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But the painful areas extended distal-wards OBSTETRICS AND GYNECOLOGY to the vena cephalia, and by the 2d of July had reached the middle of the forearm. It

W. H. Vogt, M. D. could be definitely determined that the ves

Origin of Oblique and Transverse Positions. sels affected were not obliterated. Blood con

-(Fritz Kermauner, Centralblatt fuer Gy. tinued to pass through them. On the 4th of naekologie. No. 34.) -An obligue position July, an area 1 cm. by 3 mm. was seen over

was observed by the author in a 19-year-old the left vena mediana antibrachialis. An

primipara. The pelvis was somewhat gener. other node was seen on the right arm in the

ally contracted, and the head lay on the left sulcus cubitalis ulnaris. The forearm was

ileum. The patient was placed on her left side similarly affected afterwards, the first nodes

during labor in the hopes of correcting the losing their painfulness. On the 27th of

position, but without any effect. An internal July, nothing remained but the thickened

examination was then made, and it was vessels. Death occurred on the 31st of July.

found that the entire pelvis was filled with Autopsy showed chronic tuberculosis of both

a fairly tepse cystic tumor about the size lungs, atrophy of the muscles of the right

of a child's head. The membranes were un. upper extremity, aoute hemorrhagic nephri.

ruptured and the os was dilated to a degree tis, skin covering this part pale. Vena ce

sufficient to allow two fingers to pass. phalica thickened.

This The intima showed no

tumor was immediately suspected as being visible cbanges. The veins of the right arm

the filled bladder. Upon catheterization 900 were excised, as in case 1, laid open and bard.

cc. of urine was drawn, whereupon the tuened in 95% alcohol, imbedded in celloidin

mor immediately disappeared and the head and cut into sections. These sections showed

entered the pelvic inlet. He mentions the that the intima was not affected and that the

fact that transverse positions in primipara process was an inflammatory one, affecting with a full term child are rare and usually the media and the adventitia. There were

the causes of the same are obstructions prenumerous. round cells and lymph cells in

venting the presenting part from entering these two parts of the blood vessel wall. The

the pelvis as tumors, contracted pelves and cases were apparently free from syphilis. The

in very rare cases placenta praevia. The fact writer explained the phlebitis on the ground

that the bladder remained in the pelvis after that he had to deal with a chronic disease

being so tensely filled with urine makes this (tuberculosis of the lungs), that the patients

case interesting, for we know, although the were bed-ridden for some time, that they lay

bladder is a pelvic organ it rises out of the in bed with their arms under their head, thus

pelvis when greatly Gilled. Strange, too, is making an undue pressure upon these arm

the fact that on the second day of the puerveins; that there was a mixed infection, pus

perium the bladder at one time contained and tubercle organisms; that toxins of these

500 cc.of urine, and still it was not to be felt two sources were floating in the blood stream

above the pelvic inlet. and that with the pressure above described marking in the veins a locus minoris resisten Operative Treatment of Retrodisplacements. tiae, phlebitis began and ran from one vein –(Channing Barret, Surgery, Gynecology to the other. In short he calls attention to and Obstetrics, Nov., 1905).-The following the difference between this kind of phlebitis propositions are made: (1) That retrodeviaand the syphilitic form which was described tions of the uterus are frequent; (2) that they by Neisser; in the sypbilitic patient, phlebi. are pathological per se; (3) that they tend to tis occurs in strong, bealthy appearing per create further pathology; (4) that because of sons while in the non-luetio kind the patient the symptoms which they produce, and the was weak and bed-ridden. The sypbilitic further pathology which they create, they are phlebitis yields readily to anti-syphilitic with few exceptions, deserving of treatment. treatment only, while the cases just described This treatment should be either operative or seemed to do well under simple local treat. non-operative. Cases without intra-abdomment of compresses of aluminum acetate. In inal complications, with a fair pelric floor the syphilitio phlebitis, the veins histologi. and with only moderate pathology in the cally showed islands of infiltration,” while uterus, may be given the non-operative treatin the non-syphilitic variety there is a uni. ment if the conditions are such that the paform infiltration. In the sypbilitic phlebitis, tient can remain under observation and treat. the intima showed hemorrhagic areas, which ment for some months. The best results are was not true of these cases. In conclusion, obtained in this class of cases shortly after the writer believes that there should be a dis delivery. All of the rest of the cases come tinction made clinically and histologically under the head of operative cases. The re. between the specific and the non-specific quirements of any operation should be: (1) phlebitis migrans.

The operation must have the slightest mor.

tality; (2) the incision must allow the correc. the wave motions of the air, these again detion of complications; (3) the operation must pendent on the form of the tone waves, create the least possible pathology; (4) in a they are much slower than the others and child-bearing woman it must allow of no in- differ with them particularly, in their variaterference with future pregnancy; (5) it must bility, lack of periodicity, and the absence assure us of a permanency of results, with or of oscillatory character. The first group of without future pregnancy - must stand movements Bard ascribes to a function for Goldspohn's "double test of pregnancy;" the protection of the inner ear; the second (6) it must have the least possible morbidity. group transmitting to the labyrinth the inThe author thinks well of the Alexander tensity, tone, pitch and location of noise; the Adams operation where no complications ex- third group is the acoustic form of the sound. ist. But in order to find an operation that ing body. The active movements of the cbain will meet with all the above requirements the of ossicles serve for the accommodation for author has devised the one described by him, tones. The first group of passive movements and finds it extremely satisfactory. His oper. (refoulement tympaniques) plays no roll in ation consists in opening the abdomen by a the hearing, the second group of movements median incision of 11 to 2 inches in length; the true, acoustic vibrations take place withintra-abdominal complications are then dealt out any participation of the articulations of with and the round ligaments are then picked the chain of ossicles. The third group was up and a control ligature is thrown around dirst described by the author, and be ascribes each about 24 inches from the angle of the to it an important roll in the perception of uterus. The edge of the aponeurosis over the acoustic forms. Regarding the accommodarectus muscle is caught near the lower angle tion the author remarks that the movements of the wound, and the author's curved liga- of the tensor tympani do not swing the malture forceps are carried between the aponeu- leus around its neok, but draws the handle to. rosis and the rectus muscle outward to the in. ward the inside. These changes of the ten. ternal ring, where the forceps is guided into sion of the membrane called forth are the exthe abdomen, the control ligature is now pression of the adaptation of the membrane grasped by the forceps, and along with it is a to noise, respiration quiet. The contraction loop of round ligament, and the same is of the sta pedius draws the neck of the stapes withdrawn. Each loop of round ligament and with it the entire chain of ossioles, inwhile being held by the control ligature, is cluding the handle of the malleus, backward. sewed to the under side of the aponeurosis Therefrom result differences of tension bewith catgut, about one inch from the median tween the vertical halves of the membrane, line, and if the loops should be long enough making it possible for the membrane to adapt they are sutured together over the recti mus. itself to the distance of the origin of the cles. He terms the operation intramural sound. Whilst be compares the internal mus. transplantation of the round ligaments. He cles of the ear with the muscles of accommobelieves that anything that can be said in dation of the eye, he places the tensor with favor of the Alexander-Adams operation as the iridis muscle (adaptation for the intens. regards pregnancy can also be said of this ity) the sta pedius with ciliary muscle (acoperation.

commodation for distance). OTOLOGY.

Pathological Anatomy of the Inner Ear

and the Question of Primary Brain Abscess. ALBERT F. KOETTER, M. D.

.-(Sohwabach). -Girl of fifteen received in The Movement of the Ossicles and the Part bospital with headache, vertigo and nausea, They Play in Hearing.-L. Bard (Journal of which have been present for five weeks fol. Physiology and General Pathology) reports lowing a suppurative otitis media sinestra, bis observations in the study of physiology which appeared seven weeks before. Left of the middle ear. First of all he differen. membrane slightly congested. Lumbar tiates distinctly between active and passive puncture reveals 40 com, of clear sterile fluid. motion of the chain of ossioles, the former Pulse continually sluggish. When author saw are caused by muscle contraction, the latter patient she was in a stupor, pupils irregular, by movement of the tympanic membrane. deviation conjugée to the right, contraction The passive movement may be traced to three of left elbow joint. Death occurred with the causes: 1. Driving back the membrane de appearance of paralysis of respiration. Postpendent on a considerable change of air mortem.-On right under medullary sub. movements. 2. Acoustic vibration of the stance of the frontal lobe an abscess the size membrane corresponding to the rhythmic of a hen's egg filled with sterile pus, capsule periodicity of the sound waves. 3. Morpho several millimeters in thickness. Brain sinus logical deformation of membrane formed by free. Right petrous portion of temporal bone clear; on left tough yellowish mucus in of myxomatous tissue. In the bone there the tympanum.. Histological examination were observed in one case extensive softenbesides slight inflammatory changes on the ing, and in four other cases in a slighter non-perforated membrane, small quantity of degree. When the resorption foci are nearly free pus, considerable tumefaction of the mu- all found in the mastoid process, Goerke thinks cous membrane of the tympanic cavity. the tympanio cavity which is rich in connec. Eruption of pus, with partial destruction tive tissue submucosa offers great resistance of the annular ligament of the sta pes into to the extension of the inflammatory process. the vestibule, furthermore, on different parts Author has found the middle ear exudate al. of the labyrinth capsule in the oavity of the most exclusively in weak individuals, those cooblea, with simultaneous appearance of suffering from long continued disease, which connective tissue and new bone formation in eventually causes death; he therefore thinks the spongiosa of the temporal bone. Sligbt that the origin of the otitis (otitis of the cachanges in the mucous membrane of the mass chectio) is favored by the lowered vitality toid cells. Extensive suppuration and con- and diminished resistance of the tissues with neotive tissue formation in the labyrinth, also the insufficiency of the normal protecsmall cell infiltration of the vestibule, suppur. tion. With this be divests, as compared to ative hemorrhagio exudate in'the semi-circu. Preysing and others, the otitis media of the lar canal both in the endo. and peri-lympba. infant and many other middle ear inflammatio spaces. Inflammatory infiltration of the tions considered specifio, in so far as they becooblear nerve, also traces in the vestibuler long to the above mentioned group, comnerve. Facial nerve intact. Of importance pletely of their specific character. is the incongruity between the comparatively slight changes in the middle ear and the ex.

The Relation of Diseases of the Circulatory tepsive destruction in the temporal bone as

System to Diseases of the Ear.-(C. Stein, well as in the cochlea. The brain abscess al.

Zeitschrift fuer Ohrenbilkunde). –Of the though it existed, in an otitis media suppura

diseases of the circulatory system, arterio. tive sinestra, on the right side can be traced

sclerosis, mitral stenosis and myodegeneraback to this suppuration, an abscess mem

tive cordis are most frequently associated brane can occur in abscesses whose existence

with disease of the ear, and in the majority can be dated back only a few months.

of the cases, arteriosclerosis. The symptoms

on the part of the ear were tinnitis, deafness The Exudative and Plastic Processes in the and other subjective symptoms of a non-inMiddle Ear.-(Goerke, Archiv fuer Ohren- flammatory nature, most often as a result of heilkunde.)—The interesting and painstaking

disease of the sound perceiving apparatus. examinations of the author, embracing the

Author thinks there is a direct connection post-mortem sections of hundreds of cases

between arteriosclerosis and diseases of the and the histological description of eighty

sound perceiving mechanism, which is of temporal bones refer to the pathological anat

especial value to the clinician, in that the ear omy of acute otitis media without perforation

symptoms in conjunction with increased of the membrane. They prove first of all that blood pressure, can be utilized as early sympthe exudates found so often in the middle ear

toms of arteriosclerosis. The above men. cavity in post mortems are not transudates,

tioned affections of the circulatory apparatus but in fact inflammatory exudates. Whereas,

influence the middle ear processes in tbat the exudate was found in the tubes in small they favor the spread of the process to the quantities, the tympanio cavity was usually

labyrinth. The cause for the detrimental in. entirely filled. Parts most often involved

volvement of the ear is due to the anemia are the windows, the posterior pouch of the

brought about by disease of the blood vesmembrane, the floor of the tympanic cavity,

sels. Therefore all local therapy should be the smaller and smallest spaces between the

discarded, and in its place, the treatment of ossicles and their ligaments and Shrapnell's the heart, respectively the blood vessel affeo. membrane. In the antrum and mastoid cells tion is advised. the exudate enters the dependent parts if it. does not entirely fill them. The exudate undergoes remarkable changes until it becomes

PEDIATRICS. connective tissue. While now the epithel.

A. LEVY, M. D. ium grows down to the vessel carrying bridges which spread out between the mu- «Gone Off His Legs."-(G. A. Sutbercous membrane and the exposed exudate land, Brit. Jour. of Children's Diseases, there arise the so-called cavity proliferations March, 1905). —The occurrence of weakness of Preysing, a condition which was perhaps of the lower extremities in a child previously erroneously connected with the involution able to stand, walk and run normally is a peculiarly striking symptom. The most fre. slowly changes, owing to deep cracks which quent cause of this symptom is probably now come to view and to the accompanying rachitis depending upon too abundant carbo. desquamation. The fissures go through the hydrate diet, where the soft bones and relaxed entire skin, and the bleeding stripes and muscles are not in condition to bear the body spots give the surface a variegated aspect. weight. Return to rational feeding by dim. There is no icterus. In severe cases the in. inishing the carbohydrates and substituting fants were completely apbonio and died milk, butter, cream and cod liver oil results within six days. No other known symptoms in rapid recovery, especially if at the same of syphilis were present in cases studied by time fresh air and sunshine treatment, salt the author. This new diagnostic feature, if baths, massage of the trunk and extremities it can be confirmed will evidently acquire are carried out. Another frequent cause of great importance, owing to its very early the giving way of the lower extremities in presence. The author also goes into a dischildren in diphtheria paralysis. If the his. cussion of the histological bearing of his tory does not tell of a recent diphtheria or symptom. throat trouble the diagnosis may be safely taken for granted if there is an existing nasal Whooping Cough ; Its Prevention and Treatvoice or strabismus or regurgitation of fluids ment.—(Louis C. Ager, Brooklyn Med. Jour, through the nose. In cases of infantile par. Nov., 1905) opens his rather comprehensive alysis (pioliomyelitis anterior acuta) the de. paper with the statistical statement that velopment of paralysis after an acute febrile whooping cough causes more deaths than ty. attack accompanied by convulsions is charac. phoid fever. The danger lies in the compli. teristic. Upon examination there is found cations, especially convulsions, bronchitis to be paralysis and after a time marked and pneumonia. In a historical review of atrophy of certain muscles or muscle groups. the disease he mentions this fact: In EngThe possibility of hysteric paralysis should land and Wales from 1881 to 1890 the mean not be forgotten, even in very young child. annual death rate for children under five ren; sometimes an attack can be the start years was 12.97 for respiratory diseases, 4.35 ing point of functional disturbances. Among for diarrheal diseases, 3.37 for pertussis, 3.13 those diseases which are rarer yet not to be for measles and 1.67 for scarlet fever. Etiolost sight of are, brain affections, e.g., cor. logically the disease appears to be due (not tical sclerosis or cerebellar tumors, cord affec- fully established) to a short bacillus resem. tion, e.g., Fredereich's ataxia, compression bling the influenza bacillus, is transmitted from vertebral caries, myopathies, e.g., par- through expectorated mucous of infected in. alysis pseudohypertrophica, arthritio diseases, dividuals and may be carried by third per. bone diseases, e.g., osteomyelitis. All of sons or infeoted clothing and utensils. The these diseases are accompanied by destructive diagnosis is easy when the characteristio par. changes which may be recongized by careful oxysmal cough cours accompanied by examination.

whoop, but for purposes of prophylaxis iso.

lation, etc., the author seeks early symptoms. A New Sign of Heredity Syphilis.- (W. P. Among these, a leucocytosis, 10,000 to 20,000, Jukowski, Med. Obs. Ixiii, No. 7; quoted the increase being principally in small and Archiv of Pediatrics.)—The author begins large lymphocytes, paroxysmal croupy cough, with a short critical survey of the usual especially at night without auscultatory signs symptomatio aids to the diagnosis of heredi. of bronchitis; adenoids must of course be extary syphilis and pronounces most of these cluded. Much value is placed by some on signs and symptoms to be inconstant and un. the oocurrence of ulcer on the frenum. The reliable. He then describes a new sign which urine is said to be present certain character. consists in a peculiar dryness and mobility of istic changes, being pale and clear of high the epidermis. In the new-born presenting sp. gr. 1022 to 1035, the obange being due to slight atrophy we find this phenomenon only increased uric acid excretion. In considering in certain regions, as on the chest, the abdo the therapy of whooping cough he mentions men, the neck, sometimes only on palms and the waning popularity of belladonna and soles. In cases of syphilis, however, the en. antipyrine, and later of antitussin. He contire skin is loose and covers the underlying .demns the “do nothing'' plan, and recom. cuticle like a thin skirt. When the child mends the use of formalin inhalations, being moves, the loose epidermis is thrown into convinced that the length and severity of at. folds and presents à curious wary surface. tacks are much diminished (to three or four The entire picture is very characteristic and weeks). The formalin acts as a disinfectant cannot be mistaken for anything else. So and expectorant. The formaldehyde may be much can be observed immediately after birth. generated from a small lamp or an aqueous In a few days the appearance of the skin solution may be sprinkled about the room,

upon the clothing and bed of the child. In blood in the anterior chamber was resorbed addition to this he gives a combination of in the course of four days, the vision being a pomorphine muriate and codeine phos. entirely regained. The author reports the phates. Apomorphine 1-30 to 1-16 gr. every cases, as he wishes to direct the observation half hour for several doses with longer in. of others to this rather unexpected result from tervals between paroxysms. Digitalis should the application of adrenalin. be given to steady the heart when it is needed. He speaks favorably of the use of elastic

Radium in Trachoma.--(J. C. Besk, Chi. bands about the middle of the trunk. He cago, Annals of Ophthalmology, July, 1905.) personally used unbleached muslin fastened –The results from the application of radium with safety pins like a post partum binder. in iritis, irido-cyolitis and vptic atrophy are It is of value to pull down the jaw during a not as satisfactory as Darier reports. These paroxysm, and to try to train the children affections are not influenced by it radioactiv. to cough with the lungs full of air.

ity at all. There is, however, a decided im.

provement and a permanent cure of traStreptococci and Antistreptococcic Serum.

choma. The exposures are at first ten min(Herbert D. Pease, Med. Rev. of Rev., Sep- utes daily, later for thirty minutes three tember, 1905).-In that part of this article

times a week. Burns seldom ocour, although treating of scarlet fever we find that the best

some cases show a marked reaction to the results obtained by this serum are those re treatment. ported by Moser and a group of Austrian in. vestigators using the Moser-Paltauf serum in Inoculation of Rabbits' Eyes with Luetic scarlet fever. This serum is prepared by im. Material.-- (Dr. W. Schultze, Berlin, Fried. munizing the horse with cultures of strepto. enau, Klin. Monatsbl. f. Augenheilk.)— Very cocci obtained from the heart's blood of fatal little original research was attempted in this cases of scarlet fever. The dose recommended connection as long as the dogmatic belief that is 200 cubic centimeters and should be given syphilis is a disease of man only, was univer. early. Escherich first used Marmorek's sally accepted. The interesting results obserum with unsatisfactory results. He re- tained by other and very recent investigators ported 142 cases treated with Moser's serum. in this field, led the essayist to attempt the Effeot is seen within four to twelve hours. inoculation of rabbits' irides with syphilitio All symptoms are improved without shock material. Animals do not contract lues like or collapse. Temperature falls, pulse and res. man, but they can be inoculated with it, as piration diminish, and nervous symptoms has been demonstrated by perfecting the subside. The serum should be given before technique of inoculation. The author care. the height of the disease is reached. The fully inoculated the irides of 28 rabbits sequelae, otitis, endocarditis, nephritis are from primary lesions, mucus patches and not prevented nor influenced, unless the serum gummatous organs, and lastly from one in. is given early in the disease. According oculated animal to another, and in every in. to Esherich the death rate in St. Anna Kin. stance on the third day the injection about derspital was reduced from over 12% to 6% the focus of inoculation became intensified, since the use of the Moser serum.

the cornea and aqueous humor became cloudy. The iris became hyperemic, lost its

markings, and the pupil became contracted. OPHTHALMOLOGY.

A thickening of the iris occurred, especially WALDEMAR FISCHER, M. D.

about the focus of inoculation on the four.

teenth day, when the acme of the inflammaAccident with Adrenalin.-David de Beck, tion had been attained, after which all symp. Seattle, Washington (Annals of Ophthalmol. toms gradually subsided excepting the nod. ogy, July, 1905), reports that a man aet. 37 ules which became circumscribed and diswith a plastic sypbilitic iritis, begged tinct, and might be slightly visible for three that something be done to remove the months before their final disappearance. The congestion from the eye, which he feared animals suffer from constitutional symp. would prove injurious to his business inter. toms, as drowsiness, ulcerations on the skin, ests. Several instillations of adrenalin chlor- . rhagadae on their lips; some even die. The ides P. D. & Co., were made. The patient microscopic findings confirm the clinical pio. returned the following day complaining that ture. Syphilis is probably due to the cytor. the eye pained him severely about an hour rhyctes luis of Siegel, they may be classed after the adrenalin had been used. An ex- under the protozoa. They are very minute, amination revealed a hypbema which filled their greatest diameter being one-half to two one-half of the anterior chamber, and was ao. and one-half u., their longest flagellae meas. companied by the usual impaired vision. The uring about 10 u. The pathologic process is

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