« ForrigeFortsett »
patients. In view of this fact, it seems that of calculus are tuberculosis, pyelitis, pyelothe gonococous may be a cause of late abor. nephritis and pyonephrosis from the ordinary tions, and in all cases of unexplained late pus-producing infections, tumor and interabortions this infection should be considered. mittent hydronephrosis. Each of these is Gonoocccus conjunctivitis ocourred in three noticed separately. The only positive evi. infants. No infant at birth showed any signs dence of renal tubercuosis is the finding of of inflamed eyes, and all bad Crede's treat. the tubercle bacillus in the urine or during ment from the prevention of the infection. the disease in animals by inoculation with the The conclusions are the following: Gonocoo. diseased urine or tissues. Other symptoms cus infection was present in a mucb larger are a more or less unreliable. The differential proportion of cases of the obstetrical clinic stain must always be employed in diagnosing than was previously supposed by the writers. tuberculous from the finding of acid-fast bacThe failure to discover the gonococcus by illi in the urine, as is shown by a case bere means of smears is explained by the fact that reported. It may be impossible to diagnose such smears are usually taken early in the pyelitis, pyelonephritis or pyonephrosis from puerperium, and are obscured by blocd. The an infected nephrolithiasis except by operapositive diagnosis of the gonococcus is diffi. tion, nor is it easy to differentiate between cult in the absence of pus cells, and these calculus and tumor, and bere also the chief do not, as a rule, appear until later in the dependence is on the urinary examination. puerperium. The temperature cure of the A movable kidney and kinking of the ureter patients having fever were so varied and may cause attacks closely simulating those differed so much from one another, that no of calculus, but the enlarged and movable reliance could be placed upon this as an aid kidney during the attack and the relief of to diagnosis. The most common type, how- pain and increased flow of urine on its return ever, seemed to be that of a sudden rise fol. to normal size will aid the diagnosis. In lowed by return to the normal in three or this connection, Hunner mentions the unacfour days, simulating sapremia. The puer. countable renal bemorrbages known as idioperal state has a direct influence upon the pathic hematuria or renal epistaxis, and says course of the disease. Gonorrhea, which there is, he believes, a tendency nowadays to has been latent before labor, coipmonly connect these with the chronio interstitial spreads upward with rapidity during the form of Bright's disease. The diseases of puerperiun. Gonorrheal irfection is a fre. neighboring organs noticed as having to be quent cause of abortions, and in all cases of differentiated from calculus of the kidney are late abortions this should be considered. gallstones, appendicitis, intestinal obstrucThus if adnexal disease follows an abortion, tion, pancreatio calculus and Henoch's pur. it should not be ascribed to the abortion, as pura and angioneurotic edema; cases are regonorrheal infection may have been the ported illustrating the difficulties sometimes cause of both. No positive conclusions are encountered. The history of the case, exam. drawn as to the relation of this infection to nu. ination of the urine, eto., are generally the tritional, or other disturbances in the child. main dependence in the differentiation, ren, except from the well known frequency Kelley's method, injecting the kidney pelvis of ophthalmia. The morbidity and the with a bland solution, is mentioned as one of mortality, however, are relatively so marked the best diagnostic aids in case of suspected in this series of cases that a relation between gallstones. In conolusion he refers to the disease in the niother and nutritional dis. Israel's saying that in diagnosing other than turbances in the child is probable.
typical cases, one must, first of all, divest himself of the schematic picture so often pre
sented in the text-books. GENITO-URINARY.
The Choice of Method in Operating upon the T. A. HOPKINS, M. D.
Hypertrophied Prostate.— Willy Meyer (Med.
Record) advocates the use of the three The Diagnosis of Renal Calculus.—G. L. methods in general use in operating on the Hunner, Baltimore (Jour. A. M. A., March enlarged prostate, according as each method 24), remarks that few diseases present more fits the case be treated. It is not wise to pracprotean symptoms and simulate so varied an tise one to the exclusion of the others. Each array of other maladies as stone in the kin of the methods, perineal, and suprapubic pros. dey. Large calculi may exist in and cause tatectomy, and galvano-caustic prostatotomy destruction of both kidneys without marked has its own decided merits, and holds a dissymptoms, while minute caculi may give rise tinct place in surgery. Operation for ento agonizing pains. The more common kid. larged prostate must be urgently recomney diseases to be considered in the diagnosis mended to most patients with enlarged pros
tate as soon as it becomes necessary for them fever in tertiary syphilis. He illustrates bis to use the catheter habitually. The death point by giving the history of two cases rerate following operations is 5 per cent or cently observed. The first patient was a man less; the mortality due to pyelonephritis re- twenty-four years old, who was admitted to sulting from self-catheterization is much the hospital witb remittent fever said to have greater. The author has performed Bottini's been contracted at Papama. He was treated operation in fifty-nine cases, perineal pros. with quinine and arsenic. He denied syph. tatectomy nine times, the sprapubio opera- ilis. The plasmodium of malaria was not tion twenty-two times. The only deaths found and quinine was stopped. Fowler's by the perineal method were from the anes. solution, with an iron tonic pill, was given. thetio in one case, and in a case almost mori. Nigbt sweats with occasional obills developed. bund at the time of operation. Of the The tubercle bacillus was searched for with twenty-two suprapubio operations, seventeen negative results. Still later a slight swelling cases of benign hypertrophy are living, two over the sternal notoh was noticed and the died of causes not due to the operation; three patient reluctantly admitted having had an of cancerous hypertrophy died of causes due attack of syphilis four years before. Specific to the operation; three of cancerous byper treatment was instituted and exploratory introphy died of causes due to the nature of the cision was made, revealing a pocket of thin disease. The author believes that it is pos- brown pus at the sternal attachment of the sible to out the grooves with the galvano. sternocleido mastoid muscle. The necrotio cautery both deep and wide; that a median parts were removed. In a few weeks a small lobe is a contraindication to the Bottini uloer of the velum palati appeared. With a operation, if is possible to do an enuclea. mixed treatment containing mercury, it was tion; the cystoscope is of value in ex. noted that whenever the dose was moderately plaining the conditions at the neck; Bot increased the lesions seemed to become agtini's operation, even when done twice, does gravated. Observation of these cases shows not prevent a prostatectomy, should that be the necessity of administering m
the necessity of administering mercury with come necessary. But, being a purely in- caution. Both of the patients whose histor. travesical operation, it has many failures, ies are here reported improved more rapidly and sometimes entails tedious after-treat. when potassium iodide was used alone. As ment. If radical operation is refused it the danger of large doses of mercury in syph. should be done. When prostatectomy is ilitio cachexia was realized, and since its use done full power orer the urine is obtained. was regarded as a necessity in the cure of the A small portion of the urethral mucous mem- disease, it was - only after repeated trials in brane may have to be removed with the gland, both of these cases that the true value of the but it is no disadvantage. There is little iodide was appreciated. choice between the perineal and suprapubic routes. In the perineal operation there is a Transperitoneal Ligation of Renal Vessels. rapid return to normal control of the urine, -George Walker, Baltimore (Jour. A.M.A., and leakage over the abdomen is vot present. Nov., 25), concludes from a study of the subThe suprapubic operation can be done in less ject that with the ordinary methods of pertime. Cystoscopy should always be performed forming lumber nephrectomy there is danger before Bottini's operation, as the hypertro. that the operator may squeeze out tuberou. phy may be entirely intravesical. In ad. lous or malignant material, and thus cause a vanced oaroinoma Bottini's operation is to general infection. He gives his reasons for be preferred, since all the cancerous me this belief in detail, and in order to prevent tastases cannot be removed. A gland such a possibility proposes the following palpable by rectum and rising not far from operation: “Do a laparotomy, push to the the spbincter muscle can best be at. intestines to one side, incise the posterior tacked from below; when higher up and peritoneum, expose the renal vessels, put a projecting into the bladder it should be double ligature around each of them, cut beoperated on from above. When soft and tween and free the distal end for a short discomposed of small lobes, operated from be. tance. In passing the ligatures it is well to low. When complicated by a large calculus include a certain amount of the immediately work from above. The preservation of sexual surronding tissue, so as to pass around and power is inportant, and the suprapubic ligate the lymph tract, which is not visible, method retains it in the largest number of but which runs alongside of and very near to cases.
either the artery or vein. The peritoneum
is then closed posteriorly, and the anterior Fever in Tertiary Syphilis.-Dudley N. abdominal wound sutured in the usual Carpenter (Med. Rec., March 17, 1096) calls manner. The patient is then turned on his attention to the difficulty in the diagnosis of side, and the usual lumbar nephrectomy is
under proport the opthat removawound or bec
onth, he believes laparotomitoneal nepbrou
done." He notes the objeotion that the pro MEDICAL MISCELLANY cedure produces two separate wounds, but thinks that the opening of the peritoneum REMOVES Tax.-The unjust tax to which under proper precautions does not add to the Virginia physicians bave been annually sub. mortality of the operation. On tbe other jeoted was recently removed by a bill framed hand, he believes that removal of the kid. by Dr. Powell and passed by the House. ney, through the laparotomy wound or per
OFFERS REWARD.-The New Orleans Board forming a simple transperitoneal nepbrec. of Health offers a reward of $5 for the first tomy would probably be more dangerous live
gerous live female specimen of the stegomyia fasthan by removing it by the lumber route.
ciata brought to tbem, providing it is found Scarlatinal Nephritis.—This most import.
in that city. ant complication of scarlet fever, its etiol. HOSPITAL FOR ACUTE ALCOHOLISM. - A ogy and prophylaxis, is discussed by H. Chioago alderman bas introduced an ordin. Lowenburg, Philadelphia (Jour. A. M. A., ance providing for the construction and February 17). In scarlet fever, he states, the maintenance of a hospital for the treatment function of the skin is almost completely of acute alcoholism. suppressed, thus overtaxing the kidneys, which are also called on to carry ofi the toxic
HOTEL BELLECLAIRE.-Physicians in at. agent of the disease. There seems to be evi.
tendance at the Boston meeting of the dence that this last alone may be sufficient to
American Medical Association next June, produce the kidney disorder without the usual
who visit New York City, en route, will clinical manifestations of soarlatina. Con.
find Hotel Belleclaire a pleasant place to stipation, diet and exposure to cold are all
stop. Conveniently located, and complete in important contributory factors, the last
all its appointments. Make arrangements mostly in susceptible and anemic patients. now to meet your friends there. For prevention, Lowenburg would insist on A TRIP TO CHINA AND JAPAN --Dr. Alexgood ventilation and constant, carefully reg- ander J. Stone is oragnizing a party of phy. ulated temperature (68 to 70 F.), a milk diet sicians, their families and friends, for a trip varied toward the close of the disease, with to Japan and China, and can offer transpor. tender vegetables, fruits and farinaceous tation, inoluding sleepers and dining car ser. substances cautiously added. Fruit juices vice to Seattle and return-hotel accommoda. are refreshing and help to lessen urinary tions in Seattle-transportation on the 28,000 acidity. Daily urinary examination sbould ton Steamship Minnesota to Japan and be made, especially after each change of diet, China and return; railway transportation and on any appearance of albumin å return and first-class hotel accommodations in Jato an absolute inilk diet should be made at pan, with jinriokishas every day if desiredonce. Hydrotheraphy is mentioned as the hotel accommodations and transportation in one chief remedy. The free use of water aids China, all included for $700. The party will in elimination of toxins and it should be leave St. Paul about July 21st; sail from given as regularly as food. If plain water Seattle July 25th, and reach St. Paul on its can not readily be taken, some of the mineral return about October 9th, making an exwaters may be used, or better, lemonade or pense of less than $10 per day. The cheaporangeade, to each pint of which a teaspoon- est trip of its kind ever offered. Those wishful of cream of tartar may be added. A dailying to join the party should communicate bath with friction is a valuable adjunct in with Dr. Alexander J. Stone, St. Paul, Minn. promoting the skin functions, and its ternperature should never be lower than 8 or 10 degrees below that of the patient. Enteroclysis is also of use; from 1 to 8 ounces of saline solution may be given once or twice a day. The only drugs of any value
FOR RHEUMATISM, NEURALGIA, Tonsilin preventing renal complications are alka
LITIS, PAIN AND FEVER. —
LITIS, lies and laxatives. Lowenburg would give B Codeiniae sulph ............ gr. iv 5 or 10-grain doses of acetate or citrate of
Acetanilide........ potassium. Minute doses of calomel should
3 iiss be given at intervals of three or four days
3 ss during the disease, followed by broken doses Glycerinae...
5 SS of magnesium sulphate. The use of anti Syr. rubii idaeii.... streptococcus serum is mentioned and au.
Aq. destillatae............... 3 ss thorities favoring it are quoted, but without M. Sig. Take one teaspoonful every three special recommendations.
hours.-E. S. McKEE, M, D., Cincinnati.
Among fractures of the carpal bones the (International Journal of Surgery.)
scaphod is the one most liable to be involved.
This injury is often overlooked on account To obtain the best results of Colle's frao.
of the absence of the ordinary signs of fracture the patient should be placed under an
ture, but should be suspected in the presence anesthetic during reduction.
of localized pain, tenderness and swelling over In septic conditions of uncertain origin, the region of the bone. the presence of localized pain will sometimes Inflammation of the pleura are so often of afford a clue to the portal infection.
tuberculous origin that it is well to treat all To operate and find that a suspected osteo. these cases as if they were acturally tubercumyelitis is actually an acute rheumatism is losis. Hence after operations upon the pleufar preferable to deferring operation until an ral cavity an antituberculous plan of treatexaot diagnosis can be made.
ment should be pursued and the patient kept
under observation for some time. In operations on alcobolic subjects it should always be remembered that the vital. For the control of nasal hemorrhage tamity of the tissues is often so low that the ap- pons can be readily prepared as follows: A plication of even moderate degrees of heat layer of cotton is wound around a penholder may give rise to sloughing.
or similar object until the desired thickness
is obtained and then withdrawn. The cotton The transformation of uterine fibromata cylinder is then moistened, squeezed dry into malingant growths is comparatively com- and inserted into the nasal cavity. If the mon, and hence the possibility of such an projecting end of the tampon is now moist. occurrence should always be taken into con- ened it will swell up and thus produce suf. sideration in the prognosis and treatment. ficient compression.
Patients with long and thick foreskins An excellent ointment for the treatment of when suffering from gonorrhea are rather un boils is that recommended by Bulkley. It favorable subjects for a speedy cure. The consists of carbolic acid, 5-10 grains; A. exprepuce seems to keep the urethra in an ab- tract of ergot, dr.; staroh, 2 dr.; zinc oxide, normally hyperemic condition, thus favoring 2 dr.; and ung. aquae rosae, 2 oz. It is microbal growth.
spread upon the center of a moderately thick A condition sometimes simulating inguinal
layer of absorbent cotton, several times the bernia is the protrusion of masses of fat
size of the inflamed area, and secured with through the canal in front of the peritoneum.
strips of adhesive plaster. This dressing can If this fat be later absorbed a true hernia may
be left on for ten or twelve hours. result, owing to the dilated condition of the Injuries to the elbow-joint the rapid decanal which remains.
velopment of marked swelling frequently Fecal fistula, if uncomplicated, small and prevents the diagnosis of a suspected fracture situated in the vicinity of the ileocecal valve, or dislocation. Under these circumstances will often close spontaneously. Operation the plan suggested by Gerster and described should therefore be postponed until it seems
by Dawbarn will prove of value when the certain that a cure cannot be hoped for by X-ray is not available. The patient having nature's unaided efforts.
been anesthetized, an Esmarch elastic band.
age is slowly and firmly applied from the In the treatment of intussusception the ir, band up the forearm and over the elbow to rigation method should not be persisted in the arm-pit. This is left on for about fifteen for too long a period, 48 hours being the minutes and then removed from below up. maximum limit. The fluid should not be in ward, the final turns upon the upper arm jected under bigb pressure, the irrigator not being allowed to remain. The removal of the being suspended more than one and one-half edema in this manner permits of the recogni. or two feet above the patient.
tion of a fracture or dislocation, and this bav. The possibility of urethral stricture in
ing been accomplished, the upper turns of young children suffering from urinary dis
the bandages are removed. turbances (frequent micturition, vesical tenesmus, retention of urine, etc.) should always BRITISH MEDICAL ASSOCIATION. —The sev. be considered even in the absence of a trau. enty-fourth annual meeting of the British matio cause or gonorrheal infecton. Internal Medical Association will be held at Toronto, uretbrotomy followed by systemic dilatation Canada, on Tuesday, Wednesday, Thursday, is as successful in these cases as in older per Friday and Saturday, August 21, 22, 23, 24
and 25, 1906.
THE MEDICAL FORTNIGHTLY venience. "In some cases the pecacuanha
rearages, this magazine will not be discontinued.
June and December.
and wake without experiencing any inconvenience. In some cases the ipecacuanba
does produce sickness in spite of the chloral A Cosmopolitan Biwookly for the General Practitioner
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it to come on in less than one and a balf sent topics of interest and importance to physicians, and to this bours, and in no case did the vomit contain end, in addition to a well-selected corps of Department Editors, it bas secured correspondents in the leading medical centers of ipecacuanba, showing that it had already Europe and America. Contributions of a scientific nature, and
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recommends much larger doses (up to 150-210
drops daily), even though slight after-effeots FAVORITE PRESCRIPTIONS (headache, apathy) may appear. Tbe rectal
application is indicated where the serum is SEVERE DIARRHEA IN TYPHOID FEVER. — not well tolerated by mouth, but somewhat Osler employs a staroh and opium enema; or larger doses are then necessary.-Medical bismuth in large doses and Dover's powder News. by the roouth; or a mixture of lead acetate, two grains, dilute acetic acid, fifteen to twenty CARDIAC DYSPNEA.-Satterthwaite (“Dis. minims, and morphine acetate, 1-8 to 1-6 eases of the Heart and Aorta'') says that in grain. -Denver Med. Times.
severe attacks of dyspnea due to cardiac fail. ENLARGED SPLEEN.—The following is of
ure he gives nitroglycerine in doses of 1-100
to 1-25 of a grain. In sudden and violent at. much value in cases of enlarged spleen:
tacks he gives a capsule containing: B Specific polymnia............. 3x B Nitroglycerin.............. gr. Ito Specific chionanthus.......
Amyl nitrite.............. gr. & Fl. ext. grindelia squarrosa.. aa 3 v
Menthol.................. gr. 56 M. Sig.: Twenty drops three to five times
Oleoresin of capsioum...... gr. Ito a day.-Ex.
Sig. One capsule every four hours. The ACUTE DYSENTERY.-R. J. Windle recom- Med. Bull. mends the following combination:
CYSTODIAGNOSTIC EXAMINATION OF Gon. No. 1.
ORRHEAL SECRETIONS.—Max Joseph and M. B Chloral hydrat.......... gr. XX.XXX E. Polano, having made many examinations Liq. opii. sed.......... m xx
of this nature (American Journal of Urology), Aq, ad............. .. 3j
conclude with Pappenheim, that mononuclear Syr. aurant......... ... 3 ij
cells are always the first sign of the extension No. 2.
of the catarrhal, epithelial process to the subR Pulv. ipecac............ gr. XX-XXX
mucosa, and their appearance gives distinct
indications for prognosis and therapy.-DenAq. obloroformi........ 3 j.
ver Med. Times. Mucilag. tragacanth., q. s. No. 1 draught is given, and usually takes EARLY STAGE OF INTERSTITIAL NEPHRIeffect in from ten to fifteen minutes. When TIS. -Hugbes presoribed : the patient is just asleep he is sufficiently B Hydrarg. chloridi corros.... aroused to take No. 2. It must be shaken up Auri et sodii ohloridi....... gr. zo in a phial and poured out just before being Ferri reducti...... ....... gr. 1 taken. In many cases the patient will, after Spir. glonoini...... this treatment, sleep from three to six hours, One pill after meals.– Denver Med. Times.