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of slight prostatic hypertrophy, the suspicion being ocean (salt) water were found in the stomach, doubt now confirmed by rectal examination. The long-con- would then be cast upon the mode of death, as a strong tinued dysuria and necessity for the catheter were, I probability would exist that death antedated the subthink, in large measure due to the increase of this mersion. former trouble. From June 30th to July 9th the blad- Again, a purely accidental drowning would be more der was daily washed, at first with boracic solution, likely to show water in the lungs, the bronchial tubes, later with bichloride of mercury, i to 16,000. On and trachea than suicidal or intentional drowning, as July 9th the pain in the renal regions, both sides, in- one going into the water intentionally would almost creased and became severe. Up to this time it had Up to this time it had involuntarily take a deep inhalation before the plunge,

a been slight. Under the vigorous application of hot and the lungs, being filled with air, that would prevent baths and large hot poultices this subsided. On the the water entering ; while, when accidentally falling evening of the 9th Holland gin was given, a teaspoon- into water, the inhaling movement would naturally folful every two hours. Within twelve hours improve- low the shock of the immersion, and water, instead of ment in the urinary symptoms was marked, due doubt- air, would be drawn in by the inspiration. less to the juniper in the gin. The use of the catheter · Drowning, then, asphyxia by submersion, “is not was stopped on the roth. On this date the temperature owing to a certain quantity of liquid being introduced and pulse became normal.

into the alimentary or air-passages, but simply to the In the meantime the bowels had, with periods of interception of air, and of the respiratory phenomremission, gradually improved. By July roth the ab- ena ;” hence the post-mortem appearances other than dominal tenderness had largely passed away, and with those which show externally-the cold, pallid, corruit the gaseous distention, which had been present al- gated skin, with the half-open eyes, swollen tongue, most from the start. The movements had lost the partly protruded, and with the lips and nostrils covblack color, their appearance indicating simply a catar- ered with frothy mucus—would be those of suffocation rhal condition of the bowels. It is of interest to note, and consequent upon the sudden and complete suspenas showing the violent disturbance of the intestines, sion of respiration, the right side of the heart and the that for two weeks after the beginning of the attack all lungs gorged with blood, the bronchial tubes and trasolid food, which was several times tried, passed chea more or less filled with frothy mucus, and not through with hardly any appearance of digestion. The necessarily anything else. There may be water in the urine was examined during the height of the attack for lungs and the bronchiæ and the stomach, or there may albumin and sugar. Neither was found ; casts were not, the condition may be the same, and only the same not looked for. It is to be noted that this examination as if the person had been confined in nitrogen gas, or was not made till after the treatment had induced a as if the individual had been simply smothered, suffomarked increase in the amount of urine passed. I re- cated, and died from lack of oxygen, or as if he had gret that the blood was not examined.

been in a vacuum, except that there would be the After the cyanosis passed away the appearance of added symptoms caused by the removed air-pressure. the patient was that of marked anæmia, which was still pronounced at the time of my last visit, on July 14th. He was ordered to continue iron, which he had been taking for a week, and a short time after was sent to

A CASE OF OPIUM - POISONING TREATED West Baden Springs, this State, to recuperate.

BY PERMANGANATE OF POTASSIUM. During his illness the patient was seen by Dr. H. M.

By R. G. EBERT, M.D., Lash, and by Dr. Thompson, of Irvington.

In looking back over the case the things which stand out most prominently in the clinical history are,

Mrs. F-, mulatto, aged twenty-three, took an unthe violent irritation of the bowels, the equally violent known quantity of morphine solution at about 10.30 A.M. urinary disturbance, the great prostration, and the

An hour and a half later she was found by her neighbors evidences of profound alteration of the blood.

in an unconscious condition, and medical attendance was summoned. At 12.40 P.M she could not be roused; gave no response to external stimulation ; inability to

swallow ; extremities, cold; cornea, insensitive to DEATH BY DROWNING.

touch ; pupils, contracted ; pulse, weak but regular, and By N. L. NORTH, M.D.,

about seventy ; respirations, superficial, and not to exceed eight per minute. At this time no history of tak

ing or time of taking the opiate was obtainable. She In a recent case of supposed drowning doubts were was too deeply narcotized to attempt evacuation of the cast upon the cause of death because little or no water stomach by apomorphine. Treatment was one-fiftieth was found in the lungs, naturally exciting the inquiry, of a grain of sulphate of atropia and two drachms of What is the mode of death by drowning? The answer, whiskey hypodermically. By asphyxia," is not enough, as asphyxia is the result Respiration and pulse, the former slightly, the latter of the absence of air, the respiratory medium in the markedly, responded to this medication. While awaitlungs, and may result' from numerous causes, as from ing arrival of stomach-pump, heat and counter-irritants enfeebled respiratory power, torpor of the medulla ob- were applied to the extremities. longata, enfeebled action of the heart, or from various At 1.5 P.M. an additional one-fiftieth grain of atropia mechanical causes, or from inhalation of gases. So it was given ; at this time the post surgeon, Major Wilcox, would seem that water in the lungs is no necessary arrived, and at his suggestion permanganate of potash, part of the process of drowning. It is a fact, also, that which was being prepared for irrigation of stomach, was in many cases of drowning no water is found in the injected deeply into the tissues of both thighs in a conlungs, nor even in the bronchial tubes. Taylor cites centrated solution, quantity not measured, but assumed case after case of undoubted deaths by drowning in to be between one and a half and two grains of the which no water was found in the lungs, but instead salt. In less than three minutes (only time sufficient to only a frothy mucus about the lips and nostrils

. Water lay aside the hypodermic syringe and render the stommay be found in the stomach, having been swallowed ach-tube flexible) she responded to the stimulus produring the struggle ; but if the individual be stunned duced by the passage of the æsophageal tube through before falling into the water, or if in any way death had the pharynx, the first reflex obtained. A pint and a been caused previously, water would not be found in half of a strong solution of permanganate was thrown the stomach. If the person were supposed to have into the stomach, further introduction being arrested been drowned in the ocean, bay, or Sound, and no by regurgitation of the fluid, and on withdrawal of the

ASSISTANT SURGEON UNITED STATES ARMY.

BROOKLYN, N. Y.

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ADJUNCT PROFESSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA PO-YCLINIC.

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tube copious emesis followed ; the returning liquid vertebra were fractured. Crepitation could be elicited, was not wholly discolored.

Two days previous he was about to take a bath in Further active medication ceased. Coffee and nurs- small river, eighty miles from this city. He jumped ing meeting all requirements. At 1.45 P.M. conscious- in the river head first, thinking the water was deep; ness was manifested ; fifty minutes later questions were but to his misfortune struck the bottom and became answered intelligently, and the facts elicited that mor- unconscious immediately, in which state he remained phine had been taken at the time above mentioned. for about five minutes. His companions noticed the

The first injection of atropia had no perceptible in- condition he was in and carried him to the shore. fluence on the pupils; the second was so shortly fol- After regaining consciousness he was unable to move lowed by the permanganate that no time had been any part of the body, excepting the head, Pain was allowed to show its effects, if there were any, upon the felt only in the neck. The next day he was sent to the eye. An hour afterward the size of the pupil was still hospital, and when first seen he presented the symp. below normal. The good results, so rapidly and toms above stated, with these additions : Temperature, markedly obtained, are attributed by Dr. Wilcox and 103° F.; pulse, 72; labored breathing; retention of myself entirely to the permanganate.

urine and fæces; anesthesia of lower extremities, exFort HUACHUCA, Arizona Territory.

tending over the abdomen, and complete paralysis of lower extremities, bladder, and lower bowel. The arms could be raised slightly, but fingers could not be

moved. Complained of thirst, was unable to take any THE EMPLOYMENT OF PILOCARPINE IN

nourishment, and could not sleep. Bowels and blad.

der were attended to, and head fixed. THE TREATMENT OF URTICARIA.

The following three weeks he was expected to die BY AUGUSTUS A. ESHNER, M.D.,

every day, as no improvement could be noticed. Tem

perature ranged from 102° to 105° F. Pulse never I am prompted to make this report by the recommen

went over 72, but was generally about 65. Vesication dation of Abrahams,' of pilocarpine hydrochlorate in

and head-sores developed. After the third week the the treatment of acute and chronic urticaria, with a re

temperature commenced to sink, and a slight improve.

ment could be noticed daily. cital of three illustrative cases, and by the confirma

In the meantime quite a severe cystitis had develtory report of McBrayer.? A married woman, forty-three years of age, came to

oped, although every precaution had been taken in remy service at the Polyclinic several weeks ago, with a

gard to cleanliness. This, however, abated, and was history of having suffered for two months, intermittent

followed by incontinence, and it became necessary to ly, with an urticarial eruption upon the elbows, fore

keep a urinal in the bed to receive the urine, which arms, and legs, recurring for periods of two or three

came drop by drop until the twelfth week, when it

could be retained for an hour's time. In the eighth weeks at a time, at intervals of about a week. There was

week anæsthesia commenced to disappear on the right no history of the ingestion of shell-fish or other article of diet to which etiologic significance could be attached.

side, and in a short time on the left also. The paralyThe woman was constipated and complained of attacks

sis gradually disappeared in the same order. of smothering attributable to distention of the stomach.

Improvement continued, and about December 1, No heart-lesion could be detected, and the urine pre

1893, he was able to sit up in the bed, having his head sented no abnormality. Other symptoms of vasomotor

supported. About January 1st, this year, he com

menced to walk with the aid of a chair. He remained ataxia were wanting. On inquiry it was learned that

at the hospital for ten months, and his improvement a dog was kept in the family, but investigation disclosed a freedom from fleas, and no other member of

was uninterrupted. The enlargement in the neck was the household suffered as did the patient. Pills of

quite marked when discharged. Head being fixed

with appropriate dressings, the other symptoms were pilocarpine hydrochlorate, gr. 12, three times daily, were prescribed, and the woman returned in a week

treated as they appeared. Iodide of potassium in inmuch improved. Thereafter no more "hives"

creased doses was given from the sixth week, and later

ap- on electricity and massage.
peared, and four days later the woman reported that
she had not felt so well for two years.

A few days ago I had a letter from my patient, in

which he stated that he has recovered almost entirely, My employment of pilocarpine in this case was purely empirical. The drug has such a pronounced effect

and that he has been attending school ever since last

fall.
upon the circulatory and secretory activity of the skin,
and I had observed such strikingly favorable results might prove so to some fellow-practitioner

.
I

This case has been quite interesting to me, and from its systematic employment in the treatment of

erysipelas, that I was led to its use for the relief of urticaria. I fancy, too, that the drug is worthy more extended application in the domain of dermato-therapy than it has

LOOSE BODY IN THE KNEE-JOINT.
heretofore received. I should prefer its subcutaneous

BY HUGO E. WAUGELIN, M.D.,
injection when the patient is under immediate obser-
vation, but I feel safer in directing its administration
by the mouth in the case of out-patients.

MR. A. M-, a farmer, was admitted to the St. Clair County Farm in June, 1894. He was admitted as a patient with inflammatory rheumatism. He gave

a history of two years' suffering, all his trouble being FRACTURE OF THE FOURTH CERVICAL

located in the left knee-joint.

Examination of the
VERTEBRA AND RECOVERY.

knee showed it to be very much swollen and exceed-
BY CHARLES J. RINGNELL, M.D.,

ingly painful to touch, and almost immovable. Local
applications and rest in bed with the leg elevated re-

duced the symptoms very materially.
On August 3, 1893, Julius A, a farmer, aged nine- About a week after, at another examination, I found
teen, came under my care at the Deaconess Institute, what later proved to be the cause of the trouble

.
presenting all the symptoms of a “broken neck." There was a loose body floating in the joint. This
After having made a careful examination, I arrived at body was movable to almost all parts of the knee, both
the conclusion that the laminæ of the fourth cervical anterior and posterior, and could be carried about six
1 MEDICAL RECORD, September 15, 1894, P. 342,
inches above the patella. At times it would be lost

,
3 Ibid., November 3, 1894, P. 564.

and then could not be found after the most diligent

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ST. CLAIR COUNTY PHYSICIAN, BELLEVILLE, ILL.

MINNEAPOLIS, MINN.

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The top

BAY CITY, MICH.

search. I have hunted as long as an hour for it and During her recovery she had a mild attack of facial been unable to locate it. Twice I was ready to remove erysipelas, which, with the use of carbolic acid and comit and it slipped from my fingers and was lost. Fin pound tincture of iodine, equal parts, applied to and nally I located it about three inches above the patella to around the infected area, was easily controlled. the inner side of the thigh. I then passed a needle under The mastoid opening was completely healed in two it and fixed it so I could cut down on it. The incision or three days, the discharge ceasing promptly. The was about two inches long. With a pair of thin for- antrum was irrigated with dilute hydrogen dioxide, folceps I removed the body, stitched up the sac with lowed after a few weeks by potassium permanganate catgut, closed the external wound with the interrupted solution, and at the present writing, three months after stitch, and put on a dry dressing. The patient made a the operation, she is still cleansing the cavity by irrigagood recovery.

tion from below, causing the fluid to issue from the nose. This body which I removed was globular in form The secretion of pus is very small in amount, and will and about half an inch in size, covered all over with no doubt in a short time more entirely cease. little knobs which made it look very much like a black- In a series of sixteen mastoid cases, this is the second berry, only that it was perfectly white. Microscopical in which water in quantity, douched or snuffed into the examination showed it to be of bone tissue.

nose, has carried infection into the middle ear, and the How did this piece of bone get into the joint? The necessity of care in cleansing the nose cannot be too only explanation I know of, and I think probably it is strongly insisted upon. Cold water, by its action on the the correct one, is this. About two and a half years ago erectile tissues of the nose and pharynx, is more liable he had his knee caught between the wheels of a wagon, to cause swelling and retention long enough for miswhich laid him up for some time, and after that thought chief to be done, but any fluid which enters the Eustahe had rheumatism in his knee. To my way of think- chian tube after first passing over a suppurating nasal ing, it is more than likely that a piece of bone was membrane is dangerous. knocked loose and floated in the joint, causing his In this connection I have often noticed an anatomitrouble,

cal peculiarity which predisposes to the entrance of seFive months after I saw him, and he was doing all cretions into the Eustachian orifice, and so far as I have the work on a farm, and had as good use of his left examined it has been present in all my cases. knee as his right.

of the Eustachian tube, in a normal throat, protrudes from the side of the pharyngeal vault somewhat as a dormer window does from a roof, thus shedding the mucus to either side and causing it to flow down the

pharynx. A UNIQUE CASE OF COMBINED ANTRUM

But in these and some other cases, I have seen the AND MASTOID DISEASE.

opening nearly or quite flush with the side wall of the BY CHARLES H. BAKER, M.D.,

pharynx ; or even having the lower edge of the opening the most prominent, thus predisposing to the en

trance of fluids into the Eustachian tube. The following case is, I believe, unique from the occurrence simultaneously of abscess of the antrum of Highmore and of the mastoid antrum, and because the latter was the direct result of the former,

Mrs. Mary N—, fifty-eight years of age, had in PERMANGANATE OF POTASSIUM IN MORApril, 1893, what she calls hay-fever and sunstroke (?),

PHINE POISONING. which was accompanied by swelling between the eyebrows and in front of the left ear; considerable pain

BY WILLIAM E. PUTNAM, M.D., in the cheek and a profuse nasal discharge, which lasted two or three weeks. She was treated by the use of the nasal douche, prescribed by a physician, and Had I known the value of permanganate of potassium remained well until September 27, 1894.

sooner, I might have saved the lives of two men who At this time she nursed a very severe case of puer- have died from morphine poisoning in less than two peral fever, losing much sleep and becoming much ex- years. But thanks to the discovery of Dr. Moor, my hausted. While overheated, and in this condition, she third case was saved. laid down for a nap between two open windows, and Mrs. aged forty-five, took at least two ounces was awakened by severe pain in the left cheek.

of laudanum. When I was called the pupils looked This was soon followed by a thick, foul, and bad- the size of a pin's point, the hands and feet were cold, smelling discharge from the left nostril, and to relieve and the nails blue. Respiration was irregular. I sent it she again resorted to warm douches, which she con

first for my bottle of one-grain tablets of permanganate tinued a week, when one day she took cold water and of potassium. Second, for my colleague. Dr. J. R. snuffed it into the nostril from the palm of the hand. Harvey. Our diagnosis was death in thirty minutes

She was immediately seized with pain in the middle unless permanganate of potassium would save the womear on the left side, which increased until the exuda- an's life. tion forced an opening through the tympanic mem- Dr. Harvey, like Dr. C. Monroe McGuire, had no brane ; no relief followed the perforation, and the tissues faith in permanganate of potassium, simply because he behind the ear rapidly swelled. On visiting her with had never fitted the drug to the right case. the attending physician, it was decided to drill into the We dissolved fifteen one-grain tablets in four ounces mastoid and also the antrum, which was done, finding a

of water and two ounces of white wine vinegar, but we little pus in the mastoid antrum and a great deal of could not get the patient to swallow. I picked up a

in the antrum of Highmore. The opening piece of rubber hose and cut off four inches, and with into the latter was made through the socket of the first

this over

piece of pine stick I made a gag and inmolar, which was extracted for the purpose.

serted it between the jaws. I then held the nose A soft rubber drainage-tube was used, for want of a tightly and Dr. Harvey fed the woman the permangaregular antrum-tube, and the teeth adjoining the open

nate of potassium solution with a tablespoon. We gave ing being absent, it was stitched to the gum in order forty-five grains or more, and slowly our patient began that it should not be lost in the antrum or swallowed to recover. She was very low for about four days, her

mouth and throat, and I suppose stomach, were thorThe patient was a confirmed morphine eater and in oughly blackened and dry and sore from the permanthe habit of consuming large quantities of the drug. ganate of potassium.

WHITING, IND.

a

foul

pus

during sleep.

ADJUNCT PROF&SSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA PO _YCLINIC.

a

tube copious emesis followed; the returning liquid vertebra were fractured. Crepitation could be elicited. was not wholly discolored.

Two days previous he was about to take a bath in a Further active medication ceased. Coffee and nurs- small river, eighty miles from this city. He jumped ing meeting all requirements. At 1.45 P.M. conscious- in the river head first, thinking the water was deep ; ness was manifested ; fifty minutes later questions were but to his misfortune struck the bottom and became answered intelligently, and the facts elicited that mor- unconscious immediately, in which state he remained phine had been taken at the time above mentioned. for about five minutes. His companions noticed the

The first injection of atropia had no perceptible in- condition he was in and carried him to the shore. fluence on the pupils ; the second was so shortly fol- After regaining consciousness he was unable to move lowed by the permanganate that no time had been any part of the body, excepting the head, Pain was allowed to show its effects, if there were any, upon the felt only in the neck. The next day he was sent to the eye. An hour afterward the size of the pupil was still hospital, and when first seen he presented the sympbelow normal. The good results, so rapidly and

,

toms above stated, with these additions : Temperature, markedly obtained, are attributed by Dr. Wilcox and 103° F.; pulse, 72 ; labored breathing ; retention of myself entirely to the permanganate.

urine and fæces; anesthesia of lower extremities, exFort HUACHUCA, Arizona Territory.

tending over the abdomen, and complete paralysis of lower extremities, bladder, and lower bowel. , Th arms could be raised slightly, but fingers could not be moved. Complained of thirst, was unable to take any

nourishment, and could not sleep. Bowels and bladTHE EMPLOYMENT OF PILOCARPINE IN

der were attended to, and head fixed. THE TREATMENT OF URTICARIA.

The following three weeks he was expected to die BY AUGUSTUS A, ESHNER, M.D.,

every day, as no improvement could be noticed. Temperature ranged from 102° to 105° F. Pulse never

went over 72, but was generally about 65. Vesication I am prompted to make this report by the recommen

and head-sores developed. After the third week the dation of Abrahams of pilocarpine hydrochlorate in

temperature commenced to sink, and a slight improvethe treatment of acute and chronic urticaria, with a re

ment could be noticed daily. cital of three illustrative cases, and by the confirma

In the meantime quite a severe cystitis had develtory report of McBrayer.?

oped, although every precaution had been taken in reA married woman, forty-three years of age, came to

gard to cleanliness. This, however, abated, and was my service at the Polyclinic several weeks ago, with a

followed by incontinence, and it became necessary to history of having suffered for two months, intermittent

keep a urinal in the bed to receive the urine, which ly, with an urticarial eruption upon the elbows, fore

came drop by drop until the twelfth week, when it arms, and legs, recurring for periods of two or three

could be retained for an hour's time. In the eighth weeks at a time, at intervals of about a week. There was

week anæsthesia commenced to disappear on the right no history of the ingestion of shell-fish or other article

side, and in a short time on the left also. The paralyof diet to which etiologic significance could be attached.

sis gradually disappeared in the same order. The woman was constipated and complained of attacks

Improvement continued, and about December 1, of smothering attributable to distention of the stomach.

1893, he was able to sit up in the bed, having his head No heart-lesion could be detected, and the urine pre

supported. About January 1st, this year, he comsented no abnormality. Other symptoms of vasomotor

menced to walk with the aid of a chair. He remained ataxia were wanting On inquiry it was learned that

at the hospital for ten months, and his improvement a dog was kept in the family, but investigation disclosed a freedom from fleas, and no other member of quite marked when discharged.

was uninterrupted. The enlargement in the neck was

Head being fixed the household suffered as did the patient. Pills of

with appropriate dressings, the other symptoms were pilocarpine hydrochlorate, gr. 12, three times daily,

treated as they appeared. Iodide of potassium in inwere prescribed, and the woman returned in a week

creased doses was given from the sixth week, and later much improved. Thereafter no more “hives” ap

on electricity and massage. peared, and four days later the woman reported that

A few days ago I had a letter from my patient, in she had not felt so well for two years.

which he stated that he has recovered almost entirely, My employment of pilocarpine in this case was pure

and that he has been attending school ever since last ly empirical. The drug has such a pronounced effect

fall. upon the circulatory and secretory activity of the skin,

This case has been quite interesting to me, and and I had observed such strikingly favorable results

might prove so to some fellow-practitioner. from its systematic employment in the treatment of erysipelas, that I was led to its use for the relief of urticaria. I fancy, too, that the drug is worthy more extended application in the domain of dermato-therapy than it has

LOOSE BODY IN THE KNEE-JOINT. heretofore received. I should prefer its subcutaneous

BY HUGO E. WAUGELIN, M.D., injection when the patient is under immediate obser

ST. CLAIR COUNTY PHYSICIAN, BELLEVILLE, ILL. vation, but I feel safer in directing its administration by the mouth in the case of out-patients.

MR. A. M-, a farmer, was admitted to the St. Clair County Farm in June, 1894. He was admitted as a patient with inflammatory rheumatism. He gave

a history of two years' suffering, all his trouble being FRACTURE OF THE FOURTH CERVICAL located in the left knee-joint. Examination of the VERTEBRA AND RECOVERY.

knee showed it to be very much swollen and exceed: BY CHARLES J. RINGNELL, M.D.,

ingly painful to touch, and almost immovable. Local applications and rest in bed with the leg elevated re

duced the symptoms very materially. On August 3, 1893, Julius A—, a farmer, aged nine- About a week after, at another examination, I found teen, came under my care at the Deaconess Institute, what later proved to be the cause of the trouble. presenting all the symptoms of a “broken neck." There was a loose body floating in the joint. This After having made a careful examination, I arrived at body was movable to almost all parts of the knee, both the conclusion that the laminæ of the fourth cervical anterior and posterior, and could be carried about six MEDICAL RECORD, September 15, 1894, p. 342.

inches above the patella.

At times it would be lost, ? Ibid., November 3. 1894, p. 564.

and then could not be found after the most diligent

MINNEAPOLIS, MINN.

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BAY CITY, MICH.

search. I have hunted as long as an hour for it and During her recovery she had a mild attack of facial
been unable to locate it. Twice I was ready to remove erysipelas, which, with the use of carbolic acid and com-
it and it slipped from my fingers and was lost. Fi- pound tincture of iodine, equal parts, applied to and
nally I located it about three inches above the patella to around the infected area, was easily controlled.
the inner side of the thigh. I then passed a needle under The mastoid opening was completely healed in two
it and fixed it so I could cut down on it. The incision or three days, the discharge ceasing promptly. The
was about two inches long. With a pair of thin for- antrum was irrigated with dilute hydrogen dioxide, fol-
ceps I removed the body, stitched up the sac with lowed after a few weeks by potassium permanganate
catgut, closed the external wound with the interrupted solution, and at the present writing, three months after
stitch, and put on a dry dressing. The patient made a the operation, she is still cleansing the cavity by irriga-
good recovery.

tion from below, causing the fluid to issue from the nose.
This body which I removed was globular in form The secretion of pus is very small in amount, and will
and about half an inch in size, covered all over with no doubt in a short time more entirely cease.
little knobs which made it look very much like a black- In a series of sixteen mastoid cases, this is the second
berry, only that it was perfectly white. Microscopical in which water in quantity, douched or snuffed into the
examination showed it to be of bone tissue.

nose, has carried infection into the middle ear, and the How did this piece of bone get into the joint? The necessity of care in cleansing the nose cannot be too only explanation I know of, and I think probably it is strongly insisted upon.

strongly insisted upon. Cold water, by its action on the the correct one, is this. About two and a half years ago erectile tissues of the nose and pharynx, is more liable he had his knee caught between the wheels of a wagon, to cause swelling and retention long enough for miswhich laid him up for some time, and after that thought chief to be done, but any fluid which enters the Eustahe had rheumatism in his knee.' To my way of think- chian tube after first passing over a suppurating nasal ing, it is more than likely that a piece of bone was membrane is dangerous. knocked loose and floated in the joint, causing his In this connection I have often noticed an anatomitrouble.

cal peculiarity which predisposes to the entrance of seFive months after I saw him, and he was doing all cretions into the Eustachian orifice, and so far as I have the work on a farm, and had as good use of his left examined it has been present in all my cases. The top knee as his right.

of the Eustachian tube, in a normal throat, protrudes
from the side of the pharyngeal vault somewhat as a
dormer window does from a roof, thus shedding the mu-
cus to either side and causing it to flow down the

pharynx. A UNIQUE CASE OF COMBINED ANTRUM

But in these and some other cases, I have seen the
AND MASTOID DISEASE.

opening nearly or quite flush with the side wall of the
BY CHARLES H. BAKER, M.D.,

pharynx ; or even having the lower edge of the open-
ing the most prominent, thus predisposing to the en-

trance of Auids into the Eustachian tube.
The following case is, I believe, unique from the occur-
rence simultaneously of abscess of the antrum of High-
more and of the mastoid antrum, and because the latter
was the direct result of the former.
Mrs. Mary N-, fifty-eight years of age, had in

PERMANGANATE OF POTASSIUM IN MORApril, 1893, what she calls hay-fever and sunstroke (?),

PHINE POISONING, which was accompanied by swelling between the eyebrows and in front of the left ear; considerable pain

BY WILLIAM E. PUTNAM, M.D., in the cheek and a profuse nasal discharge, which lasted two or three weeks. She was treated by the use of the nasal douche, prescribed by a physician, and Had I known the value of permanganate of potassium remained well until September 27, 1894.

sooner, I might have saved the lives of two men who At this time she nursed a very severe case of puer- have died from morphine poisoning in less than two peral fever, losing much sleep and becoming much ex- years.

But thanks to the discovery of Dr. Moor, my hausted. While overheated, and in this condition, she third case was saved. laid down for a nap between two open windows, and Mrs. —-, aged forty-five, took at least two ounces was awakened by severe pain in the left cheek.

of laudanum. When I was called the pupils looked This was soon followed by a thick, foul, and bad- the size of a pin's point, the hands and feet were cold, smelling discharge from the left nostril, and to relieve and the nails blue. Respiration was irregular. I sent it she again resorted to warm douches, which she con- first for my bottle of one-grain tablets of permanganate tinued a week, when one day she took cold water and of potassium. Second, for my colleague. Dr. J. R. snuffed it into the nostril from the palm of the hand. Harvey. Our diagnosis was death in thirty minutes

She was immediately seized with pain in the middle unless permanganate of potassium would save the wom-
ear on the left side, which increased until the exuda- an's life.
țion forced an opening through the tympanic mem- Dr. Harvey, like Dr. C. Monroe McGuire, had no
brane ; no relief followed the perforation, and the tissues faith in permanganate of potassium, simply because he
behind the ear rapidly swelled. On visiting her with had never fitted the drug to the right case.
the attending physician, it was decided to drill into the We dissolved fifteen one-grain tablets in four ounces
mastoid and also the antrum, which was done, finding a of water and two ounces of white wine vinegar, but we
pus in the mastoid antrum and a great deal of could not get the patient to swallow.

I picked up a foul pus in the antrum of Highmore. The opening piece of rubber hose and cut off four inches, and with into the latter was made through the socket of the first this over a piece of pine stick I made a gag and inmolar, which was extracted for the purpose.

serted it between the jaws. I then held the nose A soft rubber drainage-tube was used, for want of a tightly and Dr. Harvey fed the woman the permangaregular antrum-tube, and the teeth adjoining the open- nate of potassium solution with a tablespoon. We gave ing being absent, it was stitched to the gum in order forty-five grains or more, and slowly our patient began that it should not be lost in the antrum or swallowed to recover. She was very low for about four days, her

mouth and throat, and I suppose stomach, were thorThe patient was a confirmed morphine eater and in oughly blackened and dry and sore from the permanthe habit of consuming large quantities of the drug. ganate of potassium.

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