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REPORTS ON PROGRESS of large amounts of sodium chloride is fol. Comprising the Regular Contributions of the Fortnightly De Jowed by a chloride retention. The patient

gains in weight, the edema becomes more

marked, the albuminura increases and symp. INTERNAL MEDICINE.

toms may develop resembling uremia. In

patents with severe nephritis, and especially 0. E. LADEMANN, M. D.

those with uremia, chloride retention is very The Etiology and Treatment of Constipa

marked, as scarcely any of the extra chlor. tion.—Brov (N. Y. Med. Jour., Dec. 16,1905)

ides administered are elininated. In indi. describes the great variety of causative fac

viduals with apparently healthy kidneys, fol. tors of this condition under the following

lowing the ingestion of sodium chloride there classification: 1. Mechanical obstruction.

is a retention equal to that of mild nephritis. 2. Defective peristaltio action. 3. Deficient

The individual gains in weight, but there is intestinal secretion. 4. Deficiency of liquids.

no visible edema, no albuminuria and no 5. Deficient nervous excitability. 6. Mus

uremio symptoms appear.

uromio s cular spasms in the lower part of the rectum. 7. General disturbances. The treatment in

Variation in the Ratio of Diameters of the each case is naturally dependent on the cause.

Normal Chest at Different Ages – The Form of

the Phthiscal Chest.-Bessesen (Jour. A.M. According to bis experience prolonged use of purgatives and rectal injections soon lose

A., Dec. 30, 1905) says the study of the hu. their power. In most cases dietetic and hy.

man chest is always one of much interest to gienio measures suffice to regularly perform

the medical practitioner for the valuable dethe function of defecation.

ductions that may be obtained. The skill

with which the diagnostioian of the present The Elimination of Chlorides in Nephritis. day utilizes the chest conditions in their vari. -Miller (Jour. A. M. A., Dec. 23, 1905) first ous aspeots has reached a high degree of refers to the observations of Widal and Lavel perfection. He discusses the methods em. regarding the inability of many nephritics to ployed, indices, median values and an analy. eliminate sodium chloride in a normal sis of data, summarizing his monograph as manner, and who hold that the deposition follows: 1. The method of using fixed bony of this salt in the tissues is responsible for landmarks for the placing of chest diameter the edema in nephritis, contending that the is accurate and readily applied. 2. The time retained sodium chloride requires a certain and the results derived from this method of amount of water to maintain it in the evolution are more accurate than the arithproper molecular concentration, thus leading metical average. 3. Important features in to a dropsical condition. Miller's own ob- the shape of the chest as well as in the moveservations in this direction inolude a study of ment and the capacity, may be appreciated fourteen cases; two cases of acute nephritis by an observation of its principal diameters. with moderate and marked edema; 'seven 4. The human chest, in the course of its de. cases of chronio parenchymatous nephritis, velopment, has passed through various stages six bad more or less edema, and the one with. from the deep or dorsoventral to the broad or out edema probably had a secondarily con- transverse type. 5. In the fetus and young tracted kidney; four apparently normal pa. babe, the lower plane gives a greater depth tients; and one case of myocarditis with gen- and breadth than the midplane. 6. The fetus eral edema. While no attempt was made to under 30 centimeters in length presents a determine the exact intake of the salt, the pa dorsoventral type of chest. 7. The new-born tients were kept on a fairly uniform diet dur child represents the transitional type of chest ing the period of investigation. In some -it is round chested. 8. During the first cases this was milk only; in others the light five years of life the most conspicuous obange ward diet. The sodium chloride was first ad. is the rapid widening of the chest in its trans. ministered in wafers, but later in solution. verse diameter—it becomes broad chested. 9. Toe chlorides were estimated daily by the At puberty the length of the chest takes on Volbard metbod for nine consecutive days, an aotive increase in growth over the other and when possible, the patients were weighed diameters—the adolescent becomes long daily. The first three days the patient had chested. 10. From the eighteenth to the merely the chlorides contained in his food; twenty-fifth year the development of the chest the following three days he received daily an is fairly uniform in all its dimensions, and additional 10 grams; then the three following represents the highest development - the days merely the oblorides in his food. The broad long chest. 11. The dorsoventral di. conclusions of Miller's investigations are as ameter increases at an even rate from birth follows: In patients with moderately severe to maturity. 12. The phthisical chest of Depbritis associated with edema, the ingestion adult years, in general, shows an arrest in development of the transverse diameter fol. from the duot lymph. In one of the four re. lowing puberty. 13. The phthisioal chest is maining cases in which the duct was normal a narrow one, tending to the rounded form, there was a primary tuberculosis of the epi. with a relative elongation.

didymis and testicle, with organized thrombi Prognosis in Tuberculosis.-Flick (Ameri.

in the vesical vein, containing caseous masses can Medicine, Jan. 6, 1906) states the prognosis

and tuberoles. In eight instances the generalin tuberculosis depends: (a) on the virulence

ized process was subacute or chronic. Large of the tuberole bacillus; (b) on the dose; (c)

tubercles or caseous masses were scattered on the resistance of the heart; (d) on the co.

in small numbers through the various organs, existence of other micro-organisms; (e) on

while during life the course of the disease was the amount of tissue which has been de

protracted, lasting from three to nine months stroyed; (f) on the duration of the disease;

In only two of these cases was there a tuber(g) on complications arising from toxemias;

culosis of the thoracic duot. Iv both in(h) on age; (i) on race; (j) on social condi.

stanoes the tubercles were small and Oc. tion; (k) on environment; (1) on financial

curred sparingly, but in one a few tuberole resources; (m) on temperament, and (n) on

bacilli were found in smears from the fluid of oharacter. In forecasting the future of a tu.

the duot. Finally, in three instances, the tu. berculous subject the physician should

berculosis was of a chronic type and confined weigh carefully all matters bearing upon the

to the lungs and peritoneum. In all of these case, and even then be guarded in his opin

cases the thoracic duct was normal. It is ion. He should bear in mind that the tend.

difficult to draw a line between the cases of enoy is always toward recovery, but there are

aoute and subacute generalized tuberculosis, many impediments in the way of recovery.

but between the extremes of tbe two types a Restoration to physical health is compara

distinction can certainly be made. Of the tively easy, but the establishment of a condi.

twenty-seven cases of tuberculosis in which tion of absolute sterility from the tubercle

the process was more or less generalized, sev. bacillus is difficult. Relapses take place

enteen, or almost 63 per cent, showed tuber. even after years of apparent perfect health.

culosis of the thoracic duct, or, as in one in. A person wbo has had tuberculosis should

stance, tubercle bacilli in the lymph from the not consider bimself free from the necessity

duct without lesions of its walls. Of the acute of leading a careful life, no difference how

cases in over 79 per cent the duct was affected long he may have been well. Prognosis

or contained tubercle bacilli. The type of should therefore, always be guarded and

lesion in the duct varied considerably. conditional. We may assure the patient that

Sometimes there was a single large caseous he will be restored to physical health and

nodule usually near the receptaculum or remain well so long as he takes proper care

about the arch of the aorta, with small tuber. of himself, but we should impress it upon

cles over the intima of the vessel above and him that his good health will only continue

below it, sometimes several caseous nodules so long as he does take good care of himself.

were scattered through the duct, while ocoa

sionally the walls of the lymphatic were simTuberculosis of the Thoracic Duct and ply seeded with small tubercles. In every Acute Miliary Tuberculosis.- Longcope instance the lymph-nodes of the mesentery, (American Medicine, Jan. 6, 1906) reviews retro-peritoneum, posterior mediastinum, or the literature on tuberculosis of the thoracic bronchial regions were the seat of a chronio duot epitomizing the history and necropsy of tuberculosis. At times several groups of 30 cases of tuberculosis, in whioh the process glands were affected, but more often only one was more or less generalized, paying especial group, and rarely one or two glands. Often attention to a study of the thoracic duct as a the lesion in the duct appeared almost as old possible point of origin for the generalized as that in the neighboring lymph-nodes and process. Of these thirty cases, nineteen were was in close association with it, though a di. typic instances of generalized acute miliary rect extension of the process from the gland tuberculosis, in which mipute tuberoles were to the wall of the duct was never seen. In at scattered in enormous numbers through most least two instances the caseation of a small of the organs of the body. When histories group of lymph-nodes and of the thoracic could be obtained the course of the disease duct wall were the only fooi of chronic diswas rapid, lasting usually form two to twelve ease which could be found in the body. The weeks. The thoracio duct in fourteen out of author's series of cases suggest that the thor. the nineteen cases showed a more or less ex- acio duot is of great importance as a channel tensive tuberculosis, usually with caseous for the spread of tubercle bacilli through nodules, while in one instance, though there the body from the various groups of lymphwas no tuberculosis of the wall of the vessel, nodes. Undoubtedly, tuberculosis, of the many tubercle bacilli were found in smears veins and arteries is also to be reckoned as

a factor in the rapid dissemination of tu. in amount and more or less constant in oobercle bacilli through the body, but is sub- currence. The nature of the accompanying sidiary in importance to tuberculosis of the tube casts must not be relied on too greatly thoracio duct and its tributaries. From & to determine the seriousness of the renal lestudy of these cases Longcope concludes sion, and in particular the presence of an octhat tuberculosis of the thoracic duct is of casional hyaline cast, or even the frequent great frequency in cases of acute general. occurrence of such must not be regarded ized tuberculosis. The lesions in the duct with with too much apprehension. The from which tubercle bacilli are, swept in modern method of centrifugation and the great numbers through the lymph to the gen- consequent examination of fresh urine ineral circulation form the starting point for creases the likelihood of our finding casts, the generalized acute process. In certain and there is often difficulty in distinguishing cases of acute generalized tuberculosis, tuber between insignificant oylindroid of the mild cle bacilli may be found in the lymph from est grades of renal irritation and the definite the duct, though the duot itself is not the hyaline cast of more decided disease. Even seat of tuberculosis. In a small percentage the latter, however, is so frequent in cases of cases of subacute generalized tuberculo. of arteriosclerosis, cardiao disease, hepatic sis the duct may also be affeoted.

disease, jaundice and gouty affections with.

out serious renal disease that its significance Albuminuria in Nephritis and Bright's Dis- is more or less trivial, unless general olinioal ease. -Stengel (Jour.A.M.A., Jan. 6, 1906) conditions accentuate the importance of its emphasizes with all earnestness that diagno. presence. The author does not wish to con. sis in renal disease can not proceed from the vey the wrong impression that he estimates urinary examination alone any more than can lightly the importance of urinary examina. the diagnosis of cardiac disease from physical tion, but it is his conviction that a trace of exploration alone, or that typhoid fever solely albumin is too often magnified in importance from the examination of the serum for the re- in the physician's mind, and that the olinical action of agglutination. Taken in conjuno. conditions as a whole are not sufficiently oontion with the general symptomatology, ac sidered. Above all things, it is important in curate examinations of the urine are indis. cases of suspected renal disease that the urine pensable, but without the general conditions be repeatedly examined and its constant or As a cheok urinary examination may be as fluctuating condition be taken into account. misleading as would be the symptoms without urinary findings. Among 581 cases there were 51 cases of undoubted Bright's disease,

DERMATOLOGY. exclusive of chronio interstitial nephritis. In all of these there was constant and more or

ROBERT H. DAVIS, M. D. less uniform albuminuria. In 7 cases of arteriosclerosis there was more or less incon.

A General Consideration of the Contagious stant albuminuria, without casts in 16, and Diseases of the Scalp and Skin Observed in with casts in 58. In 187 cases there was oc- Children of the Public Schools.- Lobel casional or less often constant albuminuria (Medical News, December 16, 1905) consid. in association with acute infectious diseases, ers exhaustively this important, and too gout, diabetes, tuberculosis, syphilis, oysti. much neglected subject, in the article refer. tis, pyelitis, cardiac diseases, movable kid. red to. In pediculosis capitio, he has found ney, gallstones and jaundice, stone in the crude petroleum and olive oil as to answer kidney, in occasional cases of other diseases, well for the destruction of the pediculi, much in pregnancy, and in adolescents without dis better than the usual mixture of kerosene and coverable disease. In 41 cases, in gouty or olive oil. In twenty-four hours, under this so-called lithemia subjects, there was ooca. treatment, most of the pediculi are dead, sional albuminuria at times when the urine and a majortiy of the ova are incapable of was excessively acid. In 215 cases there was development. He recommends also, spirits no albumin at any time. In 11 oases casts of camphor, or the tincture of delphinium were found without albumin. Stengel con- in hot vinegar (1:3) or bichloride of mer. cludes his paper by directing attention to the cury in hot vinegar (1:2000 to 1:500, de. fact that albuminuria is an extremely com. pending upon the sensitiveness of the scalp), mon occurrence in various general diseases or bichloride of mercury gr. i, tr. staphisa. and that, though it may in a sense indicate gria ziv. In those instances in which we find an inflammastory condition of the kidney, "papu les, pustules, excoriation and crusts, such inflammation or nephritis may be of with the formation of a moist exudation and merely pathologic rather than clinical sig- the agglutination of the bair,” he finds the nificance, unless the albumen is considerable following efficacious: B Balsam of Peru 20,

ilti

hili

lilho

olive oil 50, crude petroleum 100. Sig.: scaly and without much apparent loss of hair. Apply twice daily; or the following ointment. There is, also, a sharply defined and marginrecommended by Lassar: B Hydrargyri sul. ated eruption, occurring on the upper or furati rubri 1.00, sulfuris sublimati 24.00, lower lip, or both, in school children. It is olei bergamottae gr. XXV, vaselini favi ad caused by lip sucking, or by the intermittent 100.0. Sig. : Apply twice daily. A condi. protrusion of the tongue, and its excursion tion of the eyelids is occasionally met with in over the upper and lower lip. A constant sohool obildren wbich is apt to be considered source of irritation is thus afforded, and a a blepharitis marginalis. It is really a pedi. suitable soil for fungus growth. Diluted oulosis of the eyelids due to the pubic louse, white precipitate ointment will cure the and is readily cured by soaking with olive condition, provided the lip sucking habit is oil, and then applying the well known Pa. discontinued. In the treatment of scabies, gensteoher's yellow ointment. Of course, it is he has abandoned the usual sulphur oint. with the nits, in pediculosis capitis that the ment. Instead, after the preliminary bath great obstacle to a cure is encountered, and the with green soap and hot water, the patient is author's experience leads him to say that there furnished with powdered sulphur, and told is no one drug which will hold out any hope to rub tbis thoroughly into the affooted reof rapid removal. With boys, the hair should gions twice daily, and to dust a quantity be clipped short, while, with girls, clipping into the bed sheets before retiring. It is the hair should be the last resort. "Tight more oleanly than the usual ointment treatbraiding in the class-room and unbraiding ment, and, he claims, less irritating and at home for care and treatment should be in more rapid in its results. After the itching sisted upon." The only plan for pronounced is controlled, the following ointment, reocases is the patient, persistent, painstaking, ormended by Kaposi, is applied twice daily : removal of the nits, strand by strand, with the B Beta naphtholi, cretae albae aa 10.0, sahand or fine comb. Eduoation of the parents ponis viridis 50.0, axungiae porci 100.0. He to the nature and cure of the trouble is of the closes with a plea for the more careful epila. utmost importance. For the associated, or tion and treatment of cases of tinea tonsurindependent, impetigo contagiosa, he recom- ans, and the necessity of such patients being mends the usual wbite precipitate ointment required to keep their hats, books, pencils, (5%) in unguentum diachyli. (The editor eto., separate from those of other scholars, if has always found wbite precipitate 2% in they are not excluded from school until oured. vaseline sufficiently strong.) For localized They should, of course, have individual spots a protective dressing of iobthyol collo. towels, soap, combs and brushes. dion (10%) is excellent. The individual lesious heal and dissemination is guarded The Erythema Group of Skin Diseases.against. This remedy, however, may be ob. Brayton (Indiana Med. Jour., Nov., 1905) jected to on the face near the scalp, and, of calls attention especially to the visceral and course, cannot be used in the bair. In con- nephritic lesions so often associated with this sidering tinea corporis be warns against a con- interesting group of troubles whose correct dition which is often diagnosed as eczema, diagnosis is often so difficult, and the nobut which, he says, is due to the trichophyton. menclature of which is so confused. Pur. It consists of more or less irregular, scaly, pura, angio-neurotic edema, urticaria and ill-defined, eczematous looking patches on the simple erythema are often quoted as the skin face, and sometimes three or four cases are manifestations in these cases, which are ad. found in one class-room. They yield usually mitted to hospitals suffering, also, with arth. to sulphur or white precipitate ointment. ritis, severe, and often paroxysmal, attacks of For ring worm of the body, he reports excel. abdominal pain, albuminuria, hematuria, and lent results fron the use of formalin, 40% vomiting of blood. Of course, not all of these solution diluted two or three times. Several are present in each case. Sometimes only one applications are frequently sufficient. In a is, sometimes several. In several oases oper. sensitive skin, it is well to avoid vigorous ated on, the findings were, dark patches in rubbing, and, if the smarting or burning is the intestinal walls, due to extravasa ted serum intense, the application of ammonia water and blood. In one case, which ended fatally, will give relief.' He has had the usual dis- there was hemorrhage into the wall of the couraging results with tinea tonsurans, but colon, leading to paralysis of the affected part, has found the 10% formalin solution useful and to increased muscular contraction, with beje, too. A form of ring worm of the scalp colio, in the adjoining part of the bowel, and that is often mistaken for eczema, with cor- a consequent intussusception of the cecum responding rebelliousness to treatment and and adjoining portion of the ileum into the danger of spreading, is evidenced by many colon. Gangrene and acute general peritoni. disseminated, small areas, wbich are dry and tis were the immediate cause of death. Osler says that the subjects of the erythemas, with the seven deaths in Osler's 29 cases, fire were visceral manifestations, are usually by young. from uremia. The poisons, whatever they Twenty-one out of twenty-nine cases collected are, that cause the erythema cause also by him were under twenty years. Seven of the nephritis, which comes on, as a rule, the twenty-nine died, proving the condition at the height of the skin lesions, or even to be a serious one. As regards the causes as late as a week thereafter. Of a series of these affections, certain diseases are known of 14 cases in which nephritis developed, five to be frequently associated secondarily with died of uremia. In four, purpura alone, as a definite skin lesions. Severe purpura goes skin inanifestation, was present; others had with Bright's disease; urticaria and purpura mixed types, edema and urticaria, but pur. with cirrhosis of the liver; urticaria with pura also occurred in thirteen of the fourteen asthma; and all forms of erythema with cases. Arthritis is, of course, a frequent comchronic valvular heart lesions of children. plication, but is often quite independent of Urticarias are usually due to autotoxins of the rheumatic poison. There is undoubtedly gastrointestinal origin, wbich Osler says may a toxic, or blood factor in the causation of be bacterial, protozoal, vegetable, or ineta. these serous and sero-sanguineous effusions bolio in character. To quote the same au- such as urticaria, erythema, erythromelalgia, thor, “It is not likely that the poison in it. and even purpura, but they may be caused self, of whatever kind, is of less intrinsic im- by the same factors that determine undoubted portance than certain transient aspects of nervous manifestations, the effusions being cell metabolism, for there is no constancy of due certainly in part, and perhaps sometimes action of the same poison in different per entirely, to the neuro-vascular irritability and sons, or even in the same person ut different irregularity which form the essential element times. The chronio forms of urticaria prob. of nervous (hysterical) conditions. “The by. ably illustrate a morbid and persistent sensi. sterical patient (in this sense) has lost his tiveness of the cutaneous vessels to poisons vasomotor equilibrium, and is the victim of of either intestinal or tissue origin.” The lo. a vasomotor ataxia.” “It is, then, a ques. cal status is also important, and a peculiarity tion of dual causation, and both the toxic and may be transmitted through several genera- the neuro-vascular factors are met with in tions, as in angioneurotio edema, which is diferent proportions in different cases, just only urticaria “writ large." Here there must as they are met with in epilepsy and other be either a morbid susceptibility of tissue, or neuroses in varying quantities. an inherited peculiarity of metabolism, or both combined. “The relation of the ery. Some Practical Points in X-Ray Therapy.thema to infective processes is interesting. Gray (Southern Medicine and Surgery, Dec., Certain types of exudative erythema behave 1905) suggests, as an explanation of the occalike an acute, febrile disease, there may be sional failure of the X-ray in cases of supersymptomatic erythemas. Many of the graver ficial epitheliomata, in the aged, that, in such cases of purpura have followed an acute in cases, the tissues offer such low resisting fection, puerperal fever, gonorrhea, otitis power that the invading element, be what it media, eto. The rheumatic poison is respon- may, finds little difficulty in spreading to the sible for many cases. But in the large group adjacent structures and deeply infiltrating of cases persisting for years, an infective pro. them with the process of disease, and that the cess is out of the question.” The complica- insufficient administration of the X-ray tions of the erythema group fall under two (which loses to a degree its destructive effects classes: (1) the angioneurotic, (2) the inflam. in passing through the superficial tissues) matory. To the former belong the swelling acts only as a stimulant on the disease-proof the fauces, edema of the glottis, changes ducing factor, and, so far from a cure, an inin the bronchial mucosa causing asthma, and crease in the rapidity of the growth will tbe colic, which is due to the localized edema be the result, just as heat, in a moderate deof the gastro-intestinal walls. To the in- gree, acts as stimulant to cell growth. “In flammatory group belong the more serious these cases, treatment should be begun with complications, endocarditis, pericarditis, energy, and penetrating, prolonged exposures pleurisy, pneumonia, and nephritis. The should be given, at frequent intervals, in oredema of the glottis may cause death. Both der to speedily produce the desired destructcroupous and lobar pneumonia have followed ive action on the disease-producing ele. an exudative erythema. Endocarditis and ment." However, the inability of the tispericarditis have occurred in connection with sues to repair, in the aged, when a destruct. intense arthritic purpura. As would be ex. ive effect has been produced, causes often a pected gastro-intestinal symptoms are the tedious recovery, and the physician is for. most oommon features of the group, but the tunate if pyogenic infection does not compli. renal complications are the most fatal. Of nate the field, and further retard the healthy

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