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partment Staff.

ing after the latter has been absorbed into

REPORTS, ON PROGRESS the system, as is shown by the intravenous

Comprising the Regular Contributions of the Fortnightly Deexperiments on dogs. 4. Alcohol and phenol placed in the stomach give no different results from phenol alone. 5. Lavage with alcohol is effective when the phenol is in the

INTERNAL MEDICINE. stomach, but its superiority over lavage with water is not pronounced.” From the clinical

0. E. LADEMANN, M, D. aspect alcohol seems to have a local antagon

Clubbed-Fingers of the Left Hand in Aneurism to carbolic acid, and they would not say

ism of the Arch of the Aorta.- Groedel's that it is of absolutely no value in poisoning by this drug. Its solvent action may never

(Meunchner Med. Wochenschrift, No. 6, theless be, under certain conditions, a danger 1906) descriptive report is interesting, and rather than an advantage, as shown by the

tends to elucidate the origin of dumbell-fin. more marked symptoms of intoxication seen

gers. The case in question was a man, 47 when the poison has been taken in whiskey,

years old, presenting the following pbysical and this seems to contraindicate the alcohoi diagnostic features: Dilation of both right

and left heart with evidence of cardiac inbeing used as an antidote and left in the stomach. The procedure recommended is as

competency; a dilatory pulsating tumor situ. follows: Immediate abundant lavage, with 10

ated in the upper left half of the thorax; a per cent alcohol, this to be followed by lavage in the first and second left intercostal spaces;

diastolic murmur with its maximum intensity with plain water, and stimulation as indicated. To be effective alcohol must be used while

a decided diminution in the pulse volume in the acid is in the stomach; it is of no use

the arteries of the left arm, including the after it has been absorbed. The danger of

subclavian artery, whereas the volume in the pneumonia from inbalation of the regurgi- carotids showed no perceptible difference. tated stomach contents during lavage in an

The arterial tension in the right arm was 85 unconscious subject is pointed out, and the

mm. of mercury (Gartner's tonometer) and authors advise during lavage turning the pa- registered 12 right (Frey) and 25 left.

40 mm, in the left, while the venous pressure

This tient on the side or face, with the head low

arterial and venous incongruity of the left so that anything entering the pharnyx will flow out through the mouth. Since using arm, according to Groedel, is best reasoned this plan they have bad but few pulmonary by an aneurism of the arch of the aorta effectcomplications in their patients.

ing a constriction at the orifice of the subclavian artery, while the carotid opening remains intact, and the aneurism secondarily pressing on the subclavian vein interferes

with the return circulation. The terminal DR. NICHOLAS SENN, of Chicago, will deliver an address at the International Medical phalangeal thickening of the left, hand not Congress, to be held in Lisbon, April 19 to

only consisted in an increase of the soft struc. 26. His subject will be "The International

tures, but as the radiogram showed, in the

bones also. The frequent occurrence of Investigation of Carcinoma."

clubbed-fingers, particularly in respiratory THE ST. LOUIS MEDICAL SOCIETY has and cardiac disease, has led to considerable elected the following delegates to the State controversy regarding their origin. The auMedical Association: Drs. P. Y. Tupper, thor's case uniquely illustrates the role of J. C. Morfit, W. W. Graves, W. H. Stauffer, two factors, namely, mechanical and toxio. Jesse Myer, Malvern Clopton, C. A. Snod. The increased venous pressure resulting grass, F. L. Henderson, H. W. Soper and from the obstruction affords a stagnation John Green, Jr.

of the toxio products of metabolism. In

this instance Groedel also considers the NEW ORLEANS AGAIN IN THE LIME Light.

diminished arterial blood supply an element Press reports have it that there are a num.

of importance in lowering the resistance of ber of cases of yellow fever in New Orleans,

the tissues favoring the action of the 20and there is a consequent feeling of a com

cumulated toxic substances. prehension throughout the country. It would seem that even such a suspicion A Comparative Study of Human and Animal should be stamped out, but in case of the Tuberculosis.-Korsel (Zeitschrift für Tuberestablishment of the suspicion as a fact so kulose, Bd. VIII, Heft 1 and 2, 1906) form. aggressive a campaign should be inaugur- ulates the following deductions from bis ated against this disease as will insure work on the subject: 1. From a bacterio. safety in the South during the coming logic study of tuberculous lesions in man, summer and for all the future.

cattle and hogs there are two varieties of tu.


may also

bercle bacilli designated as human and bo- symptoms-complex, and what part has vine type.

2. The spread of tuberculosis sulted from the arterial disease itself. 2. A among cattle results exolusively from infec. middle period, during which the arterial distion with the bovine type. 3. Hogs are ease is easy to recognize, but in which sec. highly susceptible to the bovine variety, in ondary organism changes have a role of vari. less measure to the human type. 4. Hu. ablé importance. 3. A final stage of failure man tuberculosis is primarily a disease of of circulation, organic failure, and terminal the human variely, the infection being di- infections. The diagnosis of arteriosclerosis rectly conveyed from man

man to man. 5. is usually established during the second per. Tuberculous lesians in human subjects iod, and then rarely offers serious difficulty.

originate from an infection Only when undue attention is given to some of the bovine type. 6. The transmission of local disturbance, such as albuminuria, palthe bovine variety to man is by food taken pitation or vertigo, or when the vascular disinto the alimentary tract, particularly of ease is so uniformly distributed that it mani. animals with tuberculosis of their udders. fests itself only in a general failure of vital. 7. The role played in the dissemination of ity, is the recognition of the disease likely the disease through the bovine type is subor- to occasion confusion. In the final stages, dinate and of comparatively little danger to too, though the form of local disease and the that of the consumptive individual. •

immediate occasion of the patient's failing Significance of Small Quantities of Sugar sized in the physician's mind, the contribu

healtb or taking off may be too much emphaand of Albumin in the Urine. --Burnet (Brit. tory influence of the hardened blood vessels ish Medical Jour., Jan. 20, 1906) holds that rarely escapes attention.

Among the varie. the presence of albumin in the urine in any

ties of early arteriosclerosis, the author has appreciable quantity cannot be regarded as either normal or physiologic, although it nutritional

, neurasthenic and nervous. observed several more or less distinct types,

The does not necessarily imply any gross path. nutritional type are those group of cases ologio alteration, nor does it signify that

presenting obscure disturbance of general the disturbance in function if of a permanent or progressive character. On the other and anemia or pseudo-anemia. There may be

health with a tendency to digestive disorders band, however, it is an indisputable fact that a certain number of patients originally developing cases emaciation may proceed

a slight loss of weight at first, but in rapidly belonging to this category later on do show

rather steadily. The pseudo-anemia, as a evidence of definite organic renal disease.

rule, is a cundition of the more advanced It may likewise be said the presence of

stages, but sometimes makes its appearance sugar in any appreciable amount is an ab. normal constituent; in the young, partiou traction of the vascular channels with result

rather early, and is largely the result of oonlarly, it is to be regarded with apprehension, ing pallor than deterioriation of the blood. and if persistent, is likely to terminate in

The neurasthenio type are those cases prediabetes, while its occurrence in individuals senting various evidences of neurasthenia past middle life, especially those of a gouty with or without definite nutritional disorders. tendency, it is of less import and as a rule, It is difficult to distinguish between the neuis more or less readily amenable to treatment,

rasthenic symptoms that may attend developbut in some cases it is likely to reappearing arteriosclerosis and such secondary arteunder conditions similar to those wbichoc

riosclerosis as may engraft itself upon a precasioned its first appearance. The presence existing neurasthenia from other, except that of both albumin and sugar in the urine is in. dicative of a serious disturbance in the pro

circulatory symptoms are perhaps more com

mon. cess of metabolism. Burnet thinks that by

The nervous type include those varie.

ties of arteriosclerosis in which certain ner. relieving the nervous strain which the patient may have been undergoing and improving as

vous symptoms are conspicuous. When the

hardening of vessels is considerably advanced far as possible bis state of environment be

various central nervous symptoms, as tempor. may continue in at least fair average health

ary paresis, spasmodio or convulsive disorders for many years.

or disturbances of consciousness may be met Arteriosclerosis as a Disease.- Stengel with. In the earlier stages minor symptoms (American Medicine, Feb. 10, 1906) says in as vertigo, tinnitus and syncopal attacks may the consideration of arteriosclerosis as a gen- manifest themselves. Peripheral symptoms eral disease three stages may be recognized: of the type of claudication are met with in a 1. A preliminary one, difficult of recognition variety of forms. Migraine and neuralgio in its beginnings and confusing to the clini. troubles also figure among the forms of nercian in his efforts to distinguish what pert of vous symptoms in the early stage. In the the etiologic factors have contributed to the more advanced stages arteriosclerosis is easily recognized by the discovery of palpable the cases remained normal for some hours. thickening of the blood vessels, by the in. The ofiaracteristic facial expression (facies

creased vascular tension, by the auscultatory hippocratica) was usually a late manifestaphenomena at the heart, and by the general tion. Percussion, palpation and the count

, appearance of the patient. The disease pre- ing of leucocytes furnished unreliable data. sents itself in a variety of types, according to Rectal examinations are of some value, the the special involvement of one or another of pressure exerted by the examining finger the important viscera, or by special vascular sometimes caused pain at the site of the conditions, and are classified by the writer perforation. The author believes one is al. under the following beadings: 1. The thor- ways justified in resorting to a laparotomy acio type, of wbich may be distinguished (a) whenever pain, tenderness and muscular cardiac, as moderate disturbances of the rigidity coexist, as in doubtful cases it is heart's action with a tendenoy to arrhythmia better to operate once too often than not or special involvement of the coronary arter- enough. ies (angina pectoris); (b) aortic, not merely

Notes on the Cerebrospinal Fluid.-Pasbareferring to aneurism of the arch of the aorta, but also to sclerotio and calcareous roughen; tologic analysis of the cerebrospinal Huid in

gan (Med. Rec., Feb. 10, 1906) made a cys. ing without any dilation of the aorta, but

patients suffering from paresis and other causing embarassment of the heart's action.

mental affections with the view of determin. 2. Abdominal type, of wbich there are (a)

ing the constancy of the lymphocytes. renal, evidencing itself, as the clinical picture of interstitial nephritis; (b) intestinal,

Among 37 cases of general paresis there was

a'marked increase of the lymphocytes noted less commonly recognized, and manifesting

in 16 cases, a moderate increase in 5 cases, itself by atrophy of mucous membrane and a

doubtful in 3 cases, and negative in 3 cases. tendency to chronio colitis, ulcerations in

In 7 chronic alcoholics, 6 old leutics, 25 epi. sudden painful obstructions (paresis of the leptios, 13 bebephrenics, 8 katatonics, 7 man. walls) of the bowel; (c) pancreatic, difficult iac-depressive cases and 7 paranoiacs the

lymphocytes were diminished. of recognition, however, often active in dia. betes; (d) hepatio, occurring as cirrhosis. 3. Grave's Disease and Its Treatment.-MurCerebrospinal type, most numerous and vari. ray's (British Med. Jour., Nov. 11, 1905) ed and probably a number of definite nervous paper en braces an elaborate discussion of the diseases of cerebral causation have as their symptomatology and therapy of exophthalmio underlying basis arteriosclerosis of the cere. goitre. Concerning the treatment, rest in bed bral vessels. 4. Arterio-capillary type, man- and fresh air in conjunction with a "mast ifested in moderate circulatory disturbances. kur” is absolutely essential in the severe

forms, especially the acute cases, while rest, Perforation in Typhoid.-Meakins (Mon. fresh air and nutritious diet are also importtreal Med. Jour., Oct., 1905) bases bis article ant factors in the later stages of the disease. on a study of 32 cases of perforation occur. Murray strongly recommends mild faradizaring among 1230 cases of typhoid treated at tion applied twice daily for a period of one the Royal Victoria Hospital, Montreal. hour each time. Tłe electrodes, to be made Twenty of this number were operated, 5 re- of a pliable material, are to be respectively covering In the remaining 12 operation placed on the goitre and back of the neck. was deferred because the patient was either In some cases radiotherapy acted beneficially. in a moribund state, or a conclusive diagnosis Among drugs, the author regards arsenic as of perforation had not been made. Of the one of the few remedies which has proven symptoms, sudden and severe pain in the ab. efficient. For the tachycardia, arsenic in domen was most constant, being present in combination with convallaria is of greater 84 per cent of the cases. In one case this benefit than either digitalis or strophanthus. symptom_alone prompted surgical interfer- Potassium bromide may be given to alleviate enoe. Disappearance of hepatic dullness the nervous symptoms. Thyroid extract and in the absence of meteorism proved a valu. the iodides are positively harmful. Sodium able diagnostic feature. The pain in most phosphate, recommended by many, has proven cases was diffuse. Abdoidinal rigidity was to be of no value in the author's hands. present in 24 cases, but as a rule, did not The different sera (Möbius and others) bave evidence itself until late. The temperature been applied in several cases, but without and pulse afforded but little diagnostic clue, any apparent beneficial results. Rodagon on the former not falling below normal until the other hand (desiccated thyroidectomized some time after the onset, and the latter not goat's milk) gave promising results.

Cauexceeding 100 beats per minute till several tion, however, is necessary in the administrahours had elapsed. Respiration in most of

Respiration in most of tion of rodagon, as large doses may so reduce

thu pulse as to cause cardiac cessation. A Hospital. About the fourth week of the dis serum obtained from rabbits and goats, which ease a polyuria sets in. The twenty-four had been given large amounts of thyroid ex. hour amount of urine increases from 30 oz. tract, was tried in two cases of exophthalmic to as high as 100 oz. This polyuria is to be goitre without any result. Operative meas- regarded as indicative of a favorable termin. ures are dangerous, and if resorted to should ation, and when once akes its appearance be only under local anesthesia, as the danger the danger of perforation or hemorrhage is apparently seems to lie in the narcosis. insignificant and a relapse is quite a rare

event. Trichinosis and Eosinophilia in General. Stäuble's (Deutsche Archiv für klinische

Heart-Massage in Chloroform Syncope.Medizin, Bd. 35, Heft 3 and 4, 1906) illus. Smith and Dazbich (British Med. Jour., trated contribution emphasizes the value of Nov. 18, 1905) report an interesting case of making hematologio examinations in trichi. a man who had been put under a chloroform nosis. In the 7 cases observed by him the anesthesia for the purpose of making a rectal eosinophiles were markedly increased, and in examination with the view of determining 4 of these, which were of a severe type, there any malignant growth. While under the in. was also a considerable general hyperleuco. Auence of the anesthetic the heart and res. cytosis. The increase of eosinophiles was

piration suddenly ceased. The ordinary res. not at the expense of the neutrophiles, as the toratives, as artificial respiration and the sub. latter were increased during the entire course cutaneous injection of strychnine, had no of the disease. The lymphocytes, although effect when an abdominal incision was made in the beginning somewhat diminished, like. and the heart gently massaged through the wise showed an actual increase. In the severe

relaxed diaphragm. About sixty seconds forms of trichinosis, especially those termin. later the heart began to beat again and the ating fatally, the eosinophiles may again patient made an uneventful recovery. disappear, or an eosinophilia may be entirely

The Effect of Posture on Cardiac and Vasculacking. Eosinopbilia does not evince itself

lar Murmurs.-Rudolf (American Medicine, until about the eighth or tenth day after the

March 3, 1906) emphasizes the influence of ingestion of the trichiniferous meat. The

different postures on the various bruits incentive of the eosinophilia is not the ab

which occur in the circulation, a matter of sorption of some toxic substance contained

which some writers make only a scanty alin the trichina capsule which might be lib.

lusion, while others do not mention it at erated in the gastrointestinal tract, but seems

all. The murmurs most markedly influenced dependent on the liberation of the embryos

by change in posture are the functional or their invasion of muscles. The dissemin.

ones, but organio bruits by no means al. ation of the embryo is by means of the blood

ways escape. In studying the effect of po. channel, as is evidenced by the fact that

sition on murmurs one must avoid possible their presence is demonstrable in the circula

sources of error. The effects of muscular tory blood of the heart. A local accumula

action made by the patient in assuming a tion of eosinophiles at the point of muscle substance disintegration could not be dis- ing him to remain in the new posture for u

different position can be obviated by allowceroable. The eosinophiles may, therefore, short time before auscultating: Under vasbe looked upon as a reactive manifestation

cular murmurs are the arterial bruits and the of substances emanating from the embryonal trichina (probably also from the degenerated

venous hum, the former, often heard in ane.

mia, neurasthenia, eto., are most pronounced muscle-substance) and passing into the cir.

in the recumbent position, while the latter oulation. Stäuble's animal experimentation

is best heard in the sitting or standing pos. also corroborates the clinical observation

ture. The murmur is loudest generally at that a rapid lymphocytic reduction (lympho

tbe roct of the neck on the right side and is zytensturz) in infectious diseases is signifi. exaggerated by the patient turning bis head cant of a bad prognostio omen. A rare con

to the left. Cardiac murmurs, whether func. comitant symptom occurring in the four ex

tional or organic, are those produced within treme cases and which may prove to be of

the heart itself, and the general statement may diagnostio value, was a positive Kernig

be made that all ventriculo-systolic bruits, if phenomena with a total absence of the patellar. The urine of all cases gave a strong po.

affected at all by posture (and most of them sitive Ehrlich reaction.

are), are loudest and most extensively audible

when the patient is in the recumbent pos. Prognosis in Typhoid fever.-Simon (Brit. ture. On the other hand, all murmurs ocish Med. Jour., Nov. 1, 1905) bases his re- curring during the ventricular diastole (if marks on a clinical study of a large number affected at all by position) are loudest in the of cases treated at the Birmingham General upright posture. Rudolf discusses the theor. ies advanced by many writers regarding the the intestines, which is probably the result of influence of position in intensifying and de. metabolio disturbances. In the intestines creasing the audibility of murmurs, but the larva receive their nourishment from the throws no additional light on the subject, mucous membrane, which they devour. Hemstating that the theory of exactly why pos. orrbages resulting from vascular erosion are ture alters many circulatory murmure is of coincidental and secondary occurrences. The little practical importance, wbile the remem. former view of a per os infection of the an. brance of the fact that it does do so is of the kylostoma larva is unquestionably subordin. greatest clinical value. He urges the neces- ate to a cutaneous invasion. Introduction sity of auscultating in both the erect and hori. into the alimentary tract by means of drinkzontal positions whenever an examination of ing water, is necessarily a seldom occurrence the beart is made, and in giving a description as the larva rapidly sink to the bottom, and of a heart murmur it should always be stated the idea of contaminated bands conveying in what position the patient wus when the the larva to the mouth is certainly very infremurmur was of the nature desoribed.

quent, as the larva rapidly die under dry con.

ditions. On the other hand, cutaneous invaHeart Massage in Death following Asphyxi

sion rapidly occurs in bare foot individuals ation, Poisoning and Chloroform Syncope.

working in ditches etc., containing water pol. Müller (Wiener klinische Rundachau, Nos.

luted with ankylostoma larva. The larva, 50-52, 1905) anesthetized dogs until death

owing to their active motility, constantly ensued and fifteen to twenty minutes later

strive to leave their original place of habitaexposed the heart and gently massaged the

tion (feces, etc.) and wander elsewhere, proorgan, at the same time injecting salt solution

viding the surrounding atmospheric condi. and small quantities of oxygen in the veins,

tions (sufficient moisture) are favorable. The whereupon the animal gradually returned to

higher the temperature, until a certain limit life. The author hopes this method of resus

is reached, the more active is the motion of citation may eventually be successfully ap

the larva, and in this stage of activity they plied to man, especially in those cases with a

are capable of climbing walls and embankpreviously healthy heart.

ments, providing there is sufficient moisture. Remarks on the Infection of Ankylostoma. Six per cent of the laborers working in a ditch Duodenale Through the Skin.- Loss' (Zeit.

where the temperature registered 25 deg. C. sohrft f. klinische Medizin, Bd. 58, Hft 1 and 2,

were infected. Cultural maturation of the 1906) article embraces an exhaustive resumé ankylostoma larva occurs in a temperature of his preceding research work, and is con. as low as 15 deg. to 18 deg. C.

The essenfirmatory of the work he has done in the past tial prophylactic mseasure is to prevent any on the subject of ankylostomiasis. Matured

contamination of the ditch or ground with ankylostoma larva, suspended in a drop of fecal matter, all other measures, as cleansing water, when placed on the buman skin soon the hands before eating, bathing, eto., are of causes a reaction which is evidenced by red. secondary consequence. Disinfection of ness and a sense of burning, disappearing infected ditches with chemical disinfectants from three to vight days without leaving the is not a suitable measure, better results are slightest trace of disturbance bebind. The mi. obtained by disinfecting with steam or flushcroscopio examination shows that the active ing with water at a temperature of 70 deg. to larva enter the skin chiefly through the hair 80 deg. C. Finally, systematio inspection follicles lodging themselves in the subcutane. of the workmen is good practice. ous connective tissue, from whence they wan.

The Detection of Diacetic Acid in the Urine der into the intestinal tract. The manner in

by Means of lodine.-Bondi and Schwarz which intestinal invasion takes place can be readily determined in the young dog, being 1906) propose the following test for diacetio

(Wiener klinische Wochenschrift, No. 2, more susceptible to cutaneous infection than

acid'in the urine in preference to most of older dogs. The larva in animals thus in

the ordinary reactions, which they claim are fected are demonstrable in the veins of the

not absolutely characteristio: Lugol's soluskin, the veins approaching the axillary and

tion is added to 500 cc. of urine, in drop inguinal regions, the vena azygos, in the

measure, until it changes to an orange color, right antrium, in the pulmonary alveoli, the

which it retains on slight heating. On boiling smaller and larger bronchi, the trachea and

the characteristio pungent odor of iodoacelarynx, and finally in the esophagus. The

tone manifests itself. It is to be remarked larva are also capable of entering the lym

that a positive reaction only occurs with a phatic glands through the lymph channels,

neutral or slightly acid urine. where a part of them are destroyed and the remainder rendered less active. The larva excite diarrhea long before their entrance in SUBSCRIBE for The Medical Fortnightly.

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