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tis, if not too severe, possibly aids in the ra air that must necessarily enter the circulation pidity 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 en. be 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 experi. harmful, 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 article 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 em boli 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 cartilcase 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 drachms, 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 ob. of the heart in a healthy animal gives rise
tained by Stroud justify the imitation by only to temporary symptoms, referable to the
other surgeons. heart's action and the pulmonary circulation. 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 circulation. 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 histologio 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. Nat. essentially within the same time.
urally, the wall is thinner than the walls of the other two sinuses, and, according to
Krzywicki and Kraus, constitute & locus PATHOLOGY AND BACTERIOLOGY.
minoris resistentiae. Several reports of cases
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 ventricle 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
of the right sinus valge son, Peacock, 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 rethe sinus valsalvae "those cases which 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 sucb a manner as to obliterate the Heft 2, 1905) repcrts two interesting cases of form of both sinuses.” In this connection, phlebitis migrans which presented olinical a finding made by Rokitansky (Wiener med. symptoms of this disease, which were verified Jahrbuecher, 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 salcus 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 sac or right heart. The patient died of cachexia on July 6, and obright sinus valsalvae is most frequently duction showed chronio tuberculosis of the affected of the three. Sibson accounts for lungs. The superficial and brachial 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 tu. an 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 sulcus bicipitalis medialis the right sinus valsalvae lies over and anter- up to the middle of the left arm. At these ior to the 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, which ac 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 rous. leaving the tender cord-like swellings bebind.
But the painful areas extended distal-wards OBSTETRICS AND GYNECOLOGY
W. H. VOGT, M. D. could be definitely determined that the ves.
Origin of Oblique and Transverse Positions. sels affected were not obliterated. Blood con
-(Fritz Kermauner, Centralblatt fuer Gy. tinued to pass through them. On the 4th of
naekologie, No. 34.)-An oblique position July, an area 1 cm. by 3 mm. was seen over was observed bù the
was observed by the author in a 19-year-old the left vena mediana antibrachialis. An
primipara. The pelvis was somewhat generother node was seen on the right arm in the
ally contracted, and the head lay on the left sulous cubitalis ulnaris. The forearm was
ileum. The patient was placed on her left side similarly affected afterwards, the first nodes
during labor in the hopes of correcting the losing their painfulness. On the 27th of
position, but without any effect. An internal July, nothing remained but the thickened
examination was then made, and it was vessels. Death occurred on the 31st of July.
found that the entire pelvis was filled with Autopsy showed chronic tuberculosis of both
a fairly tense cystic tumor about the size lungs, atrophy of the muscles of the right
of a child's head. The membranes were un. upper extremity, acute hemorrhagic nephri.
ruptured and the os was dilated to a degree tis, skin covering this part pale. Vena ce
sufficient to allow two fingers to pass. This phalica thickened. The intima showed no
tumor was immediately suspected as being visible changes. The veins of the right arm
the filled bladder. Upon catheterization 900 were excised, as in case 1, laid open and bard.
co. of urine was drawn, whereupon the tu. ened in 95% alcohol, imbedded in celloidin
mor immediately disappeared and the head and cut into sections. These sections showed
entered the pelvio inlet. He mentions the that the intima was not affected and that the
fact that transverse positions in primipara process was an inflammatory one, affecting
ng with a full term child are rare and usually
: the media and the adventitia. There were
the causes of the same are obstructions pre. numerous round cells and lymph cells in
venting the presenting part from entering these two parts of the blood vessel wall. The
the pelvis as tumors, contracted pelves and cases were apparently free from syphilis. The
in very rare cases placenta praevia. The fact writer explained the phlebitis on the ground
that the bladder remained in the pelvis after that he had to deal with a chronic disease
being so tensely filled with urine makes this (tuberculosis of the lungs), that the patients were bed-ridden for some time, that they lay
case interesting, for we know, although the
bladder is a pelvic organ it rises out of the in bed with their arms under their head, thus
pelvis when greatly šlled. Strange, too, is making an undue pressure upon these arm
the fact that on the second day of the puer. veins; that there was a mixed infection, pus
perium the bladder at one time contained and tubercle organisms; that toxins of these
500 cc.of urine, and still it was not to be felt two sources were floating in the blood stream and that with the pressure above described
above the pelvio inlet. marking in the veins a locus minoris resisten
Operative Treatment of Retrodisplacements. tiae, phlebitis began and ran from one vein -(Channing Barret, Surgery, Gynecology to the other. In short he calls attention to and Obstetrics, Nov., 1905).—The following the difference between this kind of phlebitis propositions are made: (1) That retrodeviaand the syphilitic form wbich was described tions of the uterus are frequent; (2) that they by Neisser; in the sypbilitic patient, phlebi. are pathological per se; (3) that they tend to tis occurs in strong, healthy appearing per- create further pathology; (4) that because of sons, while in the non-luetic kind the patient the symptoms which they produce, and the was weak and bed-ridden. The sypbilitic further pathology which they create, they are phlebitis yields readily to anti-syphilitic with few exceptions, deserving of treatment. treatment only, while the cases just described This treatment should be either operative or seemed to do well under simple local treat. non-operative. Cases without intra-abdomment of compresses of aluminum acetate. In inal complications, with a fair pelric floor the syphilitio phlebitis, the veins histologi. and with only moderate pathology in the cally showed "islands of infiltration,” while uterus, may be given the non-operative treatin the non-syphilitic variety there is a uni. ment if the conditions are such that the paform infiltration. In the syphilitio phlebitis, tient can remain under observation and treat. the intima showed hemorrhagic areas, which ment for some months. The best results are was not true of these cases. In conclusion, obtained in this class of cases shortly after the writer believes that there should be a dis- delivery. All of the rest of the cases come tinction made clinically and histologically under the head of operative cases. The re. between the specific and the non-speoific quirements of any operation should be: (1) phlebitis migrans.
The operation must have the slightest mor
tality; (2) the incision must allow the correc. the wave motions of the air, these again detion of complications; (3) the operation must pendent on the form of the tone waves, create the least possible pathology; (4) in a they are much slower than the others and child-bearing woman it must allow of no in- differ with them particularly, in their variaterference with future pregnancy; (5) it must bility, lack of periodicity, and the absence assure us of a permanency of results, with or of oscillatory character. The first group of without future pregnancy -- must stand movements Bard ascribes to a function for Goldspohn's "double test of pregnanoy;" the protection of the inner ear; the second (6) it must have the least possible morbidity. group transmitting to the labyrinth the inThe author thinks well of the Alexander- tensity, tone, pitch and location of noise; the Adams operation where no complications ex- third group is the acoustic form of the soundist. But in order to find an operation that ing body. The active movements of the cbain will meet with all the above requirements the of ossicles serve for the accommodation for author has devised the one described by him, tones. The first group of passive movements and finds it extremely satisfactory. His oper. (refoulement tympaniques) plays no roll in ation consists in opening the abdomen by a the hearing, the second group of movements median incision of 11 to 2 inches in length; the true, acoustic vibrations take place withintra-abdominal complications are then dealt out any participation of the articulations of with and the round ligaments are then picked the chain of ossicles. The third group was up and a control ligature is thrown around dirst described by the author, and he ascribes each about 21 inches from the angle of the to it an important roll in the perception of uterus. The edge of the aponeurosis over the acoustic forms. Regarding the accommodarectus muscle is caught near the lower angle tion the author remarks that the movements of the wound, and the author's curved liga- of the tensor tympani do not swing the mal. ture forceps are carried between the aponeu- leus around its neck, but draws the handle torosis and the rectus muscle outward to the in- ward the inside. These changes of the tenternal ring, where the forceps is guided into sion of the membrane called forth are the exthe abdomen, the control ligature is now pression of the adaptation of the membrane grasped by the forceps, and along with it is a to noise, respiration quiet. The contraction loop of round ligament, and the same is of the sta pedius draws the neck of the stapes withdrawn. Each loop of round ligament and with it the entire chain of ossioles, inwbile being held by the control ligature, is cluding the handle of the malleus, backward. sewed to the under side of the aponeurosis Therefrom result differences of tension bewith catgut, about one inch from the median tween the vertical halves of the membrane, line, and if the loops should be long enough making it possible for the membrane to adapt they are sutured together over the recti mus itself to the distance of the origin of the cles. He terms the operation intramural sound. Whilst he compares the internal mus. transplantation of the round ligaments. He cles of the ear with the muscles of accommobelieves that anything that can be said in dation of the eye, he places the tensor with favor of the Alexander-Adanas operation as the iridis muscle (adaptation for the intensregards pregnancy can also be said of this ity) the stapedius with ciliary muscle (acoperation.
commodation for distance). OTOLOGY.
Pathological Anatomy of the Inner Ear
and the Question of Primary Brain Abscess. ALBERT F. KOETTER, M. D.
:-(Schwabach).—Girl of fifteen received in The Movement of the Ossicles and the Part hospital with headache, vertigo and nausea, They Play in Hearing.-L. Bard (Journal of which have been present for five weeks fol. Physiology and General Pathology) reports lowing a suppurative otitis media sinestra, his observations in the study of physiology which appeared seven weeks before. Left of the middle ear. First of all he differen- membrane slightly congested. Lumbar tiates distinctly between active and passive puncture reveals 40 com. of clear sterile fluid. motion of the chain of ossioles, the former Pulse continually sluggish. When author saw are caused by muscle contraction, the latter patient she was in a stupor, pupils irregular, by movement of the tympanic membrane. deviation conjugée to the right, contraction The passive movement may be traced to three of left elbow joint. Death occurred with the causes: 1. Driving back the membrane de appearance of paralysis of respiration. Postpendent on a considerable change of air mortem.-On right under medullary submovements. 2. Acoustic vibration of the stance of the frontal lobe an abscess the size membrane corresponding to the rhythmic of a hen's egg filled with sterile pus, capsule periodicity of the sound waves. 3. Morpho several millimeters in thickness. Brain sinus logical deformation of membrane formed by free. Right petrous portion of temporal
bone clear; on left tough yellowish mucus in of myxomatous tissue. In the bone there the tympanum. Histological examination were observed in one case extensive soften. besides slight inflammatory changes on the ing, and in four other cases in a slighter non-perforated membrane, small quantity of degree. When the resorption foci are nearly free pus, considerable tumefaction of the mu all
found in the mastoid process, Goerke thinks cous membrane of the tympanic cavity. the tympanio cavity which is rich in connec. Eruption of pus, with partial destruction tive tissue submucosa offers great resistance of the annular ligament of the stapes into to the extension of the inflammatory process. the vestibule, furthermore, on different parts Author has found the middle ear exudate al. of the labyrinth capsule in the cavity of the most exclusively in weak individuals, those cochlea, with simultaneous appearance of suffering from long continued disease, which connective tissue and new bone formation in eventually causes death; he therefore thinks the spongiosa of the temporal bone. Sligbt that the origin of the otitis (otitis of the cachanges in the mucous membrane of the mas chectio) is favored by the lowered vitality toid cells. Extensive suppuration and con and diminished resistance of the tissues with nective tissue formation in the labyrinth, also the insufficiency of the normal protecsmall cell infiltration of the vestibule, suppur tion. With this be divests, as compared to ative hemorrhagic exudate in the semi-circu. Preysing and others, the otitis media of the lar oanal both in the endo- and peri-lympba. infant and many other middle ear inflammatio spaces.
Inflammatory infiltration of the tions considered specifio, in so far as they becooblear nerve, also traces in the vestibuler long to the above mentioned group, com
Facial nerve intact. Of importance pletely of their specific character. is the incongruity between the comparatively
The Relation of Diseases of the Circulatory sligbt changes in the middle ear and the extensive destruction in the temporal bone as
System to Diseases of the Ear.-(C. Stein, well as in the cochlea. The brain abscess al
Zeitschrift fuer Ohrenbilkunde).-Of the though it existed, in an otitis media suppurai sclerosis, mitral stenosis and myodegenera,
diseases of the circulatory system, arterio. tive sinestra, on the rigbt side can be traced back to this suppuration, an abscess mem
tive cordis are most frequently associated brane can occur in abscesses whose existence
with disease of the ear, and in the majority can be dated back only a few months.
of the cases, arteriosclerosis. The symptoms
on the part of the ear were tinnitis, deafness The Exudative and Plastic Processes in the and other subjective symptoms of a non-inMiddle Ear.—(Goerke, Archiv fuer Ohren- flammatory nature, most often as a result of heilkunde.)—The interesting and painstaking disease of the sound perceiving apparatus. examinations of the author, embracing the Author thinks there is a direct connection post-mortem sections of hundreds of cases
between arteriosclerosis and diseases of the and the histological description of eighty sound perceiving mechanism, which is of temporal bones refer to the pathological anat especial value to the clinician, in that the ear omy of acute otitis media without perforation symptoms in conjunction with increased of the membrane. They prove first of all that
blood pressure, can be utilized as early sympthe exudates found so often in the middle ear
toms of arteriosolerosis. The above mencavity in post mortems are not transudates,
tioned affections of the circulatory apparatus but in fact inflammatory exudates. Whereas,
influence the middle ear processes in that the exudate was found in the tubes in small they favor the spread of the process to the quantities, the tympanic cavity was usually labyrinth. The cause for the detrimental in. entirely filled. Parts most often involved
volvement of the ear is due to the anemia are the windows, the posterior pouch of the brought about by disease of the blood vesmembrane, the floor of the tympanic cavity,
sels. Therefore all local therapy should be the smaller and smallest spaces between the discarded, and in its place, the treatment of ossicles and their ligaments and Shrapnell's the heart, respectively the blood vessel affeo. membrane. In the antrum and mastoid cells
tion is advised. the exudate enters the dependent parts if it does not entirely fill them. The exudate undergoes remarkable changes until it becomes
PEDIATRICS. connective tissue. While now the epithel.
A. LEVY, M. D. ium grows down to the vessel carrying bridges which spread out between the mu " Gone Off His Legs." -(G. A. Sutbercous membrane and the exposed exudate land, Brit. Jour. of Children's Diseases, there arise the so-called cavity proliferations March, 1905).- The occurrence of weakness of Preysing, a condition which was perhaps of the lower extremities in a child previously erroneously connected with the involution able to stand, walk and run normally is a