« ForrigeFortsett »
The Medical Society of City Hospital Alumni
President, LOUIS H. BEHRENS, 374! Olive Street
Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
CHAIRMEN OF STANDING COMMITTEES :
Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive, A. Ravold, Century Building
Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.
Public Health, R. B. H. Gradwohl, 522 Washington Ave
trude through the labia majora. The case
was fully demonstrated by Dr. Elbrecht to Dr. C. G. Wright presented a case of the society. lympbangioma of the band in a negro obild.
DISCUSSION. Family history was not obtained; physical Dr. F. J. Taussig said that the question of examination showed well-nourished child;
therapy in these cases puzzling to the profes. palpation and auscultation negative. Skin sion.** The first thing to be considered is
whether or not the patient will consent to an glands enlarged. There was multiple dacty
operation. If not, the cup and bell supportlitis of the right hand, the dorsal surface of
ing pessary diay be tried, but it is not usu. the fingers being involved. The bones can
ally successful. Another form of pessary be palpated in the mass, the enlargement be
that is not so well known is the Menge ing hard and nodular. The left hand is in
pessary which is a modification of the ordingood condition.
ary hard rubber ring with a stem which points Diagnosis of lymphangioma was made.
outward. The main objection to the ordinary The condition has existed since birtb.
bard rubber ring is that it is easily expelled DISCUSSION.
because it tilts. The idea of the bulb stem
in the Menge pessary is to keep the round Dr. John Green, Jr., thought this was a
part transverse in the pelvis. The bulb end very interesting condition. The condition
is short. He said that he has used this of the eyes suggested struma. There is a
pessary with good results. phylctenular keratitis with some marginal
As regards the operative side of the case, trouble of the lids in this case. Yet he un. Dr. Taussig said that he personally favored derstood that the tuberoulous nature of the
the operation of inverting the interus in the condition was denied.
vagina. If the tubes are resected, conception Dr. Horwitz asked whether specific treat.
is prevented. By complete hysterectomy, ment had been tried, the answer being that
the chance of cystocele forming must always kalium iodid, had been given for the past two
be remembered. Furthermore, in such an weeks, ever since patient entered the hospital. operation the vagina is obliterated, which is Dr. Fruend asked if the condition was not
objectionable in the married women. The syphilitic, what treatment should be insti. danger of hernia likewise must not be overtuted ?
looked. The essayist said that no treatment had Dr. Elbrecht said that the prolapsus did been suggested as yet by Dr. Mook. Stel.
not bother this patient, except wben she wagon in bis text-book does not speak of the was working. He did not think use of treatment of the condition.
pessaries practicable in women who have to Dr. Elbrecht said that the only treatment
do manual labor: They produce excoriations would be resection and cauterization, and
of the vagina. He said that he has yet to that he did not feel justified in advising any
see a pessary that will last. They irritate such procedure.
and produce inflammation. He does not like COMPLETE PROLAPSUS UTERI.
the operation of inversion. He believed the
ideal operation (which he will do tomorrow Dr. O. H. Elbrecht presented a case of
on this patient) is to remove the uterus by coinplete prolapsus uteri. Patient was & the abdominal route and sew the broad liga. wash-woman. Family history negative. ments together. This gives the intestines No acute diseases. Patient has had three something upon which to rest. This feature children. Has had this prolapse for eighteen
is accomplished in the Freund-Wertheim years past. Present state, pain and tender
operation. Where the possibility of pregness in groin. The uterus, with bladder pro
nancy cannot be excluded, it is not right to do * Meeting May 17, 1906.
VENTRAL HERNIA WITH GANGRENOUS ULCERA- case is that where there is a nervous trouble ATION OVER SAC.
of an organic nature in a person of this age, Dr. Coppedge presented a case of ventral
it is apt to be multiple sclerosis. Starr in hernia with gangrenous ulceration over a sao.
his recent text-book says that out of 10,000 The patient was a very fat subject, female.
cases he only found this condition 27 times. Sbe acquired a hernia in the median line.
Dr. Campbell then presented another case An operation was performed for this condi.
which he was inclined to believe was also tion a few months previous to the presenta
multiple sclerosis. tion.
The history of the first But the protrusion recurred. There
patient (age 23 years) was that she noticed a are now three protruding areas. Each pro
numbness four months ago. She cannot use trusion is about the size of an orange. The
the right hand io eating. The knee jerks abdominal walls are very las. There is a
are increased; Babinski reflex increused. The gangrenous ulcer over one side. Notice the
pupils react to light. Nystagmus is present. · large scar of the laparotomy which runs
There were no signs of mental disturbance. across the abdomen.
The feet sometimes swell. She has a distinct DISCUSSION.
nervous disturbance of the bladder. The
ankle clonus present stamps the organio naDr. Deutsch said that no operation would
ture of the trouble. Tbe essayist said that be justifiable on such a case. He had never
the most common diffuse organic condition seen such a large protrusion before. He
that occurs in young women is multiple thought the ulcer could be excised so as to
sclerosis. Among the symptoms are inten. prevent the death of the patient from gan
tion tremor, being a trembling in the bands grene.
when an individual attempts to perform some Dr. Elbrecbt stated that the patient's con. voluntary act that require precision. In tbis dition bad improved since ertering the hos. case there is a distinct jerk of the eye-ball. pital. The ulcer was healing. The opera. Among the important symptoms which this tion that had previously been performed was case show are spastic condition of the lower the overlapping operation of Mayo, made in
limb and the ankle olonus. If the condition this case by Dr. Brown of the City Hospital. were due to a specifio trouble, there would be The speaker did not believe that any surgical sluggishness to light reaction. Another improcedure would avail at this time. He portant point found by Dr. Green who examthought it would only be surgical exer. ined the case, in the two temporal halves of cise to attempt to repair the condition. the optio disos, there was a tendenoy to atro. He did not think that the uloer should be phy which is symptomatio of multiple sclero. healed by grafts, but rather preferred the sis. The speaker said that the condition is method of healing by scar tissue, thus sometimes confounded with hysteria. When strengthening the abdominal walls.
in doubt, he said that you are more apt to
be right in calling it multiple sclerosis SPINA BIFIDA.
rather than bysteria. The cther patient Dr. Given Campbell presented a case of presented shows the phenomenon of 'scanspina bifida. The patient is a girl of 12 ning speech," that is to say, an accentua. years. Ever since birth she has been unable tion of words in talking much like one aoto use the lower extremities, bladder and rec. centuates in scanning poetry. The inten. tum. This condition he stated was un. tion tremor was very pronounced in the doubtedly a meningo-myelocele, with projec. second case. The speaker believed the rest tion of the lower part of the spinal cord into cure the best treatment. The salicylates, the tumor. Part of the nervous tiseue was iron and quinine help some cases. The defective and produced the paralysis and tendency of the disease, however, is to pro. the paralytic olub-foot. This condition is gress. Some patients bold their own for always found where the spinal cord is in twenty years with this condition. the tumor. The condition is more to be classed as a surgical disease than a neurologi.
DISCUSSION. cal. The otber limb in this case, being Dr. John Green, Jr., stated that he had useless, was amputated. Sensation was not examined the eyes of the first patient pre. entirely absent.
sented last November. There were some
suggestive symptoms of insular solerosis. INSULAR SCLEROSIS.
Her vision wus good. The left pupil was Dr. Campbell then presented a case of in- larger than the right. The reaction to light sular sclerosis. The patient was a woman of was sbarp. The visual fields were appar. 28 years. The trouble began two years ago. ently quite normal.. He was only able to The practical point to be deduced from the apply through finger tests at the time of
the examination at the hospital He said in A CASE OF ANEURISM OF THE THORthe differential diagnosis between hysteria ACIC AORTA WITH ULCER OF THE and multiple sclerosis, it is of great im ESOPHAGUS AND PERIGASTRITIS. * portance to get a careful estination of the color fields There did not appear to be any
WM. H. RUSH, M. D. true nystagmus, but towards the end of the Jateral excursions to the right and to the
ST. LOUIS. . left, there was a slight twitching It is char. The subject of this report, an American, acteristio of the nystagmus of multiple scler- a licensed night-watchman, 56 years old, preosis—this condition being more marked than sented himself at the medical clinic of the the physiological nystagmus. There was no Washington University Hospital on Septemocular paralysis. Mobility was free in all ber 6th, 1905, when I made the following directions. The patient never "saw double." notes: The ophthalmoscope revealed pallor of the Tbe patient's mother died of typhoid fever; discs. The atrophy of multiple sclerosis is a cause of father's death unknown. No dispost-neuritic atrophy. The speaker said that ease of hereditary significance in the family. he was loath to asoribe the temporal pallor in Chews tobacco; has not drunk alcoholice to this case of sclerosis because of the absence excess. of otber signs of persistent sclerosis. Dr. The patient has had measles, pertussis, Green called attention to the fact that ooular malaria, pneumonia twelve years ago (proba. examination is often of the greatest assistance bly on the right side), influenza, gonorrhea in estimating easily the differential diagnosis and a chancroid. No chancre so far as between multiple sclerosis and hysteria. Last known, and no secondary manifestations of year Dr. Schwab and the speaker reported syphilis remembered. Had suppurating such a case. There was slight ocular atropby. glands in the neck pine years ago, excised The fields were contracted in the usual way, by Dr. Dixon. not inverted. There was no evidence of tube. The present trouble began five days ago, sbaped fields. It is said that certain of these with pain in the left side in the region of the cases present eye symptoms years before the peotoralis muscles. The pain is constant, other symptoms of multiple sclerosis appear is increased by a deep inspiration, by a cough and therefore it behooves the neurologist in or a sneeze, or by sudden elevation of the left any doubtful case to have tbe eyes examined. arm. There is no pain in any other part of
Dr. Elbrecht in discussing the case of the body. There is dyspnea on exertion. The spina bifida presented by Dr.Given Campbell patient bas had no cbill, and, so far as be said that most of these cases die within the knows, no fever. Had a severe “cold" two first week of life. Operation for their cure weeks ago, with cough. The appetite is fair, are not successful. In view of tbe high no increase of pain after eating; bowels conmortality of the operation, the dootor did stipated. The patient has continued at not approve of operation. Dennis has re- work. ported 57 cases, 25 operated, 15 deaths, 7 re- Physical Examination.—Tall, slenderly coveries, 3 recoveries with nc improvement, built, somewhat stooped, rather poorly nourThe doctor said that these cases often occur ished man. Teeth badly decayed, mouth in bunches, be having seen four at the Fe. foul with tobanco. Scar below the left ear male Hospital in six weeks. The contrain and one at the angle of the jaw on the same dications for operation are involvement of the side. Respiration sounds and percussion bladder, hydrocephalus, olub-foot and mar note normal over the entire lung surface. asmus. Deaths after operation occur from Pulse intermittent, apex beat felt in the fifth meningitis through infection. Another interspace one-half inch to the left of the method used in the treatment of these cases mammary line. Cardiao dullness from the is the injection of Norton's fluid, such as left border of the sternup to the line of the was formerly used in the treatment of bernia. apex impulse. An occasional soft, blowing This method has a mortality of 40%. It is murmur, systolic, loudest at the apex, transnot, therefore, proper to advise operation in mitted to the left. Liver dullness at the cases of spina bifida.
sixth rib. A walnut-sized gland in the left axilla, painful on pressure, not fluctuating,
which the patient says appeared after infecDR. B. O. KERN, former city physician at tion of a wound in the left hand twelve months the City Hospital, St. Louis, has been ap- ago. No general glandular enlargement. pointed chief physician at the poorhouse to Tenderness and extreme muscular rigidity succeed Dr. John M. MoKeage who has in the epigastrium. Tenderness in the pecbeen appointed assistant chief physician at toralis major and over the intercostal musthe same institution.
Meeting May 17, 1906.
cles in the affected region. Temperature 98 acid 1.8%. No blood (guaiao-turpentine test), deg., pulse 72, respiration 24. The patient nothing abnormal-microscopically. is advised to enter the buspital, but refuses. The patient was now turned over to tbe
September 9.–The pain in the thorax and medical department and came again under pectoralis is diminished. The patient now my care. complains of pain in the epigastrium, in the The skin was asben, not cachectic. Lungs left hypochondrium and in the left anterior normal to percussion and ausoultation. Apex lumbar region. The tenderness in the epi. beat in the fifth interspace one inch inside gastrium is increased, and now extends to the the mammary line. No heart murmur, car. left bypochondrium. There is also a tender diao dullness from the left border of the sterspot below the angle cf the left scapula. The num to within one inch of the mammary line. muscular rigidity renders satisfactory ab. Liver dullness at the sixth rib. Two par. dominal palpation impossible. Temperature tially healed wounds of recent incision of 99 deg. He is again urged to enter the hos- glands in the left axilla, still discharging. pital, or to remain in the hospital a day for Dorsal spine rigid, not irregular. Extreme examination in naroosis, but refuses both. tenderness in the entire epigastrium and in The patient was not seen again at the
the left hypochondrium, point of greatest clinic until March 20, 1906, when he was
tenderness to the left of the median line placed in the surgical ward by Dr. Dixon.
about two inches below the ensiform carti. He had failed greatly, and was now evidently
lage. Marked tenderness to the left of the desperately sick. His gait was unsteady, his
spinal column from the third to the ninth face baggard, his voice weak, his respirations
dorsal vertebra, slight tenderness also to the sballow and panting. He had lost sixteen
right on the same level. Pressure on the left pounds in weight in the last three months.
lower anterior and lateral thoracic wall painHe suffered with a constant, heavy, aching
ful. Attempt at anteflexion of the dorsal pain that extended from the epigastrium and
spine causes pain from the left - soapula sternum through to the back, under the left
through to the epigastrium. Purplish scapula. This pain had been present about
blotches or scars on the legs, white papery one mouth and had grown worse daily. In
scars on the left knee. addition to this there was a severe cutting
Pupillary and patellar reflexes normal, pain in the stomach soon after eating solid con after eating solid pupils equal.
pu food, which was first noticed three months
Urine. -Specific gravity 1020, trace of alpreviously. The pain under the scapula and
bumin, a few hyaline casts, no pus, no sugar.
Blood.—Hemoglobin 85%,red cells 4,850,bebind the sternum increased with the stom. ach pain. The pains bad destroyed tbe pa.
000, leucocytes 14,400.
Stool.- Free from tient's rest at night, and had frequently been
tine test) and mucous. so serere as to require morphine.
Temperature 100 deg., pulse 80, respiraThe appetite bad remained good, but the
tion 24. patient had refrained from eating solid food The features of the case that impressed on account of the pain that followed. There themselves most prominently upon the mind was no pausea, and no belching except of gas, of the observer were the pains as described, which brought relief. Tbere had been no increased by taking food, the tenderness over vomiting, except once, when the patient had the entire area of the stomach, but greatest taken some medicine said by his physician over a definite point below the ensiform car. to have been intended to cause vomiting. tilage, the tenderness inside of the left soapThe vomitus contained nothing apparently ula, and lastly, fever. This, with the excepto suggest blood. The bowels bad been con- tion of hemorrhage, is as complete a picture stipated, stools never observed to be black. of gastrio ulcer with perigastritis as one The patient complained of an inability to could wish to see. To the perigastritis, I take a deep breath, and deep inspiration attributed the fever, the diffuse tenderness caused pain in the lower left thoracic and in the upper abdomen, the pain on pressure splenic region. There was no cough nor over the lower thoracio wall and the pain on hoarseness. The patient bad always bad a bending the spine. The dyspnea I supposed "strong back” until about one month pre- was due to interference with the excursion of viously.
the diaphragm by the perigastritis. Stomach examination, at the request of Tenderness posteriorly is found in one-third Dr. Dixon.-Stomach fasting empty. Test of ulcer cases. * Usually the tender point is meal of toast bread 35 grams, water 400 cubio small and located to the left of the 10th to the centimeters, removed in one hour. Amount 12th dorsal vertebra, rarely to the right. Occaobtained, 75 cubic centimeters, well digested, sionally, however, there is a more extended no mucous, free hydrocbloric acid 1.6%, total
* Boas, Magenkrankheiten. Pel. Handb. d. prakt. Med.
tender zone bigher up in the region of the 4th rather recent, loose adbesions, and the suor 5tb dorsal. Tuberoulosis of the spine was perficial vessels of the stomach in the corresthought of as a possible cause of the fever, the ponding region were injected. spinal rigidity and much of the pain of which The heart was displaced to the rigbt, the this patient complained; but that could not apex lying in the median line. The left explain the tenderness in the epigastrium or pleural cavity was filled with blood, parthe pain after food.
tially olotted. The lungs were both adber. Ulcus ventrioulae then with perigastritis ent at the apices, and the lower lobe of the was the diagnosis to which I was driven. left, also along the posterior border. This And though he was seen by several other lobe contained considerable blood, and the physicians after he came into the medical tissue was soft and friable, especially in the ward, none of whom, however, examined him portion opposite the sixth dorsal vertebra. more than casually, no one considered seri. The entire arch of the aorta and the thoracic ously any other explanation of the patient's aorta were atheromatous, and projecting condition. He was accordingly put at once from the outer curve of the arch and from upon a strict ulous regime. He was given the outer side of the upper part of the thorabsolute rest in bed, moist hot paoks were acic aorta was a group of several small sacplaced on the epigastrium, and hot bottles on oulate aneurisms, the smallest no larger the side and under the shoulder for the re- than a pea. The largest, very thin walled, lief of pain. At the suggestion of Dr. Fisch. about two inches long and irregularly cylinel, the attempt was made to carry out a drical in shape, had ruptured into the left few days of rectal nourishment. But agaiust pleural cavity and into the left lung. The this the patient rebelled absolutely, and be bodies of the fifth and sixth dorsal vertebrae received then by mouth every two hours were eroded irregularly to a depth of one censix ounces of milk, lukewarm. After two timeter. days, strained oatmeal gruel, or an egg Tbe esophagus showed nothing abnormal beaten in inilk, was substituted for the milk externally, and the stomach nothing further at part of the feedings, and the portions than mentioned abore. On opening the stomwero increased from six to eight ounces. ach, the contents were found to consist of In view of possible syphilis, potassium iodide dark groumous material, obiefly blood. There and mercury were administreed after a few was no ulcer. In the esophagus, on a level days trial, and the iodide was rapidly in with the upper and one of the smaller aneur. oreased to sixty grains three times daily. isms was an irregular sballow ulcer about He received no other medication.
two centimeters in diameter, partly covered For about two weeks the patient made a by a recent clot. The ulcer accounted for the remarkable improvement. The nourishment blood in the stomach. was cautiously increased in quantity, more I must reproach myself for not having even semi-solid food was given and was followed thought of aneurism in connection with this by no pain. The pains in the shoulder and case, I regret also that I did not have an side were so diminished that they were en. X-ray examination made. This might have tirely controlled by the hot bags. The pa rendered evident the erosion of the vertetient slept fairly well, and complained chiefly brae, and possibly revealed the aneurism itof tbe oonfinement and of bunger. Again on self. I thought of the X-ray in connection April 7th, he complained of severe pain un. with a possible disease of the spine, but the der the left shoulder-blade, without other conditions, all saving hemorrhage, pointed unusual symptoms. Trusting that this so clearly to ulous, that this possible means would soon subside as before, I made no of enlightenment dropped from my mind. further examination. The next morning, The aneurism was, of course, the cause of after taking his food as usual, he was sud. the pain and tenderness in the back, the pain denly seized with hemorrhage, and in thirty in the thorax, and doubtless of some of the minutes was dead. The blood was bright pain in the upper abdomen, possibly also of colored, frothy, free from food particles, the dypsnea. The tenderness anteriorly and about one-fourth litre in amount, manifestly the pain after solid food, I think must have from the lungs.
been due to the perigastritis. The perigas. Of the post-mortem findings I will tritis may have been caused by an inflammamention only those that have a direct tory process originated by the aneurisin bearing upon the case. The portion of through pressure, and which penetrated the the obest over the lower lobe of the left diapbragm; or it may have been simply a lung was dull on peroussion. The stomach local peritonitis of some other origin. Periwas greatly distended and filled with fluid. tonitis localized in this region is not rare, The fundus was connected with the spleen, and is sometimes very troublesome, and and with the diaphragm posteriorly by causes many symptoms noted in this case.