« ForrigeFortsett »
sunced by a com. THE MEDICAL FORINIGHTLY
KING EDWARD Africa is asked the submit
ren with eruptions should be excluded until the eruption has been pronounced by a com. petent person noncontagious in obaracter. New York Medical Record.
Issued Tenth and Twenty-Fifth of Every Month.
THOMAS A. HOPKINS,
Managing Editor. The king of the Belgians, as sovereign of the Congo Free State, is offering a prize of
Editorial Staff: 200,000 francs, open to all nationalities, for
0. E. LADEMANN, Internal Medicine.
JOHN MCHALE DEAN, Surgery. the discovery of a method of successfully F. P. NORBURY, Nervous and Mental Diseases.
R. B. H. GRADWOHL, Pathology and Bacteriology. treating sleeping sickness.
W. H. VOGT, Obstetrics and Gynecology.
WALDEMAR FISCHER, Ophthalmology. KING EDWARD thinks the spread of sleep
A. LEVY. Pediatrics.
W. T. HIRSCHI, Therapeutics. ing siokness in Africa is one of interna
A. F. KOETTER, Otology.
HERMAN STOLTE, Laryngology and Rhinology. tional importance and has asked the Liver.
T. A. HOPKINS, Genito-Urinary Diseases. pool School of Tropical Medicine to submit
• ROBERT H. DAVIS, Dermatology.
Editorial Rooms, Suite 319-321 Century Building, St. Louis. a plan for the prevention of the disease. He promised his co-operation if it is in any way possible or practicable. At the meeting of the Association of
EDITORIAL Military Surgeons, held in Buffalo recently, it was announced that the Enno Sanders LOCAL conditions seem to have designed prize bad been awarded to Major Pilcher these as days of reform in many walks and for an essay on “The Training of the Med.
we, in the medical proical Officer of the State Forces to Best
fession, are not finding Qualify Him for Local Service and for
Honor for a
our lives free from need Mobilization with National Troops.”
of greater or lesser im. EPILEPSY.-Two remedies have recently
provements. It is a lit
tle surprising that among the many sugges. been introduced for the treatment of epi. lepsy. One of these is verbenin, which has
tions as to needed medical reforms there has been highly recommended by a number of
been suoh a speaking silence in the matter of clinicians; especially in cases of gastroin.
contract practice; in many sections this bas testinal irritation from worms or other
been heralded as the foremost foe of legiti. oauses. The other is solomine, the alkaloid
mate and honest medicine; societies have is. of the horse nettle. The plant has attracted
sued their pronouncement against it and a great deal of attention as remedy for the
have banded their individual membership in nervous irritability which render the epileptio
a pledge that it shall be effaced. Nothing of more liable than ordinary persons to suffer
the kind has happened in St. Louis; we have from these explosions. The Journal of Ad
struggled for the elimination of the “50.cent.
a-month hospital” and against examining vanced Therapeutics.
for life insurance for less than $5.00, and for DENATURIZED ALCOHOL will become a faot many lesser reforms, are we to conclude that in this country on January 1, 1907. The contract practice does not exist here? The rules and regulations have been published at suggestion seems something of a joke, for great length by the Department of Internal we all know that there is hardly a corporation Revenue. These provisions are being crit doing business in our city wbich has not its icized by those familiar with tbe denaturiz. physician, or its medical staff, and which is ing of alcohol in Europe. It is, however, not getting medical service at rates which best to wait for a few months of practical would surprise the average householder. We tests before expressing an opinion on the know of no legitimate reason why a physi. feasibility of the government regulations. cian should serve a corporation for less fee One point is, however, evident and that is per case than he will allow the wage earner the desire of the department to provide for who sweats for every cept be gets, and pays the use of denaturized alcohol in the vari. bis physician with a warning to his family ous arts and industries. The small distiller that they must exercise economies, because seems to have been left out of consideration so he has done so. Economies ! And that in that farmers will not become distillers but the face of such economy as few of us know profit by an increased demand for their alco. anything of. But the fattening corporation hol making products. Every precaution, as wbich deals in first dressings and plans for might be expected, will be taken to prevent protection from subsequent damage suits, can defrauding the government out of internal buy physicians body and soul for a paltry revenue.
$300 or $500 per year, and receive from bim
in return, not only scientific service for A RECENT issue of the Journal of the Ameriwhich regular rates would net the doctor can Medical Association contains a commun. many times as much, but suob protection
ication from Dr. W. W. in case of subsequent actions for legal re
Keen, calling attention dress as could not be bought in an honest
to some of the more market.
common and distressing Patients from such a practice net the doc
errors in medioal Engtor very little per capita, but they are great lish. The letter is one wbich merits wide as chair warmers, and to sbow that things republication, as every writer on medical subare doing in the doctor's line, bis is a busy jeots should be certain that his copy is office! To us such practice seems one of free from the errors, and he should also the worst prostitutions of medical honor have bis attention drawn to tbe fact that that has been devised. The medical man's bis readers are critical and ind it difficult first interest should be in the patient and to excuse bad English. Dr. Keen says: remedying his ailment, to consider the em “May I call attention to two very common ploying corporation and have thought of instances of faulty English which I am oonprotecting it financially in conneotion with stantly meeting in letters, in print, and in work on the case is much more reprehensible conversation? One is the assertion that 'the than is doing the work for a less fee than patient had no temperature.' I presume that would be charged the patient were be to pay the writer does not mean that the patient's the bill bimself. It is the patient every time temperature was zero, but that he had no rise who should have every consideration, con- of temperature beyond the normal. Certainly cession and protection which it may be in a temperature of 98.4 F. is universal in the our power to give, and he who sells these well. Any rise above that should never be to an outside party is unworthy of the called 'temperature,' but a ‘rise of temperamedical mantle.
ture,' or 'an increase of temperature.' If It comes to our ears that there is an. temperature falls below 98.4, to 97 or 96 other class of physicians in St. Louis F., how would those who speak of any rise which, while nct openly employed by cor. above 98.4 F. as 'temperature' designate such porations, is tacitly pledged to their protec- a fall—'less than no temperature ?' tion in return for favors received, we refer “The other instance is really an atrocious to those who ride on car tiokets, and who are misuse of the language. I constantly hear expected to interest themselves in case of it used orally. In a rcoent letter occurred emergency accidents in their neighborhood, the phrase, 'since my case, I have seen two and that to the advantage of the company. others operated;' and in a single number of This would seem almost beyond belief, but an admirable, well-known medical journal the report comes with such persistence that occurs the phrases the first case to be diag. there must be truth in it. How a man who nosed or operated in P--,' 'three further bolds a medical degree and poses as meriting cases have been observed and operated here,' the dignity which should be characteristic of and two other similar transgressions. every physician could allow himself to be “May I call attention also to a confusion party to such an arrangement is beyond oom- of two similar terms? "Tubercular' and 'tuprehension. Honor for a car-ticket!! To berculosis' are constantly used interchangeawhat are we coming ?
bly. At the last tuberculosis congress in It is not the newly graduated and strug. Washington I proposed to the executive gling pbysician who is in on these reprehen- committee that we should recognize defin. sible practices. The contract physician is itely in all our publications a distinotion in the amen corner, and his voice is beard in between the words as follows: Tuberoulous call for reforms. To bint at unrighteousness shall be used only of those lesions caused when speaking of his character is like ques. by the tubercle bacillus. Tubercular shall tioning the virtue of the gods, and is rarely bo used in describing those lesions which tolerated and never given serious considera- resemble tuberoles, but which are not caused tion.
by the tubercle bacillus, for instance, tuberThese days of reforms and medical reforms calar syphilid, etc. This suggestion was are quite as much needed in high places as adopted and the proposed usage approved.” elsewhere; it is time to make the profession of St. Louis, of New St. Louis, above re. proach, and lets make a clean job of it.
ONE reason why some people are still the happy possessors of an appendix is that they didn't have the price of the operation, and
were never picked up unconscious on the SUBSCRIBE for The Medical Fortuightly. streets. —The Trio.
The Hospitals of New St. Louis
• We present this issue excellent pictures of two of the Bethesda institutions, the Hospital and Home for Inourables
" tha leadership of Mrs. There Bethesda institution includes beside to
REPORTS ON PROGRESS quent function. As for the treatment if nonComprising the Regular Contributions of the Fortnightly De
operative measures are adopted the joint should be liberated after two weeks when
massage and passive movements should be SURGERY.
instituted. Operations should be performed
within the first ten days. Suture of the frag. JOHN MOHALE DEAN, M. D.
ments with absorbable material together with
suture of the para patellar wings of the quad
Tetanus. – Nathan rioops tendon are to be performed. Some Jacobson and Herbert Pease (Annals of Sur. surgeons are content with suture of the paragery, Vol. xliv) treat the subject of serum patellar wings alone, but one is doubly assured therapy of tetanus. Of especial interest is when the fragments are united at the same the conolusion drawn after a close study of time. The day of wire is passed for so often the reported cases in the literature. The does it cause trouble that necessitates its reauthors concluded as follows: "As a prophy. moval. When the fracture is stelate are badly lactic measure it merits our fullest confi- splintered the author removes the patella endence, but as a therapeutic agent after tetanus tirely. In this paper the well known dangers is fully established we are forced to admit from serious infection in operations about the that as yet no method has been discovered knee are emphasized. Dr. Weir in discuss. whereby it can be administered so as to reach ing the subject states that he would rather effeotively the toxin not free in the blood or bave his abdomen opened than bis knee-joint. lymph." Reports from clinios teem with the In all operations about the knee scrupulous wonderful results received from the serum aseptio precautions should be used. after the disease is established, but the reviewer's experience coincides with the above Surgery of the Biliary Tract.-J. B. Dea. authors. Mild cases recover as well without ver, Philadelphia (Jour. A. M. A.) is in the serum as with it, while severe cases in favor of removing gallstones whenever pres. variably die in spite of all established treat- ent, provided there are no contraindications, ment. The authors olaim that intracranial and also considers choleoystotomy the safest or spinal injections accomplish as little good treatment of any frank attack of route choleas subcutaneous and are far more dangerous. cystitis that does not subside under judicious Early Operation in Traumatic Intracranial
medical measures in thirty-six or forty- eigbt Hemorrhage.-Murray (Annals of Surgery,
hours. Operation is almost imperative if the Vol. xliv) makes a plea for early operations
attack is not the first and we believe from the in intracranial bemorrhage and reports some
bistory that gallstones are present. In mild interesting experience in his own practice.
recurrent cases, also, he considers operative He is not accustomed to wait for definite
interference indicated, and in the later stages focal sypmtoms, but relies on the compression
of gall-bladder disease operation is also invari.
ably demanded. In hydrops, cholecystecsymptoms, as shown by the choked diso and the high blood pressure, as shown by exam.
tomy is required, as the closing of the cystic ipation with the sphygmomanometer.
duct renders the gall bladder useless and there
The author reports several cases greatly benefited
is constant danger of reinfection or even of by this early operation.
rupture. Cholecystectomy is also indicated
The technio is simple, merely trephine and enlarge the opening
in gangrene and perforation, but not in empy. if necessary by the ronguer forceps. All
ema, except when of long standing and with
the walls very extensively diseased. When blood clots are to be removed, and if the dura fails to show the normal pulsation syn.
gallstones exist the condition is more serious,
and the patient is fortunate if they can be chronous with the heart's action it should be
removed before they wander from the gall incised and all hemorrhage checked and blood
bladder. The advantages of operation in the clots removed. The dura is closed with cat.
latent stages are pointed out. Deaver progut with or without drainage. Seldom do the adhesions formed between the flap and
tests against any indiscrimiate resort to
cholecystectomy in operating for impacted dura cause subsequent trouble.
stone in the common duct unless the gall Fracture of the Patella.--Ransonoff (Jour. bladder is very much diseased. He believes A.M.A., Vol. xlviii) discusses the subject of that its retention and drainage constitute a fractures of the patella. Some interesting very valuable part of the after-treatment. points are brought out by the author. In When the infection has traveled beyond the oases of fracture of the patella if extension is gall bladder and involved the hepatio duots, lost the capsule is torn as well as the parapa. or even if the cystio duct is very much infil. tellar wings. In such cases operation is in trated, he would drain the common duot as dicated if we expect to ever procure subse- well. This is not, in his opinion, a difficult
or dangerous procedure, but it requires to first red, then black, and eventually yellow. be done judiciously. There are times when No hemorrhage from or on the mucous memthe surgeon, against bis will, is oalled on to brane. Accompanying these phenomena operate for acute impaction of a stone in the marked cerebro-spinal symptoms, coma for common duot. The mortality in these cases fourteen days with paraparesis, especially on is appallingly bigh, but with progressing the right, reduction of sensibility of skin, infection it may be the only chance. The more on right. Patellar reflex gone un right, possibility of the pancreas being also involved reduced on left, no vomiting, no rigidity of is to be considered and this makes operation neck, no paralysis of eye muscles, no sympthe more imperative when it ocours. In con. toms of meningitis, no cases of cerebro-spinal olusion be mentions typhoid obolecystitis as a meningitis in the vicinity, the fever varied matter of importance and expresses surprise from 37.5 deg. to 39 deg., pulse 95 to 150; no that it has not been more considered. Pa bloody urine, no albumen. During the distients who during typhoid give evidence of ease ohild never uttered a sound, and could biilary involvement should, if possible, un- only be roused from stupor by sbaking, never dergo cholecystotomy on recovery if their through loud calling. After recovery child symptoms persist, thus not only avoiding fu. remained totally deaf and bad abnormal loco. ture serious disease, but also more effeotually motion. This gradually improved. The preventing their dissemination of typhoid in deafness remained unobanged and by degrees fection from their intestinal tracts. Tabu lead to deaf-mutism. Examination of the lated statistics of 216 cases are appended to ears revealed moderate retraction, no doubt the article.
due to fairly well developed adenoid vegetation. Author believes that deafness is due
to hemorrhage into labryinth, as often 00OTOLOGY
curs in other infectious processes, and we can
therefore class the purpura hemorrhagica as ALBERT F. KOETTER, M. D.
a cause for deaf-mutism. Relation Between Diseases of the Ear and The Disturbance of the Sense of Taste in Those of the Face.- (Baudebranche, Rev. Chronic Suppurative Inflammation, Especvalencia nor de aiencias medicas. - In the ially After Operative Interference.-Kauder, first part of his work author examines the Archiv fuer Ohrenheilkunde.)– The work funotional optio disturbances, that is those embraces besides a resumé of the literature without anatomical lesions. To explain these on the anatomy, physiology and pathology reflex phenomena on the part of the eye he of the chorda tympani and the tym panic demonstrates several clinical facts, among plexus, fifty vases of clinical observation rethese a case reported by Verdos of reflex dip- garding this subject. For the practitioner lopic due to impacted cerumen; pain in the the following conclusions are of importance. eye and tearing while extracting a polyp The chorda tym pani is often involved in from the tympanio cavity (Mons). Hypere- chronic middle ear suppuration. Total demia in oatheterization of the tubes; blepharo. struction of the chorda indicates extensive spasm, paresis of the orbicularis with logoph. process of destruction, but its absence does thalmus in inflammation of the middle ear not allow the contrary conclusion. The rad(Holt); strabismus and myosis in mastoiditis ical operation destroys the chorda forever. In (Tillaux); paresis of abducens in inflamma. the hammer-anvil extraction the chorda tym. tion of the middle ear (Gradenigo, Urban- pani is always torn. In a much smaller scale tschitsch); strabismus divergens (Spear); is the tympanio plexus altered by these promyosis of the iris by irritation of the otio cedures. ganglion (Moos, Cyon); nystagmus, rotary and horizontal, in suppurative inflammation
The Treatment of Suppurative Middle Ear of the middle ear; hemiopia, mouches vol.
Diseases by Bier's Method of Hyperemic Enantes, mydriasis, nystagmus in Meniere's dis.
gorgement.- (Fleischmann, Monatschrift fuer ease. The second part embraces the organio
Ohrenheilkunde.) – After Fleischmann dischanges of the eyes following diseases of
ousses the reports of Keppler, Heine and the ear: optic neuritis in otitic cerebral
Stenger on the above treatment and declares complications.
that the results by no means coincide. He
describes the experience bad at Politzer's A Rare Case of Deaf-Mutism Following clinic in Vienna by the use of hyperemio Purpura Hemorrhagica.-(Citelli, Arohives engorgement in suppurative middle ear disItal, di Otologia.)-A child of two suddenly ease. There were twenty-four patients with seized with fever, no pain in limbs, soon after twenty-five diseased ears that were treated hemorrhagic spots appeared on the skin, which by this method, viz., nine acute suppurative spread to the whole body excepting the face, middle ear inflammations without complica