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present as in several other renal affections. specimen had been taken from a patient who Periodical attacks of hemorrbage, with fre. had been under observation for some time, quency of micturition, often with passage of and a diagnosis of cerebral abscess had been clots, seem characteristio. These clots some. made. The specimen showed one side of the times blook the ureter, cause diminished brain, with the cerebellum and 1 oc. of hem. urine, and the pain is referred to the corona orrhagic bloud which had been removed at glandis. Between the attacks of bleeding time of operation. there is fairly constant pain in the back. A fresh hemorrhage relieves the pain, thus con- FOURTH OF JULY EYE INJURIES.-R. L. trasting with pain and bleeding connected Randolph, Baltimore (Jour. A. M. A., July with the passage of stone.

7), has collected over 500 cases of eye injury

occurring from fireworks during the last few PATHOLOGIC SPECIMENS.

years, some variety of fire crackers being Professor J. H. Larkin, of Columbia Uni. usually responsible for the injury. He gives

the result of work in stirring up public versity. presented some pathological speci. mens of great interest and gave the history of

sentiment showing a decided decrease of each, in so far as he was able to obtain it.

such injuries in Baltimore. He laid the

statistics before the leading newspapers and The first were of diseased appendages, a field of surgical research which is becoming more

before the police, and secured the publicaand more important. Until a few years ago

ticn of strenuous articles on the subject it was supposed that lesions of the pancreas,

and also the issuance of stringent orders to as found at post-mortem examinations, were

enforce the laws. He believes that much fairly well understood, but little was known

can be done in other cities by ophthalmolo. of the etiological significance; but now path. gists in the same way, and that in due ologists are able io show the causative factor. season we may be able to educate the pubIts close relationship to cholelithiasis and

lio and to accustom it to a quiet and senother diseases of the intestinal tract bas

sible celebrations of the holidays. been understood for some time. The clini. THE INTERNATIONAL POSTAL histories in these oases are very simi. A congress of the greatest importance to lar. There is usually a severe onset of gas- the world in general bas been conducting tric pain that at times is almost diagnostic its deliberations modestly and quietly in to the surgeon of appendicitis or intestinal the Italian capital. We refer to the Inter. obstruction and many patients have been national Postal Congress, whose concluoperated on for one or the other of these con- sions have been a useful and practical contri. ditions. In the majority of cases, stone in bution to internationalism. In the first place the ampulla duct has been a very common the international letter weight unit has been factor.

raised from half an ounce to an ounce, makThe specimen presented was mounted so ing the rate five cents (or the equivalent in as to preserve its normal color. On the right the money of other countries) for the first side was a portion of the duct and on the left ounce and three cents for each additional a portion of the pancreas. It is presumed ounce. There is also to be the equivalent that one or more stones had been passed in of an international stamp, in the form of an this case, because of the immense dilatation international postal order, for five cents, of the common duct. The lesion is easily which will be exchangeable for a stamp of explained, and experiments bave reproduced the same value in any country of the unionexactly the same condition. The stone passes this for "return" postage.

A number of down into the common duct and is impacted proposals were made to reduce the unit from at Bardes' ampulla, and this leaves a contin. five cents to four (the British “tup-pence''), uous passage from the common duct to the but these were defeated. Our own currency ampulla, and the bile, instead of going down, system prevents our taking much interest in is sidetracked and goes directly into the pan. this proposal, since a nickel is a much more creas, and this produces hemorrhagio pancre- convenient unit than four cents.

The new atitis. This can be reproduced by putting regulations will no doubt result in a great exbile into the pancreatic duct, or a solution of tension of the postal business throughout the hydrochloric acid will produce the same re- world, and will in all probability thereby in. sult.

crease the rerenues of the postoffices in all The next specimen presented also showed civilized countries. The international postal the connection of the pancreas with the duct, exchange order marks an interesting advance and also showed the gall-bladder with an in the peaceful business relations between immense amount of stone. Several interest- . nations. In all probability it will prove the ing brain specimens were presented, but no germ of international currency of the future. clinical histories would be obtained. One -American Monthly Review of Reviews.

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The MEDICAL FORINIGHTLY the following may be used

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CHRONIC RHINITIS.-In chronic rhinitis


Cocainae ..
A Cosmopolitan Biwookly for the General Practitioner

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Indication.-Used in atrophic rhinitis.The Medical Fortnightly will not be discontinued at expira tion of subscription, as many of our readers prefer not to have

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Camphorae PURULENT OPHTHALMIA.-Wm. F. Rielly,

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Ungt. zinci oxidi benzoat....

3 ss bydrastine hydrochloride (Merck) in puru. M. et ft. ungt.-The Southern Practitioner. lent ophthalmia for the past three years, and never yet has it failed him. He considers it BROMIDROSIS. the best remedy to give for home use, espec- B Hydrarg. chlor. corros..

gr. j ially where a trained nurse is not in attend.

Spir. odorati..

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Magendia solut.morpbine. gtt. xv
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z j

WATER ANESTHESIA FOR REMOVAL OF After cleansing, instill two drops in the HEMORRHOIDS.-Charlotte Medical Journal, eye, and repeat every half hour, as long as in discoursing upon the subject, describes there is pus.-Merck's Archives.

Gant's method as follows: The operation ORCHITIS.-Lutaud combats the pain of

is performed by placing the patient in the

knee-chest position. orchitis by tbe administration of cachets con

The sphincter is grad.

“ taining seven and one-half gr. of quinine ually dilated, and patient is told to bear

down." By this means the hemorrhoids are sulphate. In the majority of cases pain is ar

brought into view. A large sized hypoderrested after the first dose, and it is unnecessary to give an injection of morphine. At the

mic syringe filled with distilled water is then same time the following is applied locally: until the mucous membrane over the pile be

taken and the water injected into the pile B Methyl salicylatis.

comes blanobed. Then an incision is made Guaiacoli....

through the mucous membrane about the Vaselini,....

.aa 3 ;

base of the pile, ligature applied and the pile M. Sig. Apply locally once or twice daily.

This is the same as the ligature - Medicine.

operation under anesthetic. The clamp and EXOPHTHALMUS AFTER ACCIDENTS.-Kili- cautery could be used in place of ligature. ani states that the appearance of exophthal- The patient is allowed to go on about his mus immediately or shortly after the accident work, baving the parts examined and dressed is an absolutely reliable sign of a bemorrhage every other day. They do not complain of from within, and therefore of a fracture of any after-pain and ligatures soun slough off the base of the skull.–Denver Medical Times. and parts heal.-Ex.

gr. V

3 vj

cut away.

Vol. XXX

ST. LOUIS, AUGUST 10, 1906.

No. 3

Papers for the original department must be contributed ex- Probably there is no symptum more fre. clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans- quently met with, aside from pain, that lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

causes more distress than cough. Cough is reprints may be obtained at cost, if request accompanies the an indication of some irritation or disturbance proof.

Engravings from photographs or pen drawings will be fur- in the upper or lower respiratory tract. I benished when necessary to elucidate the text. Rejected manu.

lieve, that in the vast majority of instances, script will be returned if stamps are enclosed for this purpose.

the actual disturbance to be extra-pulmonary COLLABORATORS.

in origin, and quite innocent in its nature, ALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

contrary to the conviction of the patients, FRANK BILLINGS, M, D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.

who often insist that the seat of the trouble C. G. CHADDOCK, M. D., St. Louis, Mo.

must be in the chest Extrapulmonary cough S. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

has been ascribed to almost as many causes N. S. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.

as there are organs in the body. Various FRANK R. FRY, M. D., St. Louis.

theories as to the production of reflex cough Mr. REGINALD HARRISON, London, England. RICHARD T. HEWLETT, M. D., London, England. formerly enjoyed a wide recognition among J. N. HALL, M. D., Denver. HOBART A. HARÉ, M. D., Philadelphia.

physicians. However, by a thorough and CHARLES JEWETT, M. D., Brooklyn.

accurate examination, the extraneous cause THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.

will usually be found to be due to some E. E. MONTGOMERY, M. D., Philadelphia NICHOLAS SENN, M. D., Chicago.

pathologic change in the nose, naso-pharynx, FERD C. VALENTINE, M. D., New York.

oro-pharynx, palatal region, glosso-epiglottic EDWIN WALKER, M. D., Evansville, Ind. REYNOLD W. WILCOX, M. D., New York.

fossae, larynx, or upper third of the trachea. H. M. WHELPLEY, M. D., St. Louis. WM. H. WILDER, M. D., Chicago, Il.

Cough is usually spoken of as direct or reflex. It is a direct cough when there is irri

tation from congestion, edema, inflammation, LEADING ARTICLES

pressure, swelling, or from foreign sub

stances, such as mucus, pus, etc., within the COUGH-EXTRAPULMONARY CAUSES OF respiratory tract. Cough is a reflex phenom.

COUGH, IN CONSEQUENCE OF PATHO- enon when due to some pathologic change in
LOGIC CHANGES IN THE UPPER RES- the respiratory organs.
PIRATORY TRACT, AND DISTURB- Apparently there exists among various ob-
ANCES IN THE FUNCTION THEREOF. * servers more or less confusion as to the mu-

tual understanding of the reflex cough.

There are those who consider all cough due J. C. BUCKWALTER, M. D.

to altered functions of the upper air pas

sages as reflex, while others classify it a ONE of the difficult problems confronting

direct cough. the physician is to find the cause of and cure From a physiological sense, all coughs are for stubborn, harassing and persistent cough. reflex, that is, we have an exciting organ, a This paper refers to those types of cough in central organ, and this united in turn with which pathologic changes in the chest can an executing organ.

An admirable example be excluded. This class of cases have usu- and interesting source of reflex cough is exally run the gamut of the whole pharmaco- hibited by irritation in the external auditory piea. Yet, aside from temporary relief, the canal by the presence of a foreign body, imcough lingers, causing greater or less annoy,

pacted cerumen, inflammation and irritation ance and concern to the patient, family and in the cerumen secreting area, the osteo-carfriends.

tilaginous junction of the auditory canal and The assurance that the cougb is quite in. the drum membrane. Illustrated in this ty. nocent in character, that no lesions or evi. pical case: Three years ago, Mr. A., age 38, dence of tuborculosis are present, offers the

consulted me for tinnitus in the right ear, patient little comfort. The physician often slight impairment of hearing and occasional finds it difficult to retain the confidence of pruritis in the external auditory canal. On the patient, to passify him and prevent un.

introducing the aural speculum in the audi. due and unnecessary worry, particularly so in tory canal, a most persistent and violent this time of enlightenment on and crusade cough was induced. An inspection of the against tuberculosis.

canal showed it to be covered with dark, dry,

scaly lardaceous substance extending to the * Read before the Missouri State Medical Association, Jei. ferson City, May 16, 1906.

depth of the drum, which was hyperemic and


thickened. The patient remarked that he in so far as the condition is productive of had been troubled with this troublesome partial or absolute stenosis, or in proportion cough for years. This paroxysm was likely as the hypersecretion from this region pro. to come on at any time. During the last vokes irritation to the sensitive areas well eighteen years he has consulted physicians supplied with peripheral nerve filaments, will who have prescribed various remedies with cough follow. little or no benefit to the cough. He has In the lower pharynx cough is induced by been advised to leave this climate, that his elongated uvula, low hanging uvula from lungs are affected. However, the patient re- relaxed palate, edematous uvula from contact mained in St. Louis, continuing to cough, with the epiglottis. but took on weight.

In the glosso-epiglottic fossae from vari. Diagnosis.-Eczema of the external audi. cosity and hypertrophy of the lingual or tory canal.

Treatment directed to the der tongue tonsil, the cough is dependent upon matitis stopped the cough, the itching, the the degree of disturbance in ficted to the tinnitus, and restored the hearing to nor highly sensitive epiglottis. mal. To the present the introduction of a A causative factor sometimes overlooked is speculum or probe evokes the same old hypertrophy of the lateral pharyngeal walls, cough.

or so.called pharyngitis lateralis, which in It ocours to me that undue stress has been some instances is productive of distress and laid on nasal and naso-pharyngeal reflexes barassing symptoms. The faucial topsils as a causative factor in the production of in my experience bave always been innocough. It is a term misapplied.

cent offenders 80 far as related to cough. My experience has been that almost every Cough from the epiglottis may be looked case of cough due to some disturbanve, in for in edema, ulceration and inflammation. the upper air passages, rather than a reflex In the laryns, in benign and malignant cough, is a cough due to direct mechanical growths, edema, foreign bodies, uloers and irritation of either the epiglottis, lateral walls formation of scar tissue, in acute and chronio of the pharynx, sensitive areas in the larynx, inflammation, cough is usually a prominent in the trachea and bronchi. I hardly believe feature. that too liberal construction oan be given the Treatment consists in opening the upper importance of nasal and nuso-pharyngeal ob- air passages, removing obstructions, estab. struction and its interference with proper res- lishing free and easy physiologio respiration, piration, causing periodic or absolute mouth lessening secretion, and obliterating all breathing. Mouth breathing is a course pro- sources of direct irritation by or through ductive of many bad results, and harmful in means accessible and indicated by the condi. proportion, as the air inspired is impure, tions confronting the operator. charged with dust, not sufficiently warmed, Acknowledging the value of clinical data, and humidified before reaching the epiglottis, induces me to append brief notes from the larynx trachea and broncbi. In consqeuence, following cases: November, 1905, Elizabeth direct mechanical irritation is set up with re- L. age 9. Referred by Dr. Kennedy for exsultant direct cough.

amination of the nose and throat, and treatIntra-nasal factors, which may induce ment if necessary. Complained of cough cough fron indirect irritation through mouth the past two months. Internal medication breathing or from hypersecretion in the unsatisfactory. Present state: no fever, nor. pharyngeal space, may be menticned as mal pulse, appetite good. Patient appears to chronio rhinitis, intumescent and chronic breathe through the nose freely. Mother has hypertrophy of the middle and inferior tur

never observed that the child breathes binate bones aud of the mucous inembranes otherwise. Inspection of the nose, nasoin general, posterior hypertrophies, polypi, pbarynx, oro-pharynx and larynx did not deflected septum, spurs, ridges or other ab. revel any abnormal alterations, aside from normalities of the septum and floor of the some slight bogginess of the lower margin of nasal fossae.

the inferior turbinates. The mother was in. Mention should be made of necrotio, puru. structed to note breathing during sleep. The lent, syphilitic, atrophic rhinitis and sinusi. report next day confirmed my belief that res. tis causing stenosis or profuse secretion piration was carried on at night, when recumwhich trickles down the pharyngeal walls to bent, through the mouth. Diagnosis.-Inirritate the sensitive areas of the epiglottis, tumescent hypertrophy of the inferior tur. larynx or even trachea.

binate bodies. Within the confines of the upper pharynx Treatment.–Locally, every tbird day at the pathologic changes, namely, hypertrophic office, spray in the nose 2% cocaine solution and granular pharyngitis, atrophic pharyn. to lessen irritation, induced by the applicagitis, enlarged pharyngeal tonsil or adenoids, tion of a 1% copper sulphate solution. This

Age 10.

was followed by an oily spray of menthol gr. sis of the vomer. Treatment: Internally, 3, camphor gr. 2, oil eucalyptol gtt. 3, in syrup stillingia comp. one teaspoonful three vasenol oz. 1, to the nose, paso-pbayrnx, and times daily; ten gr. kali iod. three times by deep inhalations into the larynx, trachea daily. Locally: Curettement of the necrotic and bronchi. At home, oil vasenol comp. bone with subsequent application of 20% oz. 1, with instructions to instil 10 drops in solution silver nitrate for several weeks. eacb nostril every tbree hours. Results. Cleansing douche with an alkaline solution, The nasal congestion soon disappeared, result and spraying with an astringent oily spray. ing in re-established nasal respiration at Results. - Tinnitus ceased. Hearing in nigbt. Within three weeks the cough was creased to thirty inches by the watch. In cured.

six weeks the cough entirely disappeared. From the case cited, it will be noted that

CASE IV.-September, 1904. Rosie H., it is at night, when recumbent and asleep,

Complains that for the past two the physiologio function of the nose is arrested

years has been troubled with a hacking by bypostatic congestion of the mucosa.

cough more or less constant and always From mere inspection of the nasal chambers,

worse at night. Many cough mixtures from in many instances, a definite diagnosis cannot be made.

drug stores have been tried and several phy. However, by requesting the patient to observe the condition of his mouth

sicians bave prescribed without relief. The

father thinking the trouble may possibly be and nose on awaking in the nigbt and morn.

in the throat brought the child to be exam. ing, and to note the nasal stoppage, and con

ined. Present State: The nose, pharynx sequent parohed, dry, leathery, pasty feeling

and larynx appear normal. The uvula does in the mouth and throat, with other disagree

not appear unduly long on inspecting the able symptoms, as bawking, gagging, retoh

throat with the tongue depressor, however, ing, eto., a definite conclusion can be drawn

by examining without depressing the tongue and diagnosis made.

the soft palate is noted to hang low and the CASE II.-Five years ago, Mrs. L., age 26, uvula elongated. This case demonstrates the consulted me complaining of a lump in the necessity for in examining those obscure con. throat and for the past two years. Symptoms

ditions in highly sensitive throats. Treat. were worse after dining. Present State.

ment: Removal of two-thirds of the uvula Examination revealed a large spur on the

cured the cough. septum left nuries, moderate pharyngitis and CASE V.-Mr. E. W , age 37, brought to hypertrophy of the tongue tonsil. Diagno- me by Dr. Becker for examination and treat. sis.-Hypertrophy of the lingual tonsil. ment of the nose. Complains of since over Treatment confined to reducing the enlarged two years ago has been troubled with stoptongue tonsil with the galvanic cautery. ping up of the onset, particularly at night. This was accomplished in three sittings when Take frequent colds in the head. Annoyed the symptoms cleared up.

by mucus dropping into the throat. For

over a year has been troubled with a cough CASE III.-April, 1904. Mr. G. W. G., paroxysmal in cbaracter. The cough is esage 45. Complains of the nose stopping up pecially annoying about bed time in the night for the past fourteen months, and especially and mornings. Of late the cough bas been annoying at night, when he breathes through unusually annoying early in the evenings, the mouth. Always bas a cold in the head. especially when out in company. At times The ears ring and hearing is impaired. Early the paroxysm is so violent the patient is in the mornings is awakened by an annoying forced to retreat to out door air. Mr. W. cough, which is troublesome all day. Has has never sought relief for the cough, but taken many cough remedies without relief. bas been treated for the nasal stenosis. Present State. -The nose, nares filled with Present State.-On the septum right paris a thiok greenish secretion. The septum is large spur projects impinging upon a hyperthickened narrowing the nasal fossae. The trophio inferior turbinate. . In the left naris inferior turbinates are turgescent filling the the upper third of the septum is thickened inferior meatuses. After removing the secre. and blocks that part of the fossae not closed tion and reducing the congestion a fair view by the tumefied inferior turbinate. The of tbe nasal cavities was made possible. On

On pharynx is chromically inflamed. The larynx the posterior end of the septum a crusty scab appears normal. Diagnosis.-Chronio hy. was clinging By removing the scab the pertrophic rhinitis, and spurs on the septum. probe came in contact with denuded bone. Treatment.-Removal of spurs and hyperQuestioning the patient brought forth a his- trophies with intranasal saws and scissors. tory of specifio trouble in the family. Ears: This treatment resulted in establishing free Drums normal. Hearing by watch one inch nasal respiration with gradual cessation of right and left. Diagnosis : Sypbilitic neoro.

the cough.

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