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at once. If the growths are small, soft and pliable and can be treated locally with sprays, internal medication, et cetera, these may suffice, but if the growths are large and hyperplastic operative measures will be necessary. The good results of the operation will be noticeable in a week or ten days and the improvement is sometimes surprising. As soon as the nasopharynx is healed, treatment of the ear should be inaugurated if any abnormality exists.

FEEDING BABIES. W. M. HARTSHORN, M. D. (Medical Record, June 27, 1903) says that in the past four months it has been his practice to give all babies seven months and over in age, whose digestion seemed able to stand extra feeding, whether they were artificially fed or nursed, some stronger food. Bread and milk, flaked rice, oatmeal gruel, farina anci cream of wheat were tried, but the most satisfactory results were obtained from bread and milk, especially prepared from stale bread, twenty-four to forty-eight hours old, by being soaked in boiling water until thoroughly softened. The water was then poured off and a cup of milk added. This was boiled for three or four minutes and then cooled and sweetened. From the marked change obtained in the general appearance of the weight charts, he concludes that in addition to the other cereals, bread and milk properly prepared, is a most valuable supplementary food.

THE SIMULATION OF APPENDICITIS. J. P. CROZER GRIFFITH, M. D. (Journal of the American Medica! Association, August 29, 1903) calls attention to the simulation of appendicitis or peritonitis by pulmonary processes, especially pneumonia and pleurisy occurring in early life, at which time confusion is most likely to happen. He reports several cases and reviews the general observations of different writers, and there is evident a decided uniformity in most of the statements.

There is, namely, especially in early life, a well-recognized, longknown, but frequently forgotten, tendency for patients with pneumonia or pleurisy to refer to the abdomen the pain really produced in the chest. This is more liable to happen when the disease is situated in the lower part of the thorax, but there is reason to believe that it may also occur when it has attacked the upper portion. It is also more deceptive when the right side of the thorax is affected, since the right side of the abdomen is then liable to exhibit pain and the presence of appendicitis is sug. gested. Combined with the abdominal pain in these cases, there is also constipation, abdominal tenderness and distension. These symptoms, together with the vomiting, which quite commonly ushers in an attack of pneumonia in childhood, easily produce a clinical picture very closely simulating that of appendicitis. The distinction is made by(1) the sudden rise of temperature to 103° Fahrenheit or thereabouts, and the tendency to maintain this degree; (2) the acceleration of respiration, which is out of proportion to the pulse rate or the pyrexia; (3) the relaxation of the abdominal walls between the respirations; (4) the diminution or disappearance of tenderness on deep pressure with the flat of the hand; (5) the possible presence of cough. Finally, no operation for appendicitis should be performed until after a careful or perhaps repeated examination of the lungs has been made. All these points will, however, sometimes fail to make the diagnosis certain.

THE CONVULSIONS OF CHILDHOOD. EUSTACE SMITH (Lancet, January 24, 1903) says that the reflex convulsions in infancy, due to teething, intestinal irritations, et cetera, arte well known, but similar convulsions in later childhood are not so generally recognized and are too commonly treated as epilepsy from lack of careful consideration. These reflex convulsions of older children are most often seen in children of neurotic families and in individuals with poor circulation. The convulsions are usually preceded by signs of illhealth. Gastrointestinal irritations are usually explanatory of these attacks, but other forms of local irritation may produce them, among which are hard scybalous masses in an already inflamed bowel, the eye strain of hypermetropia or astigmatism, et cetera, and children with adenoids are especially likely to be affected.

NURSING THE INFANT. Doctor E. V. Davis, of Chicago, in a paper read before the American Medical Association, May 8, 1903, at New Orleans, said that the early application of the infant to the breast causes the milk supply to increase more gradually, and advised that the infant be nursed every six hours on the first day, every four hours on the second day, every three hours on the third day, and after that at two hour intervals. Uncomfortable turgescence of the breast could be prevented by having the mother wear during the puerperium a snugly-fitting canton flannel breast binder. The doctor also reported five exceptional cases where the infants were not properly nursed by their mother's milk through some idiosyncrasy. In these cases artificial feeding proved more satisfactory.

THE TREATMENT OF SCARLET FEVER. H. M. McCLANAHAN (Journal of the American Medical Association, July 4, 1903) sums up the treatment of scarlet fever as follows: Keep all cases of scarlet fever in bed during the entire course of the disease and on a fluid diet for four weeks. A spray or gargle of some mild antiseptic should be employed together with hydrotherapy for the control of the temperature. Of the antipyretic drugs to be administered salicylate of sodium is to be preferred. Chloral hydrate should be given to quiet the restlessness, guarded by digitalis if necessary. In septic cases irrigation of the nose and throat with warm normal saline solution is required, and resort should be had to stimulation. For the itching of the skin he employs a one per cent solution of carbolic acid, and advises the use of inunctions, as they hasten desquamation and limit the spread of the infection. When cervical adenitis develops it should be treated by the local application of belladonna ointment with or without the ice poultice. Stimulating diuretics should be avoided.




OCULISTIC PRACTICE. PROFESSOR L. KONIGSTEIN (Wiener Medizinische Presse, February 15, and April 15, 1903), after speaking of the use of cocain and adrenalin, takes up the use of dionin.

In the beginning he used it in powder form. Immediately after the application the eyes begin to burn and tear, the margin of the lids become swollen and edematous, the conjunctiva is red, the blood vessels injected and the cornea begins to shine. The swelling is not localized only in the lids, but it extends also to the skin of the forehead, to the lids of the other eye and down the skin of the cheek. The conjunctiva forms a chemotic wall around the cornea and protrudes from the palpebral fissure. The pupil is not affected. The duration of this stage varies from two to twenty-four hours, and depends upon the strength of the drug used, and upon the susceptibility of the individual; in old, weak, cachectic or lymphatic individuals the reaction is stronger. The second or third application of the drug has a less irritating effect, as the eye becomes addicted to the drug, and after a while the drug ceases to irritate the eye at all.

The writer uses this drug in all forms of keratitis ; in some cases with excellent results, especially in keratitis parenchymatosa at the beginning of the affection. In old patients the drug has no effect at all. In phlyctenular affections the effect varies. In diseases of the conjunctiva it is contraindicated. In iritis the results were good, as not only did it stop the pain, but also shortened the course of the process. It is very efficacious in glaucoma hemorrhagicum. Many authors obtained good results with dionin in chorioiditis, in retinal hemorrhages and opacities of the vitreous. In cataract operations it facilitates the absorption of the lens residue, especially in cases of extraction of the lens for high degree of myopia. It has one disadvantage and that is by causing frequent sneezing, in some individuals, it might cause rupture of the wound.

R. Mengelburg (Wochenschrift fur Therapie and Hygiene des Auges, Number XXXII, 1903). The author lays stress upon a fact hitherto unknown, namely, that a combination of adrenalin and atropin is apt to produce symptoms of atropin poisoning, even in small quantities. In several cases in which this fact was demonstrated there was no idiosyncrasy for atropin, for it was quite well borne when not combined with adrenalin. He explains the result as follows: Through adrenalin the vessels of the mucous membrane of the canaliculus are much contracted and thereby the mucous membrane is made much thinner and the canal more patent, and in this way a bigger opening is made through which the atropin can pass into the tear duct and from thence into the nose. He advises great caution in the use of these two products together.



CONGENITAL INSPIRATORY STRIDOR. D. Crosby GREENE, Junior (Boston Medical and Surgical Journal, June 11, 1903) reports five cases brought to the Boston Children's Hospital in three years suffering from stridor. In one case reported the stridor entirely disappeared when the child was a year and a half old. One, died of pneumonia, aged six months. Another developed bony rickets and deformity of the chest, and at the age of six months still had the stridor. Of the remaining two one still has the stridor at the age of fifteen months, while the other outgrew it when about a year old.

A CASE OF LIPOMA OF THE TONSIL. CLEMENT F. THEISEN (The Laryngoscope, August, 1903) reports a case in a girl aged eight years. The tumor was about the size of a small marble, which was attached to the center of the right tonsil by a rather long, thin pedicle. The growth was perfectly round and smooth and of a yellowish color. The tumor was removed by excising the pedicle as close to the tonsil as possible. A microscopic examination showed it to be a lipoma. A review of the cases reported by various observers is given.


FRIEDRICH HANZEL (Archiv. fur Laryngologie und Rhinologie, Volume XIV, Number I, 1903) gives a history of a woman, aged fifty years, who for twenty years had had interference with speech. Examination revealed a tumor at the base of the tongue, which filled the isthmus of the fauces and was approximately the size of a small apple. Histological examination showed it to originate from the remains of the ductus lingualis, the duct which in the embryo runs from the thyroid gland to the foramen cecum at the base of the tongue.


THE TREATMENT. W. FREUDENTHALL (Annals of Otology, Rhinology and Laryngology, June, 1903), in an exhaustive review of the subject, draws the following conclusions:

(1) Ozena is an atrophy of the nasal interior, which is conditioned by atmospheric influences-xerasia.

(2) The bones of the turbinated bodies appear to be affected at an early stage of the disease.

(3) The effects of lack of humidity in the air are apparent in ail parts-

(a) of the nasal interior, including diseases which were formerly looked upon from a different point of view, as for example, ulcus septi nasi perforans, the rhinitis atrophica anterior, some forms of epistaxis, et cetera.

(b) Neighboring parts of the body (scalp, ears, lips, teeth). (c) Probably also in distant organs.

(4) In order to convert this atrophy into ozena, the plentiful invasion of a bacillus, similar to Friedlander's pneumobacilli, is necessary.

(5) This invasion occurs in an early period of life, and is caused, perhaps in some cases, by direct transmission from the vulva.

(6) Accessory sinus disease often appears as secondary to ozena.

(7) After all has been said, ozena is to be considered as a genuinc and autochthonous disease, resulting from atrophy of the nasal interior.


MENT OF THE CERVICAL GLANDS. WILLIAM L. CULBERT (Annals of Otology, Rhinology and Laryngology, June, 1903) reports two interesting cases. The case of septal abscess occurred in a male, aged thirty-one, who contracted a severe cold followed by chills, fever, sweats, and on the fifth day a temperature of 104° and a pulse of 132. Both nostrils were occluded by the abscess. After the evacuation of the pus by incision the symptoms were quickly relieved.

The case of abscess of the epiglottis occurred in a male, aged thirtyfour, who complained of pain on deglutition, difficulty in breathing, thick and difficult speech and a sense of swelling in the throat. There was no specific history. Examination showed enlargement of the lymphatic glands of the neck and a mass at the base of the epiglottis. Relief was promptly given by the evacuation of the pus.

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