CURRENT MEDICAL LITERATURE. A New Instrument for the Deposition of Ointments Into the Urethra or Bladder. Hugh H. Young, M. D., Baltimore (Maryland Medical Journal, May, 1908), says that for several years he has been experimenting with the use of ointments in the urethra, and has devised several instruments to facilitate their introduction. One of these instruments was illustrated in an article published last year in Vol. 13 of the Johns Hopkins Hospital Reports ("The Use of Ointments in the Urethra in the Treatment of Chronic Urethritis"). The instrument which was there described proved very satisfactory for the anterior urethra, but it was often difficult to introduce it into the posterior urethra or bladder, and for this purpose he devised an instrument shown in the accompanying illustration. As shown here it is a simple tube with a beak modeled after that of a coude catheter, which makes it extremely easy to introduce into the posterior urethra or even the bladder. On one side, near its lower end, a long opening is placed, and into this a large amount of ointment can be introduced. The solid plunger or obturator is provided, by which the ointment can be pushed out in the urethra, after the introduction into the urethra to the desired place. This instrument is so simple in its construction and satisfactory in its working that no further description is necessary. It may also be used as a catheter and for irrigation of the bladder, or for removal of urethral polyps, and is a very satisfactory instrument for the evacuation of blood clots from the bladder, as the obturator may be used to dislodge a clot which is too large to enter the orifice, or to draw it through by suction, acting in this way as a syringe. In several cases in which the bladder became plugged with blood after prostatectomy, this little instrument was of great assistance in emptying the bladder. As to the use of ointments, there is little to add to that given in the article above referred to. Two formulas, which have proven most satisfactory, are a 2% carbolic acid in lanolin, and a 2% salicylic acid in lanolin. The former is useful in many cases of chronic urethritis, particularly those associated with irritability of the posterior urethra. The disposition of ointment after prostatic massage leads to its rapid absorption into the prostate, from which it is passed in small quantities for two or three days. The use of the salicylic ointment is indicated when there is marked change of the urethral mucosa to the squamous type, as shown by the exfoliation of large shreds composed of squamous epithelial cells, and thickening of the urethra, as seen through the urethroscope. Treatment of Tuberculosis by the Administration of Mercury. Surgeon Barton 'Lisle Wright (United States Naval Medical Bulletin, April, 1908) gives a preliminary report on the use of mercury as a curative agent in the treatment of tuberculosis. He was inspired to try this method of treating tuberculosis because of the fact that he noticed, in 1905, that several patients under his care, who were tuberculo-syphilitics, showed marked improvement in their pulmonary lesions in a much more decided degree than he had ever observed in the case of unmixed tubercular infections under similar or more advantageous climatic conditions. Therefore, he considered that mercury did some good for the tuberculous condition, as well as for the syphilitic condition. He was further encouraged in this belief by seeing the work of Wolters, who, in the September, 1907, issue of the Derm. Zeitschrift, reported a case of laryngeal tuberculosis (with no syphilitic history) absolutely cured with mercury and potassium iodide. Accordingly, thirty-five cases were treated with mercury, mostly by the hypodermatic method, using the succinimide of mercury. Out of the thirty-five cases under treatment, thirty showed improvement, as evidenced by reduced pulse rate and temperature curve, increased appetite, lessened cough, and a gain in weight. The remaining five are holding their own. Two cases are fully reported in this paper, with full histories and clinical findings, with markedly successful results. The writer, in conclusion, points to the following facts: 1. Almost immediate improvement in the patient's general condition is shown following the administration of mercury; the slowing in the pulse, the reduction of temperature, and the gain in weight. It has been conclusively demonstrated that this treatment will cure extremely advanced tubercular ulceration of the larynx and pharynx in a remarkably short period of time. 3. It produced marked improvement in advanced pulmonary lesions, and it has a decidedly beneficial action of tubercular glands. Careful questioning of the patients and exhaustive examination has failed to show any syphilitic condition of these patients reported. The cases look, therefore, to be pure tubercular infection. Attention is particularly called to the necessity of using large and increasing doses of mercury in the treatment of such cases. It has been found that tubercular patients are singularly tolerant of mercury. They not only require, but, fortunately, tolerate larger doses than syphilitics. In this connection, it may be stated, also, that patients with slight infection, small pulmonary lesions, and extremely moderate constitutional symptoms, do not stand large doses as well as the advanced cases. Several of these showed sore gums following the injection of 0.026 grams (2-5 grain) of the succinimide, and the dose had to be reduced. Ileus as a Complication of Gonorrheal Epididymitis. D. Balas (Deutsche Med. Wochenschrift, No. 15, April 9, 1908) gives the history of a case of gonorrheal urethritis, with right-sided epididymitis, existing for four weeks. Four days after his entrance into the hospital, he had severe pains in the bowels, which necessitated him going to bed. He then showed constipation, vomiting, flatulency; he was well-nourished, but very weak, collapsed, frequent (120), small, weak pulse, and coldness of the extremities, temperature of 38.8° C., and odor of feces from the mouth. Organs of the thorax were normal. The abdomen was distended, and peristaltic movements were noted at the umbilicus. There was a tympanitic note on percussion. The abdomen was not tender. There was no dullness of resistance. There was persistent hiccoughing and fecal vomiting. The right epididymis was swollen, the vas deferens thickened; both were tender. The abdominal cramps seems to follow up from the funiculus on the right side. A diagnosis of ileus was made. Operation under ether narcosis showed pus in the abdomen, and a general picture of diffuse peritonitis. A mass of intestines were found knuckled together in the neighborhood of the right linea innominata, with adhesions to the pelvic peritoneum, surrounded by a mass of greenish, thick pus. A small abscess was seen near the right ductus deferens, which was thickened, its lumen showing greenish, yellow pus, and its mucosa inflamed. Another abscess was found further down, four c.m. below the right linea innominata. There was also a small abscess in the head of the epididymis, and another larger one in the right prostate lobe. There was also present cystitis and a purulent inflammation of the right vesicula seminalis. The pus showed gonococcus and another Gram-positive bacillus, which probably came from the intestines. Autopsy of this case confirmed these facts, and showed this to be a case of gonorrheal epididymitis, deferentitis and perforation of the vas deferens, with subperitoneal abscess, which was followed by a circumscribed peritonitis. The ileus was followed by acute diffuse peritonitis. Gonococcic Arthritis Treated with Anti-Gonococcic Serum. A. Perez-Miro, Chief of the Laboratory of Therapeutics, Havana Faculty of Medicine, Havana, Cuba (Therapeutic Gazette, April 15, 1908), reports six cases of arthritis of gonorrheal nature treated with the anti gonococcic serum. He gives accurate histories of the cases which were of the polyarthritis type. The dose of the serum ranged from one to two cubic centimeters, injected at varying periods of time, sometimes as frequently repeated as one in twenty-four hours, sometimes every forty-eight hours. On account of the small number of cases, the writer does not attempt to draw accurate conclusions as to the efficacy of this plan of treatment. However, he makes the following observations on the above experiments: 1. On the day following the first injection of serum, the urethral discharge has been observed to materially increase, and to take on a pronounced blennorrhagic character in regard to consistency, and the burning. pain which accompanied it, excepting on the fourth case of the writer's series of six. This increase did not occur after subsequent injections, but began to decrease, and finally disappeared, whether due to the sole action of the serum or to the simultaneous action of both internal treatment and serum. 2. The action on inflammatory conditions of the articulations and of the testes, also in alleviating general conditions of pain, was quite marked, and much more prompt and effective than with other methods of treatment. 3. It causes the return of articular functions, or materially aids in the action of sodium salicylate, vesicants (isopathic method) and fibrolysin. 4. The injection is free from pain, and has produced no reaction, except in the first case, where there was an erythema seen around the site of the second injection, but unattended by pain or fever. 5. Anti-gonococcic serum has not been employed in the treatment of acute urethral blennorrhagia, nor does the writer think its use necessary in such cases. A Plea for the Improvement in the Teaching and an Encouragement in the Study of Legal Medicine. J. J. Buist (British Medical Journal, January 11, 1908) calls attention. to the weakness of the medical man as a witness in court, particularly in testifying in criminal cases. He imputes this not so much to an inherent lack of honesty or ability on the part of the medical man, but rather to defective teaching of legal medicine in the medical colleges in the British Isies. He points to the fact that this teaching is defective because there are no medical lecturers in the schools who are specially qualified to teach the subject. This is due to the peculiar method of appointment of men to the vacant chair of legal medicine in the British medical school, i. e., whenever a vacancy occurs in this chair it is filled by any one who has especially distinguished himself in medicine or surgery; not by one who has been specializing on legal medicine. He admits the scarcity of really ex perienced men in this peculiar line of work, but says that this lack of material is due to want of support on the part of the state. Secondly, these lectures are not made interesting or attractive, and little inducement is held out to the students to pay more than a cursory attention to the subject. Of course, this makes the student attend just enough lectures to have his papers signed, and, consequently, he obtains but a meager amount of information on this subject. Thirdly, the course of lectures is defective in not providing for some instruction on legal procedure, and some explanation of certain legal definitions, as well as an elementary course in the law of evidence and criminal law. Fourthly, there is no practical teaching on the subject. The writer does not mean by this the testing for poisons and ordinary microscopic work, but he means that the student should be compelled to attend cases in court, taking notes of evidence, and generally putting his medical knowledge to the test in a practical way by solving one of the problems of legal medicine. He emphasizes the importance of the practice of notetaking. If this is not cultivated, the medical witness will find that questions are asked, based upon previously-made inquiries, that he is unable to answer. Fifthly, there is a dearth of literature on this subject. It is amusing to hear lawyers talking of Taylor with the same awe and veneration which the Christian shows for the Bible or the Mohammedan for the Koran. Only at the last assizes, the writer states, in response to a quotation from this authority thrown at the witness during cross-examination, great wonderment was expressed at his daring to think that there was any other authority in legal medicine besides Taylor. The writer points to the prolific legal medical literature of France as superior to the English, and explains this abundance of information on the ground of the French Government's fostering of this branch of medicine. Sixthly, the examining boards of England slight this subject. He demonstrates that in the London University the candidate is allowed to choose the subject of public health, and that in this examination legal medicine is subsidiary to public health. He asked why should the State protect the health of the community, and not safeguard the life and liberty of the subject. It should do everything to prevent crime as well as disease. As a solution of the problem, the writer says that the state can work a great improvement by providing suitable material-let the Home Office divide the country into areas, and let it appoint medical experts to devote their entire time to the work of their districts. Let the local expert, say, in a murder case, consult with the local practitioner, be present at the utopsy, inquest, police court, and assizes, and let him report to the Home Office on the case, and advise counsel on the medical features of the case. |