REPORTS ON PROGRESS Comprising the Regular Contributions of the Fortnightly Department Staff. SURGERY. JOHN MCHALE DEAN, M. D. Serum Therapy of Tetanus. Nathan Jacobson and Herbert Pease (Annals of Surgery, Vol. xliv) treat the subject of serum therapy of tetanus. Of especial interest is the conclusion drawn after a close study of the reported cases in the literature. The authors concluded as follows: "As a prophylactic measure it merits our fullest confidence, but as a therapeutic agent after tetanus is fully established we are forced to admit that as yet no method has been discovered whereby it can be administered so as to reach effectively the toxin not free in the blood or lymph. Reports from clinics teem with the wonderful results received from the serum after the disease is established, but the reviewer's experience coincides with the above authors. Mild cases recover as well without the serum as with it, while severe cases invariably die in spite of all established treatment. The authors claim that intracranial or spinal injections accomplish as little good as subcutaneous and are far more dangerous. Early Operation in Traumatic Intracranial Hemorrhage. Murray (Annals of Surgery, Vol. xliv) makes a plea for early operations in intracranial hemorrhage and reports some interesting experience in his own practice. He is not accustomed to wait for definite focal sypmtoms, but relies on the compression symptoms, as shown by the choked disc and the high blood pressure, as shown by examination with the sphygmomanometer. The author reports several cases greatly benefited by this early operation. The technic is simple, merely trephine and enlarge the opening if necessary by the ronguer forceps. All blood clots are to be removed, and if the dura fails to show the normal pulsation synchronous with the heart's action it should be incised and all hemorrhage checked and blood clots removed. The dura is closed with catgut with or without drainage. Seldom do the adhesions formed between the flap and dura cause subsequent trouble. quent function. As for the treatment if non- surgeons are content with suture of the para- Surgery of the Biliary Tract.-J. B. Deaver, Philadelphia (Jour. A. M. A.) is in favor of removing gallstones whenever present, provided there are no contraindications, and also considers cholecystotomy the safest treatment of any frank attack of acute cholecystitis that does not subside under judicious medical measures in thirty-six or forty- eight hours. Operation is almost imperative if the attack is not the first and we believe from the history that gallstones are present. In mild recurrent cases, also, he considers operative interference indicated, and in the later stages of gall-bladder disease operation is also invariably demanded. In hydrops, cholecystectomy is required, as the closing of the cystic duct renders the gall bladder useless and there is constant danger of reinfection or even of rupture. Cholecystectomy is also indicated in gangrene and perforation, but not in empyema, except when of long standing and with the walls very extensively diseased. When gallstones exist the condition is more serious, and the patient is fortunate if they can be removed before they wander from the gall bladder. The advantages of operation in the latent stages are pointed out. Deaver protests against any indiscrimiate resort to cholecystectomy in operating for impacted stone in the common duct unless the gall bladder is very much diseased. He believes that its retention and drainage constitute a very valuable part of the after-treatment. When the infection has traveled beyond the gall bladder and involved the hepatic ducts, or even if the cystic duct is very much infiltrated, he would drain the common duct as well. This is not, in his opinion, a difficult or dangerous procedure, but it requires to be done judiciously. There are times when the surgeon, against his will, is called on to operate for acute impaction of a stone in the common duct. The mortality in these cases is appallingly high, but with progressing infection it may be the only chance. The possibility of the pancreas being also involved is to be considered and this makes operation the more imperative when it occurs. In conolusion he mentions typhoid cholecystitis as a matter of importance and expresses surprise that it has not been more considered. Patients who during typhoid give evidence of biilary involvement should, if possible, undergo cholecystotomy on recovery if their symptoms persist, thus not only avoiding future serious disease, but also more effectually preventing their dissemination of typhoid infection from their intestinal tracts. Tabulated statistics of 216 cases are appended to the article. OTOLOGY. ALBERT F. KOETTER, M. D. Relation Between Diseases of the Ear and Those of the Face.- (Baudebranche, Rev. valencia nor de aiencias medicas. In the first part of his work author examines the functional optic disturbances, that is those without anatomical lesions. To explain these reflex phenomena on the part of the eye he demonstrates several clinical facts, among these a case reported by Verdos of reflex diplopic due to impacted cerumen; pain in the eye and tearing while extracting a polyp from the tympanio cavity (Mons). Hyperemia in catheterization of the tubes; blepharospasm, paresis of the orbicularis with logophthalmus in inflammation of the middle ear (Holt); strabismus and myosis in mastoiditis (Tillaux); paresis of abducens in inflammation of the middle ear (Gradenigo, Urbantschitsch); strabismus divergens (Spear); myosis of the iris by irritation of the otio ganglion (Moos, Cyon); nystagmus, rotary and horizontal, in suppurative inflammation of the middle ear; hemiopia, mouches volantes, mydriasis, nystagmus in Meniere's disease. The second part embraces the organic changes of the eyes following diseases of the ear: optic neuritis in otitic cerebral complications. A Rare Case of Deaf-Mutism Following Purpura Hemorrhagica.-(Citelli, Archives Ital. di Otologia.)-A child of two suddenly seized with fever, no pain in limbs, soon after hemorrhagic spots appeared on the skin, which spread to the whole body excepting the face, first red, then black, and eventually yellow. No hemorrhage from or on the mucous membrane. Accompanying these phenomena marked cerebro-spinal symptoms, coma for fourteen days with paraparesis, especially on the right, reduction of sensibility of skin, more on right. Patellar reflex gone on right, reduced on left, no vomiting, no rigidity of neck, no paralysis of eye muscles, no symptoms of meningitis, no cases of cerebro-spinal meningitis in the vicinity, the fever varied from 37.5 deg. to 39 deg., pulse 95 to 150; no bloody urine, no albumen. During the disease child never uttered a sound, and could only be roused from stupor by shaking, never through loud calling. After recovery child remained totally deaf and had abnormal locomotion. This gradually improved. The deafness remained unchanged and by degrees lead to deaf-mutism. Examination of the ears revealed moderate retraction, no doubt due to fairly well developed adenoid vegetation. Author believes that deafness is due to hemorrhage into labryinth, as often occurs in other infectious processes, and we can therefore class the purpura hemorrhagica as a cause for deaf-mutism. The Disturbance of the Sense of Taste in Chronic Suppurative Inflammation, Especially After Operative Interference.-Kauder, Archiv fuer Ohrenheilkunde.)- The work embraces besides a resumé of the literature on the anatomy, physiology and pathology of the chorda tympani and the tympanic plexus, fifty cases of clinical observation regarding this subject. For the practitioner the following conclusions are of importance. The chorda tympani is often involved in chronic middle ear suppuration. Total destruction of the chorda indicates extensive process of destruction, but its absence does not allow the contrary conclusion. The radical operation destroys the chorda forever. In the hammer-anvil extraction the chorda tympani is always torn. In a much smaller scale is the tympanic plexus altered by these procedures. The Treatment of Suppurative Middle Ear Diseases by Bier's Method of Hyperemic Engorgement. (Fleischmann, Monatschrift fuer Ohrenheilkunde.)- After Fleischmann discusses the reports of Keppler, Heine and Stenger on the above treatment and declares that the results by no means coincide. He describes the experience had at Politzer's clinic in Vienna by the use of hyperemic engorgement in suppurative middle ear disease. There were twenty-four patients with twenty-five diseased ears that were treated by this method, viz., nine acute suppurative middle ear inflammations without complica tions; twelve acute suppurative middle ear inflammations with mastoiditis; two chronic middle ear suppurations with acute mastoiditis; two cases of perichondritis. The technique of the engorgement method was that of Keppler, and the duration twenty to twenty-two hours per day, as a general rule borne well, the pain quieting affect did not appear as promptly as described by Keppler, proportionately the pains disappeared after from two to three days of daily treatment. The incision of periosteal abscesses was also done according to Keppler's method, on account of agglutination of wound margins and retenion of pus a small strip of xeroform gauze was inserted. As regards the remedial result Fleischmann constitutes the following: Of nine cases of uncomplicated acute suppurative middle ear disease, six were cured in from ten to twenty-three days, but shortening of the time of healing is not noticed in the favorable cases, so that the engorgement method in uncomplicated cases shows no better results than the present method of treatment. The other three cases showed no improvement and were finally cured by the introduction of the customary treatment in from ten to twenty days. Of the twelve cases of acute mastoiditis four healed in from seven to eighteen days by engorgement method, four were operated, partly because the condition of the patient did not improve; partly, because it grew worse. In four cases of acute mastoiditis there were pronounced periosteal changes of the mastoid process, so that they were operated without trying the engorgement method. Through the engorgement no operation was necessary in one case; three times it was postponed, but the operation was more extensive and the after-treatment longer. The two cases of chronic middle ear suppuration with mastoiditis, the acute symptoms subsided in from fifteen to twenty-one days of treatment, the otoscopic findings, however, remained the same, that is the mastoiditis changed from the acute manifest to the chronic latent form, in operating it was found that this condition had not been influenced by the engorgement method. The two cases of perichondritis showed no improvement after fourteen to twenty days treatment. These experiences, according to Fleischmann, make the use of this new method in otology rather serious, for the danger exists that the proper time for operative interference may be missed. cannot be denied that some cases of mastoiditis are cured by hyperemic engorgement; on the other hand, it is certain that not all are healed, and we must be prepared, besides the good results, to experience many with fatal outcome. It MEDICAL MISCELLANY TWELVE hours from the time of delivery the patient should have urinated. If no distress is occasioned, the physician may wait three hours longer before the catheter is passed. AUSTRIAN COUNTRY DOCTORS STRIKE.The medical profession of that country refuses to further vaccinate the poor people at two pence a head when horse doctors are paid eight pence a head for vaccinating cattle against disease They also refuse to treat paupers for a price less than the government pays the barber for cutting the pauper's hair. DR. MAX HEMPEL, aged forty-three, died from the effects of a surgical operation for cancer of the stomach, October 9. The doc tor was a very prominent educator and lecturer among the German speaking people of St. Louis. His work in a religious way along liberal lines gave him prominence throughout America and attracted attention in Europe. He graduated in medicine a few years. ago and returned from Europe quite recently, having taken additional medical work in that country. COLDS ARE CONTAGIOUS, declares Dr. Frederick Treves. The common cold is of bacterial nature; it can be conveyed from person to person. "The germ would seem to linger in the haunts of men and to find pleasure in the madding crowd." Fishermen returning to port after a two months' voyage, during which they were free of disease, were very prone to catch cold. "The chilly blasts of the North Sea in the winter were unpleasant enough; but they were not laden with the cold-in-the-bead bacillus, while the air of the cosy seaport was." NEW YORK CITY'S TUBERCULOSIS HOSPITAL. The sum of $225,000 has been appropriated for the erection of buildings on the site selected by the municipal authorities for the proposed tuberculosis hospital at Otisville, a settlement in Orange county, seventyseven miles from New York City. The land has an altitude of about 1,400 feet, and it is proposed to provide the accommodation of about two hundred patients, who will be either persons in the incipient stages of the disease or convalescents from the hospitals. It is expected that the construction and equipment of shacks for patients will cost $80,000, and the dining room and kitchens $20,000 more. A barn for forty cows will cost $18,000. The power plant is to be built for $30,000, and the rest of the appropriation will go for dormitories for employees, roadways, paths, and general improvements. THE MEDICAL FORTNIGHTLY A Cosmopolitan Biweekly for the General Practitioner The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature, and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited. Advertising forms close on the first and fifteenth of each month. Time should be allowed to submit proof for correction Advertising rates on application. Remittances and business communications should be addressed to the Fortnightly Press Co. Subscription, $2.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including Newfoundland, $1.00 a year additional. Entered at the St. Joseph post-office as second-class matter. The Medical Fortnightly will not be discontinued at expiration of ubscription, as many of our readers prefer not to have their files broken on account of failure to remit. Unless we receive a distinct request to discontinue, and payment for all arrearages, this magazine will not be discontinued. Subscriptions may begin at any time; volumes end with June and December. Contributors should understand that corrected typewritten copy is essential to clean proof and prompt publication, and is much more satisfactory than manuscript. Original articles should be as condensed as justice to the subject will allow. Editorial offices in St. Louis and St. Joseph, where specimen copies may be obtained, and subscriptions will be received. Contributions and books for review should be addressed to the Managing Editor, 319 and 320 Century Building, St. Louis, Mo. .aa gr. 12 B Hydrargyri chloridi miti...... Acidi tannici. Lycopodi.... Ungt (zinci oxidi) U.S. P..... 31 M. et ft. ungt. Sig. Apply as directed.Med. Rev. of Revs. GOUT OF THE FINGERS AND TOES.-Dr. John V. Shoemaker (Medical Bulletin, October, 1906) reports a case of gouty inflammation of the fingers and toes accompanied by nocturnal numbness of the extremities, extreme nervousness, headache, high arterial tension, etc. The blood condition was good the urine highly colored, acid, s. g. 1029, uric acid abundant; no albumin or sugar. Dr. Shoemaker prescribed locally to the fingers and toes, three times a day, pure oil of gaultheria, which gave immediate relief. (1) For the gastrointestinal disturbance the following: Strychnine sulphate...... 4-5th gr. Dilute hydrochloric acid.. oz. Glycerite of pepsin enough to make..... 6 ozs. M. Sig. Two teaspoonfuls in a little water after each meal. (2) For the nervousness the following: B Extract of cannabis indica... gr. Extract of hyoscyamus.. Camphor monobromide.. gr. 5 grs. Cacao butter, enough for.... 1 suppos. Mitte xx. Sig. Insert one into the rectum four times daily. Galvanism, 10 to 30 milliamperes, once daily was instituted. To act more decidedly on the gouty system, the following was subsqeuently given: B Strychnine sulphate...... 1-60 gr. Arsenic trioxide..... 1.30 gr. Soluble iron pyrophosphate Quinine sulphate.......aa 1 gr. M. Ft. pil 1. Mitte xx. One pill after each meal and at bedtime. The improvement was marked and contin SIMPLE CHRONIC LARYNGITIS. In cases of simple chronic laryngitis the following combination is recommended by Yeo: B Eucalyptol...... gr. iij Spiritus camphorae.. f3iv Tinct. benzoini co. q. s. ad.. f3ij M. Sig. Two teaspoonfuls to a pint of hot water and inhaled at bedtime and on arising. After the morning inhalation it is recommended that the patient remain indoors for an hour or two. Locally it is advised that silver nitrate be applied as follows: B Argenti nitratis. Aquae... .. gr. V-X £388 M. Sig. Apply locally to the enlarged follicles of the pharynx. As a lozenge to be dissolved in the mouth the following is recommended: B Pulv. guaiaci... .. Olei caryophylli. 3ij m. ij m. x 3ss 3i Destroys Pus and any Morbid Element with which it comes in contact, leaving the tissues beneath in a healthy condition. Indorsed and successfully used by leading Physicians in the Diseases of the Nose, Throat and Chest.— Open Sores.-Skin Diseases.-Inflammatory and Purulent Diseases of the Ear.-Diseases of the Genito Urinary Organs.Inflammatory and Contagious Diseases of the Eyes, etc. In order to prove the efficiency of HYDROZONE, I will send a 250. bottle free to any Physician upon receipt of 10c. to pay forwarding charges. NOTE.-A copy of the 18th edition of my book of 340 pages, on the "Rational Treatment of Diseases Characterized Prepared only by Charles Marchands by the Presence of Pathogenic Germs," containing reprints of Chemist and Graduate of the Ecole Centrale des 210 unsolicited clinical reports, by leading contributors to Medical Literature, will be sent free to Physicians mentioning this journal. Arts et Manufactures de Paris " Look well to your prescriptions-a careless or dishonest pharmacist may ruin your reputation. A SPECIFIC POWDER OR INGLUVIN VENTRICULUS CALLOSUS GALLINA CEUS WARNER & Co. Highly Recommended in all STOMACH TROUBLES Particularly The Vomiting of Pregnancy Specimen to Doctors on Request WM R. WARNER & Co., PHILADELPHIA. BRANCHES NEW YORK CHICAGO NEW ORLEANS. |