PEDIATRICS.

BY ARTHUR DAVID HOLMES, M. D., C. M., DETROIT, MICHIGAN.

PROFESSOR OF PEDIATRICS IN THE MICHIGAN COLLEGE OF MEDICINE AND surgery.

ACUTE GASTROENTERITIS.

ACCORDING to Hutinel (Interstate Medical Journal. September, 1903) there are three therapeutic indications for the treatment of acute gastroenteritis occurring in infants: (1) remove the source of the poisons which form in the intestine; (2) prevent the pathogenic germs in the intestinal tract from finding a favorable culture medium; (3) restore to the body the water it has lost. All these conditions can best be met by the withdrawal of all food and the administration of sterile water alone. If there is much vomiting the water should be given cold; if there is algidity it should be given hot, and in cases wherein gastric lavage is indicated and thrush is present a mild alkali may be added to the lavage water. The author relies upon small doses of calomel and castor oil for intestinal antisepsis. Colonic flushings with normal salt solution are often valuable and when there is a tendency to collapse hypodermoclysis of salt solution should be given and the return to food should be very gradual.

OPHTHALMOLOGY.

BY WALTER ROBERT PARKER, B. S., M. D., DETROIT, MICHIGAN.

CLINICAL ASSISTANT IN OPHTHALMOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

THE OPERATIVE TREATMENT OF GONORRHEAL
ULCERATION OF THE CORNEA.

GOLDZREHER (Bericht der Paster Med. Chirurg Presse) reports two cases of gonorrheal ulceration of the cornea which went on to perforation treated by covering the wound with conjunctival flap. The upper portion of the conjunctiva was dissected away up to the fornix, threads passed in and then this flap brought over the ulcerating area and secured. The cases were similar except in one case the flap was taken from above, in the other from below. The result in both cases was good. He advises not to wait for perforation but as soon as it looks as though perforation were imminent the plastic operation should be done.

CAUSES AND PROGNOSIS OF SUDDEN BLINDNESS. GEORGE W. VAN BENSCHOTEN, Providence (Providence Medical Journal, July, 1903), enumerates the following affections: Embolism of the central artery of the retina, or thrombosis of a vein. Blindness comes on instantaneously, is almost invariably macular, and if the embolism is complete, is absolute. If only one of the branches of the artery is occluded, the complete loss of vision is only momentary. Upon

examination an anemic retina is found with small and empty arteries. The veins are lessened in calibre, and the blood stream stationary in peripheral vessels. The nerve head is pale. Thrombosis of the veins present opposite appearances.

Hemorrhage into the retina and vitreous is the most frequent cause of sudden partial loss of vision. The latter varies with the size and location of the clot. In small hemorrhages rapid improvement may follow complete blindness. Violent physical exertion is the usual cause, and weakened blood-vessels (atheroma, Bright's disease, et cetera) the predisposing factor. Diffuse haziness of the vitreous offers a worse prognosis than small hemorrhages with a clear one.

Copious loss of blood may cause sudden blindness which not infrequently presists. The prognosis is better when the blindness comes on at once than when several hours or days intervene. In the latter case optic atrophy is common.

Uremia is a cause of blindness that is usually binocular. The vitreous may appear normal while retinal hemorrhage and other signs of albuminuric disease appears.

Spasms of the retinal vessels with blanching (commotio) of the retina causes sudden blindness, which is nonocular, traumatic, not complete, and followed by prompt restoration of sight in a few minutes or hours.

Detachment of the retina or further detachment of an already loosened retina may cause sudden blindness.

Sudden blindness from hysteria is rare. It usually develops gradually with a concentric, progressive narrowing of the visual field.

Sudden blindness occuring during the course of an acute infectious disease is rare and may usually be traced to uremia or nephritis. Possibly it is sometimes due to the administration of drugs.

LARYNGOLOGY.

BY WILLIS SIDNEY ANDERSON, M. D., Detroit, MICHIGAN.

ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE DETROIT COLLEGE OF MEDICINE

CICATRICIAL DEFORMITIES IN THE RESPIRATORY TRACT DUE TO CAUSES OTHER THAN SYPHILIS AND TRAUMATISM.

G. HUDSON MAKUEN (Laryngoscope, October, 1903) has made a study of the causes, and briefly gives the statistical results obtained from about three hundred laryngologists to whom he wrote. were four hundred forty-nine cases reported. The nostrils were involved three hundred forty-seven times, the pharynx was involved. eighty-seven, the larynx fourteen, and the trachea one.

Thus we find that three hundred observers have seen four hundred forty-nine cases of cicatricial deformities in the respiratory tract that appear not to be due to syphilis or traumatism, and that sixteen per cent of these were caused by diphtheria, eight per cent by scarlatina,

three per cent by lupus, one six-tenths per cent by tuberculosis, one five-tenths per cent by scarlet fever and diphtheria combined, one onetenth per cent by typhoid fever, five-tenths per cent by measles. Other causes in the nostrils are membranous rhinitis, catarrhal erosion, smallpox, scleroma, septal abscess, erysipelas and pemphigus.

TUBERCULAR LARYNGITIS DURING PREGNANCY AND

LABOR.

N. GODSKESEN (Archiv, für Laryngologie, Band XIV, Heft 2) gives a brief history of forty-eight cases gathered from various sources. According to the author this affection is not very uncommon and is very fatal both to the mother and child. Abortion is advised if seen early, or if actively progressing. Late in pregnancy a high tracheotomy is advised. Local treatment should be mild and such as is calculated to allay the patient's suffering.

NEUROLOGY.

BY DAVID INGLIS, M. D., DETROIT, MICHIGAN.

PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE DETROIT COLLEGE OF MEDICINE.

RECENT SUGGESTIONS REGARDING REFLEX NEUROSES THE reflex nervous and mental affections set up by irritation in the female genital organs have been made prominent, of late years, by our friends the gynecological surgeons. A good thing, even if it is overdone, once in a while.

Probably not enough attention is habitually given to similar conditions in the male. This may, in part, be due to the resolute determination which men show, to keep their apparatus, even if somewhat damaged. Nevertheless the reflex processes are alike in both sexes and we cannot afford to overlook them.

Sanger Brown, in the American Journal of the Medical Sciences, January, 1904, in an article on the "Medicolegal Aspect of Chronic Delusional Insanity," details an unmistakable case of this form of mental defect. While legal proceedings were pending a large and painful hemorrhoid was removed. Patient had been afflicted with piles, more or less, for years. On recovering from the anesthesia his delusions had vanished and up to the present time have never reappeared. Verbum sat.

Ravogli, of Cincinnati, publishes, in the Medical News, of December 26, 1903, an article on the "Reflex Eruptions of the Skin from. Morbid Alterations in the Male Urethra." The article is valuable within its own limits, but is also valuable for its suggestions. He says, first, in regard to relapsing herpes of the pudenda, "Gradually I have adopted the system of making a thorough examination of the urethra and from a large number of patients, who have applied for treatment

of herpes progenitalis, I have found in every case a condition of chronic posterior urethritis with all its complications." Of more practical importance is his discussion of pruritus of the anus, perineum and

scrotum.

That some of these cases are simply eczema, to be regarded just as a localized eczema is regarded on any other part of the body, is true, but the marvelous obstinacy of some of these cases makes the argument of Ravogli worth careful attention. He claims that, in many cases, the cause of the pruritus lies in a chronic irritation of the posterior urethra or in the prostate, and that until this is cured all local remedies fail to cure only alleviate.

The suggestiveness of the paper goes further than the points noted. It means that a chronic irritation of some internal membrane may, by reflex action, make iteslf manifest by an obstinate skin affection. A red-nosed toper can generally be relied on to have a well-established chronic pharyngitis often a laryngitis. If he desires to be rid of his visible annoyance the cure of his pharyngitis is necessary. Similarly the reflex skin affections starting from the stomach are examples in point. These things are not wholly new but we are liable to overlook internal causes of external conditions.

THERAPEUTICS.

BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.

LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.

SOME PRINCIPLES ON WHICH IS BASED THE THERAPEUTICS OF ELECTRICITY IN NERVOUS DISEASES.

ALPHONSO D. ROCKWELL., M. D. (The Journal of Advanced Therapeutics, November, 1903) presents an article on the above subject which is interesting and instructive. He begins by saying that in his opinion. diseases of the nervous system, whether functional or organic, receive more benefit from a treatment employing physical methods, aided by climate and diet, than they do from a treatment essentially of drugs.

He asks why it is that so many are disappointed in the results obtained from the use of electricity in cases wherein the treatment ought to be efficacious? He then proceeds to give the reasons for the condition of affairs implied in his question. These he says are three in number:

(1) Ignorance of the physics and physiology of the method employed.

(2) Imperfect technique.

(3) Failure to appreciate the differential indications for the use of the various modalities.

Knowledge of the indications for the use of the different electric modalities (static electricity, high frequency currents, et cetera), Doctor Rockwell thinks, is the most difficult as well as the most neglected part of the art of electrotherapeutics. On account of this belief he devotes

his paper to a consideration of certain abnormal conditions and the kind of electricity (modality) that is best adapted to the treatment of each.

Theoretically, he says, when with the galvanic current it is desired to diminish local nervous excitability it is proper to apply the anode to the sensitive part, thus producing a condition of anelectrotonus. To produce a contrary effect the cathode should be applied in the same manner. That is, this is the theoretical procedure derived from experiments on exposed nerves. In therapeutic application, however, a different result is often obtained, for it is found in the use of galvanic currents that the positive pole is more sedative in its effects than the negative in certain cases of which those presenting so-called pseudoneuralgias are the most

common.

The chief distinction made by Doctor Rockwell between true and false neuralgia is that the latter is relieved by pressure, while the former is made worse by this treatment. Also in pseudoneuralgia it often happens that the induced current will afford relief when the continuous fails utterly.

Doctor Rockwell says that one reason why electricity relieves pain is because it stimulates vasomotor activity. Pain, he says, is due to nerve pressure, and pressure is lessened when blood is made to flow more freely through a congested part. He speaks of the effect as a sort of circulatory drainage.

In the treatment of spasmodic conditions, combined electrization, or galvanofaradization, gives the best results. This double action, however, is greatly inferior to that of a single current in relieving pain.

Continuing, Doctor Rockwell says: "Let us seek an explanation for the very positive benefits so often obtained through physical and psychical methods in such functional nervous diseases as neurasthenia and those conditions of mental disturbance that have not yet crossed the border line separating them from actual insanity."

After a description of the theory that the units of nerve structure, called neurons, are in relation to each other by contiguity rather than by continuity, and that under certain circumstances these units may contract and by so doing break connections in the nerve itself so as to interfere with the conductivity of the nerve. Doctor Rockwell says:

"The powerful influence of strong emotional excitation in dissipating certain functional nervous symptoms has long been recognized. It is believed that these purely emotional neuromotor excitations accomplish these therapeutic results by overcoming the nonconductibility of the resistant neuron. In the same way, it seenis rational to believe that when a patient is placed within a field of influence of currents of high frequency, or is subjected to such influences as central galvanization, or the static wave current, the resultant effect over sensory, motor and mental symptoms is due to the power of these electric impulses to so reinvigorate the potential energy of the cell life as to open up new paths for the transmission of the nervous current. It is immaterial that the electric impulses that set in motion and regulate the wheels of industry be transmitted by any special route. The essential thing is the fact of their