bacillus coli. Subsequently nearly the whole wound opened. More or less elevation of temperature continued until the 12th day, when induration was discovered in the cul-de-sac of Douglas through the porterior vaginal vault. Free incision was made through the latter and the pus evacuated. After this the patient made an uneventful recovery. She remained in the hospital until Jan. 18th, the process of granulation in the abdominal wound being slow. At the middle of April, her family physi cian reported as follows: "I called upon Miss C. today and find her to be feeling very well indeed. She seems much better than before her first operation, and it is needless to say they are well satisfied." On the morning of Jan. 6th, 1905, Sergt. Nash, while arresting a burglar in Windsor, was shot in the neck by a 32-calibre revolver at a distance of about six inches. The bullet went through his collar and entered the neck through the sterno-mastoid, about one ince above and half an inch exterior to the right sterno-clavicular joint, in a direction backwards and slightly downwards and outwards. It did not emerge. The officer staggered and his right arm fell temporarily paralyzed. There was very little hemorrhage. In ten or fifteen minutes the wound was cleansed and dressed in campho-phemquos. No probing was done. On the 8th a decided thrill could be felt over the wound and in the line of the carotid-and outwards towards the shoulder. Jan. 8th, in consultation with Dr. McGraw, of Detroit, and Dr. Casgrain, of Windsor, it was decided that the thrill emanated from an aneur ism of the thyroid axis and should not be operated upon. The thrill by this time was very strong above the outer third of the clavicle in the position of the transverse cervical and the supracapular arteries. The thrill was not perceptible at the angle of the jaw, but the sound was very distinct. The fourth and fifth fingers of the right hand could be moved but very little. The patient was kept rigidly in bed on a very light diet and given depresents for a month. By this time, the thrill was very much less. On Feb. 20th, Dr. Hickey made an x-ray examination in order to locate the bullet. The patient being very heavily built is was impossible to take the radiograph except in an anterio-posterior position, which would not give a definite idea as to its depth. Accordingly the x-ray was taken stereoscopically. The combined negatives showed that the bullet is lodged in the deep muscles of the back just below the scapula. May 19th, Sergt. Nash is on duty every day. There is no apparent tremor the thrill is slight. There is no noise in his ear. The fingers and arm have regained considerable strength. REPORT OF CASE OF MYOCLONUS MULTIPLEX (PARAMY- By WM. J. STAPLETON, JR., M. D. Detroit. On April 21, 1905, at 2 p. m., the ambulance brought to the hospital a man who had fallen in the street in a fit. The following history was obtained. Name; weight, 180 lbs.; height, 6 ft. I in.; occupation, pugilist-ex-soldier; at present, no occupation. Further questioning showed that he had been extremely active in the athletic line, especially boxing and bag punching. Had held championship at one time in bag punching. Had served in the United States Army, 31st Regulars for eight months, seeing service in Cuba and Philippines. On Dec. 27, 1904, while lying on his back at home, his right leg became stiff and he had a convulsion-since then hardly a day passes that he does not experience one. These attacks come on without warning. There is a sudden contraction of the trunk and hip muscles, which cause the body to be alternately flexed and extended so violently that he is sometimes thrown from a chair, if he is sitting. In some of the attacks the whole body is involved. He does not become unconsciousnever bites his tongue, no vomiting or inconvenience. The spasmodic movements are bilateral. During the last seven years he has been a steady drinker, and now drinks to ward off the attacks. The pathology of this disease is unknown. Diagnosis is based upon the peculiar character of the spasm, on the fact that the trunk muscles are involved and that the spasms are bilateral. Duration is from a few months to years. Prognosis is said to be good. Treatment-tonics and chloral. Electricity and hydrotherapy are said to be beneficial. 176 Lafayette Boul. DETROIT MEDICAL JOURNAL A MONTHLY EPITOME OF PRACTICE AND THERAPEUTICS HERBERT M. RICH, M. D., Managing Editor COLLABORATORS-Frank Burr Tibbals, M. D., Augustus Wright Ives, M. D., Joseph Sill, M. D., Henry Jasper Hartz, M. D., Don M. Campbell, M. D., Preston M. Hickey, M. D., Burt Russel Shurly, M. D., Richard R. Smith, M. D., Grand Rapids. J. F. HARTZ, Business Manager. SUBSCRIPTION PRICE, $1.00 PER YEAR. SINGLE COPIES, 15 CENTS. NOTE.-W. do not assume responsibility for the opinions of contributors. The management cannot undertake to return rejected manuscript unless full postage for the purpose is submitted with the contribution. Requests for reprints should accompany manuscript. Address all communications to 103 and 105 Miami Avenue. Detroit, Michigan, U. S. A. Vol. 5. DETROIT, MICHIGAN, AUGUST, 1905. No. 5. An Opportune Epidemic. Much as we deplore the suffering and loss of life in the prevailing yellow fever epidemic of Louisiana, it seems providentially sent with a message, and if this message be properly interpreted by the medical profession, results will follow making the epidemic no unmitigated curse, The good to be accomplished may be divided into three general heads. In the first place, we are promised that the city of New Orleans shall be thoroughly cleaned. This means the saving of many lives from other diseases than yellow fever. It means another American municipality getting a lesson in public health, the only sort of lesson they ever seem to heed. A second result will be the popular appreciation of what the work of Gen. Leonard Wood and his medical associates in Cuba meant, and what the present results in Panama are. The average number of deaths per day in the Louisiana epidemic has been greater than the average per month in the Canal Zone under American control. Finally, what more forcible argument for a National Board of Health can be brought than the present "shot-gun quarantine" of Louisiana by her sister states? It deserves a place beside Lynch-law and the Vigilance Committees of horse-thief days on the frontier. It is to be hoped that the legislative committee of the American Medical Association who are presenting to Congress the need of a National Board of Health, will not fail to push home the lesson of this epidemic. We have national commissions to regulate inter-state commerce, immigration, and a host of other things. We have a whole department of the government with a Cabinet officer devoted to the care of our agriculture, making constant warfare on the parasites of our plant life. But when a human parasite, like the yellow-fever germ, begins to devastate human life the National government is powerless and each man must stand before his own home with a shot-gun, while sister states of this Union are arrayed against each other with armed troops on their borders by order of the governors of the states. It should be pointed out in this connection, also, that this sort of epidemic control is as ineffective as it is crude. because the mosquito, the real bearer of the disease, can not be kept away by a shot-gun. The Public Schools and Medicine. Of 87 school children named as "dull" in the Dundee* (England) schools, 43 showed deafness, mostly marked; 69 had visual defects; 37 had adenoids or enlarged tonsils, or both. Among other ailments found in this class were bronchitis, eczema, impetigo, tinea, adenitis, heart lesions of various kinds, chorea and rickets. Not one was physically "fit." These are not the first figures which have shown that there is usually a physical basis for the gross dullness of children in school, but they are at hand and serve to illustrate one phase of the question which is coming to the consciousness of the city of Detroit more and more each year. That is the question of the medical inspection of school. The Health board of the city have already taken the matter up and are consistently carrying it forward. But, as stated by Health Officer Kiefer in his paper before the State Medical Society at Petoskey, this is only a beginning. The inspection of schools with the idea of eliminating infectious diseases is the merest rudiment of the work in question. In spite of the great amount of discussion in recent years concerning school buildings, many of them remain altogether unfit places in which to imprison children five hours a day.. There should be a thorough physical examination of every child entering school, and at stated intervals thereafter. In one high school in this city two boys with herniæ were recently taken from a gymnasium class by a watchful principal, and one girl in the same school became livid while waving dumbbells over her head and was discovered later to have a valvular lesion of the heart. No doubt these illustrations could be duplicated by the majority of physicians in the city. In the figures quoted above, it is quite likely that very few if any of the parents of the 39 children with adenoids were aware of this condition. Why should the state not provide for the medical examination of pupils as well as for their intellectual examination? It has been objected that this savors of paternalism in government and that parents will themselves look after the health of their children. The fact remains, however, that they do not, and to oblige parents to send a child to school for mental training and pay no attention to a physical infirmity which prevents him from utilizing the opportunities provided for him is rank inconsistency and resembles offering meat to a muzzled dog. It behooves physicians to be awake in these matters. The public, as Dr. Osler so aptly expressed it a few days ago, "are waking up and sittitng on the edge of the bed," in medical matters, and they are going to hold the medical profession responsible for insisting on reforms, the need of which is made evident by our professional knowledge and 'raining. 1. Dundee Social Union. Report of Investigation into Social Conditions in Dundee. Part; Medical Inspection of School Children. J. Long & Co.. Bank Street, Dundee, 1905. Nothnagel and Miculicz. The last few weeks saw the death of two European medical professors, both of whom have been for many years particularly wellknown on this side of the Atlantic. Professor Herman Nothnagel, "Vorstand" of the first medical clinic in the General Hospital of Vienna, died in that city on July 7th. He was born in Germany in 1841 graduating from the Medical School in Berlin in 1864, and became a teacher, serving in Königsberg, Breslau and Jena. In 1882 he was appointed professor of Clinical Medicine in the University of Vienna and took the hospital position which he held at the time of his death. From this great vantage point of clinical medicine, his fame spread rapidly throughout the whole medical world. He was undoubtedly one of the most erudite medical men of this generation. While not a few clinicians have been his superiors in bedside diagnosis, few if any were his equal in general information on the subject of internal medicine. He was a great medical writer bringing together in his published works gleanings from an enormous field of reading. He had himself superintended a large amount of research work, particularly in the physiology and pathclogy of the intestines. His death will be mourned by a wide circle of friends in this country. In the death of Professor von Miculicz, of Breslau, on June 17th, surgery suffers a distinct loss. He first became known when still an assistant of Billroth, and since then his contributions to surgery have been both numerous and important. There is scarcely a field which has not been enriched by his thought and work, his name being associated with many operations and devices. More recently, the work on enhancing the resistance of the peritoneum before operations and on the use of the pneumatic cabinet for chest operations has received much attention. Born in Austria 55 years ago, he was trained under Billroth and held the chairs in surgery successively in Cracow, Königsberg and Breslau, going to the latter clinic in 1890. He was also known as an editor of marked ability and was ever a true friend of the American student. His visit to this country two years ago, will be remembered by many. Diabetes Insipidus. In connection with the paper under the above title in this number of the JOURNAL it is important to keep in mind that an hereditary form of this disease exists. A good illustration is furnished by the recent exhibition by Knöpfelmacher in Vienna* of a brother (aged 12), and sister (aged 8), who had suffered from earliest childhood with this disease. The father, grandfather, and paternal great-grandmother had been similarly affected. Out of twenty members of the family in the four generations, five had the disease. Both children were thin. The boy had a cystitis and the girl ichthyosis congenita, but no other abnormalities were shown except that each had an enormously distended bladder. The boy passed from 7 to 9 litres of urine per day and the girl 5 to 6.3 litres. Knöpfelmacher believes therapeutic measures to be of no avail so far as the fundemental condition is concerned in these congenital cases. Monotschrift Kinderh, April, 1905. |