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ing after the latter has been absorbed into. the system, as is shown by the intravenous experiments on dogs. 4. Alcohol and phenol placed in the stomach give no different results from phenol alone. 5. Lavage with alcohol is effective when the phenol is in the stomach, but its superiority over lavage with water is not pronounced." From the clinical aspect alcohol seems to have a local antagonism to carbolic acid, and they would not say that it is of absolutely no value in poisoning by this drug. Its solvent action may nevertheless be, under certain conditions, a danger rather than an advantage, as shown by the more marked symptoms of intoxication seen when the poison has been taken in whiskey, and this seems to contraindicate the alcohol being used as an antidote and left in the stomach. The procedure recommended is as follows: Immediate abundant lavage, with 10 per cent alcohol, this to be followed by lavage with plain water, and stimulation as indicated. To be effective alcohol must be used while the acid is in the stomach; it is of no use after it has been absorbed. The danger of pneumonia from inhalation of the regurgitated stomach contents during lavage in an unconscious subject is pointed out, and the authors advise during lavage turning the patient on the side or face, with the head low so that anything entering the pharnyx will flow out through the mouth. Since using this plan they have had but few pulmonary complications in their patients.

DR. NICHOLAS SENN, of Chicago, will deliver an address at the International Medical Congress, to be held in Lisbon, April 19 to 26. His subject will be "The International Investigation of Carcinoma."

THE ST. LOUIS MEDICAL SOCIETY has elected the following delegates to the State Medical Association: Drs. P. Y. Tupper, J. C. Morfit, W. W. Graves, W. H. Stauffer, Jesse Myer, Malvern Clopton, C. A. Snodgrass, F. L. Henderson, H. W. Soper and John Green, Jr.

NEW ORLEANS AGAIN IN THE LIME Light. -Press reports have it that there are a number of cases of yellow fever in New Orleans, and there is a consequent feeling of a comprehension throughout the country. It would seem that even such a suspicion should be stamped out, but in case of the establishment of the suspicion as a fact so aggressive a campaign should be inaugurated against this disease as will insure safety in the South during the coming summer and for all the future.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Clubbed-Fingers of the Left Hand in Aneurism of the Arch of the Aorta.- Groedel's (Meunchner Med. Wochenschrift, No. 6, 1906) descriptive report is interesting, and tends to elucidate the origin of dumbell-fingers. The case in question was a man, 47 years old, presenting the following physical diagnostic features: Dilation of both right

and left heart with evidence of cardiac incompetency; a dilatory pulsating tumor situated in the upper left half of the thorax; a diastolic murmur with its maximum intensity in the first and second left intercostal spaces; a decided diminution in the pulse volume in the arteries of the left arm, including the subclavian artery, whereas the volume in the The arterial tension in the right arm was 85 carotids showed no perceptible difference. mm. of mercury (Gartner's tonometer) and registered 12 right (Frey) and 25 left. 40 mm, in the left, while the venous pressure This arterial and venous incongruity of the left arm, according to Groedel, is best reasoned ing a constriction at the orifice of the subclaby an aneurism of the arch of the aorta effectvian artery, while the carotid opening remains intact, and the aneurism secondarily pressing on the subclavian vein interferes with the return circulation. The terminal phalangeal thickening of the left, hand not only consisted in an increase of the soft structures, but as the radiogram showed, in the bones also. The frequent occurrence of clubbed-fingers, particularly in respiratory and cardiac disease, has led to considerable controversy regarding their origin. The author's case uniquely illustrates the role of two factors, namely, mechanical and toxic. The increased venous pressure resulting from the obstruction affords a stagnation of the toxic products of metabolism. this instance Groedel also considers the diminished arterial blood supply an element of importance in lowering the resistance of the tissues favoring the action of the accumulated toxic substances.

In

A Comparative Study of Human and Animal Tuberculosis.-Korsel (Zeitschrift für Tuberkulose, Bd. VIII, Heft 1 and 2, 1906) formulates the following deductions from his work on the subject: 1. From a bacteriologic study of tuberculous lesions in man, cattle and hogs there are two varieties of tu

bercle bacilli designated as human and bovine type. 2. The spread of tuberculosis among cattle results exclusively from infection with the bovine type. 3. Hogs are highly susceptible to the bovine variety, in less measure to the human type. 4. Human tuberculosis is primarily a disease of the human variety, the infection being directly conveyed from man to man. 5. Tuberculous lesions in human subjects may also originate from an infection of the bovine type. 6. The transmission of the bovine variety to man is by food taken into the alimentary tract, particularly of animals with tuberculosis of their udders. 7. The role played in the dissemination of the disease through the bovine type is subordinate and of comparatively little danger to that of the consumptive individual.⚫

Significance of Small Quantities of Sugar and of Albumin in the Urine.-Burnet (British Medical Jour., Jan. 20, 1906) holds that the presence of albumin in the urine in any appreciable quantity cannot be regarded as either normal or physiologic, although it does not necessarily imply any gross pathologic alteration, nor does it signify that the disturbance in function if of a permanent or progressive character. On the other hand, however, it is an indisputable fact that a certain number of patients originally belonging to this category later on do show evidence of definite organic renal disease. It may likewise be said the presence of sugar in any appreciable amount is an abnormal constituent; in the young, particularly, it is to be regarded with apprehension, and if persistent, is likely to terminate in diabetes, while its occurrence in individuals past middle life, especially those of a gouty tendency, it is of less import and as a rule, is more or less readily amenable to treatment, but in some cases it is likely to reappear under conditions similar to those which occasioned its first appearance. The presence of both albumin and sugar in the urine is indicative of a serious disturbance in the process of metabolism. Burnet thinks that by relieving the nervous strain which the patient may have been undergoing and improving as far as possible his state of environment he may continue in at least fair average health for many years.

Arteriosclerosis as a Disease. Stengel Stengel (American Medicine, Feb. 10, 1906) says in the consideration of arteriosclerosis as a general disease three stages may be recognized: 1. A preliminary one, difficult of recognition in its beginnings and confusing to the clinician in his efforts to distinguish what part of the etiologic factors have contributed to the

The

symptoms-complex, and what part has resulted from the arterial disease itself. 2. A middle period, during which the arterial disease is easy to recognize, but in which secondary organism changes have a role of variablé importance. 3. A final stage of failure of circulation, organic failure, and terminal infections. The diagnosis of arteriosclerosis is usually established during the second period, and then rarely offers serious difficulty. Only when undue attention is given to some local disturbance, such as albuminuria, palpitation or vertigo, or when the vascular disease is so uniformly distributed that it manifests itself only in a general failure of vitality, is the recognition of the disease likely to occasion confusion. In the final stages, too, though the form of local disease and the immediate occasion of the patient's failing sized in the physician's mind, the contribuhealth or taking off may be too much emphatory influence of the hardened blood-vessels rarely escapes attention. Among the varieties of early arteriosclerosis, the author has nutritional, neurasthenic and nervous. observed several more or less distinct types, nutritional type are those group of cases presenting obscure disturbance of general health with a tendency to digestive disorders and anemia or pseudo-anemia. There may be developing cases a slight loss of weight at first, but in rapidly emaciation may proceed rather steadily. The pseudo-anemia, as a rule, is a condition of the more advanced stages, but sometimes makes its appearance rather early, and is largely the result of contraction of the vascular channels with resulting pallor than deterioriation of the blood. The neurasthenic type are those cases presenting various evidences of neurasthenia with or without definite nutritional disorders. It is difficult to distinguish between the neurasthenic symptoms that may attend developing arteriosclerosis and such secondary arteriosclerosis as may engraft itself upon a preexisting neurasthenia from other, except that circulatory symptoms are perhaps more common. The nervous type include those varieties of arteriosclerosis in which certain nervous symptoms are conspicuous. When the hardening of vessels is considerably advanced various central nervous symptoms, as temporary paresis, spasmodic or convulsive disorders or disturbances of consciousness may be met with. In the earlier stages minor symptoms as vertigo, tinnitus and syncopal attacks may manifest themselves. manifest themselves. Peripheral symptoms of the type of claudication are met with in a variety of forms. Migraine and neuralgic. troubles also figure among the forms of nerVous symptoms in the early stage. In the more advanced stages arteriosclerosis is easily

recognized by the discovery of palpable
thickening of the blood-vessels, by the in-
creased vascular tension, by the auscultatory
phenomena at the heart, and by the general
The disease pre-
appearance of the patient.
sents itself in a variety of types, according to
the special involvement of one or another of
the important viscera, or by special vascular
conditions, and are classified by the writer
under the following headings: 1. The thor-
acic type, of which may be distinguished (a)
cardiac, as moderate disturbances of the
heart's action with a tendency to arrhythmia
or special involvement of the coronary arter-
ies (angina pectoris); (b) aortic, not merely
referring to aneurism of the arch of the aorta,
but also to sclerotic and calcareous roughen-
ing without any dilation of the aorta, but
causing embarassment of the heart's action.
2. Abdominal type, of which there are (a)
renal, evidencing itself, as the clinical pic-
ture of interstitial nephritis; (b) intestinal,
less commonly recognized, and manifesting
itself by atrophy of mucous membrane and a
tendency to chronic colitis, ulcerations in
the upper part of the small intestine, and
sudden painful obstructions (paresis of the
walls) of the bowel; (c) pancreatic, difficult
of recognition, however, often active in dia-
betes; (d) hepatic, occurring as cirrhosis. 3.
Cerebrospinal type, most numerous and vari-
ed and probably a number of definite nervous
diseases of cerebral causation have as their
underlying basis arteriosclerosis of the cere-
bral vessels. 4. Arterio-capillary type, man-
ifested in moderate circulatory disturbances.

Perforation in Typhoid.-Meakins (Mon-
treal Med. Jour., Oct., 1905) bases his article
on a study of 32 cases of perforation occur-
ring among 1230 cases of typhoid treated at
the Royal Victoria Hospital, Montreal.
Twenty of this number were operated, 5 re-
covering. In the remaining 12 operation
was deferred because the patient was either
in a moribund state, or a conclusive diagnosis
Of the
of perforation had not been made.
symptoms, sudden and severe pain in the ab-
domen was most constant, being present in
In one case this
84 per cent of the cases.
symptom alone prompted surgical interfer-
ence. Disappearance of hepatic dullness
in the absence of meteorism proved a valu-
able diagnostic feature. The pain in most
cases was diffuse. Abdominal rigidity was
present in 24 cases, but as a rule, did not
evidence itself until late. The temperature
and pulse afforded but little diagnostic clue,
the former not falling below normal until
some time after the onset, and the latter not
exceeding 100 beats per minute till several
hours had elapsed. Respiration in most of

the cases remained normal for some hours.
The characteristic facial expression (facies
hippocratica) was usually a late manifesta-
tion. Percussion, palpation and the count-
ing of leucocytes furnished unreliable data.
Rectal examinations are of some value, the
pressure exerted by the examining finger
sometimes caused pain at the site of the
The author believes one is al-
perforation.
ways justified in resorting to a laparotomy
whenever pain, tenderness and muscular
rigidity coexist, as in doubtful cases it is
better to operate once too often than not
enough.

Notes on the Cerebrospinal Fluid.-Pashagan (Med. Rec., Feb. 10, 1906) made a cystologic analysis of the cerebrospinal fluid in patients suffering from paresis and other

mental affections with the view of determining the constancy of the lymphocytes. Among 37 cases of general paresis there was a'marked increase of the lymphocytes noted in 16 cases, a moderate increase in 5 cases, doubtful in 3 cases, and negative in 3 cases. In 7 chronic alcoholics, 6 old leutics, 25 epileptics, 13 hebephrenics, 8 katatonics, 7 manac-depressive cases and 7 paranoiacs the lymphocytes were diminished.

Grave's Disease and Its Treatment.-Murray's (British Med. Jour., Nov. 11, 1905) elaborate discussion of the paper en braces an symptomatology and therapy of exophthalmic goitre. Concerning the treatment, rest in bed and fresh air in conjunction with a "mast kur" is absolutely essential in the severe forms, especially the acute cases, while rest, fresh air and nutritious diet are also important factors in the later stages of the disease. Murray strongly recommends mild faradization applied twice daily for a period of one hour each time. The electrodes, to be made of a pliable material, are to be respectively placed on the goitre and back of the neck. In some cases radiotherapy acted beneficially. Among drugs, the author regards arsenic as one of the few remedies which has proven efficient. For the tachycardia, arsenic in combination with convallaria is of greater benefit than either digitalis or strophanthus. Potassium bromide may be given to alleviate the nervous symptoms. Thyroid extract and the iodides are positively harmful. Sodium phosphate, recommended by many, has proven to be of no value in the author's hands. The different sera (Möbius and others) have been applied in several cases, but without any apparent beneficial results. Rodagon on the other hand (desiccated thyroidectomized goat's milk) gave promising results. tion, however, is necessary in the administration of rodagon, as large doses may so reduce

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Trichinosis and Eosinophilia in General.Stäuble's (Deutsche Archiv für klinische Medizin, Bd. 55, Heft 3 and 4, 1906) illustrated contribution emphasizes the value of making hematologic examinations in trichinosis. In the 7 cases observed by him the eosinophiles were markedly increased, and in 4 of these, which were of a severe type, there was also a considerable general hyperleucocytosis. The increase of eosinophiles was not at the expense of the neutrophiles, as the latter were increased during the entire course of the disease. The lymphocytes, although in the beginning somewhat diminished, likewise showed an actual increase. In the severe forms of trichinosis, especially those terminating fatally, the eosinophiles may again disappear, or an eosinophilia may be entirely lacking. Eosinophilia does not evince itself until about the eighth or tenth day after the ingestion of the trichiniferous meat. incentive of the eosinophilia is not the absorption of some toxic substance contained in the trichina capsule which might be liberated in the gastrointestinal tract, but seems dependent on the liberation of the embryos or their invasion of muscles. The dissemination of the embryo is by means of the blood channel, as is evidenced by the fact that their presence is demonstrable in the circulatory blood of the heart. A local accumulation of eosinophiles at the point of muscle substance disintegration could not be discernable. The eosinophiles may, therefore, be looked upon as a reactive manifestation of substances emanating from the embryonal trichina (probably also from the degenerated muscle-substance) and passing into the ciroulation. Stäuble's animal experimentation also corroborates the clinical observation that a rapid lymphocytic reduction (lymphozytensturz) in infectious diseases is significant of a bad prognostic omen. A rare concomitant symptom occurring in the four extreme cases and which may prove to be of diagnostic value, was a positive Kernig phenomena with a total absence of the patellar. The urine of all cases gave a strong positive Ehrlich reaction.

Prognosis in Typhoid Fever.-Simon (British Med. Jour., Nov. 1, 1905) bases his remarks on a clinical study of a large number of cases treated at the Birmingham General

Hospital. About the fourth week of the dis ease a polyuria sets in. The twenty-four hour amount of urine increases from 30 oz. to as high as 100 oz. This polyuria is to be regarded as indicative of a favorable termination, and when it once makes its appearance the danger of perforation or hemorrhage is insignificant and a relapse is quite a rare event.

Heart-Massage in Chloroform Syncope.Smith and Dazhich (British Med. Jour., Nov. 18, 1905) report an interesting case of a man who had been put under a chloroform anesthesia for the purpose of making a rectal examination with the view of determining any malignant growth. While under the influence of the anesthetic the heart and respiration suddenly ceased. The ordinary restoratives, as artificial respiration and the subcutaneous injection of strychnine, had no effect when an abdominal incision was made and the heart gently massaged through the relaxed diaphragm. About sixty seconds later the heart began to beat again and the patient made an uneventful recovery.

al.

The Effect of Posture on Cardiac and Vascular Murmurs.-Rudolf (American Medicine, March 3, 1906) emphasizes the influence of different postures on the various bruits which occur in the circulation, a matter of which some writers make only a scanty allusion, while others do not mention it at all. The murmurs most markedly influenced by change in posture are the functional ones, but organic bruits by no means ways escape. In studying the effect of position on murmurs one must avoid possible sources of error. The effects of muscular action made by the patient in assuming a different position can be obviated by allowing him to remain in the new posture for a short time before auscultating. Under vascular murmurs are the arterial bruits and the mia, neurasthenia, etc., are most pronounced venous hum, the former, often heard in anein the recumbent position, while the latter is best heard in the sitting or standing posture. The murmur is loudest generally at the roct of the neck on the right side and is exaggerated by the patient turning his head to the left. Cardiac murmurs, whether functional or organic, are those produced within the heart itself, and the general statement may affected at all by posture (and most of them be made that all ventriculo-systolic bruits, if are), are loudest and most extensively audible when the patient is in the recumbent posture. On the other hand, al murmurs occurring during the ventricular diastole (if affected at all by position) are loudest in the upright posture. Rudolf discusses the theor

ies advanced by many writers regarding the influence of position in intensifying and decreasing the audibility of murmurs, but throws no additional light on the subject, stating that the theory of exactly why posture alters many circulatory murmure is of little practical importance, while the remembrance of the fact that it does do so is of the greatest clinical value. He urges the necessity of auscultating in both the erect and horizontal positions whenever an examination of the heart is made, and in giving a description of a heart murmur it should always be stated in what position the patient was when the murmur was of the nature described.

Heart Massage in Death following Asphyxiation, Poisoning and Chloroform Syncope. Müller (Wiener klinische Rundachau, Nos. 50-52, 1905) anesthetized dogs until death ensued and fifteen to twenty minutes later exposed the heart and gently massaged the organ, at the same time injecting salt solution and small quantities of oxygen in the veins, whereupon the animal gradually returned to life. The author hopes this method of resuscitation may eventually be successfully applied to man, especially in those cases with a previously healthy heart.

Remarks on the Infection of Ankylostoma. Duodenale Through the Skin.-Loss' (Zeitschrft f. klinische Medizin, Bd. 58, Hft 1 and 2, 1906) article embraces an exhaustive resumé of his preceding research work, and is confirmatory of the work he has done in the past on the subject of ankylostomiasis. Matured ankylostoma larva, suspended in a drop of water, when placed on the human skin soon causes a reaction which is evidenced by redness and a sense of burning, disappearing from three to eight days without leaving the slightest trace of disturbance behind. The microscopic examination shows that the active larva enter the skin chiefly through the hair follicles lodging themselves in the subcutaneous connective tissue, from whence they wan. der into the intestinal tract. The manner in which intestinal invasion takes place can be readily determined in the young dog, being more susceptible to cutaneous infection than older dogs. The larva in animals thus infected are demonstrable in the veins of the skin, the veins approaching the axillary and inguinal regions, the vena azygos, in the right antrium, in the pulmonary alveoli, the smaller and larger bronchi, the trachea and larynx, and finally in the esophagus. The larva are also capable of entering the lymphatic glands through the lymph channels, where a part of them are destroyed and the remainder rendered less active. The larva excite diarrhea long before their entrance in

the intestines, which is probably the result of metabolic disturbances. In the intestines the larva receive their nourishment from the mucous membrane, which they devour. Hemorrhages resulting from vascular erosion are coincidental and secondary occurrences. The former view of a per os infection of the ankylostoma larva is unquestionably subordinate to a cutaneous invasion. Introduction into the alimentary tract by means of drinking water, is necessarily a seldom occurrence as the larva rapidly sink to the bottom, and the idea of contaminated hands conveying the larva to the mouth is certainly very infrequent, as the larva rapidly die under dry conditions. On the other hand, cutaneous invasion rapidly occurs in bare foot individuals. working in ditches etc., containing water polluted with ankylostoma larva. The larva, owing to their active motility, constantly strive to leave their original place of habitation (feces, etc.) and wander elsewhere, providing the surrounding atmospheric conditions (sufficient moisture) are favorable. The higher the temperature, until a certain limit is reached, the more active is the motion of the larva, and in this stage of activity they are capable of climbing walls and embankments, providing there is sufficient moisture. Six per cent of the laborers working in a ditch where the temperature registered 25 deg. C. were infected. Cultural maturation of the ankylostoma larva occurs in a temperature as low as 15 deg. to 18 deg. C. The essential prophylactic mseasure is to prevent any contamination of the ditch or ground with fecal matter, all other measures, as cleansing the hands before eating, bathing, etc., are of secondary consequence. Disinfection of infected ditches with chemical disinfectants is not a suitable measure, better results are obtained by disinfecting with steam or flushing with water at a temperature of 70 deg. to 80 deg. C. Finally, systematic inspection of the workmen is good practice.

The Detection of Diacetic Acid in the Urine' by Means of Iodine.-Bondi and Schwarz (Wiener klinische Wochenschrift, No. 2, 1906) propose the following test for diacetic acid in the urine in preference to most of the ordinary reactions, which they claim are not absolutely characteristic: Lugol's solution is added to 500 cc. of urine, in drop measure, until it changes to an orange color, which it retains on slight heating. On boiling the characteristic pungent odor of iodoacetone manifests itself. It is to be remarked that a positive reaction only occurs with a neutral or slightly acid urine.

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