A Case of Mastoiditis Acutissima.

By EDWARD J. BERNSTEIN, M. D., Kalamazoo.

I am indebted for the choice of this name, to an article by Dr. Emil Amberg in the Medical Record, April 15, '05; it seems to fit a condition fortunately rare, but of very serious import.

The history of the following case portrays one that I have never seen before nor do I know of one just like it.

On Oct. 26th, at noon, I was asked by Dr. J. T. Grace to see Mr. E. R., aged 33. The man went to work on the morning of the 25th, but quit at noon feeling weak and feverish with some little chilly sensation, which he ascribed to having "caught cold." He went home, used a nasal douche, took some purgative, etc. Along about 4 in the afternoon, feeling very much worse, he sent for his doctor. Up to this point there was no intimation of any implication of the ears. His temperature was 99.4, pulse rapid, no special symptoms of any note. Was given acetanilid and quinin. Diagnosis of grippe was made.

Very early next morning, Dr. G. was sent for as the man had passed a very uncomfortable night and then had some pain in his ear, pulse rapid and temp. 98.4., resp. irregular and somewhat slowed. Hot applications were ordered to be kept on the ear, salines and other appropriate treatment given. At noon, I was asked to see him in consultation. This was 24 hours after onset of malady.

I found a rather spare man fairly well nourished, lying on his back, head slightly retracted, more or less mental obtundity, breathing irregularly and not more than nine per minute, temp. 97.8, pulse irregular-at times 92, then again up to 110 and rather dicrotic in nature. He had considerable pain in his left ear. He could be aroused, but only with some effort, there were jerking movements of the forearm, but the doctor thought this was rather an old condition. When I saw him there was no bulging of the mastoid nor was pain elicited on rather deep pressure. I am told that there had been a little bulging over the mastoid, but this I did not see when I came. The external auditory canal and tympanum were very deeply inflamed and the upper posterior wall of the canal was slightly bulging. The tympanum bulged, but the striking thing was the intensity of the color. I made a complete section of the posterior segment of the drum and continued the incision well in the wall of the canal. No pus was obtained, only a little serous discharge but the relief was instantaneous and marked. He demanded a glass of water and sat up in bed to drink it. Seeing how very serious his condition had been I also opened his right tympanum for a slight redness with no bulging, considering it less dangerous to do this than to run the danger of having it involved in this process when we could not be gotten very easily.

Ice packs to the head and warm bichloride irrigations for the ear were ordered. I left with the inward assurance that this was a case saved by prompt action. His improved condition was maintained till 2 a. m. next morning, when he suddenly became comatose, respiration became more irregular and went down to four, and from this up to eight or nine. The doctor who happened to be with him thought he might die at any moment, and that it was useless to do anything further. Indeed I can not imagine any one to have had the hardihood to suggest any further interference under the circumstances-nor can I imagine what could have been suggested. When I saw him, later in the morning it looked as if he might die at any minute, but when the doctor told me that he had been in practically the same condition eight or ten hours, I suggested, that if he continued to hold out till afternoon or showed the slightest sign of amelioration, that I would do a mastoid operation if we got the family to understand and, give in writing that they understoodthe desperate chances we were taking--merely as a last chance and not with any fixed hope of help. However, he did not rally at all and died late in the afternoon. The unique feature of this case was the rapidity of the onset of acute leptomeningitis and its rapidly fatal ending.

Both Gowers and Oppenheim, in speaking of the rapidity of a fatal termination, speak of from 48 hours to two weeks for this to occur from this history it seems that meningitis commenced but 36 hours before death, the whole illness did not last over 60 hours.

m. m.

The headache was not of a severe type, though it was marked. There was no optic neuritis nor any involvement of the eye muscle. Pupils fairly even at 221⁄2 We unfortunately did not think of lumbar puncture at a time when it might have availed. Whether a mastoid opening might have proved useful is another problem. I feel rather fortunate that we did not do this, for it would hardly have availed and might have prevented our gaining consent in a better case.

SURGERY:

DETROIT MEDICAL JOURNAL

A MONTHLY EPITOME OF PRACTICE AND THERAPEUTICS

HERBERT M. RICH, M. D., EDITOR
CARL S. OAKMAN, M. D., AssoCIATE EDITOR

Frank Burr Tibbals, M. D.

EYE AND EAR:

Don M. Campbell, M. D.

COLLABORATORS:

NOSE, THROAT AND CHEST :
Henry Jasper Hartz, M. D.,
Burt Russell Shurly, M. D.
ORTHOPEDIC SURGERY:

William E. Blodgett, M. D.

INTERNAL MEDICINE:

Victor C. Vaughan, Jr., M. D.

LABORATORY MEDICINE:
Joseph Sill, M. D.

RADIOGRAPHY:

Preston M. Hickey, M. D.

NERVOUS DISEASES:

A. W. Ives, M. D.

GYNECOLOGY AND OBSTETRICS :

Richard R. Smith, M. D., Grand
Rapids.

PUBLIC HEALTH:

Guy L. Kiefer, M. D.

J. F. HARTZ, BUSINESS MANAGER

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Address all communications to 103-105 Miami Avenue. Detroit, Michigan, U. S. A.

Vol. 6.

DETROIT, MICHIGAN, FEBRUARY, 1906.

A New Editor.

No. 2.

We congratulate the Michigan State Medical Society on securing the services of so able a man as Dr. Benjamin R. Schenck, of Detroit, as editor of its journal. Dr. Schenck is admirably fitted for the position and may be relied on to conduct their organ in a manner every way worthy of the Society.

A Correction.

We regret that in commenting editorially last month on the annual report of the Detroit Board of Health, an error was made. In citing the marked reduction of the number of cases of various infectious diseases, the word deaths was unintentionally substituted for cases. The matter is an important one, hence we hasten to make the correction.

The Directory of the American Medical Association.

The practicing ranks of the medical profession have hardly been able as yet to appreciate the great importance of the work recently undertaken by the American Medical Association, in connection with the publication of the National Medical Directory. The volume itself promises to be of great usefulness, but the preliminary work of assembling and verifying the information is of much greater importance. This involves nothing less than the creation of a biographical card index of every man

in the United States and Canada qualified to practice medicine. This will be kept corrected up to date by an elaborate system of correspondents. The Bureau having control of this index will, then, constitute a national clearing house of information concerning the individual members of the medical profession. Moreover, the information therein contained will be authentic. A physician's statement will be accepted in regard to his own age and a few other minor points, but the essential facts of his graduation, qualifications and practice, etc., will be verified from official sources. The boards of medical registration in all the states and territories are co-operating in this work in a way never before attempted.

It will be readily seen that this work of securing lists of practitioners from local sources and comparing it with the official record will reveal the names of many unqualified practitioners, and be of great assistance to state authorities in their police duties of protecting the public from unqualified quackery. It will also place at the disposal of licensing. bodies information as to the previous career of applicants for permission to practice. This alone is a very important point. Today a jailbird may go from Connecticut to Missouri, take the state examination, pass, and be licensed to practice medicine. No state board is able or expected to do detective work outside of the state. An actual case in point recently came to our notice. A woman applied for permission to practice medicine in Denver. She claimed that her diploma from the University of Michigan had been burned. The University authorities would not issue a new diploma, but they did state that a woman with the name given had graduated in medicine in the year stated. Upon the strength of this, she was licensed to practice. It was afterwards learned that she was an impostor who had assumed the name of a woman whom she knew to be practicing in Massachusetts. She was convicted of fraud and is now living under a suspended sentence. The discovery, however, was entirely accidental. No doubt many similar schemes remain unrevealed. With the cross-checking system of the new directory bureau, such attempts are almost sure to be discovered.

Reputable physicians will recognize in the new directory an important and essential step in the perfection of the organization of the profession. It can be properly and adequately done only by the profession itself, and every deserving member will benefit by this. We believe the profession at large are to be congratulated upon having the work in such good hands as it is at present.

Defense League.

The excellent showing made by the Defense League of the Wayne County Medical Society in its annual report printed on another page is a matter for general felicitation. The record is decidedly significant. The experiment here, for such it was, is sure, sooner or later, to be subject to close scrutiny by many medical societies. Its showing well deserves the support of all physicians eligible to membership.

TRANSACTIONS OF SOCIETIES

WAYNE COUNTY MEDICAL SOCIETY.

Program.
February 5.

Colostomy in the Treatment of Cancer and Other Grave Lesions of the Rectum-Dr. J. A. MacMillan.

The Treatment of Chronic Constipation Without Cathartics-Dr. Louis J. Hirschman.

Discussion: Dr. F. B. Tibbals and Dr. Angus McLean.

February 12.
Medical Section.

Treatment of Tetanus-Dr. T. B. Cooley.

February 19.

The Value of Drugs Administered During Labor-Dr. J. E. Davis.
The Treatment of Ulcer of the Stomach-Dr. C. D. Aaron.
Discussion general.

February 26.
Surgical Section.

The Rational Treatment of Urethritis-Dr. N. E. Aronstam.
Discussion opened by Dr. W. A. Hackett.

Prostatitis and Its Treatment-Dr. William C. Martin.

DETROIT ACADEMY OF MEDICINE.
January 23.

Second Clinical Meeting, Heart Disease.-Dr. C. G. Jennings, Dr. George Duffield.

GRAND RAPIDS ACADEMY OF MEDICINE.

January 3.

Shortening of the Round Ligaments within the Inguinal Canal through a Single Suprapubic Transverse Incision with or without Opening the Peritoneal Cavity.— Dr. Reuben Peterson, Ann Arbor.

January 17.

Degeneration of the Myocardium.-Dr. J. B. Whinery.

NORTHERN TRI-STATE MEDICAL ASSOCIATION.

The 32nd semi-annual meeting of the society was held in the Hotel Cadillac. Detroit, on Jan. 9th. The following program was carried out:

Tonsillitis and its Complications.-Dr. Chas. F. Kuhn, Detroit.

Treatment of Pneumonia.-Dr. Theo. F. Wood, Angola, Ind.

Suppurative Mastoiditis Associated with or Caused by Bright's Disease or Diabetes. Dr. Thomas Hubbard, Toledo, O.

The Character and Clinical Significance of Eye Symptoms in Bright's Disease. -Dr. Francis W. Alter, Toledo, O.

The Treatment of Pulmonary Hemorrhage.—Dr. William A. Dickey, Toledo, O. Some Common Errors in Diagnosis.-Dr. Miles F. Porter, Ft. Wayne, Ind. Kidney Fixation.-Dr. J. H. Carstens, Detroit.

The Diagnosis of Prostatic Hypertrophy.-Dr. Julius H. Jacobson, Toledo, O. Acute Diseases of the Nasal Sinuses.-Dr. Geo. W. Spohn, Elkhart, Ind. The Morning Drop; its Significance and Treatment.—Dr. Wm. A. Hackett, Detroit.

THE KALAMAZOO ACADEMY OF MEDICINE.

The annual meeting of this society on Jan. 23, was one of the most successful and important in its history. The attendance was large, enthusiasm was plenty, and the fraternal spirit ran high. Dr. W. E. Schroeder, of Chicago, addressed the society on "Subcutaneous Injuries of the Abdominal Viscera. Dr. Henry Hultz, of Grand Rapids, spoke on "Roentgen Rays in the Diagnosis of Diseases of the Stomach and Intestines."

The following officers were elected. President, Dr. A. H. Rockwell, Kalamazoo; 1st vice-president, Dr. N. A. Williams, Bangor; 2nd vice-president, Dr. O. F. Burroughs, Plainwell; secretary and treasurer, Dr. Walter den Bleyker, Kalamazoo (re-elected); librarian, Dr. E. H. Van Dusen, Kalamazoo.

An important action of this meeting was the iniation of a movement to unite the medical societies of Allegan and Van Buren counties with this society and to make it a unit of the State Medical Society. A highly successful banquet was held in the evening.

ANNUAL REPORT OF DEFENSE LEAGUE.

Detroit, Mich., December 31, 1905.

To the Members of the Wayne County Medical Society:

At the close of its first year, the Defense League desires to report gratifying progress. A sufficient number of members has been secured to guarantee our success financially, and a handsome balance remains on hand, ample in amount to defend any cases coming to trial during 1906.

As as to be expected strong opposition to our plan for co-operative defense has been encountered from the various insurance companies writing this kind of insurance, the fact being recognized that a successful effort on the part of the medical profession to protect itself means eventually a great limitation of their field of business.

There is really no comparison between the protection offered by an insurance company and that offered by us.

Insurance companies do business for the money in it, we for the benefit of the profession, and at actual cost. Our funds belong equally to every member and our strongest defense lies in the mutual feeling of esprit de corps existing in our profession, which is firmly cemented by the Defense League. Moreover, the league protects from date of membership, while an insurance policy becomes fully protective only after two years.

From the first day of organization there has been no question of our ability to protect, and if need be, defend every member.

During this our first year six threatened cases have been reported to the secretary-treasurer, all menacing the general practitioner, the alleged cause of grievance in each instance being as follows:

V. and VI. Laceration of cervix uteri occuring during labor.

In the first two cases the attending physician received sharp letters from reputable attorneys, demanding immediate settlement, else suit would be commenced. These cases were handled by our attorneys, who assure us that there is little likelihood of any further action being taken. Nothing further has been heard from the other four cases, the emphatic statement by the doctor that he had ample legal protection against such blackmail threats being sufficient to ward off trouble, although the insurance companies in which two of these men had policies may have aided somewhat in averting suit.

Our first year's experience demonstrates what was at first assumed to be true, that most of these threats are made by patients or attorneys for revenue only, and that a show of fight disposes of most of them. It also demonstrates that the general practitioner rather than the surgeon or specialist is the most frequent object of these attacks, and that no pretext is too trivial as a basis for threatening demands.

A united profession would soon put an end to this ever-present menace which comes annually to about one physician out of every 20, and from the possible dangers of which no man is ever exempt.

In order to do the greatest good to the greatest number we want every eligible member of the Wayne County Medical Society to join the Defense League.

At a meeting of the executive board, held on Dec. 8, the present officers and attorneys were re-elected.

No initiation fee will be charged during 1906, and the annual dues remain at five dollars, with a collection charge of $1.00 for payments in arrears beyond Feb. 1st. Very truly,

F. B. TIBBALS,

THE BOARD OF DIRECTORS.

Secretary-Treasurer.