cases without post partum hemorrhage. PATHOLOGY AND BACTERIOLOGY. There seems to be a peculiar tendenoy for placenta with a low attachment to become ad.

R. B. H. GRADWOHL, M. D. herent. In two cases of adherent placenta

Pathologic Histology of Hereditary Syphthere was atony of the uterus; both died. ilis, With Especial Reference to the Spiro. One case of puerperal melanoholia was chaeta Pallida.-(C. Levadati, Annales de recorded. In one group of 27 cases only l'Institut Pasteur, Tome XX, No. 1, January, such minor steps as rupturing the mem. 1906.)– The presence of the spirochaeta palbranes or giving ergot was taken. There lida in the organ, of newly-born children afwas no case of complete placenta previa in flicted with hereditary syphilis was deterthe group. In six other cases bipolar version mined shortly after the first publication by was the treatment adopted. Twenty-one Schaudinn and Hoffman by several observers, cases were treated by internal version or Buscke and Fischer, and Levadati; this was manual delivery in the case of pelvio pre

subsequently confirmed by Hoffman, Babes sentations. Of the 21 mothers 5 died; of the and Panea, Bodin, Nigris, Bronnum, etc. 22 children 14 died. Forty patients were Staining according to Giemsa's method showed treated by the insertion of the de Ribes bag constantly the existence of spirochaetae palNone of the mothers died; 25 of the infants lida in cutaneous and visceral lesions of hesuccumbed.

reditary syphilis. Herxheimer and Huebner Medical Treatment of the Uterine Fibroids were the first to stain with Nile blue the sec. is the title of a paper by Thomas Wilson; of tions of syphilitic chancre showing the spiroBirmingham, Eng., in the Lancet. He chaeta. The small number of parasites dem. shows that these tumors have not wholly onstrable by this method in relation to the been given over to the knife. Uterine severity of the lesion indicated a flaw in the fibroids are extremely common, but only in technical worth of this procedure. Later, small proportion give rise to symptoms, in Bertarelli, Volpino and Bovero (Rivista 30 per cent of those that do the consequences d'igiene, 1905, No. 16, p. 564) proposed a are so serious as to demand operative treat. method of staining based upon the impregnament. Of the 70 per cent some with no active tion of spirochaeta in silver nitrate, with the symptoms merely require watching, while use of Van Ermengen's fluid as a reducing others call in addition for medical treatment, agent. They claimed that this enabled one to under which heading may be included minor stain the organism in tissue satisfactorily. surgical and other local means. Medical The writer tried this method and found that treatment may be direct or symptomatio. it was not uniformly successful; thus proThe direct or absorptive treatment does not longed immersion of sections in a solution of promise much advantage, especially if we bear silver nitrate, from 0.05 to 38% in strength in mind the many sources of fallacy that in left the organisms very pale. There was also terfere with the correct appreciation of the a precipitation of the silver in the sections results of treatment, Symptomatic treatment which made it quite objectionable. The is successful in many cases in tiding the pa. writer changed the method somewhat by fixatient over a crisis and obviating the necessity tion in formol and impregnation of the whole for operation. Bleeding is most often suo piece of tissue in silver, much after the cessfully treated by rest, ergot and tbe intra method of Ramon y Cajal in staining nerve uterine application of iodine. Pain requires fibrillae. With this method a study of lesions treatment adapted to its cause; aloobol and of man and monkeys afflicted with syphilis morpbine should be only administered in was made and publisheu in C. R. de la Societe temporary and exceptional circumstances. de Biologie, vol. LIX, No. 34, p. 527. The The general condition of the patient, and present work is a study of the lesions of four especially the state of general nutrition and cases of hereditary syphilis. Method: 1. the cardiac and renal functions should be Pieces of tissue, imm thick, were fixed in carefully watobed. And, finally, cperation formol, 10%, for 24 hours. 2. Washing and should be recommended when bleeding gives hardening in alcohol, 96%, 24 hours, 3. rise to anemia and does not yield to ordinary Washing in distilled water several minutes treatment; when pain is severe and obstinate; until pieces fall to bottom of glass. 4. Imwhen pressure symptoms, especially retention pregnation in silver nitrate solution, concenof the urine oocur; when the tumor is rapidly tration varying from 1.5 to 3% ; 3% solution increasing in size; and generally when there is preferable for pieces of tissue obtained from is evidence tbat the health of the patient is living cases. The impregnation should take becoming impaired, and such impairment ap- place at a temperature' of 38 C., for 3 to 5 pears to be referable to the uterine fibroid." days. 5. Short washing in distilled water Surely a very conservative consideration of and immersion at room temperature for 24-48 the subject.

hours in following solution :

Pyrogalic acid.......... 2-4% , absence of the parasites from the blood ves.
Formol................. 5 C.C.

sels themselves in most situations would seem Distilled water.......... 100 cc. to indicate that the circulating blood is not a 6. Washing distilled water, dehydrate in alco favored site for the development of these hol; xylol, paraffin, section (5 microns max. spirochaeta. They seem to rapidly leave the imum). 7. Stain as follows: Geimsa's solu- blood vessels and fix themselves in the adjation for several minutes, wash in water, dif- cent tissues. This differs from most spirilloferentiation in alcohol with few drops of es ses of man and other animals, e.g., recurrent sence of girofle, clear in oil of bergamot and fever, spiriliosis of chickens of Marchoux and xylol, mount in Canada balsam. Staining as Salimbeni. The spirochaeta seems to have follows can also be accomplished: concen- the faculty of penetrating certain histological trated solution of toluoidin blue, differentiation parts by preference, notably the hepatic and in alcohol with few drops of ether-glycerin mix. Tenal cells, the cells of the supra-renal capsule ture (Unna), clearing with oil of bergamot and and even the cells of the sudorific glands. 5. xylol, mounting in Canada balsam (method of As to the pathogenesis of the lesions of syphManouelian). With this method, the spiro- ilis in connection with the mere presence of chaeta appears dark, with the nuclei of the the parasites, it can be said that these lesions epithelial cells and leucocytes blue, while the are caused by the spirochaeta pallida. 6. As connective tissue is yellow, Four cases of to the explanation of the macerated state of a infants dying shortly after birth and showing hereditary syphilitic-afflicted fetus, we can visible signs of hereditary syphilis were stud say that this state of maceration is an autoied, skin, viscera, etc., examined. A number lytic act, due to fermentation in tissues killed of definite conclusions were forthcoming as a by an intense intra uterine spirillary disease. result of this investigation : 1. The spiro. 7. A last point to be considered is the manner chaeta pallida is found in those parts of the in which the fetal organism defends itself body in cases of hereditary syphilis in which against the morbigenic action of the spirothe lesions themselves predominate, viz., the . chaeta pallida. We have only the observaliver, lung, supra-renal capsule and skin. tion of an intense 'phagocytosis in the liver They are most abundantly found in the liver adjacent to the spirillary onslaught, also the where there are lesions of diffuse interstitial rarity of the finding of the parasite in the hepatitis (hepar silex) and in lungs afflicted spleen as contrasted with its relatively frewith pneumonia, in hypertrophic supra-renal quent appearance in an adjacent organ (the capsules, and in the cutaneous lesions of liver). It has already been established that syphilitic pemphigus. The absence of the or- there is an intense phagocytosis accompanyganism from organs not commonly affected by ing the disappearance of the parasites of rehereditary syphilis, viz., the brain and kidney current fever and of spirillosis of hens respecfor example, together with the presence of tively (Metchnikoff, Cantacuzene, Levaditi). these self-same organisms in still-born infants 8. Regarding the infectivity of the various as well as those dying after the first few in- excretions and secretions from syphilitic dis. spirations exclude the possibility of the inter- ease, we have but little to offer that is new. pretation of the bodies as agents of secondary The presence of the spirochaeta pallida in the infection. 2. The finding of the parasites in protoplasm of the renal epithelial cells in the the internal viscera of cases of tardy heredi. bronchial tree suggests the danger of syphilitary syphilis entitles the writer to speak of tic contagion from products of expectoration the possibility of a heredo-syphilis which is and perhaps the urine (Lavadati and Salmon). exclusively splanchnic. This is a form quite On the other hand the conservation of the different from that showing external cutane tinctorial and morphological characteristics of ous lesions. 3. The predominance in these the spirochaeta not only in the dermic papilla, findings of the parasites in the liver indicates but also in the contents of the vesicles of in some measure the route by which the para syphilitic pemphigus proves the possibility of site enters the fetal body from the maternal contagion from that source. placenta, i, e., the liver is the first organ to receive blood from the mother, by way of the placental villosities. The hepatic organ being

THERAPEUTICS. thus the first to receive the incoming blood laden with parasites, it is but natural that it

W. T. HIRSCHI, M.D. should show the heaviest signs of attack by invading parasites. This is shown by the The Internal Treatment of Appendicitis.numerous parasites in the liver sections and Mooslrugger (Muench. Med. Wochen., No.37, by the presence of parasites in the hepatic 1905) has used argentum colloidale Credé inblood vessels themselves. 4. The marked ternally and inunctions of ung. Credé exter. nally in cases of appendicitis with good re- with pulmonic circulation. The inflation and sults. In mild cases of several days duration collapse of the lungs should onl with slight pain, slightly irregular stools and variations of the thoracic movements. 2. Imabsence of tympanites bed rest, warm appli- portance of oxygen in extra amount (exceptcations or poultices and internal administra ing in CO poisoning) since normal air contion of argentum colloidale 0.5 per cent, tains 20.8 volume of oxygen, and we can easaqueous solutions of which one-half to one ily get along with less oxygen. Expired air tablespoonful are taken every hour. More contains about 4 per cent carbonic acid, and serious cases with symptoms of nausea, vom if air contains a larger amount, this gas is iting, chills and high fever, and severe consti given off with difficulty by the lungs. With tutional disturbances receive io grams of a l air containing 12 per cent oxygen some diffiper cent solution argentum colloidale every culty in respiration is experienced; with 6 hour, and in addition ung. colloidale is used. per cent the condition becomes serious. The Remedies to relieve the meteorismus, or to following factors have been underestimated in make the bowels move often dogreat harm, the physiology of respiration. The free elimand if indicated must be used guardedly. The ination of carbonic acid in respired air, and same is true of the used of opiates. Improve for this purpose the respiratory passages must ment with this method is usually observed on remain open, i. e., elevation of jaw, pulling the second day. The writer has used his forward of the tongue, etc. The systemic method in 75 cases of appendicitis with but rhythmic ventilation of the lungs best accomtwo fatal results, and believes that an early plished by the Sylvester method. diagnosis and a systematic use of collargol will often save the patient from surgical treat

Floating Kidney in Women.—Heidenheim ment.

(Ther. Monatshefte, No. 2, 1906) does not

believe that the shrinking of adipose tissue The Effect of Various Substances on Arti

about the kidneys plays a role in the etiology ficial Gastric Digestion.—(J. Tijitain, Arch. of movable kidneys. Trauma, empyema of internat. de pharm. et de therapie.)-The

the lungs, chronic coughs, chronic constipasalts of inorganic bases, excepting the ace

tion, heavy labor and pregnancy are etiologic tates, retard gastric digestion. This is due to

factors. Wolkow and Delitzin have found the nature of the acids and not of the bases.

paravertebral depressions in which the kidWeak solutions of boracic acid have little ef.

neys, rest normally. In men these are funnel fect, but a 2 to 4 per cent solution retard di

shaped with the apex downwards, in women gestion entirely. The sulphates have the

they are cylindrical. The intra-abdominal most depressing effect, the chlorides have the

pressure normally retains the kidneys in least. The salts of organic acids act like the

these depressions. It is still undecided borates. The salicylates are decidedly de

whether a movable kidney precedes gastropressing. The effect of alkaloidal salts de

enteroptosis, or whether it follows the latter. pends on the alkaloid and the acid. Quinine

Probably it is not always the same. The and cocaine retard and morphine increases

ideal treatment for movable kidney is surgidigestion. Among acids, sulphuric acid re

cal, but it only becomes necessary in the tards digestion decidedly. Alcohols retards

more severe cases. The wearing of abdomdigestion if used in excess of 10 per cent

inal supports which hold the abdominal organs strength, and therefore the depressing effect

in place do much good. These must compress of alcoholic beverages is usually due to some

the lower abdomen to force the bowels upother factor. Coffee, tea and sugar, if used

wards. Special pads to hold the kidney in in small amount are beneficial, but depressing

place do more harm than good. The writer if used to excess.

prefer Glenard's hypogastric girdle in most First Aid and Artificial Respiration.-(Dr. cases of movable kidney, especially if it is as. Kuhn, Ther. Monatshefte, No. 2, 1906.)—The sociated with gastroenteroptosis. cause of asphyxia almost always is not due to the absence or small volume of oxygen in the inspired air, but to the large amount of carbonic acid in the air, or the difficulty with

LARYNGOLOGY AND RHINOLOGY. which it is given off. This has led to confu

HERMAN STOLTE, M. D. sion in the method of treating asphyxia. The following factors have been overestimated in Syphilitic Empyema of the Accessory Sinuthe treatment of asphyxia: 1. Increased pres. ses of the Nose, with a Report of Four Cases. sure of inspired air or oxygen, and aspiration - Joseph H. Abraham (Med. Rec., March 3, of exhaled air, since atmospheric pressure is. 1906) declares that although luetic lesions sufficient in all cases. Increased pressure will may invade any part of the upper respiratory injure the parenchyma of lungs and interfere tract, and although tertiary lesions seem to


prefer the naso-pharyngo-laryngeal cavities tients being all children between II and 14 and tissues to those of any other part of the years. He points out that tracheotomy should body, syphilis of the accessory sinuses is not be directed by vital indications only, but rather uncommon. He describes four cases should be performed oftener as curative measthat have come under his care. The chief ure. Suitable conditions are represented (1) symptoms were nasal discharge and fetid by juvenile age of the patient, in which the breath. Pain was not constant, but was al vitality is stronger and the damaging afterways present during mastication. Pus was effects of the surgical interference are much present in all these cases. The writer, in less marked as in older persons, being in making his diagnosis, relied upon the presence youth remarkably slight; (2) by the lack of of a purulent accumulation in the middle any greater tubercular change in the lungs meatus anteriorly, transillumination, and and the existence of fair general condition of puncturing and aspirating the maxillary sinus. health, these latter depending chiefly on the In order to detect pus, the nasal cavities are former; (3) by the benignity of the tubercufirst thoroughly cleansed, and the patient is lar process in the larynx being slowly prodirected to incline the head to the opposite gressive and representing more the forms of side for a minute, then downwards and for infiltration and tumefaction, not the ulcerative wards. If the middle meatus be then exam form. Guided by these points of view we ined, pus, if present, will be seen adhering to can expect excellent curative results by the inferior surface of the middle turbinate tracheotomy in laryngeal tuberculosis, anteriorly. A darkened area over the maxil

The Use of the X-Ray in Sinus Disease of lary sinus is noted on transillumination of the

the Nose. - Mosher (Laryngoscope, Feb., maxillary antrum. From his experience with these cases, the writer thinks one is justified

stified 1906) claims a superior diagnostic value for in claiming that no syphilitic patient is free

the X-ray plates in sinus disease, and brings from the possibility of tertiary manifestations,

forward some very interesting cases to supin one form or another, even after a thorough

port his contention. He admits, however, the course of antisyphilitic treatment, lasting two

necessity of being an expert operator and the years or more. On this account all syphilitic

difficulty of recognizing what is seen, particu. patients should be advised to consult their larly on plates taking a iateral view. physicians every one to three years subsequent to their treatment. A positive diagnosis of empyema of the antrum of Highmore

OTOLOGY. may be reached by means of the proper appli

• ALBERT F. KOETTER, M. D. cation of the aspirating needle. Syphilitic empyema of the accessory sinuses quickly re A Case of Leukemia Hemorrhage in the Insponds to specific treatment and conservative ner Ear with Special Reference to the Pathosurgery. The administration of iodides in logic-anatomic Examination of the Temporal small doses, increasing one grain three times Bone.—(Aage Kock, Kopenhagen, Zeitschrift a day, has proved of more value in the wri. fuer Ohrenheilkunde.)-Man of thirty-two, ter's experience than large doses rapidly in acquired malaria in China, since then has creased. Finally, he believes that unless ur been ailing. Based on the clinical and blood gent symptoms demand immediate operation, examination the diagnosis of leukemia, me. operative interference should be delayed, in dulla lienalis was made. Suddenly vertigo order to obtain as great an absorption of the tinnitis and decrease in bearing set in, after gummatous infiltration with the iodides as two days total deafness. The post-mortem possible.

verified the olinical diagnosis. The histoSignificance of Edema of the Pharynx.

logical examination of the temporal bone (Jacob E. Schadle in the February number of

showed the following: Left Ear.-Abundant the Laryngoscope.)-In a well written article

fresh hemorrbage in the cochlea, especially in Dr. Schadle gives a carefully followed his.

the basal convolutions, mainly in the scala tory of true edema of the pharynx accompan

vestibuli, every part of Reissner's membrane ied by albuminuria. His theory of an infec

sprinkled. Differentiation of the cells in the tious nephritis caused by an attack of tonsil



organ of Corti impossible. From the scala litis is supported by the facts he records.

vestibuli the hemorrhage continues to the

vestibule, where it is localized on the median Indications for Curative Tracheotomy in wall, furthermore, in the ampullae in the Laryngeal Tuberculosis.-A. Henrici (Archiv endolymppbatio as well as the perilymphatio fuer Laryngologie, Vol. XXVII) illustrates his spaces. Hemorrhage in the tympanum also advocation of tracheotomy in laryngeal tuber- cocurs. The medullary space of the malleus culosis by very interesting histories of four and incus are filled with lymph cells. Right cured cases of laryngeal tuberculosis; the pa- Ear.-Hemorrhagic changes more pro.


nounced than in left ear, scalla vestibuli and resting horizontally on the shoulder, in the scala tympani entirely filled with blood; of revolving stool, defect of the eyes upward. the delicate parts of the membranous cochlea In irritation of the anterior semi-circular nothing is visible, the basilar membrane is canal the sensation must appear as if the fenestrated in several places. In the course field of vision were turning from the front of the semi-circular canals the perilymphatic to the rear and the individual himself were spaces in both ears are filled with blood, falling forward. The maculae acusticae of whereas the interior of the membranous semi. the utricle should functionate in upward and circular canals are for the greater part downward, and in rectilineal side movements, olear.

the maculae of the saccule functionate in

forward and backward movements. Clinical Examination of the Sense of Equilibrium.-(Panse-Lucae, Festschrift.)- Ver. The Aqueductus Vestibuli as a Means of Intigo is a condition of space disorientation fection.—(Boesch, Zeitschrift fuer Obrenof our body against its surroundings. The heilkunde). -Based on his own observations irritations that lead to semicircular canal ver- and twenty-one cases reported in the literatigo must be strong enough or they will be ture, the author compiles a statement of the equalized by the eye, or the tactile sense. pathogeny of suppuration in the aqueductus One can therefore bring about the semicir vestibuli. Contrary to Hinsberg, Boesch in oular canal vertigo if the control by the eye sixty-five cases of labyrinth suppuration, in -closing the eyes—and control of the tactile which the path of infection from the laby. sense, putting the feet together, standing on rinth to the interior of cranium was plainly one leg, is inade impossible or rendered diffi. indicated, the extension of the pus through cult by creating an irritation of the semi. the aqueductus, vestibuli occurred twentycircular canal track. The latter is reached two times. A fact, which puts the import. by turning the head to the side on which the ance of this manner of extension in a proper semicircular canal is to be tested, namely, light. The cases cf aqueductus vestibuli through touching a semicircular canal fistu. suppuration that Boesch gathered where lar, or by turning the eyes to opposite side of chronio suppurations, the labyrinth was in. the canal tested. If we now consider as volved preferable through the fenestra ovalis, the semicircular irritation of the flow of or the horizontal semi-circular oapal. From lymph from the narrow part of canal to the vestibulum the pus extended to the saothe ampullae as the active moment, the kind cus endolymphaticus, providing the aqueof test and the results to be expected for duct has not had time to close up by means the individual semi-circular canal follow of of connective tissue formation, ard then its own accord. The factor of the exclusion there occcurs an empyema of the sacous of control through the eye and rendering endolymphaticus. In extremely isolated cases difficult the control through the tactile sense the saccus seems to have been reaobed di. remains equal in the test for all semi.circular rectly from the antrum and surroundings of canals, including utriole and saccule. Test the labyrinth and aqueductus by the carious for the horizontal semi-circular canal: Turn. process. The pus very seldom extends ing to the side of the canal in question around through the acutely distended saccus, be it a vertical axis, or turning to the opposite subdural through the posterior membrane or side with sudden cessation of the turn, posi. extradural through the anterior membrane. tion of eyes to opposite side of canal tested. In most cases there is time for the formation The body, in test of left semi-circular canal, of adhesion in the vicinity of the inflammaturns to the left side, objects to the right tory focus. The dura hecomes adherent to side, phenomena that have been recognized the pia respectively with the cerebullum in irritation of left semi-circular canal. Cor- wbioh can only be reached in a direct way responding test of the anterior semi-circular by the infection. As moreover the saocus is canal, always supposing that the flow of too small and too delicate to become a retainer lymph from narrow part of canal to the am. for the pus, it is therefore probably an accupullae is active: raising of the head which mulation of pus between the dural mem. has been bent, forward or turning forward branes, and Boesch proposes the name inter. and sudden cessation of revolving stool with dural abscess. Of cerebral complications in head bent forward so that the bridge of the the twenty-three cases of Boesoh were as fol. nose is horizontal, defect of eyes downward; lows: one extradural abscess, three purulent, an irritation of the anterior semi-circular meningitis, four meningitis and sinus thromcanal causes therefore a sensation of reeling bosis, three meningitis and abscess of core : backward, and the sliding forward of objects. bellum, ten abscess of cerebellum. The sig. Test for posterior semi-circular canal: drop. moid sinus can be infected by way of vena ping of the head, turning forward, with head aqueductus vestibuli. The prevalence of

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