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MEDICAL MEMORANDA.

Just a few lines to inform you of the excellent results I had with resinol in a most stubborn case of frost bite this winter. It would positively not yield to any other treatment. and by faithful use of this preparation, the patient is now completely relieved.-Jos. Lebenstein, M. D., 670 Lexington Ave., New York City.

"Our Observation of the medical literature indicates that echinacea is being used far more than formerly."-J. A. M A., April 8th, 1905. Ecthol contains in each fluid drachm twenty-eight grains echinacea and three grains thuja. It is put up in bottles holding twelve ounces and any physician who has not used ecthol, can get a 12-ounce bottle for experimental purposes by sending 25 cents to Battle & Co. to prepay express charges.

Quarantine Sketches is the title of an interesting booklet issued by the Maltine Co., Brooklyn N. Y., in which are portrayed the precautions taken by our government to prevent disease from being carried into this country by the thousands of emigrants that are landed every day. The pamphlet is beautifully gotten up, and the illustrations are from photographs. The company will take pleasure in sending a copy to any physician who makes request.

Eusoma in Infection. Under date of January 20, 1906, Dr. J. R. Phelan, editor Oklahoma Medical News-Journal, Oklahoma City, Okla., writes: Last week I treated a case of infection following vaccination, in which the arm was much swollen, discolored, and so painful as to render sleep impossible. I put him on teaspoonful doses of eusoma, every two hours, and kept gauze, saturated with eusoma, around the arm; relief from the pain was almost instantaneous with the first application, and in twenty-four hours the swelling was reduced by one-half, while at the end of forty-eight hours the swelling and other evidences of inflammation had entirely subsided, leaving a perfectly healthy vaccination sore. The rapid improvement of such cases is very gratifying to both physician and patient.

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Spraying for Diseases of the Respiratory Passages.-Dr. David Walsh, senior physician to the Western Skin Hospital, London. writes: Glyco-Thymoline was brought to my notice as an excellent lotion for nasal and oral sprays and washes. On due inquiry it was found to fulfil the two conditions usually recognized by medical in the United Kingdom as vouching for the character, so to speak, of such a preparation. First, its advertisements are accepted by our three leading journals, the Lancet, British Medical Journal and the Medical Press and Circular. Secondly, its composition is not a secret. its formula being freely published. Under these circumstances, I determined to try the effect of this preparation in a few simple cases. As a general antiseptic fluid that does not coagulate albumen, and is non-irritant, deodorant and praetically non-poisonous, glyco thymoline has clearly a wide range of usefulness. My own observations, however, have been practically confined to its use in the nose and mouth, with results that have proved satisfactory in every instance, especially in acute coryza, pharyngitis, influenza and septic conditions of the mouth.

Do not ligate tumors of the navel without making sure that intestine is not included wilhout the ligature.

Do not be too hasty in ascribing the cause of pain in the tendo Achilles, or Achilles bursa, to an ill-fitting shoe. First exclude gonorrheal infection.

THREE prime essentials in the nursery are fresh air, good food and pure water. Milk will not quench an infant's thirst. Give it pure water

at regular intervals.

The history of a discharge from an ear appearing a few days to a few weeks after the beginning of a slowly developing deafness in that ear, unaccompanied at any time by pain, is suspicious of tuberculous otitis media.

THERE will be a sketch of that friend of all young hearts, Robert Louis Stevenson, in the April St. Nicholas, by Ariadne Gilbert, under title of "The Lighthouse-Builder's Son." While the boyhood of Robert Louis will be dwelt upon with much interesting detail, the story of his later life and his work will also be covered; and there will be extracts from Stevenson's letters and a number of interesting illustrations, one a reproduction of the bronze memorial of Stevenson by Augustus Saint-Gaudens, now in St. Giles's Cathedral, Edinburgh.

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Papers for the original department must be contributed exclusively to this magazine, and should be in hand at least one month in advance. French and German articles will be translated free of charge, if accepted.

A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the proof.

Engravings from photographs or pen drawings will be furnished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

COLLABORATORS.

ALBERT ABRAMS, M. D., San Francisco.
M. V. BALL, M. D., Warren, Pa.
FRANK BILLINGS, M. D., Chicago, Ill.
CHARLES W. BURR, M. D., Philadelphia.
C. G. CHADDOCK, M. D., St. Louis, Mo.
S. SOLIS COHEN, M. D., Philadelphia, Pa.
ARCHIBALD CHURCH, M. D., Chicago.
N. S. DAVIS, M. D., Chicago.

ARTHUR R EDWARDS, M. D., Chicago, Ill.
FRANK R. FRY, M. D., St. Louis.

Mr. REGINALD HARRISON, London, England.
RICHARD T. HEWLETT, M. D., London, England.
J. N. HALL, M. D., Denver.

HOBART A. HARE, M. D., Philadelphia.
CHARLES JEWETT, M. D., Brooklyn.

THOMAS LINN, M. D., Nice, France.
FRANKLIN H. MARTIN, M. D., Chicago.
E. E. MONTGOMERY, M. D., Philadelphia.
NICHOLAS SENN, M. D., Chicago.
FERD C. VALENTINE, M. D., New York.
EDWIN WALKER, M. D., Evansville, Ind.
REYNOLD W. WILCOX, M. D., New York.
H. M. WHELPLEY, M. D., St. Louis.
WM. H. WILDER, M. D., Chicago, Ill.

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Oculist and Laryngologist to Mo. Pac. R. R. Co., Colorado & Southern R. R. Co., Colorado State Insane Asylum, Member American Medical Association, Medical Society of the Missouri Valley, American L. R. & O. Society, American Academy Ophthalmology and Oto-Laryngology, etc.

THIS pathologic condition is very common, and is so far reaching in its results, upon the general nutrition of children and young adults, that the writer wishes to emphasize the importance of early diagnosis, and treatment of the morbid process, as he believes it responsible for many of the nervous, and nutritive disturbances of the young. We all know, that much has been written on this subject in the past fifteen or twenty years, yet I feel that many physicians in general practice do not fully recognize the importance of the abnormal condition, and I fear too often, advise parents that the trouble is "one of no consequence," and their children "will grow out of it" or something to that effect. Such advice, in my humble judgment, is little less than criminal. The physician who assists at The physician who assists at the infant's birth and prescribes for it

*Read before the Pueblo County Medical Society.

No. 9

through early life, should be especially able to recognize this abnormality.

Lymphoid hypertrophy in the pharyngeal vault, is a familiar condition known as hypertrophy of the third, pharyngeal or Luschka's tonsil, and adenoid vegetations. According to my records, I find this diseased condition in 80% of all cases consulting me from infancy to eighteen years of age, in Colorado, and whether the trouble is more common in the Rocky Mountain region, than other sections of the United States, I do not know.

Both sexes are about equally affected; it may be congenital, and appears to be hereditary in some families, although the occurrence of several cases of the disease in the same family, could be referable to the same diathesis or same exciting causes.

It is said that the trouble is never seen in the negro. Dr. Calhoun, of Georgia, in a personal letter to the writer states, that "he had never seen hypertrophy of the pharyngeal tonsil in the negro, and this same opinion was held by many laryngologists of the South." I have seen two cases in negroes in Pueblo in the past seven years; whether these two childern were of pure negro blood, I am not able to say.

Many constitutional diseases predispose to the affection, such as scrofula, syphilis, tuberculosis and kindred diseases. It has often been an interesting question with me, whether or not, tuberculous ancestry, might not account for so many cases being seen in this particular section of country.

Most authors agree, that the larger percentage of cases of this trouble are seen in children from four to ten years of age; the writer has seen cases in infants at the breast; and in individuals at twenty-five years of age.

It cannot be disputed that there exists in many children a tendency to lymphatic inflammation, a condition known as "lymphatism," or if you please, a lymphatic diathesis, in which there is a tendency for all lymphoid tissues of the body, to take on an overgrowth at an early age, the lymphoid deposits becoming particularly manifest in the naso-pharynx and pharynx.

Such children contract the contagious diseases very readily, and indeed when affected with any acute disease, the type of the given disease, is much more malignant and intense in degree, than is seen in children who do not have the tendency to lymphoid inflammation.

The most striking features in the symptomatology of hypertrophy in the pharyngeal vault, in a well marked case, is the peculiar facial expression, the dull, listless, stupid, vacant stare, the parted lips, open mouth, prominent eyeballs, with the inner canthi drawn down; often accompanying conjunctivitis with lachrymation, elevated eyebrows, the skin of the forehead is often corrugated, obliteration of the normal lines of expression of the face, mouth-breathing, a noisy respiration, snoring and lack of resonance of the voice, thickness of speech, the child talks as though it has something in its mouth, or the voice has a peculiar "dead" quality.

There is generally always a profuse nasal discharge, often excoriations or eczematous erosions about the alae of the nose, due to irritating mucopurulent secretion, the alae often looked pinched, and frequently the nose is abnormally broad across the ridge, the child is almost constantly sniffling, often there is cough, night terrors, sense of choking; the little sufferer will often cry out in sleep and start up in its couch; often too there is nocturnal incontinence of urine, frequently recurring earaches, and invariably 'catching cold" at every change of the weather.

By impairment of the functions, there is deficient oxygenation of the blood, with resulting carbon di-oxide poisoning, impaired nutrition, and anemic conditions, from which recovery is often prolonged after normal respiration has been fully established.

As the trouble progresses, there is permanent alteration of the voice, laryngeal and bronchial catarrhs result, and there may be thoracic deformity; the mental and physical growth is seriously impaired, the children are inattentive, absent minded, and slow in their studies; their teachers often say they are dull, and cannot study and keep up with their classes.

Children affected with hypertrophy in the pharyngeal vault, and who do not obtain relief, are sure to fall below their full measure of health and strength, they usually grow up feeble and sickly. The severe forms of this abnormal condition, will surely leave its mark on their whole future existence.

In addition to the serious consequences, which result from this affection, may be mentioned acute and chronic otorrhea, perforation of the membrana-tympani, necrosis and anky. losis of the ossicles, permanent deafness, indeed, I may safely say, that it accounts for fully fifty per cent of the cases of deafness which the aurist is called upon to treat.

There is increased liability of subjects of this condition, to infection, as has been seen, and the so-called "colds" are very often the

result of entrance into the system of pathogenic organisms, carried into the air passages by dust, the writer believes also that the frequent so-called "bilious attacks" in children suffering from this disease, are of. ten, nothing more or less, than septic processes due to infection.

Some authors have reported torticollis coexisting with, but cured by removal of the lymphoid hypertrophy, and the same of epileptic seizures and asthma.

How far the presence of such growths, may influence certain errors of refraction of the. eyes, together with muscular abnormalities is an interesting question. The writer recently examined the case of a girl of twelve, who had a well marked case of adenoids, and also twenty degrees of esophoria; two months after adenoid operation and correction of refractive error, the esophoria had been reduced to ten degrees.

Also the author operated on a case, for adenoids, about a year ago in which there was a decided convergent strabismus, and following the removal of the growths several weeks, there was great improvement in the squint.

The diagnosis of lymphoid hypertrophy in the pharyngeal vault is easy, from the symptoms and history, in a well marked case, and can be recognized at sight; in tractable children, the growths can be seen by reflected light, with a small rhinoscopic mirror, when the case is not tractable, the diagnosis can easily be made, by passing the forefinger of the left hand behind the soft palate, either seating the patient on a chair or having them stand erect, while the surgeon stands behind the child, with its head against his chest, passing the right hand around the neck, with the forefinger pressing in the cheek between the upper and lower jaw, while the mouth is open.

In this manner the examination can be quickly made without injury to the patient, while at the same time it is firmly held, and during this examination, the whole vault can be quickly explored, and the exact location, and consistency of the growth can be determined. No matter how vicious the child may be, there is absolutely no danger of wounding the surgeon's finger, with the teeth; because the child cannot close the mouth, if the right forefinger is firmly held in above manner.

The examining finger will usually have on it a show of blood upon withdrawal, which is not present if the vault be clear.

The surgeon can also throw a warm antiseptic solution through one anterior naris, with an atomizer or small syringe, and if the nose and naso-pharynx are clear the fluid will

escape through the other nostril and practic. ally with undiminished force.

As has been seen, these growths can be of a malignant, syphilitic or tuberculous nature; so far as their pathological structure is concerned; but in such cases, visible evidence, and the history of the case, will decide their character.

Questions frequently asked by parents are: will the growths do any permanent injury if left alone? and will they return if once removed? To the first, I emphatically answer "Yes," and to the second absolutely "No." The majority of cases with their symptoms so clearly seen, and in general called "catarrh" have usually long since attracted the parents' attention and they will usually consent to operation for removal of the growths.

In the author's opinion there is no operation in nasal or laryngeal surgery attended with happier results than the one for removal of lymphoid hypertrophy from the pharnygeal vault. Physically the child is a new person after a successful operation.

If left alone, there is always great danger of permanent damage to the organs of hearing, with resultant, and practically incurable postnasal catarrh, to say nothing of the multitude of other complications already seen.

After puberty the deposits of lymphatic tissue in the nose and naso-pharynx tend to atrophy, establishing a train of symptoms of ten as far reaching as hypertrophy of these tissues, and certainly causing diseased conditions of contiguous tissues and organs which are practically incurable.

The immediate dangers, are increased liability to any contagion, diseases caused from impaired vitality of the upper respiratory tract, defective mental and physical develop ment, deformities of the jaws, and defective dental development.

After successful operation, dull intellects brighten, deafness is often relieved in a short time, phonation becomes clear and distinct, and nasal respiration is quickly established.

The treatment of such cases is constitutional, hygienic, local and operative.

All these cases should have careful directions regarding their food, clothing and care of the body, in short, their general hygiene should be rigidly supervised; many require general tonics, alteratives and reconstructives; a very few can be relieved, and often cured, by constitutional treatment, combined with antiseptic sprays to the nares and local application to the post-nasal space, but this applies only to the limited few cases where there is no impairment of hearing; where mouth breathing is not permanent, and where the growths are quite small, and true hy

pertrophy is not fully established, or where the general symptoms are not well marked; such cases, however, but rarely consult the

surgeon.

In well marked cases, the treatment, to insure permanent results is, radical removal, which I prefer to do with the curette, occasionally the forceps, completing the operation with the finger nail of either right or left fore-finger.

The operation is quickly done, after which I pass through the nares several syringefuls of a warm antiseptic solution, to clear the nose of blood, and to assist in stopping hemorrhage, which is always quite free, the patient is then placed in bed, and given a few doses of five to fifteen grains of bromide of sodium, and liquid or or semi-liquid food for forty-eight hours; the nostrils being sprayed twice daily with a warm antiseptic solution. The subsequent treatment depends entirely upon the complications which have resulted, from the presence of the abnormal growths.

There is generally, however, several weeks of after treatment, to restore the tissues of the upper respiratory tract to a normal condition.

Caustic acids, and other destructive agents, the galvano-cautery, and the cold snare, have their advocates, for removal of these growths, and I only mention to condemn them.

The subject of general anesthesia is one of great importance, and we have a choice of either ether, chloroform, nitrous oxid, somnoform or ethyl bromid; I am fully convinced, from experience, that the subjects of the pathologic condition under consideration, as a rule, take general anesthesia badly, and I feel, that the operation can be done quite as quickly, and successfully with local, as with general anesthesia, as the element of danger in the operation, is in the general anesthesia.

Of course, the operation should be done as aseptically as possible with the patient in best possible physical condition.

MISSOURI VALLEY SPECIAL TO BOSTON. -Arrangements have been perfected for a superb special train to Boston, to attend the meeting of the American Medical Association, June 5 to 8. Route: Grand Trunk, via Niagara Falls, Toronto, Montreal, Thousand Islands, daylight ride down the St. Lawrence iver, returning by rail. One fare, plus $1, for round trip. This train will run special through from Chicago, and will be made up of Pullman palace sleepers, dining cars, buffetlibrary and observation cars. For reservations and itinerary address Dr. Chas. Wood Fassett, Secretary, Medical Society of the Missouri Valley, St. Joseph, Mo.

PATHOLOGY AND DIAGNOSIS OF THE LESIONS OF THE SPINAL CORD AND PERIPHERAL NERVES.*

FRANK PARSONS NORBURY, A. M., M. D.

JACKSONVILLE, ILL.

Professor of Nervous and Mental Diseases, Keokuk Medical College, College of Physicians and Surgeons, Keokuk, Ia.; Medical Superintendent, Maplewood Sanitorium.

In order to properly understand the diseases and injuries of the spinal cord and peripheral nerves, it is of the first importance that we have familiarity with the anatomico-physiological features of these special nerve structures. It is not necessary for me to enter into an extended anatomical description of the cord, but I would like to emphasize the importance of certain essentials which aid us when operative treatment is under consideration.

We must remember that irritation and conduction occur by means of the neuron, each one consisting of a nerve cell with its dendrites, of the nerve process (root process, neurite, axis cylinder) arising from the nerve cell and of the terminal splitting of the same (terminal arborization).

In order to insure performance of the functions of the neuron, there must be an intact condition of its anatomical structure. Irritation occurs in the neuron by travelling from the cell to the neurite. and thence to the terminal arborization, and is there transformed to other ganglionic cells, the fibers of which are in intimate contact with the terminal arborization by way of the dendrites of the ganglion cell.

The arrangement of the neurons in tracts serves to systematize these anatomical elements and in the study of their physiological function, diagnosis has been greatly advanced in recent years. The motor tract, the sensory tract, the reflex tracts, thus studied, have been compiled in tables and illustrated in diagrams, so that with their aid, localization diagnosis has been perfected to the extent of what we may now call it, the science of localization. Of course, it has not reached an absolute, unalterable degree of perfection for there yet remains much clinical and physiological investigation to establish the perfect science of localization. However, facts have accumulated regarding the localization of cord lesions sufficient to meet all surgical requirements. There are

certain elementary facts which we must always remember, and which even in their simplicity bear repetition, frequently. I allude

to:

*Read before the Illinois State Medical Society at Rock Island, Ill., May 16th, 1995.

First. The fact that the cord terminates opposite the second lumbar vertebra. Sec

ond. That the spinal nerves do not leave the cord immediately in line with their origin, but extend downwards and have their exit through vertebrae sometimes remotely from their origin, this distance increasing as we descend the cord from the cervical vertebra. The lumbar and sacral nerves in their formation of the cauda equma having quite a distance foramina. Third. That as the spinous proto go before having their exit through their sions, it is necessary to remember that the cesses are taken as guides in making incispines of the vertebrae do not correspond to the level of the bodies and that their relation

ship between nerve roots and spinous processes varies the entire length of the spinal colmun; thus, at the cervical region, the nerve roots are almost opposite the cervical nerves, while in the dorsal region the spinous process of the sixth vertebra is opposite the ninth dorsal nerve root. Gowers' diagram is of help in understanding these facts. Fourth. When root symptoms are being considered, it is necessary to remember, that one root may give evidence of irritation in several different nerves and destruction of a root will cause atrophy of muscles to which these different nerves originating in this root are distributed.

In considering diseases of the peripheral nerves this fact of importance, as there is a difference between peripheral nerve distribution and root distribution (to facilitate in localization), in accordance with the above going statements, tables and diagrams have been prepared showing accurately the root and peripheral distributions.

Pathology. The gross and special pathology of lesions of the cord cannot be discussed in their fullness, and we must therefore hastily review a few essentials which when understood are sufficient to meet the requirements as we are apt to meet them in surgical practice. It is also necessary to consider the surgical pathology of the vertebra briefly, inasmuch as diseases of the vertebra are responsible for the greater part of surgical interference where the cord is involved. Degenerations, usually secondary, are the most marked pathological changes in the cord. They follow after injury to the cord, from compression or from severance of fibres. In both conditions the fibres are cut off from their cell bodies and degeneration follows, from the point of injury to the peripheral termination of the fibre. For this reason a small lesion in the cord may cause extensive secondary nerve fiber degenerations. Below the lesion in the cord a

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