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0. E. LADEMANN, M. D. ment of bare-lip and cleft palate. The text One Day Pneumonias.—Bechtold (Muench. is clearly written and the type used appeals Med. Wochenschrift, No. 44, 1905) briefly very gratefully to tired eyes, especially if reviews the literature of ephemeral pneu. stricken with refractory errors. The author monia, epitomizing the history and diag. illustrates by photographic prints the various nostic data of ten such cases occurring among deformed temporomaxillary joints and bites a total of 1057 cases of croupous pneumonia that are present in cleft palate. The opera. treated in the Würzburger medical clinic dur. tive treatment is explained and inany useful ing the years of 1887-1905. The symptoms points are brought out in this connection. were those ordinarily common to an acute in. Much stress is placed on the size of the feotious disease; an initial chill followed by tongue and its future accommodation in the high fever, headache, vomiting and general above treatment. For completeness and lu- lassitude. In all the cases the temperature cidness of the subject of hare-lip and cleft ended by a more or less typical crisis, usu. palate this volume merits commendation. ally associated with profuse sweating. Pain
in the side was present in eight of the ten ANNOUNCEMENT. — Messrs. Lea Brothers & cases. The objective signs were inconstant. Co. bave pleasure in announcing for publi. Palpation offered no diagnostic information cation early in January, 1906, a completely in a single instance. The percussion note new work on Dietics adapted to the use of varied from normal to a slight diminution in practitioners and students of medicine, nurses the volume and duration, sometimes with an and the laity. “Food in Health and Dis. associated tympany, and in some instances ease." By Robert F. Williams, A.M., M.D., to a distinct dullness. In two cases a preProfessor of Principles and Practice of Med. symptive diagnosis of croupous pneumonia icinein the Medical College of Virginia, Rich. was made on the general symptoms, the cormond. The volume will be a convenient rectness of the diagnosis being verified by the 12mo of abont 350 pages. Its price has not subsequent appearance of bronchophony and yet been fixed, but it will probably be about changes in the respiratory murmur (rough. $2.00, net, delivered to any address. It is ened breathing, crepitation, etc.). In two divided for convenience, into two parts: Part other patients the percussion note remained I dealing with food in Health, and Part II normal until twenty-four hours after the ini. with Food in Disease. In Part I the needs tial chill. The ausculatory findings are even of the body for different kinds of foods and more, variable than those of percussion. the manner in which they are utilized are ex. Bronchial breatbing was present in two cases. plained. The principles of cooking foods and In some instances the only evidence of a detailed descriptions of the different articles pulmonary disturbance was diminished or of food in common use are given, with chap. harsh vesicular breathing, or rales, sparing ters on the proper nutriment of infants, child in number, limited to localized areas. Pleuren, adults and the aged. Part II deals with ritio friction appeared later in the course of the variations from the normal diet in the disease in two cases, signifying an exhealth, necessitated by the more common tension of the pneumonia process to the sur. diseases, and includes a chapter on general face of the lung. The friction sound in one methods to be observed in feeding the sick, of these cases persisted for some timu. as well as the special directions for nour. Bronchopbony apparently seemed to be the ishment in diseases of different kinds. most constant auscultatory phenomena, being There exists today a need for a small prac- present in four cases. The sputum lacked all tical books on foods and how they should characteristics, save in a single instance, be used, which will give the facts, as known where it was rusty brown, while another case today, in a brief and clear manner, with the presented a bloody tinged expectoration. In fewest possible technical terms. The import the remaining cases it was either mucous, ance of a work of this kind, which is simple muco-purulent or absent entirely. It is diffi. enough for a child to read and yet abso. cult to determine whether the morbid process lutely trustworthy and based upon the scien- in these cases passes through the different tific achievements of accepted leading author- pathologic stages or remains stationary, as ities, is obvious.
such cases rarely come to autopsy. While Bechtold is of Leube's opinion, who holds creased the number with changes in the that the abortive factor depends on an ener- leucocytio formula. Irritation, as blistergetic reaction of the economy in producing ing, bemorrhage and suppuration only mod. an excessive formation of antitoxine, his ob- erately increased the number of polymor. servations also prove that the degree of at. phonuclear cells. Splenic faradization intenuation of the virus is another prime factor. creased the lymphocytes, probably by caus
ing the organ to contract and forcing them The Accumulative Effects of Digitalis and into the circulation. The blood serum of Its Prevention.—Casares' (Rev. de Med. y. these patients possessed but slight agglutinAr. Pract., July 28, 1905) experience with ating power, but contained no hemolytio or digitalis coincides with that of Eichhorst Jeucolytio properties. d' Amato's investiga. and Hoffmann who claim the universal fear tions warrants him in concluding that the of accumulative effects of digitalis is un cause of splenomegalic leukopenia lies in warranted and very much exaggerated. The a disturbance of the leukopoietic organs, es. author says there is little danger of the pecially the spleen and bone marrow. That drug accummulating so long as there is free the bone marrow undergoes myeloid transdiuresis. He advocates the administration formation in a large number of cases is of digitalis in combination with a diuretic, evidenced by the appearance of melocytes. preferably diuretin. He reports a case where No plausible reason can he give wby there o.1 gm. of the powdered digitalis leaves had should be a diminution in the leucocytes or been administered three times a day for three the sluggish reaction of the organism to consecutive weeks without any ill effects substances which ordinarily proniote an inwhatsoever.
crease in the number of white blood cor. A Case of Extreme Bradycardia.- Frey puscles. (Muench. Med. Wochenschrift, No 41,1905) Tuberculosis of the Appendix.- Sitsen reports in detail an instance of this kind in (Weekbl. voor. Genessh., No. 19, 1905) bolds a man, 56 years old, with a history of syph. that a tubercular affection of the appendix is ilis. Remarkable about the case was that for a rare occurrence, and according to postmorfifty hours before death the heart contractions tem statistics is always associated with tu. registered on the average thirteen beats per berculosis of other organs (lungs, intestines). minute with no circulatory disturbance in In his opinion the appendix is never the prithe internal organs or extremities, and only mary seat of the trouble, and says that the in the last eight hours did a disturbance in reported cases of amputation of a tubercuthe cerebral circulation evidence itself, which lous appendix with an absence of clinical presumably was the direct cause of death. manifestations of a tuberculosis elsewhere Although no autopsy was made, the presump fails to prove that the appendix was primarily tion is that the condition was a progressive diseased. degeneration of the heart muscle, on a syph. ilitic basis, with a sudden exacerbation.
A Case of Hysterical Singultus.--Makelarie
(Spitaul, No. 19, 1905) reports a unique case Blood Investigations in Leukopenic Spleno- of hysterical hiccough in a girl 16 years of megaly.--L. d'Amato (Zeitschrift f. klin.
age resulting from fright. The attacks apMedizin, Bd. LII, 1905) made a hematologic peared daily, usually between the hours of study in a number of diseases with splenio four and six in the afternoon numbering enlargement as the predominating feature. about 100 contractions of the diaphragm dur. In two cases of so-called Banti's disease, two ing each attack with absolutely no response cases of chronic malaria and a case of hepato- to the ordinary medicaments. The therapy splenio syphilis be noted a decrease in the consisted in suggesting that the attacks will number of leucocytes. In only one of these the
gradually diminish from day to day with leucocytic formula approached the normal, the result that in six weeks the patient while in the remaining four there was a de- completely recovered. Later, a transitory crease, in the polymorphonuclear variety.
exacerbation occurred from a psychic emo. There was a slight diminution in the lympho. tional effect. cytes in all five cases, and in two cases a small
er of myelocotes were present. The Remarks on the Etiology of Tetany.leucocytic formula, for some unknown rea. Chvostek (Wiener klin. Wochenschrift, No. son may vary in the same individual. 38, 1905) discusses the theoretical problems Doubtless the etiologio factor in the pro. of tetany, and concludes that it can neither duction of splenomegaly has some influen- be regarded as a diseased state of the cencence on the leucocytic formula Digestion tral nervous system, nor one of systemic infuened a slight increase in the number of poisoning. Animal experimentation, with leucocytes in four cases, while in one it de. the associated clinical evidence, warrants him in considering tetany as a distinct of the organ restored. Neck recommends clinical entity having its origin in a elevating the pelvis when siphoning the disturbed functionation of the parathy- stomach, as this procedure facilitates evacuatroid glands. This epithelial impairment ing the organ. The distended stomach somemay be either congenital or acquired, perma. times interferes with the function of the nent or transitory. It is probable that the bowel. This can be obviated by tbe patient causative factors of endemio and epidemic lying face downwards or changing to the knee tetany are analogous to those of endemio chest position every two hours, and remain. struma. Among the different exciting agents ing in this posture fifteen minutes each time. which also produce the specific tetany reac. Surgical interference is a last resort. Gastion in individuals with this constitutional troenterostomy might be tried, but in the anomaly, are gastrio dilation, pregnancy, etc. four cases thus treated, it was too late to
benefit the patient. Acute Dilation of the Stomach.-Neck (Centralblatt f. d. Grenzgebiete der Med. und Cbir., Nos. 14-17,1905) critically reviews the
SURGERY. literature on acute gastric dilation, analyzing tbe 64 recorded cases, among which are 44
JOHN MCHALE DEAN, M. D. with autopsy findings. In the majority of cases the organ extended to the pubic bone, Local Effects of Peritoneal Drainage.and in some instances to the floor of the pel. Yates, in Surgery, Gynecology and Obstet. vis. The onset was usually sudden without rios, publishes the results of peritoneal drain. any previous evidence of a storpach disturb. age after a series of experiments on the dog, ance. In 28 of these cases the distention oc- and later clinically on patients. While the curred after chloroform anesthesia. It is results were obtained on healthy peritoneal possible that in 17 of this number the stom. cavities, yet the results would not materially ach might have been injured during the oper differ in diseased conditions. His conclu. ation (laparotomy), but it is more than prob. sions are best expressed in his own words, as able the chloroform injuriously affected the follows: "Drainage of the general peritoneal walls of the stomach, as in the remaining 11 cavity is physically and physiologically imcases the possibility of having injured the possible. The relative encapsulation of the stomach at the operation is out of the ques. drain is immediate. The absolute encapsulation, the operations having been on the ex- tion occurs early (less than six hours in tremities, as knee, elbow, foot and hip. The dogs), and can be retarded, but not prevented author cites the following case to illustrate a The serous external discharge is an exudate probable idiosyncrasy of the stomach against due to the irritation of contiguous peritoneum certain drugs, possibly acting as exciting fac- by the drain. There is a similar inward curtor of the distention: A man, who on several rent from the potential into the general cav. occasions had undergone chloroform anes. ity. This external exudate diminishes rethesia without any after effects suddenly de. markably with the formation cf encapsulat. veloped an acute gastric dilation two hours ing adhesions. These adhesions, under ap. after the taking of a single dose of 0.1 gm.of proximately normal conditions, form about veronal. In other cases the distention fol. any foreign body. Their extent and density lowed indiscretions in food or drink-in one depend on the degree and the duration of the case four bottles of champagne, and in an irritation of this body. Primarily fibrinous, other two bottles of lemonade. Cases of these adhesions become organized in a few aoute gastric enlargement have also been ob. days (three days in dogs). If the irritation served following abdominal contusion or other persists, they become progressively more injury. The symptoms are quite deceptive. mature fibrous tissue. After irritation Pain may be acute at various points; vomit. ceases, their disappearance depends princi. ing generally occurs, but it may be absent or pally upon a mechanical factor—the ability cease abruptly. Sometimes the symptoms of the involved surfaces to pull themselves or suggest the action of toxines. The tempera- to be pulled loose. Drains should be tbe ture remained normal in all but two cases. least irritating, and should be gradually and As a rule it is difficult to differentiate this finally removed as soon as possible. Irrigacondition from acute intestinal obytruction tion through grains is futile to prevent ad. and peritonitis. Recorery occurred in only hesions, and dangerous. After a drain is in. 17 out of tbe 64 cases. Concerning the treat. serted, all intra-abdominal movements should ment, the use of the stomach tube three times be reduced to a minimum. As soon as the daily has proven most efficient, but must be drain is removed, intra-abdominal activity continued until the stomach has returned to should be stimulated, to aid in the disappear. its normal size and the proper functionation ance of the remaining adhesions. Peritoni.
tis, if not too severe, possibly aids in the ra- air that must necessarily enter the circulation fidity of the encapsulation of the drain. A at the time we can not conclude otherwise drain in the presence of infection is deleteri. that death from air emboli is uncommon. In ous to peritoneal resistance, and should only the mere sewing up of wounds we always enbe introduced to exclude more malign influ. close a certain amount of air and never with ences. Postural methods, unless destined to ill effects. Still that death may ensue from facilitate encapsulation, are both futile and air emboli we can not doubt, but the experibarmful, as far as drainage is concerned. ments indicate it must enter rapidly and in Peritoneal drainage must be local, and unless very large quantities. How it disappears after there is something to be gained by rendering entering the circulation is a point not well an area extraperitoneal, or by making from explained. The air molecule is absorbed after such an area a safe path of least resistance disintegrating into its component parts of leading outside the body, there is, aside from oxygen and nitrogen. hemostasis, no justification for its use."
Cartilage Plates from the Scapula of the The Injection of Air into the Circulatory Calf for Liver and Spleen Suture.-Stamm, in System of Animals.-In the Journal of Sur. Surgery, Gynecology and Obstetric Journal, gery, Gynecology and Obstetrics, Ezra Read comments on the artiole of Payr and Martin Larned gives the results of seven experiments in Archiv fuer klin. Chruirurgie, in which on dogs by injection of air in the croulation. the use of cartilage plates from the scapula of It has been the general impression that if air a calf are used for suture material in liver and should enter a vein when given a salt solution splenic injuries. Anyone who has had to deal intravenous injection, the danger of death by with these injuries can appreciate this sugair emboli was a thing to be anticipated. The gestion. In experiments on dogs the cartil. injection of air in hypodermic medication is age plates were fully absorbed and no depressa very frequent daily occurrence, and yet no ion found at the site of suture. The cartil. case of death is shown to have ever resulted. age plate is easily sterilized and its applicaPirogoff, Laborde and Muron found that tion does not entail much difficulty. The when 200 grains of air was injected in jugu. plates are fastened with mattress No. 2 dry lar vein of a horse death resulted. Hare claims catgut suture. A straight or curved needle that the small air emboli are more to be is used. dreaded than the large. The author found
Antiseptic Action of Bromine.—A solution after injecting air into the circulation of
of bromine two drachms, bromide of potash arimals merely a transitory dyspnea resulted,
two dracbms, and one pint of water, inixed due to pulmonary emboli. Sunn's conclu.
and kept in glass stoppered bottle, has been sions from similar experiments are as follows:
used by Stroud in the treatment of infected 1. A small amount of air in the right side
wounds as an antispetio. The results obof the heart in a healthy animal gives rise
tained by Stroud justify the imitation by only to temporary symptoms, referable to the heart's action and the pulmonary circulation.
other surgeons. 2. When air has been injected into the right Action of Roentgen Rays on the Blood.side in such quantities as not to arrest the A very instructive article in the American contractions of the heart itself, it is forced Medicine, Morris explains after much clinical through the pulmonary capillaries into the work the effects of the rays on the blood as left side of the heart by the contractions of follows: 1. The Roentgen rays cause a the right ventricle. 3. The danger attending marked diminution in the absolute number the insufflation of air into veins is propor- of leucocytes in the peripheral ciroulation. tionate to the amount of air introduced, as 2. Preceding the leukopenia, there may be a well as to the capacity of the right ventricle moderate rise in the number of leucocytes to resist intracardiac pressure. 4. When a from eight to twelve hours after the exposure, fatal dose of air has been introduced into the the increase being due largely to the greater circulation, death takes place almost instan. number of polynuclear cells in the circulation taneously from arrest of the heart's action, or (observed only in the rabbit); the same conlater from suffocation. 5. Spontaneous in. dition may be found just at the end of the gress of air into a wounded healthy jugular exposure, subsiding rapidly. 3. The lympho. vein never occurred in tbese experiments, and cytes are especially susceptible to the action must be considered almost a physical impos- of the rays; they are affected first and most sibility, as the resilent walls of the wounded intensely. 4. Alterations in the histologic vein collapse readily when exposed to atmos- characters of the lymphoctyes and polynu. pheric pressure.
clear amphophiles may be found in the rabWhen we consider some abdominal and cer- bit, similar to those described in the lymvical operations and realize the amount o phoid tissue and bone marrow. 5. Hard tubes produce the most marked changes in the leu- cular tissues of the ventricular septum. The cocytes. 6. No noteworthy numerio or his walls of the sinus valsalvae (right) consists tologio alteration takes place in the red blood of the elastio tissue of the aorta, the intercells within the first few hours following ex. mediary connective tissue, and partly the posure; the percentage of hemoglobin is not muscular tissue of the right ventricle. "Natessentially within the same time.
urally, the wall is thinner than the walls of the other two sinuses, and, according to Krzywicki and Kraus, constitute a locus
minoris resistentiae. Several reports of cases PATHOLOGY AND BACTERIOLOGY.
at autopsy are given in this paper. One of R. B. H. GRADWOHL, M. D.
these cases showed an aneurism of the right
sinus valsalvae perforating into the left venAneurism of the Right Sinus Valsalvae of tricle of the heart. There was an insuffi. the Aorta and its Relationship to the Upper ciency of the aortic valves. The aneurism Ventricular Septum.-Karl Hart (Virchow's in this case was directed backwards, which Archiv, Bd. 182, Heft. 2, 1905) states that accounted for its perforating into the left aneurism of the sinus valsalvae is not com- ventriole of the heart. A communication monly spoken of in the standard works on bad been established between the aorta and pathologio anatomy. Orth speaks of its the ventricular cavity, just as if it were an rarity. Heyman in bis Dissertation of 1874 aneurisma dissecans. As causes of aneurism collected cases. English writers, Redi, Sib- of the right sinus valsalvae, Krzywicki gives son. Peacook. have made most of the observa- the following: (1) atheromatous (aneurisma tions on the subject. They call aneurism of spurium); (2) pressure on a locus minoris re. the sinus valsalvae ''those cases wbioh while sistentiae (aneurisma verum); (3) lues. not located direotly in the sinus are seen at point bebind the aortio valves, just on the Phlebitis Migrans (Non-syphilitica).-Gottedge of the sinus valsalvae, aneurisma which fried Schwartz (Virchow's Archiv, Bd. 182, grow in such a manner as to obliterate the Heft 2, 1905) reports two interesting cases of form of both sinuses.” In this connection, phlebitis migrans which presented clinical a finding made by Rokitansky (Wiener med. symptoms of tbis disease, which were verified Jabrbuecher, 1867, Heft III) is interesting, at the obduction in each case. The first case i.e., he reports an aneurism at the common was a woman of forty years with well marked insertion of the two aortic valves, that the pulmonary tuberoulosis. She had no specific sinus was separated from the valve attach- history. She entered the hospital (Vienna) ment. Sibson and Peacock made similar ob- in March, 1903, and in May presented a pain. servations. On account of the rarity of this ful swelling in the left sulcus cubitalis ul. lesion, it has been impossible to determine naris. A few days later a palpable and visi. the exact relationship an aneurism of the ble strand-like swelling was seen extending sinus would bear to the right and left ventri. from the sulcus bioipitalis med. to the axilla. cular cavities, to the pulmonary artery, and The skin over it was slightly reddened. The to what extent a lesion of this kind would arm seemed warmer than the right. In June contribute to aortic insufficiency, and finally the right arm became similarly affected. The to rupture into the pulmonary blood vessels, sensory symptoms finally disappeared. The into the pericardial sao or right heart. The patient died of cachexia on July 6, and ob. right sinus valsalvae is most frequently duction showed chronio tuberculosis of the affected of the three. Sibson accounts for lungs. The superficial and braobial veins of this on the basis that the arterial wall is both arms were excised. The second case, a thinnest at this point (Med. Anatomy, Lon. man of 33 years, presented himself on April don, Fasc. V). This can be explained from 24, 1903, showing lung tuberoulosis with tuan embryological standpoint by the observa. bercle bacilli in sputum. No history of any tions of His on the anatomic structure and venereal disease was elicited. On June 23 the observations of Krzywicki on the patho. he complained of pain in the sulous oubitalis logic changes induced at this point, to wit, ulnaris and in the sulous bicipitalis medialis the right sinus valsalvae lies over and anter- up to the middle of the left arm. At these ior to ihe pars membranacea of the ventri. places could be seen an edema and diffuse cular septum. Its wall is developed according reddening of the skin; pressure showed tender to His, from the septum inferius aortae grow. cords along these sites. Immediately over ing out from the right ventricle, whioh ao. the vepa basilica mediana down on to the counts for the fact that the right sinus con- forearm, for a space of 7 mm, diameter could tains the elements of the muscle of the right be seen a distinot, painful swelling. The pain ventricular wall on the one side and on the disappeared in these places after a day or two, other side, it is traceable directly to the rus. leaving the tender cord-like swellings behind.