recognized by the discovery of palpable the cases remained normal for some hours. thiokening of the blood vessels, by the in. The ofiaracteristic facial expression (facies creased vascular tension, by the auscultatory hippocratica) was usually a late manifesta. phenomena at the beart, and by the general tion. Percussion, palpation and the count. appearance of tbe patient. The disease pre. ing of leucocytes furnished unreliable data. sents itself in a variety of types, according to Rectal examinations are of some value. the the special involvement of one or another of pressure exerted by the examining finger the important viscera, or by special vascular sometimes caused pain at the site of the conditions, and are classified by the writer perforation. The author believes one is al. under the following beadings: 1. The thor ways justified in resorting to a laparotomy aoio type, of wbich may be distinguished (a) whenever pain, tenderness and muscular cardiac, as moderate disturbances of the rigidity coexist, as in doubtful cases it is heart's action with a tendenoy to arrhythmia better to operate once too often than not or special involvement of the coronary arter. enough. ies (angina pectoris); (b) aortic, not merely

Notes on the Cerebrospinal Fluid.-Pasbareferring to aneurism of the arch of the aorta,

gan (Med. Rec., Feb. 10, 1906) made a oys. but also to sclerotio and calcareous rougben.

tologic analysis of the cerebrospinal fluid in ing without any dilation of the aorta, but

patients suffering from paresis and other causing embarassment of the heart's action. 2. Abdominal type, of wbich there are (a)

mental affections with the view of determin.

ing the constancy of the lymphocytes. renal, evidencing itself, as the clinical pic

Among 37 cases of general paresis there was ture of interstitial nepbritis; (b) intestinal,

a'marked increase of the lymphocytes noted less commonly recognized, and manifesting

in 16 cases, a moderate increase in 5 cases, itself by atrophy of mucous membrane and a

doubtful in 3 cases, and negative in 3 cases. tendency to chronio colitis, ulcerations in

In 7 chronic alcoholics, 6 old leutios, 25 epi. the upper part of the small intestine, and

leptios, 13 hebephrenics, 8 katatonics, 7 man. sudden painful obstructions (paresis of the

iac-depressive cases and 7 paranoiacs the walls) of the bowel; (c) pancreatic, difficult

lymphocytes were diminished. of recognition, however, often active in dia. betes; (d) hepatio, occurring as cirrhosis. 3. Grave's Disease and Its Treatment.-Mur. Cerebrospinal type, most numerous and vari. ray’s (British Med. Jour., Nov. 11, 1905) ed and probably a number of definite nervous paper en braces an elaborate discussion of the diseases of cerebral causation have as their symptomatology and therapy of exophthalmic underlying basis arteriosclerosis of the cere- goitre. Concerning the treatment, rest in bed bral vessels. 4. Arterio-capillary type, man. and fresh air in conjunction with a "mast ifested in moderate circulatory disturbances. kur" is absolutely essential in the severe

forms, especially the acute cases, while rest, Perforation in Typhoid.-Meakins (Mon. fresb air and nutritious diet are also import. treal Med. Jour., Oot., 1905) bases bis article ant factors in the later stages of the disease. on a study of 32 cases of perforation occur. Murray strongly recommends mild faradizaring among 1230 cases of typhoid treated at tion applied twice daily for a period of one the Royal Viotoria Hospital, Montreal. hour each time. Tłe electrodes, to be made Twenty of this number were operated, 5 re- of a pliable material, are to be respectively covering. In the remaining 12 operation placed on the goitre and back of the neck. was deferred because the patient was either In some cases radiotherapy acted beneficially. in a moribund state, or a conclusive diagnosis Among drugs, the author regards arsenic as of perforation had not been made. Of the one of the few remedies which has proven symptoms, sudden and severe pain in the ab. efficient. For the tachycardia, arsenic in domen was most constant, being present in combination with convallaria is of greater 84 per cent of the cases. In one case this benefit than either digitalis or strophanthus. symptom alone prompted surgical interfer- Potassium bromide may be given to alleviate enoe. Disappearance of hepatic dullness the nervous symptoms. Thyroid extract and in the absence of meteorism proved a valu. the iodides are positively harmful. Sodium able diagnostio feature. The pain in most phosphate, recommended by many, has proven cases was diffuse. Abdoidipal rigidity was to be of no value in the author's hands. present in 24 cases, but as a rule, did not The different sera (Möbius and others) have evidence itself until late. The temperature been applied in several cases, but without and pulse afforded but little diagnostio clue, any apparent beneficial results. Rodagon on the former not falling below normal until the other hand (desiccated thyroidectomized some time after the onset, and the latter not goat's milk) gave promising results. Cauexceeding 100 beats per minute till several tion, however, is necessary in the administra. hours had elapsed. Respiration in most of tion of rodagon, as large doses may so reduce the pulse as to cause cardiao cessation. A Hospital. About the fourth week of the dis serum obtained from rabbits and goats, which ease a polyuria sets in. The twenty-four bad been given large amounts of thyroid ex. hour amount of urine increases from 30 oz. tract, was tried in two cases of exophthalmic to as high as 100 oz. This polyuria is to be goitre without any result. Operative meas- regarded as indicative of a favorable termin. ures are dangerous, and if resorted to should ation, and when it once makes its appearance be only under local anesthesia, as the danger the danger of perforation or hemorrhage is apparently seems to lie in the narcosis. insiguificant and a relapse is quite a rare Trichinosis and Eosinophilia in General.

event. Stäuble's (Deutsche Archiv für klinische Heart-Massage in Chloroform Syncope.-Medizin, Bd. 35, Heft 3 and 4, 1906) illus- Smith and Dazbich (British Med. Jour., trated contribution emphasizes the value of Nov. 18, 1905) report an interesting case of making hematologio examinations in trichi. a man who had been put under a chloroform nosis. In the 7 cases observed by him the anesthesia for the purpose of making a rectal eosinopbiles were markedly increased, and in examination with the view of determining 4 of these, which were of a severe type, there any malignant growth. While under the in.

á considerable general hyperleuco. fluence of the anesthetic the heart and rescytosis. The increase of eosinophiles was piration suddenly ceased. The ordinary res. not at the expense of the neutrophiles, as the toratives, as artificial respiration and the sub. latter were increased during the entire course cutaneous injection of strychnine, had no of the disease. The lymphocytes, although effect when an abdominal incision was made in the beginning somewhat diminished, like and the heart gently massaged through the wise showed an actual increase. In the severe relaxed diaphragm. About sixty seconds forms of trichinosis, especially those termin. later the heart began to beat again and the ating fatally, the eosinophiles may again patient made an uneventful recovery. disappear, or an eosinopbilia may be entirely The Effect of Posture on Cardiac ar lacking. Eosinophilia does not evince itself

lar Murmurs.-Rudolf (Amerioan Medicine, until about the eighth or tenth day after the

March 3, 1906) emphasizes the influence of ingestion of the trichiniferous meat. The

ditferent postures on the various bruits incentive of the eosinophilia is not the ab.

which ocour in the circulation, a matter of sorption of some toxic substance contained

which some writers make only a soanty al. in the trichina capsule which might be lib.

lusion, while others do not mention it at erated in the gastrointestinal tract, but seems

all. The murmurs most markedly influenced dependent on the liberation of the enıbryos or their invasion of muscles.

by change in posture are the functional

The dissemin. ation of the embryo is by means of the blood

ones, but organio bruits by no means al

ways escape. In studying the effect of po. channel, as is evidenced by the fact that their presence is demonstrable in the ciroula.

sition on murmurs one must avoid possible

sources of error. The effects of muscular tory blood of the heart. A local accumula.

action made by the patient in assuming a tion of eosinophiles at the point of muscle

different position can be obviated by allowsubstance disintegration could not be dis.

ing him to remain in the new posture for a ceruable. The eosinophiles may, therefore,

short time before auscultating. Under vas. be looked upon as a reactive manifestation

cular murmurs are the arterial bruits and the of substances emanating from the embryonal

venous bum, the former, often heard in ane. triohina (probably also from the degenerated

mia, neurasthenia, eto., are most pronounced muscle-substance) and passing into the cir.

in the recumbent position, while the latter oulation. Stäuble's animal experimentation

is best heard in the sitting or standing pos. also corroborates the clinical observation

ture. The murmur is loudest generally at that a rapid lymphocytic reduction (lympho.

tbe roct of the neck on the right side and is zytensturz) in infectious diseases is signifi

exaggerated by the patient turning his head cant of a bad prognostic omen. A rare con.

to the left. Cardiac murmurs, whether func. comitant symptom occurring in the four ex

tional or organic, are those produced within treme cases and wbioh may prove to be of

the heart itself, and the general statement may diagnostio value, was a positive Kernig

be made that all ventriculo-systolic bruits, if phenomena with a total absence of the patel.

affected at all by posture (and most of them lar. The urine of all cases gave a strong po.

are), are loudest and most extensively audible sitive Ehrlich reaction.

when the patient is in the recumbent posPrognosis in Typhoid Fever.-Simon (Brit. ture. On the other hand, all murmurs ocish Med. Jour., Nov. 1, 1905) bases his re. curring during the ventricular diastole (if marks on a clinical study of a large number affected at all by position) are loudest in the of cases treated at the Birmingham General upright posture. Rudolf discusses the theor. jes advanced by many writers regarding the the intestines, wbich is probably the result of influence of position in intensifying and de- metabolio disturbances. In the intestines creasing the audibility of murmurs, but the larva receive their nourishment from the throws no additional light on the subject, mucous membrane, which they devour. Hemstating that the theory of exactly why pos- orrhages resulting from vascular erosion are ture alters many circulatory murmure is of coincidental and secondary occurrences. The little practical importance, wbile the remem- former view of a per os infection of the an. brance of the fact that it does do so is of the kylostoma larva is unquestionably subordin. greatest clinical value. He urges the neces- ate to a cutaneous invasion. Introduction gity of auscultating in both the erect and hori. into the alimentary tract by means of drink. zontal positions whenever an examination of ing water, is necessarily a seldom ocourrence the heart is made, and in giving a description as the larra rapidly sink to the bottom, and of a heart murmur it should always be stated the idea of contaminated bands conveying in what position the patient wus when the the larva to the mouth is certainly very infremurmur was of the pature desoribed.

quent, as the larva rapidly die onder dry con

ditions. On the other hand, cutaneous invaHeart Massage in Death following Asphyxi

sion rapidly occurs in bare foot individuals ation, Poisoning and Chloroform Syncope.

working in ditches etc., containing water pol. Müller (Wiener klinische Rundachau, Nos.

luted with ankylostoma larva. The larva, 50.52, 1905) anesthetized dogs until death

owing to their active motility, constantly ensued and fifteen to twenty minutes later

strive to leave their original place of babita. exposed the heart and gently massaged the

tion (feces, etc.) and wander elsewhere, proorgan, at the same time injecting salt solution

viding the surrounding atmospheric condi. and small quantities of oxygen in the veins,

tions (sufficient moisture) are favorable. The whereupon the animal gradually returned to

higher the temperature, until a certain limit life. The author hopes this method of resus.

is reached, the more active is the motion of citation may eventually be successfully ap.

the larva, and in this stage of activity they plied to man, especially in those cases with a

are capable of climbing walls and embankpreviously healthy heart.

ments, providing there is sufficient moisture. Remarks on the Infection of Ankylostoma. Six per cent of the laborers working in a ditch Duodenale Through the Skin.-Loss' (Zeit. where the temperature registered 25 deg. C. sohrft f. klinische Medizin, Bd. 58, Hft 1 and 2, were infected. Cultural maturation of the 1906) article embraces an exhaustive resumé ankylostoma larva occurs in a temperature of his preceding researob work, and is con- as low as 15 deg. to 18 deg. C. The essenfirmatory of the work he has done in the past tial prophylactic mseasure is to prevent any on the subject of ankylostomiasis. Matured contamination of the ditch or ground with ankylostoma larva, suspended in a drop of fecal matter, all other measures, as cleansing water. when placed on the human skin soon the hands before eating, bathing, eto., are of causes a reaction which is evidenced by red. secondary consequence. Disinfection of ness and a sense of burning, disappearing infected ditches with chemical disinfectants from three to eight days without leaving the is not a suitable measure, better results are slightest trace of disturbance bebind. The mi. obtained by disinfecting with steam or Ausb. croscopio examination shows that the active ing with water at a temperature of 70 deg, to larva enter the skin chiefly through the bair 80 deg. C. Finally, systematio inspection follicles lodging themselves in the suboutane. of the workmen is good practice. ous connective tissue, from whence they wan.

The Detection of Diacetic Acid in the Urine der into the intestinal tract. The manner in

by Means of Iodine.- Bondi and Schwarz wbich intestinal invasion takes place can be

(Wiener klinische Wochenschrift, No. 2, readily determined in the young dog, being

1906) propose the following test for diacetio more susceptible to cutaneous infection than

acid in the urine in preference to most of older dogs. The larva in animals thus in.

the ordinary reactions, which they olaim are fected are demonstrable in the veins of the

not absolutely characteristic: Lugol's soluskin, the veins approaching the axillary and

tion is added to 500 cc. of urine, in drop inguinal regions, the vena azygos, in the

measure, until it changes to an orange color, right antrium, in the pulmonary alveoli, the

wbich it retains on slight heating. On boiling smaller and larger bronchi, the trachea and

the characteristio pungent odor of iodoacelarynx, and finally in the esopbagus. The

tone manifests itself. It is to be remarked larva are also capable of entering the lym.

that a positive reaction only occurs with a pbatio glands through the lymph channels,

neutral or slightly acid urine. where a part of them are destroyed and the remainder rendered less active. The larva excite diarrhea long before their entrance in SUBSCRIBE for The Medical Fortnightly.


ution in the size of the tumor masses. The

author does not state whether the raying in ROBERT H. DAVIS, M. D.

these cases was pushed to the point of ulcera. Observations on the Use of the X-Ray in tion or not. but presumably not. In the exthe Treatment of Certain Diseases of the Skin.

tensive, diffuse, keloidal conditions following -Wise (Med. Rec., Jan. 20, 1906) gives an burns the results were unsuccessful. In tinea elaborate article on the results obtained with barbae, the so-called non-parasitio sycosis, the X-ray in the treatment of various derman and the 'ingrowing hairs; frequentlů seen toses at the New York Skin and Cancer Hos on the neck of young men who use the razor, pital. His conclusions are: (1) The X-ray the results were satisfactory in the extreme. will cure ring-worm and favus of the hairy He gives excellent advice with respect to the skin more rapidly and reliably than any other caution with which the X-ray should always metbod of treatment; the advantages of the be used. Suitable protective measures should, method are that it is painless, barmless when of course, be taken, and the effect of each properly used, and thorough. (2) Hypertri. treatment carefully noted before repeating it, chosis should be treated with electrolysis, not as the burns resulting are (except apparently with the X-ray. (3) The X-ray gives very in leprosy. See abstract in this issue. -Ed.) satisfactory results in the various forms of peculiar obstinate in healing. outaneous tuberculosis; in keloid, in kera. toses, in infiltrated patohes of chronic ecze Leprosy in the Philippines, with an Account ma, lichen planus, pityriasis rubra; in the of Its Treatment with the X-Ray.-Wilkinson tubercles, ulcers and tumor masses of myco. (Jour. A.M.A., Feb. 3, 1906) gives some exsis fungoides, in psorospermosis, and in ceedingly interesting data and conclusions idiopathio, multiple, hemorrhagio sarcoma. based on the large number of cases he has (4) X-ray relieves pruritus, burning, ting. seen, and the thorough test to which the X. ling, and often pain; it decreases the dis- ray has been put in treating them. He is incharge and foul odors of various dermatoses, olined to believe tbat the disease is rarely, if often causing them to disappear completely. ever, transmitted from parent to offspring, and (5) In selected cases, radiotherapy is the ideal is with difficulty transferred from one person agent in tbe treatment of epithelioma and 10- to another, but there frequently exists a comdent ulcer. Of course, in a certain percent. mon source of infection to which the members age of cases of epitheliomata of the skin, there of the same family may be subjected, es. was no benefit whatever from X-radiation, peoially during early childhood. Of nu. while not a few becarpe more extensive and merous ohildren under his care born in intractable, but this was not true of the great the Philippines of leprous parents (seven majority of cases treated. The recent, super. in the hospital of which he had charge, ficial, non-extensive growths yield most easily, tbree having both parents leprous), none but it was found best to exercise radically all have been known to suffer leprosy. Of cases suitable for such action, and in which five cases in which a parent and child both consent to operation could be obtained. The had the disease, the development occurred X-ray can then be used to prevent recurrence towards the end of the child's adolesin the scar. The cases of lichen planus re- cence, appearing at about the same time ferred to were of the hypertrophic form. In in both parent and child, the child develop. cases of keratosis palmaris et plantaris, the ing the disease first in three cases, and the X-ray was applied to the palm, and sole of parent first in two cases, thus indicating one side, and strong salicylio acid plasters to common origin and not transmission from the palm and sole of the other. Radiotherapy a parent to child. He classifies the types as showed much the better results; the treat hypertrophio, atrophic and mixed, instead ment causing no inconvenience, the effect of tubercular or nodular, and anesthetio or was more lasting, and the necessity of having neurotio, as is commonly done. The hyperthe band covered with plasters and bandages trophic forms develop most rapidly, and are was eliminated. (The editor saw and to eated usually diagnosed earlier. They ulcerate ove of these cases, and can fully concur in the freely and promptly. The atrophio forms advantage of the X-ray therapy.) In the develop more slowly, rarely, if ever, ulcerate, treatment of keloid, it was sometimes neces- and exhibit the greatest variety of deformi. sary to push the exposures up to the point of ties. The bacilli are found with difficulty ulceration. When the ulcer healed, and the in the skin sorapings from these, but are scab dropped off, a large portion of the tumor present in great numbers in scrapings taken was found to have disappeared. This was for from the hypertrophio lesions. In the atro. small keloids on the chest and arms. In the phio forms, the bacilli are often found at large keloids of the face, neck, and chest, the post mortem, in the nerves, leading to the X-ray caused a decided softening and dimin. affected parts. In the treatment, the part

of the body which presented the greatest

OPHTHALMOLOGY. amount of leprotio deposit was selected for the first series of rayings, and it was exposed

WALDEMAR FISCHER, M. D. to the rays at from seven to ten inches dis.

So-called Gummata of the Ciliary Body.-tanoe, and for ten minutes at a time. The

(N. J. Weil, Annals of Ophthalmology, Jan., distance and time of exposure were varied 1906.)-One case, a man 25 years of age, presomewhat from time to time, and the effortsented a swelling fully one-half cm. in all its was made to approach as near to the point of

diameters in the upper posterior, temporal burning the skin as possible without actually region of the left eye, the solera did not ap. doing so. In only two cases were the pa pear much thinner in the region of the tients actually burned, and it is worthy of re

tumor. Rigid antisyphilitic treatment gave mark that these were the first two patients

a satisfactory result.
a satisfactor result. The secon

The second case, a man cured. If superficial burns occurred, treat. 28 years of age presented a swelling in the ment was suspended until tissue repair began.

upper posterior ciliary region, also of the left The burns showed little tendency to pro. eve in which the sclera had become so tbin gress, and healed readily leaving little or no that it was nearly wanting in two places. In scar. The author submits the following

this case enyoleation had been advised, by explanation of the action of the ray; that,

heroic doses of potassium iodide, mercurial when a local lesion of leprosy is treated with

inunotions, sweats and hot baths the patient the X-ray, the organisms there localized are

retained an eye with a normal contour and killed, and their bodies absorbed by the

tension. system, thereby producing an immunity against the living organisms. This is prac Clinical and Anatomical Examinations tically analogous with the immunization of About the Influence of Radium on the individuals against bubonic plague by inject. Trachomatous Conjunctiva.-(Birsch-Hirsching into them killed cultures of plague organ. feld, Leipsig, Klin. Monatsbl. f. Angenheil. isms. In the case of leprosy, he claims that kunde, Dec., 1905.)-The inference of the we grow the culture of lepra bacilli in the radium could be clearly seen in all the cases human body as a culture medium, and then 80 treated. The follicles became flattened kill them by ineans of X-rays. In support of and sank to the niveau of the surrounding this theory, the following reasons are ad. conjunctiva. These changes in the follicles vanced: 1. The treament of one leprous spot could be seen as early as se ven hours after any on a patient produces improvement in spots exposure, but in some instances they became at a distance from the one actually treated. noticeable after one or two days had elapsed. 2. The cure, in the distant spots, seems to The question, does radium act on the trachoprogress parallel to, and to be just as com matous conjunctiva? is answered in the plete as in the one treated. 3. The best re. affirmative ip as far as the follicles disappear sults seem to be obtained only when treat. without increased inflammatory manifestament is pushed to the point of killing, or be- tions or scar formation. The question, can gipning to kill, the tissues, which would also trachoma be cured by exposures to radium? probably be to the point of killing the organ is answered in the negative. Cobn's, Darier's isms. 4. Cases in which there are massive, and Selenkowsky's enthusiastio reports are localized, leprous deposits are most rapidly to be taken cum garno salis when compared improved, as, in these cases, we have an to those of da Gama Pinto, Uhthoff and the abundant culture on which to operate, and essayist's. The retrograde metamorphosis in thereby produce inimunity more rapidly. 5. the follicles can be demonstrated anatomically In diffuse, general involvement of slight de. much earlier than clinically. The changes gree, or atrophic character, where there are produced are very similar to those described by only a few scattered organisms, little success Hienke in Peyer's patches, the spleen and was had. 6. In two well advanced cases in lympbatic nodes of the animals he experi. whiob the amount of new leprotic tissue mented on. The changes produced by radi. was excessively great, the improvement was um on the follicles are unfortunately only marked and rapid, but followed by loss of transitory; and as a therapeutic agent it is general health, and rapid, physical decline. greatly eclipsed by the methods of treatment This may be an over dosage so to speak. (The in vogue. In ending the author concludes: frequency of the rayings is unusual to one 1. In ten cases of trachoma exposed to used to the technique in America, but, of radium three to twenty minutes a distinct course, this was to bring about the “killing”


flattening and disappearance of the follicles

was observed. 2. The improvement lasted effect desired. The exposures were frequently

for several weeks in only one case, in the other made every day, at the start, for some days, nine new follicles formed after a few days to and then every other day.-Ed).

a few weeks. 3. In the cases treated by

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