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into rabbits. 3. They have demonstrated the fluotuation. Whereas from some sources presence of diplococcus three times in the operation was advised, author decided to wait cerebral pia mater, and onoe in the brain from simply making an incision back of the ear. cases of chorea. 4. Also in the brain and The wound healed nicely. On the twentieth pia mater of the rabbit that has shown day, the watoh, whioh had not been heard twitobing movements. In the third section either through the air or bone conduction of their paper they discuss rheumatic men- was heard 1 cm. distance, six days later 10 ingitis, basing this upon a case fully re- cm. Discharge continuous. Two months ported in which was found a meningitis, later, after treatment with natrium sulpho. basio in distribution and spinal meningitis phenolioum, recovery, both perforations general in type. Minute diplococci were closed. Watch beard 60 cm., wbispered voice found in pus from the cerebro-spinal fluid and 2 meters. After one year complete recovery, oultures, yielded a pure growth of the diplo. hearing normal. Based on the result coccus. Two rabbits were inoculated and of this case author considers it advisable to died in twenty-four hours. The diplococcus operate on children, only under the following was isolated from the blood, injected into a conditions: 1. When the pain over mastoid rabbit and was followed by arthritis. The process is very severe and does not yield to diplococcus was found in the affected treatment. 2. When the retro-auricular ab. joints. The authors believe this to be diplo scess is not very painful. 3. When after coocus rheumaticus. The authors place rheu. opening the abscess a bone fistula is found. matic meningitis midway between the slight 4. When the bone fistula is not closed after rheumatic lesions which exist in chorea and one month's local treatment. 5. When cere. aoute fatal rheumatio hyperpyrexia, which bral symptoms appear. Complete deafness they regard as an acute rheumatic toxemia. appearing early in the disease may not nec.

essarily be permanent in children. PerforaThe Value of the Bromids in Epilepsy.

Epilepsy: - tion in lower half of membrane indicates One of the better methods of treatment of

chain of ossicles intact, consequently after epilepsy of late years 18 the reduction of the healing of perforation hearing will again be amounts of bromids given. The use of this

normal. When perforation is found in upper drug is well nigh universal; a household

half, the exudate in the attio usually leads to remedy; hence its abuse. Many epileptics

ankylosis, synecbia, eto., with consequet deafrespond well to the suppressive efforts of

ness. The favorable result of the case reported bromid, but suppression is not oure. The bromids have a limited value in holding epi. by the location of the perforation.

is no doubt due to the good drainage favored leptio attacks in abeyance, wbile other forms of treatment aim at the removal of the cause

On the Early Diagnosis and Operation of have a chance for action. Not more than one.

Empyema of the Mastoid Process in Acute half the cases treated at Craig Colony are Suppurative Otitis Media.-(Arthur of For. given bromid in any form. Its unlimited use

selles, Helsingfors, 1905 )-Author describes is disastrous. The dose as generally given is

in detail the progress made in indications for too large. It is seldom necessary to give

opening the mastoid, since Schwartz's first over 12. 15 or 20 grains three times a day as dissertation on this subiect, and reports a routine treatment for any length of time,

thirty-five cases operated on, with his obser. while 8 to 10 grains is sufficient under

vations and opinion as to the indications for guarded administration. Emergency doses

opening the mastoid. Besides the usual to check “serial attaoks" or "status epilepti.

symptoms, swelling, fever, eto., finds in the cus” may be much larger.

consistency of the pus a very important adju. vant for the location of the pus, whilst the

sticky, cell impoverished pus is usually found OTOLOGY.

in the tympanio cavity the thick, creamy pus ALBERT F. KOETTER, M. D.

rich in cells is found in the antrum and mas

toid cells. According to the experience of Bilateral Suppurative Otitis Media, Due to the author the consistency of the pus is de. Scarlet Fever, with Mastoiditis and Rupture termined by measuring the specific gravity into the Corticalis, Complete Deafness, Re- according to Hammerschlag's method: One covery and Restoration of Hearing without drop of pus is added to a mixture of chloro. Operation.-Suné Molist, Barcelona Acadé. form and benzine having a specifio gravity mie of Medicine.)-Girl of twelve, eight days of 1020, and then obloroforın or benzine after inception of scarlet fever, was taken added until the drop of pus floats in the with severe earache and discharge from both solution, then determine specific gravity of ears, complete deafness. After ten days re. fuid by areometer, this will also be specifio gion of mastoid painful, red and edematous, gravity of pus. In these examinations the

specific gravity of the pus is much higher cially mentioned in surgical interference. in mastoiditis than otherwise, fourteen cases Exposure of dura mater in the middle and (adults) were examined and in all cases the posterior cranial fossa which cannot always specific gravity was 1045, .shortly before the be avoided in cases where there is a descent of operation, whereas the specific gravity in un. the cranial fossa respectively, the protrusion complicated cases 1044. Author believes of the sinus, is without danger, especially in. that cases with specifio gravity of 1045 are jury to the dura. Injury to the facial nerve suspicious of empyema and when 1046-1047 and external semicircular canal can be the diagnosis is certain and operation indi. avoided if caution is exercised, the latter is cated. In five cases where no symptoms of more often injured than the former by the empyema were present, after this indication, beginner, and may lead to labyrinth infecnamely, high specifio gravity, operation was tion. Sometimes injury to the facial cannot performed and justified. In children the con. be avoided, namely, where infectious process dition is different, two operative cases and extends inward from the nerve. Variations several uncomplicated point to the fact that in the after-treatment: Temporary paresis of the specifio gravity in children is lower. On the facial, as it sometimes oocurs two or three the other hand, we must not forget that the days after the operation usually heals in a few presence of blood increases the speoific grav. weeks. Delay in healing or continuance of ity of the exudate. Author does not mention the suppuration are usually due to insuffi. the fact that cases occur in which the empye. cient removal of diseased surface or mistakes ma of the mastoid process, may become incap. in the plastio operation. Optio neuritis of. sulated so that no connection exists with the ten exists for months. Symptoms of disease tympanic cavity, in these cases we would of the inner ear or the brain as tbey occur in not be able to observe an increase in the spe. extensive inflammation of petrous portion of cifio cavity.

the temporal bone disappear after operation, Collection of Illustrative Cases Contributing

but not in those cases in wbioh these parts to the Question of Deafness and Deaf-mutism

are actully involved. Final result: In careful as a Result of Syphilis Hereditaria Tarda.

execution of the radical opețation permanent -Hopmann (Zeitschrift fuer Ohrenheil.

recovery oocurs unless we have to do with kunde) reports seven cases in which the pa.

malignant tumor or tuberculosis, but even tient besides other hereditary syphilitio stig.

then complete recovery takes place in the mata, retarded development, deformities of

latter cases, and in the former we have at the skull and nose, scars of the skin and mu.

least considerable relief, recurrence in about cous membranes, articular inflammation,

10%, usually at the tegmen, marasmus in Hutchinson's teeth, parenchymatous kerati.

children, may cause marantic thrombus of tis, a disturbance of the hearing was reoog.

the longitudinal sinus, after operation. The nized, this is one of the Hutobinson trio of

restoration of the hearing is of secondary symptoms. As with other observers, so with

consideration and depends on the condition bim the female preponderates in proportion

of the parts surrounding the windows. The of five to two. The deafness usually appeured

prognosis is better in acute cases, and also in the first or in the first half of the second

when the disease is limited to the mastoid decennium, the eyes usually being involved

process. Choice of cases for operation: all before his time. It is characterized as a

chronic suppurative cases should be treated nervous deafness, with bone conduction en

by the radical operation. In a case which tirely gone to greatly reduced, appears sud

was operated after six weeks suppuration the denly and always bilateral. Vertigo and

radical operation is safer than if done during tinnitis often accompany this trouble.

acute stage. Pathologic anatomical conclusions are miss. ing. Therapeutically the energetio mercury

SURGERY. treatment should be instituted. The complete schmier cure should not only be used once,

JOHN MCHALE DEAN, M. D. but is to be repeated several times in the course of two to three years.

Three Years Experience with Pyloroplasty.

-Finney in an artiole in Journal of Sur. The Daogers and Difficulties of Operations gery, Gynecology and Obstetrios gives briefly on the Mastoid Process, the Variations in an acoount of his experience with his pyloro. the After Treatment and the Ultimate Re plosty operation in benign stenosis of the pysult.-(C. A. Ballance, The Lancet.)—Dan. lorus. He reports a series of thirty-three gers. -Insuffioient anatomical knowledge, cases operated on with three deaths. The ose of impraotical instruments, insufficient deatbs were not due to the operation per se. illumination of the field of operation, infeo. He claims pyloroplasty offers more advan. tion due to faulty asepsis need not be spe- tuges than gastroenterostomy in benign cases. Mayo has had bile regurgitation after the aoid was due in any sense to the injection. one of his pyloroplasty, but the author bas 2. Injeotions into the inferior dental or no such experience. The popular opinion is other nerves should be made through the that in dense cicatrical ulcerations it is diffi. mouth, since infection of the wound and ne. cult to perform is strongly denied by the crosis may result, with consequent failure author, who claims that suoh cases are not in the action of the acid. only more easily remedied in this way, but 3. Immediate relief should not always be that the repair of the ulcer itself promptly expeoted. nothwithtsanding the cases of follows. The author believes the interrupted Bennett and Murphy were all immediately suture more expedient in its performance relieved No one of my cases, even those in than the continuous.

which the acid was accurately injeoted into Foreign Bodies in the Esophagus.-In Jour.

the nerve trunks and into the perineurial nal of Surgery, Gynecology and Obstetrics,

fat, was promptly relieved, relief coming in Stuart MoGuire reports two cases of foreign

from one to two weeks. The observations bodies in the esophagus removed by him at

on this point of Wright, who had a large Riobmond hospital. The one lodged in the experience with osmio aoid injections, coresophagus opposite the crioard cartilage respond to mine. proved to be a glass stopper. Esophagotomy 4. There is very little doubt that the was performed and the foreign body removed. stretching of the nerve trunk, necessarily in. In the other case an open safety pin with oident to the injection, is produotive of good, & sharp point directed upward was lodged in supplementing, as it must, the action of the the esophagus just opposite the heart. In acid. There is, therefore, no good reason this case the author performed gastrotomy why the stretching should be avoided in. and with esophageal bougie pushed the pin teptionally, except perhaps for experimentain reach of his finger through the cardiao tion. orifice of the stomach. Both patients recov. 5. In the case of small nerves, it will be ered promptly. The author advises in all found exceedingly difficult to inject directly cases of foreign body low in the esophagus it into the nerve trunk, that is, the needle eye is best prior to operating to force or push the will pass to the distal side of the threadlike foreign body into the stomach on account of nerve or perhaps not enter the nerve subthe danger of undue manipulation to the stanoe at all. Or, notwithstanding the utmost heart actions during anesthesia. Diagnosis .care, the fibers may be so teased a part by the of foreign bodies in the esophagus is easily needle point that the fluid will simply be spilt made from history in ability to swallow or about the nerve. In such a case, in order to painful deglutition together with the employ. bring the acid in contact with all of the ment of the X-ray.

fibers, it is wise to clip the nerve so that the Effects of Osmic Acid Injections. In Jour.

end may be bathed in the fluid. A. M. A. Eastman reviews the literature of 6. The effoot of manipulation of the nerve, osimc aoid injections in nerve trunks for the as by stretohing, has not as yet been elimrelief of neuralgia. He appends eleven cases inated as a possible aid to the chemioal acof his own in which the treatment was tion of the osmio acid; therefore, a general adopted. The author inieots ten drops of a anesthetio should be administered so that 2 per cent solution of osmic acid in the nerve

neureotasy or seotion of the nerve may be trunk after the trunk has been exposed by in.

done if desired. cision. He claims much benefit from this 7. My experiments have shown no changes procedure in neuralgias and in some cases in the nerve tissues as the result of injections permanent oure has resulted. In some cases of osmic acid other than the disintegration the aoid was injeoted subcutaneously, but of fat and oil globules in the perineurial with not as much success as in the open space and in the white matter of Sobwann, operation. Some cases received injections in such white matter of Sohwann being simply the terminal branches with good results. fatty matter in a fluid state insulating and The conclusions of the author seems so lucid proteoting the essential part of the nerve. that the reviewer thinks best to add same in The degenerations appearing in the nerve bis own words:

itself are only as may be fairly attributed to 1. The injeotion of 10 drops of osmic aoid nutritional changes and exposure, the indireot in 2 per cent solution into sensory nerve result of the selective action of osmio acid of trunks is safe. The likelihood of irritation destroying fat. There is no reason why this of the kidney, however, should not be for- fat should not be restored and the nerve again gotten in oases exhibiting kidney lesions. It become capable of transmitting sensation, is not probable that the death from cerebral that is, theoretioally, the neuralgia may rebemorrhage three months after injection of turn after injections of osmio aoid.

8. Osmic-acid injeotions are uncertain in method. Wirsing reports 42 cases and Win. effect as to the cure or relief of neuralgia. kowski 30, which were treated with Len.

9. A large percentage of cases of neuralgia hartz's method, and they also prefer it to will be relieved for months by osmio-acid in. Leube's method. Most patients oan easily jections.

digest this diet. The advantages of milk diet 10 The injeotions of osmic acid for the being partly the small amount of NaCl, can relief of tio douloureux is justifiable, even if also be achieved by Lentbartz's method by it should become necessary to repeat the in. using little salt in the eggs, ham, butter, eto. jections at intervals of a few months, partio. Winkowski deviates from Lenhartz's method ularly in view of the unfavorable results of by abstaining from all food drinks and ice the so-called radical operations..

pills fur several days after a profuse hemor. 11. The local irritation produced by the rhage, and nourishes the patient through recacid and the remote and irritant effeots are talenemata or subcutaneous injections during not serious in their consequences and bave this time. The patients are more willing and no meaning as to the effect of the osmic acid can easily carry out this method of dieting. in relieving neuralgia. 12. The solution of osmic aoid should be

Lumbar Puncture.— (Juinoke, Deutsch made fresh for each operation, as deteriora.

Med. Wnch., Nos. 6, 7, 1905.)-It is barely tion is rapid.

fifteen years since the author introduced lum. 13. Pain persisting several days in a small

bar puncture as a diagnostic and tberapeutio oircumscribed area means that the filaments

measure, but it is very extensively known and supplying this area bave not been acted on

used. The removal of some cerebro-spinal by the acid. The acid usually finally de

fluid in healthy or somewhat diseased patients stroys such filaments. It may become neo

can be done without danger to the individual. essary, however, to open a wound for the pur.

The nature of the Auid and the pressure pose of injeoting such filaments.

under whiob it is removed should be noted. 14. Mere suboutaneous injections are of

If albumips in excess of 0.5% are present an little or no value.

inflammation or venous stasis are to be expected. The normal specifio gravity is 1006. 1007, and the freezing point is 0.56 to 0.75

deg. The normal pressure is about 125 mm. THERAPEUTICS.

water; respiratory movements cause it to vary

about 20 mm. The patient is placed in a W. T. HIRSCHI, M.D.

horizontal, left side position, with lumbar The Diet for Gastric Ulcer.- Lenhartz

kyphosis. Insert the needle in the tbird in. (Med. Klinik., No. 52, 1905) does not ap

terstitial (lumbar) region. For diagnostic prove of the old Ziemisen-Leube regime

purposes and under normal pressure 1-5 ocm. wbiob consists largely of milk, for the reason

may be removed, but the pressure should not that either subnutrition follows which in.

sink below 100.80 mm. In increased pressure oreases the anemia and causes the ulcer to

it should not fall below 120 mm. Never use beal less rapidly, or if sufficient milk is taken

suction. After puncture the patient must re. to nourish the patient properly (about 3L. a

main in bed at least twenty-four hours and day) the stomach becomes dilated and over.

receive no alcohol. Juincke considers an loaded, again retarding the healing of the

angioneurotic hydrocephalous as a cause of ulcer. He proposes a diet of small volume

the severe headaches in many cases of chlornon-irritating to the uloer, being highly nu.

osis migraine and similar paroxysmul ceretritious and containing a fair amount of al.

en bral affections.

" buminous substances, to furnish a sufficient The Treatment of Pneumonia.-Fraenkel amount of nourishment and combine freely (Therapie de Gegenwart, No. 1, 1906) advo. with an excess of hydroobloric acid. From cates the use of digitalis according to Traube, one to eight eggs are given at first raw, and only that Fraenkel uses it in larger doses. later soft boiled. These can be eaten soon He does not give more than 0.4 of the infu. after a slight bemorrhage. Milk beginning sion in twenty-four hours, and does not con. with about 100 com.and gradually increasing tinue it more than two or three days to regu. to one liter is also permissible. Sugar from late the heart action and arterial pressure. 20 to 50 grams, and near the end of the first Digitalis was used only in severe infections week finely soraped beef are well borne. with a very frequent pulse and low arterial During the second week boiled rice, butter tension. Digitalis increases systolio contrac. and toast and raw ham may be used. Pa. tion, gives the heart a better chance to fill tients recover more quickly, have fewer re. during diastole and slows the pulse, through lapses, regain their strength and are able to irritation of the vagus centre. It also acts tegume work sooner than with the Leube somewhat as an antipyretic. The cumulative aotion of digitalis must not be overlooked. use of digitalis, neither digalen or digitoxin Fraenkel uses digitalis if he sees the case in are to be used, as they have a more rapid side the first three days; if no arteriosclero. cumulative action than the original drug. sis, organic heart disease or ohronio nephritis are present. If digitalis is used later in the

The Treatment of Goitre.- Hildebrandt disease it must be given in smaller doses

(Therapie der Gegenwart, No. 1, 1906) uses and with greater caution. Formerly the

the usual olassification parenchymatous, fibcollapse was considered as being due to car

rous, vascular, cystio, colloid and those with diac insufficiency and the vasomotor action

oalcareous deposits. The internal adminis. was ignored, but now the vascular paralysis tration of iodine or iodine containing sub. is considered the chief cause of collapse. The

stances, e.g., thyroid glands is often beneficarterial paresis is due to the large amount of

ial, but owing to the resulting loss of weight bacteria in the blood. The arterial tension is

and cardiac irrritation it must be used rationreduced in about 66% of all cases, and is never

ally. Surgical interference is necessary if absent in the most severe infection. The

the goitre interferes much with respiration. hearts of pneumonia patients which term

Large oysts are at times enucleated success. inate fatally rarely show marked pathologio

fully. Vasoular goitres may be improved changes. At times the right ventricle becomes

by ligating the larger vessels. The dangers incompensated on account of the great resist.

in surgical interference are postoperative ance in the lesser ciroulation. Caffein stim.

hemorrhage and pneumonia. ulates the vasomotor centre and is indicated in pneumonia, with low arterial tension, high frequepoy and cyanosis with dyspnea. It is

DERMATOLOGY. best giren hypodermatic in 10% solution, us. ing from 10-25 grains in twenty-four hours.

ROBERT H, DAVIS, M. D. Caffein produced insomnia and cerebral irri. tation in 10% of these patients. Caffein may be A Note on the Spirochaeta Pallida.-Her. combined with digitalis camphor or alcoholic man (N. Y. Med. Jour., Dec. 9, 1905) says, stimulants in the treatment of severe cases. ' that, at the present moment, it cannot be

said with certainty that this organism does, Digitalis Therapy.-(F. Umber, Die Ther. or does not, play a part in the causation of apie der Gegenwart, No. 1, 1906.)- The cor. syphilis. To base a positive diagnosis on reot indications and metbods of administer. its presence, or to exclude syphilis on its ing digitalis are very essential to obtain good absence, is certainly premature. If a dili. results. The great variability of digitalis has gent search is made, the micro-organism will led various experimenters to isolate the active be found in the majority of cases of sypbilis, principles, e. g., digitalin and digitoxin, while most frequently in the secondary stage, esothers advocate dialysed digitalis. Digitalin pecially in the latter manifestations; less freis almost insoluble, resorbed with difficulty, quently in the primary lesions, the lymphatic readily disorganized in the stomach and at glands, and the blood; and rarely in the tertimes produces alarming symptoms. Digalen tiary manifestations of the disease. Recently (soluble digitalin) is used subcutaneously, it has been demonstrated in the serum of intravenous and internally. The writer used blisters artificially produced on syphilitios. digalen in sixty cases suffering from cardiac The author gives the following method for lesions. He observed that digalen similar to this prooedure, which has the advantage of other digitalis preparations if given in thera. being both simple and rapid: A small peutic doses in well compensated cardiac le- pad of gauze, one-half an inoh square, is satsions has little effect on blood pressure and urated with strong ammonia (28%), and then diuresia, and at times produces irregularity applied. It is covered by a watch glass to in the pulse. With incompensation digalen prevent evaporation, and this may be conveni. increases blood pressure, diuresis and the ently held in place by a rubber band, if the pulse becomes less frequent. At times application is made to an extremity. This is digalen or digitalis aot more promptly if allowed to remain for three or four minutes. combined with a diuretic, o. g., diuretin, The gauze pad is then removed. In about caffein natrio benzoic or agurin. Ciroulatory fifteen minutes a vesicle begins to form, disturbances due to vasomotor paresis occur from which the serum is collected in a cap. ring during acute infectious diseases should illary tube (such as is used for vaccine), and be treated by combining diuretics with car. sealed. A portion can be used for the exam. dio-vascular stimulants. Digalen produces ination of the organism in the banging drop. little pain at the site of injection if ad. It has been claimed by Thesing that organ. ministered intravenous, but is quite painful isms morphologically identical with the if used subcutaneous. For the prolonged spirochaeta pallida may be found in the fluids

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