« ForrigeFortsett »
radium the result was so unsatisfactory that canaliculi. But the cases of Vossius and the older methods employed in this disease Elsching prove them to be caused by an inwere use to obtain a cure, even after the suf. terference in development, as the extirpated ferers had been treated for months by expo. fistulous tracts were built by stratified epi. sures to radium. 4. The affect produced on thelium resembling that of the skin; in El. the follicles are the same as those observed by sohing's case there were hair and sebaceous Heinke on normal lymph nodes, the result be. glands present, the abundance of elastic fibers ing only temporary. 5. Only those cases of found about the lacrymal sac and the goblet trachoma should be considered as cured by cells were absent, a clear proof that the fisexposures to radium that present no new de. tula was not formed from the strand of cells velopment of follicles for months after they which formed the sao, and later the canalbave been exposed to radium 6. Radium iculi. In most cases the lacrymal duct is should never be used in the immediate vicin. patent. Cases have been known to heal ity of the eyeball unless the necessary precau- spontaneously. tions have been taken to protect it, as ana. tomical changes are produced in the retina
Observations on Dionin.-(Chas. M. Steele, and optio nerve of animals so exposed.
Annals of Ophthalmology, Jan., 1906.)—The
field for the application of this remedy is The Examination of the Eye in Preg- limited. The fact that it has fallen into disnancy.-(Polte, Klin. Monatsbl. f. Angen- repute with some authorities is that they heilk., Deo., 1905.)—The ocular complica. have employed it in conditions where other tions in pregnancy are well known, but are drugs are more effective. There are two concomparatively infrequent and do not 00. ditions, however, in the treatment of which cur in the great numbers given by some dionin surpasses any other remedy: First, in investigators, for instance Bosse who exam. the various degrees of corneal opacities reined 124 women during pregnancy and 300 sulting from recent keratitis; and secondly, after delivery, 75% of the pregnant women in the essayist's opinion in subconjunctival had a neuritic appearance of the optio discs hemorrhages or hemorrhage into the anterior without subjective symptoms in the last chamber. month of pregnancy, which rapidly disappeared after delivery. According to Bosse
Chromatic Aberration in Ametropia.-Po. only one-eighth of the 300 women examined
lack, Paris, Lucerne Congress, investigated the day after delivery had a normal fundus,
artists using as tests the pigments which they on the second day one-fourth, on tbe eleventh
employ in their work. A slight ametropia two-thirds, and on the fifteenth day all anom.
has a decided influence on the perception of alies in the fundus bad vanished. The essay.
colors. Control experiments were made with ist examined 200 cases before delivery and
de Wecker's color scale. Red becomes deeper 177 cases afterward: of the 200 pregnant when seen through a weak convex glass, yel. women 178 were healthy; the urine of eight.
low more orange, and green assumes a yel. een contained albumen, among these there
lowish tint. Blue becomes deeper with a were six with eolampsia, one bad morbus ma
weak concave lens, green more bluish and oulasus, three pyelitis; 116 of the 178 preg.
yellow took a slight greenish tint. The phenant women examined in the last month of
nomenon is explained by the eye being able pregnanoy had a normal fundus. One of the
to accommodate exactly for one at a time of six cases of eclampsia showed a hyperemia the artificial pigments of which the colors are of the upper discs, which became pale the
made. Whence artists with a weak myopia day following the premature birth. Two out might work to advantage with their myopia of the eight cases of albuminuria had a ret. uncorrected. While a slight over-correction initis albuminurica. The visual acuity, light or the hypermetropic artist might be bonen: sense, color sense and visual fields in the cial, as the so-called warm colors are importhealtby pregnant women were normal. In ant for artists. concluding the relative infrequency of voular complications is emphasized in contradis.
LARYNGOLOGY AND RHINOLOGY. tinction to Bosse's.
HERMAN STOLTE, M. D. Congenital Fistula of the Lacrymal Sac.(Prof. A. Elsching, Vienna, Klin Monatsbl. Postoperative Hemorrhage Following the f. Angenheilk. Jan., 1906.)-So far there are Removal of the Pharyngeal Tonsil.-Homer about twenty oases of this interesting anom Dupuy (The Laryngoscope, 1906, No. 1) col. ally on record. The essayist had the oppor. lected in an extensive research into the literatunity to observe three cases, one of which ture covering a period of thirty-five years, 38 be examined histologically. These fistulae cases of alarming hemorrhage following adwere regarded as superfluous and misplaced enectomy with eleven fatalities. Causes were: 1. Hemophilia, contributing the greatest equipped with bemostatics and various me. number of fatal cases. 2. Constitutional dis. chanical appliances. In cases of hemophilio eases, such as leukemia, lym badenoma, stru- history where the operation has to be done, ma, exophthalmic goitre. As local causes internal administration of daily 15 grains of Dupuy mentions abnormal arterial distribu. caloium chloride for three days previous to tion, which make the field more or less un. the operation is prone to reduce the hemor. safe to the clumsy or inexperienced operator. rhage during operation and afterwards reThus the malposition of the left internal car markably. otid produced a fatal issue, and the superfic. ial seat of the ascending pharyngeal artery
Should Tonsillar Tissue be Removed in all coursing along the junction of the posterior
Cases? Why?-George W. Spohn (The and lateral nasal wall of pbarynx caused a le
Laryngoscope, No. 1, 1906) considers the sion and very alarming bleeding. Regarding
function of the tonsils to stand as a guard in the importance of age and sex, the second de
the oral cavity, to prevent the entrance of cade is tbe more dangerous period, due to the
micro-organisms into circulation, and to arprevalence of more vascular and fibrous tis.
rest and destroy toxines, hence tonsillar tis. sue in the adenoids, the latter preventing
sue should not be sacrificed to the knife un. the severed vessels from contracting. The
less absolutely necessary. The pathological male sex is more afflioted by severe hemor
condition of the tonsils (hypertrophic, crypts rbage than the female, due to the faot that
filled with foul, germ laden cheesy material) hemophilia prevails in the male (from 8 hem.
is due to irritation by food, repeated acute opbiles with 44 fatalities 7 were male). The
inflammations, autointoxication by constipahemophilio tendency being transmitted
tion. Such tonsillar toxine should be removed througb the female to the male member of the
(1) when its pathologic condition cannot be family. The fact that more fatal or severe
cured with treatment (iodine painting); (2) hemorrhage oocurred without the administra
when it obstructs the pares and oral cavity, tion of an anesthetic, is explained by the
or intereferes with their physiological funcgreater liability of instrumental injury by the
tions. Diseased tonsils, instead of standing increased gagging and unintentional move.
as a guard to arrest and destroy micro-orments of the suffering patient. In the rast
ganism, they supply a soil for their propamajority of cases the hemorrhages occurred
gation and encourage their entrance into within the first twenty-four hours; several
the system (acute joint rheumatism), thus fatal hemorrhages occurred on the fourth
failing in their proper funotions, also lower day, one on the eighth day after operation.
ing the vitality to the general system. Regarding the question of cheoking the pro
Therefore removal of diseased tonsillar tisfuse postoperative bleeding, local applications
sue, that needs removal, should be done early of astringent solutions are of no value. But
and not postponed. The mode of operation in constant or intermitting oozing of blood
is not amputation or decapitation, but enu. along the posterior pharyngeal wall or
cleation of all diseased tissue. Tonsillotomy through the nose the local application of ad.
is such a common operation in the eyes of renalin, or better dioxygen. will seldom fail the general practitioner that it does not to check the bleeding. Where there is a
have the dignified standing it deserves. If brisk flow of blood, spurting in character,
done correctly, not amputated or decapitated, postnasal plugging, quickly performed, is
but enucleated it is not an easy operation, the only benefiting measure, but this fails
and requires a special training and skill. In in about 60% in bemopbilia. To minimize
case of thorough enucleation of all the lymthe risk of postoperative bemorrhages we
pboid tissue, except the fibrous portion of have to insist upon enforced rest in bed for
the gland the result will be very satisfying twenty-four hours by giving cold drinks or
and lasting. chipped ice during the next few days. The author concludes as the death may occur after
DEPARTMENT OF LEGAL MEDICINE. adenectomy by hemorrhage that the deep ap.
R. B. H. GRADWOHL, M. D. preciation of our large responsibility forbids any but the specially trained surgeon to at. A Contribution to the Subject of Stigmata tempt its performance. Further, that it is of Degeneration.-Dobr and A Scheele (Vierour first duty before operation to elicit all tel jahrsschrift fuer ger. Medizin, Jan., 1906, facts relating to possible existence of hercor. Bd. XXX, Heft 1.)-This investigation was rhagic diathesis; further that the throat spe- undertaken for the purpose of estimating of cialist has to be forearmed and ever on the just what value the so-called "stigmata of alert to cope with a problem of the gravest degeneration" are in calling attention to import and alarming postoperative bleeding. crime in those exhibiting these stigmata. This is best done by being continually There has been much said pro and con,
since Lombroso first oalled attention of the variations in the lobe of ear. These vari. world to these signs. Lombroso called par. ations in the lobe were divided into three ticular attention to anomalies of the skull kinds. Schwalbe described eight kinds, but and mouth as stigmata and worthy signs of unfortunately the present work was finished criminality. Ganther and Wilga also spoke before Schwalbe's report appeared (Zur of the existence of stigmata iu insane as Methodik statistischer Untersuchungen uberwell as in criminal persons. In investiga- die Ohrformen von Geisteskaranken und tions in the past upon this line much has Verbrechern. Arob. f. Psycb. u. Nervnbknkh., been said and done, and yet withal, but little 1895, Bd. 27 and so the eight classified types of consequence because the manner and could into be observed. Anormalities of method of gathering statistics has been the jaws, teeth and gums sought for were faulty. The importance of the signs of prognathism, changes in the normal bite" gathering of degeneration can only be ascer of the teeth, etc. The Caucasian races have tained by comparing the measurements and their teeth so arranged that the normal descriptions of so many oriminals with so "bite" occurs when the upper teeth slightly many "normal" individuals. For this pur overlap the lower. Among certain races, the pose habitual criminals must be selected on old Eyptians, the Celts and Esquimau, the the one hand to illustrate the abnormal, and incisors fit down exactly upon each other. "honorable'' people must be selected on the Other points used to denote stigmata by other to illustrate the normal. The particular Lombroso and Manuovier are strong developpoint to determine was wbether or not cer- ments of the lower jaw, i, e., an increase in tain so-called stigmata of the insutb were the volume of the lower jaw. Lack of devel. more frequent in the criminal than in the opment or even absence of a obin is also bonest person? For the sake of comparison, pointed out by Naeoke as a stigmataum of the writers selected German soldiers to repre. degeneration, also irregularity in the artiousent the normal type, first because the meas. lation or the teeth, "open bite' (mordex urements could be most easily be taken from apertus Carabelli), diastema, variations in this class, secondly because the German sol. shape of the upper inoisors; variations in dier represents an "elite olass''-much more the number of teeth, particularly less teeth so tban either the very lowest classes of Ger than normal; abnormal development of the man citizenship or the bigher classes, being wisdom teeth; "short” teeth; erosions are recruited from all olasses. Of course the fact said to be abnormalities found in degenerate that a class of this kind might and does har. criminals and insane. A number of tables bor some with criminal instinots must be are given by these writers, sbowing exactly taken into consideration in a small way in how often these so-called stigmata occurred surveying the sum of these experipiental ob. among these habitual criminals and how servations. Again, racial characteristics are often they occurred among the soldiers who homogeneous among the soldiers, less so were taken to be normal. The abnormalities among the oriminals examined. where were found just about as often and in just foreigners were met with in some in about the same degree among the normal substances. The material for criminal class jeots (soldiers) as among the criminals exam. was selected as follows: Penitentiary at ined. The caput quadratum was alone found Wbeleiden, 253 persons, age 16 to 30 to be present in 1% of the criminals and not years; penitentiary at Fulda (Cassel) 121 per. at all among the normal persons examined. sons, age orer 30 years; penitentiary at Asymmetry of the face was found but once Ziegen bain 282 persons, age over 20 years; among the criminal class. It has been noted penitentiary at Ziegenbain 67 women, age to be three times as common among Italians over 20 years; reformatory at Wabern 120, as among Germans. Fissured uvula was age up to 19 years; house of refuge at Cassel, found in 0.3% of criminals and in 0.3% of 168 children, age up to 14 years. This makes the normal class. Pointed tongue was found 1011 people examined, 101 being illegitimate, in 1.16% of criminals and in 1.0% among and 219 or 26% being the first-born. Six normal olass. Deviation of tongue to right hundred soldiers (under-officers and privates) was found in 6.6% of normal and 6.8% of were examined for comparison, 20% being criminal class. Erect ears were found more first born. The particular stigmata sougbt commonly among the normal class than for about the head and face were the caput among the criminals. Satyr.ears were found quadratum, prominent temporal regions, re. in 0.83% of the normal class and 0.7% of the ceding forehead, asymmetry of the face, fis. criminal. The anomalies of the teeth, mouth sured uvulva, pointed tongue, broad tongue, and gums were found to exist in just about tremor of tongue, deviation of tongue to the same proportions among the normal right or left, deviation of nose to right or class as among the criminal. The general left, persistence of ear muscles, satyr-ear, run of tbe observations seem to indicate that the so-called stigmata of degeneration do not old. The patient, well-nourished, healthy. bear that importance to the existence of crim-' active and breast-fed, had enjoyed perfeot inal instincts in their possessors as Lom- health, with the exception of constipation, broso and others would have us think. The until the evening of December 18, 1905, observations were exhaustive enough to make when he was suddenly seized with severe ab. one exceedingly skeptical as to whether or dominal pain, as evidenced by crying and not there are really any stigmata of degener. flexion of the thighs upon the abdomen. He ation at all.
way given a hot mustard foot-bath, and, internally, hot water with gin and paregorio.
His bowels bad moved normally on the preSOCIETY PROCEEDINGS oeding day, but not on the day of the attack.
At 1 a. m. the child passed about half an MEDICAL SOCIETY OF THE NEW YORK ounce of blocdy mucus but no fceal matter. POLYCLINIC MEDICAL SCHOOL AND
Pain was severe and recurrent in character, HOSPITAL
and at 6 a, m, on the nineteenth a physician
was summoned. He ordered balf an ounce Stated meeting held February 5, 1906. of castor oil. This failed to produce an evac. The President, Dr. J. J. MacPhee, in the uation of the bowels. On the evening of the obair.
19th be ordered an enema (rectal) of glycer.
ine and hot water. During the night the FRACTURE OF THE ULNA DURING MASSAGE FOL
mother noticed a sudden change in the child's LOWING OPERATION FOR COLLE'S FRACTURE.
condition and thought it to be dying. She Dr. F. C. Keller showed this patient. After could not rench the physician, and in the the removal of the splint ber arm being mass. morning the speaker was summoned. On aged when the ulna snapped at a point sep. reaching the house he found that the physi. eral inches above the original site of frac. cian had arrived and had given an enema of ture. This occurred six or eight weeks after an ounce of castor oil and one pint of warm the operation, and could be attributed only water, the water returning with bloody mucus. to some inherent disease of the bone.
Hasty examination showed a state of collapse, Dr. J. C. Robertson said that he had put a weak pulse that could not be counted, a up from 200 to 300 cases of Colle's fractures tense, rigid abdomen, and a rectal tempera. during the past eight years, and until two ture of 103 deg. F. Diagnosis of intussus. years ago had applied a posterior splint, the ception was made and immediate operation arm being seniflexed in a stiff position. This advised as offering the only hope (and that a gave far from perfect results in eight out of poor one). ten cases. A careful study of these cases had The child was immediately brought to the convinced him that the best results were ob. Polyclinic Hospital and operated upon. No tained by applying a posterior splint from tumor could be mapped out, even after be the hand to the elbow, keeping the arm per had been abesthetized. An incision was fectly straight, and putting a pad of cotton nade in the right rectus muscle, just below under the wrist. As a result tbere is ho sbarp the umbilicus, the abdominal contents exam. protrusion of the ulna at the elbow, as often ined and intussusception located in the ileo. occurs when the band is put up anteflexed. cecal region. A firm, dense band of adhe.
Dr. J. A. Bodine said that sometbing was sion anchored this portion of the intestine, wrong with the composition of the bones of necessitating a considerable amount of this patient, as ulnas do not snap from mas. work before it could be brought into the sage. The bones were probably chalky. As wound. This was finally accomplished and to Dr. Robertson's experience with Colle's the intussusception reduced. The gut was fractures, he thought that each surgeon fav. not gangrenous, and therefore was returned ored the line of treatment with which he, to the abdominal cavity. A loop of small personally, bad obtained the best results. intestine was picked up and two drams of He thought a posterior splint more practi. saturated solution of magnesium sulphate cal, for the reason that the posterior surface was thrown into it by means of a syringe, of the arm is a straiget surface, and has the needle of which was carried obliquely inno cutaneous nerves and no return blood to the lumen, the object being to evacuate supply. If a rigid anterior splint is ap- the bowels as soon as possible. The ab. plied to the front of the arm, edema is dominal wound was then closed. Followcaused by obstruction of the circulation, ing the operation the child's temperature rose
to 103.5 deg. F., and remained so until 1 a. INTUSSUSCEPTION.
m. of the next day, when it dropped graduDr. Alexander Lyle reported a case of in- ally to 95. deg. F., and did not rise above tussusception ocourring in a child 74 months 100.8 deg. F. at any time afterward. The
moves after her emphasi be lost bely injuri
pulse could not be counted until the tem that the tumor was of the right ovary, but at perature bad fallen to 101.8 deg. F., when it the time of operation it was found to involve was 160, late falling to 118 or 120. The bowels the ovary on the left side and to have rotated moved five times during the first twenty-four the uterus It firmly compressed the append. hours after the operation.
ages on the right side, which accounted for · The speaker emphasized the point that val. the pain on thut side. A transverse incision uable time must not be lost by useless, or showed the cyst to be inherent in all direcmore properly speaking, positively injurious tions to the omentum and posterior peritoand dangerous medication. The sudden ab. neun. A portion of it was free from adhe. dominal pain, followed by a discharge of sions, and at this point the fluid contents were bloody mucus from the reotum, the recurrent aspirated. The sac was then pulled out, with attacks of pain and absence of fecal evacua- the intestines and omentum, and the adbe. tions indicate immediate operation. Gan. sions separated. The sao contained a dark, giene or extensive adhesions, or both, are water-like fluid, which is rather unusual, the produced by delay, and an intestinal resec- the contents of such a tumor usually being tion and circular enterorrbaphy will be neo. of a yellow straw color. essary. An early operation, on the contrary, The paper of the evening was by Dr. J. C. enables the surgeon to early effect reduction. Taylor, and was entitled
Dr. Bodine said that one point should be emphasized in the diagnosis of an inflam
ACUTE PELVIC INFECTIONS. matory abdominal condition in a child, and He said, in part: It is but a few years tbat is the expression of the face, which is since a woman's tubes and ovaries were sacalways typical. Another aid is the abdominal rificed by an operator lest a future la parotpain. He thought it would have been im. omy should be required. Actuated by a possible to have made a differential diagnosis sense of thoroughness, he deprived women of between this condition and appendicitis if it the function of menstruation, which is interbad not been for the presence of the bloody woven with their mental as well as physical mucus.
life. It is better to conserve these organs, Dr. Maurice Packard said that in cases of even if elaborate and hazardous procedures abdominal lesions in children up to three must be adopted to accomplish this end as years of age, the differential diagnosis be well as to oure the patient. He did not advotween intussusception and stranguluted her- cate, however, the carrying of conservatism nia usually has to be made. The only point in connection with special organs so far as in diagnosis especially pointing to intussus. to endanger the constitutional condition of ception is the bloody mucus. A body tem- women. There is a broader conservatism, perature of 103 deg F. and a rapid pulse are which seeks to restore the general health of also significant, as the statement is made in the patient, even if special organs must be many text-books that, except in appendicitis sacrificed to attain such an end To this end and general peritonitis, the temperature and he made an appeal for early surgical interferpulse are normal and the abdomen relaxed. ence in the acute diseases of the female or. It has been his experience that in intussus- gans. Conservative operations sometimes ception children always have a high temper. may fail; but even if they do, radical proature and have a pulse so rapid that it is al. cedures must be adopted later without added most imposisble to count it. In cases of in. risk, to the patient. On the other hand, it testinal obstruction the absence of stools and is impossible to restore organs removed by gas assists one in making a differential diag. radical work. nosis, as in intussusception only muous und For many years it has been oustomary in blood pass from the bowels.
most large hospitals to treat patients suffer
ing from extension of gonorrheal inflammaLARGE OVARIAN CYST.
tion to the tubes by hot antiseptio douches, This specimen was presented by Dr. C. G. or perhaps by tampons and an ice-bag exCbild, Jr. He had removed it from a patient ternally over the lower abdominal region. 38 years of age. She had complained of When the acuteness of the attack had some. pain during the previous four or five years, what subsided the tubes as well as the during which time she noticed the presence ovaries were frequently swollen and engorged of a tumor, wbicb grew progressively larger. to such an extent as to be designated as Examination revealed an enlargement reach. tumors and removal was advised; whereas, ing to the umbilicus. It was impossible to without apparent mutilation, the inflammapalpate the appendages on either side, and it tion might have been checked in the begin. was also impossible to determine on which ning and the woman allowed to keep her orside the tumor originated. On acoount of the gaps, though somewhat damaged. The conpain being on the right side it was conoluded servative work to be attempted is mainly that