« ForrigeFortsett »
REPORTS ON PROGRESS (22 to 30 grains) were taken, and in all these Comprising the Regular Contributions of the Fortnightly De. cases, recovery was prompt and occurred more
quickly than in similar cases in which one
large dose was administered prior to sporulaINTERNAL MEDICINE.
tion. In the tertian cases it was but very
rarely that a second chill occurred, although 0. E. LADEMANN, M. D.
in about 20 per cent of the cases a rise in
temperature was noted upon the second day The Action of Quinin on the Different Ma- of the expected paroxysm.
of the expected par
In the quartan larial Plasmodia.—Craig's (American Medi- cases a second paroxysm never ocourred afcine, April and May, 1906) study was under- ter the beginning of the administration of taken to determine, if possible, the actual quinin in this way, while in the aestivoeffect of quinin upon the various forms of the autumnal cases, which comprised nearly malarial plasmodia, and the best time for two-thirds of the total number, the temperthe administration of the drug, as shown by ature, except in two pernicious cases, its action upon the parasites. The results reached normal in from two to three days obtained show that quinin acts upon every and recovery occurred. It is in the latter stage in the growth of all varieties of the type of malarial infection that the adminisplasmodia, but that its action is most marked tration of quinin in divided doses is especupon the free spores and the young intra. ially efficient, for in this type it is generally corpuscular forms, in the latter not prevent impossible to tell the exact time of the ening entirely the development, but produc- suing paroxysni, and thus it is impossible to ing very marked developmental changes. attack the parasites while they are free in The first part of the author's manuscript is the blood plasma by administering one large devoted to a resumé of literature and a per dose of the drug. The following are the sonal consideration of the changes noted final conclusions wbioh the author believes in the fresh blood containing the tertian are justified: 1. Quinin exercises an injuri. quartan, and aestivo-autumnal plasmodia. ous effect upon the plasmodia of malaria The second part considers the appearance during all stages of their human life-cycle, presented in the stained preparations and whether intracorpuscular or extracorpuscudeductions in general. The most important lar, except when it is administered just prior practical deduction to be drawn from the to sporulation, at which time the sporulating study of the action of quinin upon the mal. body is not injured and sporulation occurs, arial plasmondia is that, in order to secure but most of the spores are destroyed by the the best therapeutic results the drug should drug while they are free in the blood plasma be present in the blood continually, and 2. The marked morphologio changes, degentherefore should be administered in divided erative in character, produced by quinin in doses at regular intervals of time. This study all species of the malarial plasmodia, during demonstrates that quinin acts injuriously all stages of their growth, prove that in order upon the plasmodia in all stages of their hu to secure the best therapeutio results the man life-cycle, with the possible exception of drug should be continually present in the the large full-grown plasmodium just prior blood, and this is only possible when it is to segmentation, and thus to secure the best administered in divided doses at regular in. : results, the drug should always be present in tervals of time. the blood. Given in divided doses at regular intervals the bluod constantly contains a Remarks on Sahli's Desmoid Test of the sufficient quantity practically to stop the de- Stomach.-Einhorn (Jour. A. M. A., May velopment of the plasmodia which have suo- 12, 1906; Deutsche Med. Wochenschrift, ceeded in escaping it wbile free in the blood May 17, 1906) says that Sahli's desmoid reacplasma, and recovery is thereby hastened. tion (see · Medical Fortnightly, Vol. XXIX, The practice of giving quinin in the man. No. 2) is unsuitable for the examination of ner mentioned is not only justified by the the stomach function because catgut is di. morphologic changes in the plasmodia, but gested in the bowel as well as in the stomach. its value is proved by practical experience. The author applied the test in four cases in To illustrate the latter, the author presents which there was a complete absence of gasthe records of over four hundred cases of tric juice (achylia gastrica) with a positive malarial fever, observed in soldiers returning desmoid reaction. In one case, where the from the Philippines and in the Philippines, desmoid test was administered four times, a including tertian, quartan and aestivo-au- varied condition was observed, the test being tumnal infections, in which quinin was ad- twice positive and twice negative. The days ministered in doses of 0.5 gms. (74 grains) on which the desmoid test was applied the every three hours until from 1.5 to 2 grms gastric seoretion of these patients was usually
examined, by means of the stomach tube, in eggs excoriated surfaces of the skin, as ec. order to be certain that no gastric juice was zema, acne, ulcerations, and suppurations of present. As the reaction was usually posi. the auditory meatus and nose. Myiasis of tive it was to be inferred tbat the desmoid the intestides occurs, but is an extreme rarity. test did not indicate whether gastric juice The incubation period is of a short duration. was present or not. In order to controvert The symptoms are variable and are dependent the idea of Sabli that after a test dinner (1) on the part. invaded and the organs there is sufficient gastric juice even when which they may penetrate, and (2) on the the test meal shows an absence of free sensitiveness of the individual. In one of bydrochloric acid, Einhorn made the fol. the author's cases tbe patient complained of lowing experiment: In case No. 2 be made severe headache and intense itobing with a a second desmoid test. Five hours after the temperature of 39 deg. C. Maggots inbabit. patient had taken the methylene blue des. ing the nose or nasal sinuses, the external moid bag, and three hours after a larger auditory canal or middle ear, or beneatb the meal the stomach contents were examined eyelids may produce symptoms of a maligagain with the result that the gastric juice nant or dangerous type. The prognosis, was entirely absent and no blue discoloration therefore, is often dubious and sometimes of the stomach contents, although the urine may be fatal. The diagnosis is simple. The voided shortly afterward was blue. In this maggots are seen from time to time emergcase the reaction must bave taken place in ing from the deeper structures (skin and the intestines; otherwise the urine would not mucous membranes) to the surface. Insufflahave been colored.
tions and tampons of calomel in the nose and
external ear are highly lauded by the writer, Determination of the Absence of Hydro
and far more efficient than any of the other chloric Acid by a Simple Stool Examination. remedial agents which have been recom-Hess (Med. Rec., April 28, 1906) bases the mended. supposition that the stool may indicate the asbence of bydrochloric acid in the stomach by utilizing the fact that connective tissue
GENITO-URINARY. can be digested only by the gastric juice. For tbree consecutive days a test diet is given
T. A. HOPKINS, M. D. the patient, the chief requirement being that Gastric Syphilis.-J. A. Armstrong reports it shall contain one-fourth pound of chopped (Montreal Med. Jour.. June, 1906) his surbeef so cooked that it is still rare within. In gical findings in this rare condition as fol. the absence of hydrochloric acid, under these lows: The stomach wall thick, about 1 c. m., conditions, particles of undigested connective in places 11 c.m.; very little bleeding, mus. tissue will be recognizable on carefully exam. cular tissue showed complete denudation of ining the finely divided stool. Hess advo- tbe mucosa over an area extending completely cates the application of this method in those around the stomach at the pyloric end of the cases where the introduction of the stomach incision. The same condition extended along tube is inadvisable.
the interior and anterior aspect of the stomVaccination with Attenuated Plague Cul.
ach toward the cardiac end of the organ fully ture.-Kolle (Deutsche Medizinioshe Woch
four incbes. Here and there, especially toenschrift, No. 11, 1906) reports forty-two
ward the margin of the bared surface, there successful inoculations on men with atten
were small islets of mucous membrane bav. uated cultures of living plague bacilli by
ing a rough cockscomb appearance and a purkeeping the cultures at a temperature of from
p!isb tint. The edges of the ulcerated area 42 to 43 deg. C. These experiments were
are well defined, serpigenous in out line and done in collaboration with those of Strong
abrupt. The edge was slightly heaped up and and demonstrate the harmlessness of such
undermined and just in the undermining protective inoculations in man, as no unpleas
angle was a whitish line. The surface of the ant symptoms exhibited themselves, although
ulcerated and denuded area was rather smooth the inoculated were closely observed for a
(neither caseous nor necrosing) of a pinkish period extending over four months.
red color and almost bloodless. In the tbick
ened area some cicatrization and contracture Myiasis and Its Treatment.-Rooda Smit had occurred, producing a certain degree of (Deutsche Medizinische Wochenschrift, No. hour.glass contracture, two or three inches 19, 1906) discussing the subject of fly disease from the pylorus. A slice of mucous mem(Fliegenkrankheit) says the larva or maggots brane, a section through the muscular wall are developed from the eggs of either the lu- and mucosa and a snipping from the edge of cilia huminivora or the aestres species. The the ulcer were taken for microscopical exam. flies usually select for the deposition of their ination. After extending the wound to give sufficient space the exuberant edges of the ul- enter from the genitalia or the lower intescer were pared, the base was curetted, and the tinal tract, the presence of albuminuria is dethermo-cautery lightly applied to as much of pendent on the previous condition of the kid. the ulcerated surface as could be reached, the neys. The history will probably suggest the very slight bleeding following curettage be causative germ. In treating the condition, ing easily checked by the same means. The urinary and intestinal antiseptios, urotropin gastric and abdominal wounds were then (hexamethylenamin), salol, boric acid and olosed by suture. The tissues removed were large draughts of water are advised. Vesical examined by Dr. P. G. Wooley, who reported instrumentation and irrigations are to be as follows: "The tissue from the base sug- avoided so far as possible. In spinal disease gested malignancy, for there were small masses with paralysis of the compressor muscle, bacof epithelial cells surrounded by a fibrous teriuria is a constant attendant affection, and stroma; but the edges of the ulcer were sim. when the urine becomes ammoniacal, cystitis ply fibrous tissue and muscle, the former in is inevitable. The danger of life in these excess and there was no marked infiltration. cases from ascending urinary affection makes The base was markedly inflammatory and not bacteriuria a serious matter, and every one malignaut.” That the condition was not recognizes the value of thorough, gentle, asepone of ulcus simplex of unusual dimensions tic bladder drainage in their treatment. In such as have been reported in medical litera- cases, as in the aged, dependent on colitis and ture, from time to time may be difficult to constipation, free purgation, regulated diet prove. Dr. Lafleur, however, reports that the and intestinal antiseptics are essential. Co. man was not a chronio dyspeptic and that an lonio'lavage for two or three months is prac. acidity and not byperacidity existed from the ticed by Janet. A case of very marked baconset of the illness. The chief argument is teriuria following dysentery is reported. drawn from the anatomic character of the lesion. Histologically the tissue removed bore a close resemblance to those in the case reported by Dr. Flaxner as gastric syphilis, in Vol. XIII of the Transactions of the
The reduction in the amount of typhoid Association of American Physicians. It is fever is than
fever is the most remarkable fact in the saniover three years since the operation was per.
tary history of Chicago during the last deformed. During this period he has been in
cade. The weekly bulletin of the health deprefect health, weight up to his standard and partment reports that the mortality there no indigestion.
from typhoid fever during the ten years from
1885 to 1894 inclusive was 7.9 per 10,000. Bacteriuria. — Bacteriuria, understanding In 1891 it was 17.31. being greater that year by the term the presence of bacteria in the
a the than in any other city in the civilized world. urinary tract above the compressor urethrae
After the drainage canal and intercepting muscle, is, according to G. P. La Roque
sewers were built the typhoid mortality was (Jour. A. M. A., June 16), a much more com.
reduced in the decade from 1895 to 1904 in. mon condition than is generally supposed.
clusive to 3.2, and in 1905 it was 90 per cent Unless associated with suppuration it pro.
less than it was in 1891. duces none of the symptoms of true inflam. mation in a healthy person, but such may FORMIC ACID IS THE LATEST REJUVENAfollow in conditions of lessened vital resist. TOR.-It is better than the once celebrated ance. Local symptoms, when present, are: Brown-Sequard elixir, or the muoh praised Slight increased frequency of micturition, glycero phosphates. It is claimed that sodi. mild ardor urinae, occasionally incontinence, um formate in fifteen-grain doses three or and in children there may be nervous dis- four times a day is the proper administration turbances. If no abrasions exist, toxins are for a healthy individual who is anxious to not absorbed In many cases there are no sub. work without fatigue. The Critic and Guide jective symptoms. The most common infect. quotes physicians who profess faith in this ing organism is the bacillus coli and it is “wonderful” remedy. The British Colum. present in nearly all cases, often in pure cul. bia Pharmaceutical Record states that a ture. In some cases of typhoid bacteriuria it customer far advanced in years regularly is absent. Alkalinity of the urine means the buys formic acid which he believes has presence of the staphylococcus or bacillus prolonged his life. Sometimes he eats red proteus vulgaris; all other organisms, these ants, we suppose with a view of getting the being absent, produce an acid urine. When formic acid at nature's fountain. It is worth the bacteria come by way of the kidneys, as while to mention that formio acid bas for in typhoid septicemia or soarlatina, there is many ages been an article of materia medica. always a positive albuminuria. When they -Meyer Bros. Druggist.
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ST. LOUIS, JULY 10, 1906.
Papers for the original department must be contributed ex the closely adjacent multiple organs of the clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans right side is difficult--frequently impossible. lated free of charge, if accepted.
The conditions that cause the excruciating, A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the agonizing, shocking pain in appendicitis is proof.
Engravings from photographs or pen drawings will be fur. perforation and extravasation into the peritonished when necessary to elucidate the text. Rejected manu neal cavity. script will be returned if stamps are enclosed for this purpose.
Right-sided muscular rigidity
means that the motor (intercostal) nerves COLLABORATORS.
supplying the abdominal muscles are irriALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.
tated. It may be any kind of peritoneal inFRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.
fection (extravasation from any viscus, hepaC. G. CHADDOCK, M. D., St. Louis, Mo.
tic, intestinal, ureteral or genital). RightS. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.
sided cutaneous hyperesthesia means that the N. S. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.
sensory (intercostal) nerves supplying the FRANK R. FRY, M. D., St. Louis.
abdominal skin are affected. It may depend
cessation of severe symptoms, as rapid dim. CHARLES JEWETT, M. D., Brooklyn.
inishing of high temperature and pulse and THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.
abdominal rigidity is an evil omen-gangrene E. E, MONTGOMERY, M. D., Philadelphia. NICHOLAS SENN, M. D., Chicago.
of the appendix has probably occurred. ImFERD C. VALENTINE, M. D., New York.
mediate operation should occur.
For years I have made it a rule to recom-
mend appendectomy to patients having exWM. H. WILDER, M. D., Chicago, Ill.
perienced two attacks. Fifty per cent of sub
joets who have bad one attack experience no LEADING ARTICLES
In perforation it is very difficult to interSUDDEN ABDOMINAL PAIN-ITS SIGNIF
pret the sudden abdominal pain. Associated ICANCE.
circumstances would aid. In typhoid fever one would naturally suspect perforation if
sudden acute abdominal pain arose, and my BYRON ROBINSON, B. S., M. D.
colleague, Dr. Weller Van Hook, successfully
operated on a typhoid perforation diagnosed (Continued from page 358.)
by his medical friend. One might think if
he was called to a young woman with sudden APPENDICITIS.
acute abdominal pain that it was a round, Appendicitis is the most dangerous and perforating ulcer of the stomach, after excludtreacherous of abdominal diseases—danger- ing pelvic and appendicular disease, but the ous because it kills, and treacherous because sudden acute abdominal pain of perforation its capricious course cannot be prognosed. is so vague and indefinite that only an The peritonitis it produces is either enteron ploratory incision would interpret it. ic (dangerous-absorptive) or colonic (mild The sudden acute abdominal pain from ap-exudative).
pendicitis (perforation) is more apt to be A concise clinical history should be ob- diagnosed from probability. Now probabil. tained when sudden pain arises in the right ity is the rule of life, and when one is called side of the abdomen for it might be due to to a boy or man with sudden acute abdominal perforated appendix, gall bladder or gestating pain, it is likely appendicitis. The pain of oviduot. The right-sided pain may arise appendicitis is at first sudden and generally from biliary, pancreatic or ureteral calculus diffuse, and in appendicitis this is, in my exor ureteral flexion.
perience, a characteristic and conspicuous Pleurisy or intercostal neuralgia (right) feature. The sudden acute pain in appendi. may confuse. In the right side, so closely citis is doubtless due to violent appendicular adjacent are eight important viscera, mo peristalsis (colic) of an inflamed appendix, or mentous in surgery, that a silver dollar will to the rupture allowing the bowel contents to touch the pylorus, gall-bladder, head of the come in contact with the peritoneum, and pancreas, kidney, adrenal, duodenum, ureter also inducing violent irregular peristalsis of and possibly the appendix.
Hence differen the adjacent bowel loops. It is the agoniztial diagnosis of sudden abdominal pain in ing, excruciating, pain of peritoneal extrava