacroabdominal operations are grave; they involve serious risks, and can be required only in very exceptional cases.

DIPHTHERIA-CULTURE INCUBATOR. The diphtheria-culture incubator which is figured and described below was devised by Dr. W. K. Jaques, chief of the diphtheria antitoxin staff, and has been adopted by the Chicago Department of Health. It is so simple, practical and inexpensive that any physician who desires to make his own bacteriological diagnoses can readily provide one for his own office. We are indebted to Dr. Jaques and the health department for the use of this cut.

Figure 1 shows the incubator complete, fitted on the ordinary glass shade bracket of a gas jet. The upper cylinder, six inches in diameter, is water-jacketed and is large enough to contain a dozen test-tubes or culture-outfits. The lower cylinder, of the same diameter as the gas bracket, is the heat-distributing chamber, provided with the tube "f," to deflect heat from the gas jet. "A" is the thermometer; "b" the thermostat; "c c," apertures through which water is introduced into the water jacket; "d," a spring-closing door; "e" is the gas bracket.

Figure 2 shows the details of the gas jet, in which "a" is the pilot light; "b", white lead packing; "c", tube which supplies gas when temperature falls; “d,” tubes to thermostat.

Figure 3 is the thermostat, in which "a" are gas tubes; "b," mercury; "c", rubber cork; "d," glass tube in which mercury falls when temperature in incubator drops below 100 degrees F., and permits gas to flow to burner.

Exposed metal surfaces-except "d" in Figure 2, which are brass tubes-are nickel-plated. The thermometer is an ordinary dairy thermometer, costing twelve and one-half cents

Fig.2.

[ocr errors]
[blocks in formation]

apiece by the dozen. The thermostat consists of a test tube, three pieces of glass tubing, two corks and the mercury-total cost about fifteen cents. This works as perfectly in maintaining a uniform temperature of 100 degrees F. as the more complicated apparatus which sells at $3.50 each.

Any physician, possessed of ordinary manual dexterity, can produce an incubator as above described, at a cost of less than $2.50 for material required. If ordered from an instrument maker it would probably cost about $4.00; and if provided with the usual thermostat and gas fixture it would cost from $8.00 to $10.00.

IS INHERITED SYPHILIS CONTAGIOUS?

The following interesting conclusions are based upon Mr. Robert W. Parker's twenty years' experience in the East London Children's Hospital (Med. Rev. of Revs.):

1. The children of syphilitic parents very frequently show manifestations of a disease which is almost universally called "inherited syphilis."

2. In a large proportion of the cases this inherited disease is not syphilis at all, in that the disease is not contagious, and would be better named "inherited from syphilis."

3. This inherited disease is true syphilis only if it conform to the ordinary tests which pertain to contact syphilis, and prove to be infectious and contagious.

4. The children of syphilitic parents occasionally inherit syphilis.

5. The mother suckling a child with such a disease may be infected by it.

6. A healthy wet nurse and other persons brought into contact with such a child are even more liable to be infected by it than the mother.

7. Lymph taken from such a child, even though apparently well at the time, will probably, or possibly, invaccinate syphilis.

8. In reply to the question, Can a healthy woman give birth to a syphilitic child, the answer must be, No.

9. Many women give birth to children who suffer from what is called "inherited syphilis" without themselves appearing to be infected. The explanation is obvious. This "inherited syphilis" is not syphilis in the true sense, and the mother's so-called escape depends on this fact.

10. There is no recent clinical evidence which fully realizes Colles' teaching, viz., a mother suckling her own syphilitic infant and escaping an infection to which a healthy wet-nurse suckling the same infant, and other members of her family who have merely handled this infant, have succumbed, the latter facts being essential, if only to establish the contagiousness of the infant's disease in any and every given case asserted to be "inherited syphilis."

URETERO-CYST-NEOSTOMY. Following the tendency of modern surgery, Bazy (Rev. de Chir.; Am. Journ. Med. Sci.) recommends conservatism in the surgery of the kidney. He recognizes the fact that if it is a great feat to remove a viscus, it is a greater to preserve it and to restore its function. Two

cases of hydronephrosis are reported-One in which he re-established a communication between the bladder and pelvis of the kidney by resecting the ureter and implanting the distal portion into the most dependent portion of the distended pelvis. This was performed as follows: "Through a median laparotomy the tumor was reached, the fluid withdrawn by an aspirator, and the pelvis of the kidney incised. The orifice of the ureter was found far up on one side. It had been flattened out and occluded in this manner. A fine catheter was passed through it nearly or into the bladder. The ureter was then resected. One side of it was cut open for a little way to enlarge the entrance and procure a larger surface to implant into the pelvis. An opening was made in the most dependent portion of the pelvis. A soft catheter, from which the tip had been removed, was passed a short distance into the ureter, while the other end passed out of the abdominal wound, and gave, through an opening situated in the catheter within the pelvis of the kidney, exit to the urine in both directions. Drainage being provided in this manner, the ureter was stitched to the pelvic wall by interrupted catgut sutures, while a Lembert suture of silk was placed externally, care being taken not to penetrate the mucous surface so that the silk would come in contact with the urine. The wound in the pelvis of the kidney was stitched to the abdominal parretes, which were then closed by the ordinary interrupted catgut and silkworm gut sutures. The patient made a slow but complete recovery, the urinary fistula closed, and the complete function of the ureter was restored.

Case second was that of a single kidney, which, of course, could not be removed. The above operation was made and the flow of urine established, but death followed.

THREE POINTS IN THE TREATMENT OF TYPHOID.

Many beef extracts on the market contain but three per cent of the nitrogenous matter necessary for nutrition (Charlotte Med. Journ.).

The fibrin, the portion most desired is, in the process of preparation, coagulated and set aside to be made into what is called "dog cake." The patient pays for a food, but instead obtains a substance poor in nutritive quality, but rich in those extractives-xanthin, hypoxanthin, osmazone, etc.—whose only effect is that of temporary stimulation. In depending

upon the beef extracts to furnish nourishment in typhoid, we are really starving our patients. If in the preparation of these substances, the albuminous compounds were acted upon by a digestive agent and converted into proteids or peptones, the legend on the containers might relate the truth instead of telling of an imag. inative property. These remarks also apply to the various home-made soups and broths and beef-teas, which contain not more available nutrition, and hardly enough saline solution to perform the good offices of a normal intravenous or rectal injection.

It is for good that strychnine is superseding the use of alcohol as a stimulant in the treatment of typhoid; for in its employment it also had its toxic action. The restlessness and sleeplessness so marked in low fevers is more often a manifestation of exhausted nerve cells than of morbid irritability. It is therefore more rational to administer a strengthening agent, such as strychnine, than a sedative, as bromide. The latter merely masks the condition for a time, while the former corrects it.

The use of cold baths in typhoid is beneficial, not only because of the antipyretic effect, but also because of the production of a leucocytosis. The increased number of leucocytes, seen after cold applications, would naturally enable a body to recover more promptly and completely, by throwing into the circulation agents offensive and defensive to germs and their products, for the inventor, if he may be called so, as the phagocytic theory has proven conclusively that leucocytes not only destroy by taking into themselves and digesting, but that they also kill extra-cellularly.

DIABETES MELLITUS.

Dr. William Pavy of London read a paper before the Twelfth International Med.cal Congress at Moscow on this subject (Med. Record) in which he claimed that diabetes mellitus is no longer an intricate disease; that it consists in a malassimilation of the carbohydrates of the food in the intestinal canal. The fault lies first with the villi of the small intestine. In the normal state the vill prevent the entrance of carbohydrates into the portal system, and hence the first indication in the treatment of diabetes mellitus is to prevent the passage of unchanged carbohydrates through the villi into the portal vein. Urine contains sugar only when the sugar exists in the blood, and hence will not be found in the urine when it is prevented from reaching the circulation. The speaker believed that the carbohydrates are normally converted

into fats by the villi of the small intestine. This is evidenced by finding almost as much fat in the lacteals after the ingestion of carbohydrates as of fats. Hence, when sugar is found in the urine we must infer that the assimilative power of the intestine is weakened.

The indications for treatment are self-evident. The first indication is to prevent the sugar from gaining access to the blood by restricting the carbohydrates in the food. Dr. Pavy expressed the belief that there will be found a nervous condition acting upon the vessels of the intestine.

CASTRATION FOR HYPERTROPHY OF THE PROSTATE.

At the recent meeting of the Association Francaise d'Urologie eleven papers were read on castration or vasotomy in the treatment of prostatatic hypertrophy (Lancet). By this we learn of the active interest the French medical fraternity are taking in this subject. The recorded results of castration show that some patients are rapidly restored to almost perfect health. These cases, however, are in the minority. Others improve slowly at first, and later the power of micturition increases, though it may never be quite complete. In others the relief obtained is slight, even after many months; and in a large number failure is absolute.

The mortality after castration, nineteen per cent, is by no means small. This high rate of mortality cannot be accounted for alone by the depressed condition of many of the patients. Wild, sometimes permanent delirium, has been known to follow the operation. There is no means of foretelling what cases will be improved by the operation. Vasotomy sometimes results in atrophy of the prostate gland, but in the vast majority of cases, it has proved a total failure.

It cannot be said that either castration or vasotomy has been established as a perfectly satisfactory method of the treatment of an enlarged prostate, which is interfering with the outflow of urine. Each method in certain cases gives excellent results, but the failures are many, and with castration at least untoward results are by no means rarely met with. We must come to the conclusion that these methods which have been discovered for the treatment of a most obstinate disease are valuable, but that we have yet to learn what are the indications for their employment with certainty of

success.

« PreviousContinue »