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2o་ཀུཀ་

Vol. XIV

5กษ

NOISON

Medical Review of Reviews

AN INTERNATIONAL MONTHLY REVIEW OF CURRENT MEDICAL LITERATURE

NEW YORK AND LONDON, JANUARY, 1908.

THE PROGRESS OF MEDICAL
OF MEDICAL SCIENCE.

GENERAL MEDICINE.

UNDER THE CHARGE OF

No. 1

HENRY H. PELTON, M.A., M.D.,

Chief of Medical Clinic, Presbyterian Hospital Dispensary. Instructor in Medicine, New York Post-graduate Medical School.

The Treatment of Tu- Fontana (Gaz. degli berculous Peritonitis. Ospedali, Oct. 20, 1907), states that the cases of tuberculous peritonitis with ascites are the ones that display the greatest tendency to spontaneous healing, and that operative intervention in these cases is useless. He reports the details of 22 cases in which the patients recovered under medical measures alone, and are still in good health after from two to ten years. In the first case the patient was a primipara, and the affection commenced with an acute onset, suggesting typhoid fever until differentiated by the ascites. Under two months of medical treatment the affection retrogressed and no traces of an abdominal affection could be detected during minute examinations five and ten years later. In the second case a young woman had two attacks of tuberculous peritonitis at fouryear intervals, each subsiding under medical measures alone. In a third case the patient, a girl of 13, passed through the ascitic phase of tuberculous peritonitis without treatment, and the fibro-caseous phase subsided under medical measuresrest in bed, ample ventilation, subcutaneous injection of iodine iodide and guaiacol, supplemented by iodine externally to the abdomen, applied in a 5 per cent. iodo

form salve, with occasionally tincture of iodine. Blisters to the abdomen were used in one case, and the effusion was tapped in one case. Guaiacol carbonate

nd quinine were given by mouth, with tonics after the subsidence of the acute phase. Absorption of the ascitic fluid. was hastened by abdominal massage. These measures proved effectual in nine patients with ascites. In seven others the ascitic phase was past when first seen; marked improvement was obtained and a clinical cure, but the products of specific inflammation can still be detected in the abdomen, and it is impossible to foresee the outcome at present. In 12 of the 22 cases pleuritic complications were manifest. He argues that a laparotomy in the cases with ascites would have been superfluous, as all the patients recovered without it, while such a serious operation might have done harm in some instances. Journal of the American Medical Association, December 7, 1907.

Inferences to be Drawn Thayer and Fabyan from a Thickened Ra(Am. Jour. of Med. dial Artery. Sci., Dec., 1907), in a paper upon arteriosclerosis, state that in old age a thickened radial artery represents normal and to-be-expected

conditions, not only in peripheral, but in central vessels. An unduly thickened radial artery at an earlier age may mean one of two things: (1) The vessel has been subjected to unusual and exceptional strain, or (2) it is a vessel which, from inherent weakness or other individual circumstances, has ben unable to cope with conditions which might ordinarily be regarded as normal. In either case the result has been the same-the artery has been obliged to fortify itself by progressive thickening of its walls, especially by a connective-tissue sclerosis of the intima and media. The unduly palpable radial artery indicates a strong possibility of arterial changes in other parts of the body, and may thus be regarded as a signal of danger.

Percussion in Slight R. W. Philip (EdinApical Involvement. burg Medical Journal. December, 1907) proposes the following valuable method of determining carly special changes:

The index finger of the left hand is used as pleximeter and is placed horizontially across the apex of the lung from back to front in a plane at right angles to the vertical diameter of the lung. Percussion is practiced with the middle finger of the right hand in a direction at right angles to the pleximeter. The pleximeter finger should be closely apposed, and percussion should be firm and sharp, but not too strong.

In cases where there exists room for doubt as to the integrity of an apex, or of both apices, great help will be obtained. from percussion in this line. The delicacy of the test has led the author to recommend it strongly at his clinic on the diagnosis of chest disease. Again and again he has observed competent clinicians fail to determine the presence of slighter degrees of consolidation by

the ordinary method, or manifest hesitancy as to their results, and express surprise at the case and certainty of determination when recourse was had to the percussion line here proposed.

Lactic Acid Bacilli Lematte, L. (Le ProBouillon in the Treatgrès Médical, No. ment of Digestive Dis29, 1906). The auturbances. ther obtained remarkable results in a series of intoxications by way of the bowel by means of the lactic-acid bacillus "B," grown by Cohondy in 1903 from so-called Bulgarian sour milk. With special reference to the manner of administration of this beneficial bacillus, the author promises further publications, and limits himself to the statement that the patients received either a malt bouillon culture, with the addition of lactose and a few mineral substances, or a culture in milk, a small wineglassful three times daily one hour before meals. The diet should be as rich as possible in carbo-hydrates (rice, vermicelli, maccaroni, fresh green vegetables). Albuminous substances are to be avoided as a

good pabulum for injurious bacilli. Experience teaches that fats are not readily tolerated by these patients.

The author reports four cases of severe muco-membranous enteritis, enteritis following dysentery, icterus and urticarias, which were cured with remarkable rapidity by the lactic-acid bacillus. The patients' ages were 6, 9, 27 and 46 years.

BIOLOGY OF LACTIC BACILLUS "B." The author selected the lactic bacillus "B," isolated by Cohendy in 1903 from a specimen of clotted Bulgarian milk, and grew cultures of this germ. Cohendy describes this bacterium as follows: It is a thick bacillus, of variable size, taking the Gram stain. It does not grow under 35 degrees nor above 63 degrees. This

microorganism possesses a capacity of fermentation towards carbohydrates which is four times higher than that of all the known lactic ferments. After 10 days in the incubator at 37 degrees it vields an acidity up to 32 grammes pro liter of lactic acid. It can coagulate milk in 8-12 hours. It yields lactic acid with the various sugars, such as maltose, lactose, saccharose, glucose. Cohendy claims that it has no action upon starches and albuminoid bodies. The latter point is at present being studied by the author. As regards the culture medium, it was found after prolonged experiments that the ferment remains for a long time alive and active in malt bouillon prepared with lactose and mineral substances. This culture bouillon is a brownish liquid of pleasant odor and slightly acidulous taste. The bacillus is found again in three to five days after the first ingestion. The proliferation is favored by a diet rich in carbohydrates, which diminishes the diminishes the toxicity of the intestinal contents.

In order to render sour milk a medicinal food the conditions of its manufac

GENERAL AND ORTHOPEDIC SURGERY.

UNDER THE CHARGE OF

ture must be regulated in such a manner that the product contains only pure lactic acid. Almost all the spontaneously soured milks contain, besides the lactic ferments, a number of yeasts which produce alcohol. Both these microorganisms are found in Kefir and in Koumiss. These combined lactic and alcoholic fermentations restrict the therapeutical use of these acid, alcoholic and gaseous milks. Their composition varies, because the "grains" with which they are prepared contain a mass of more or less injurious bacteria. Clotted milk prepared with an unorganized ferment, such as rennet or an acid (citric or tartaric), is a milk whose therapeutic properties differ entirely from those of ordinary clotted milk, and especially from the clotted milks which have been scientifically obtained with selected ferments.

Lactic-acid bacillus "B" in maltose bouillon is usefully employed in the treatment of intestinal infections. Its administration is absolutely harmless, and may prove serviceable after the ordinary remeries have failed. F. R.

Cases.

Epithelioma of the From an exhaustive Penis-Analysis of 100 study of 100 unselected cases of epithelioma of the penis, most of which were taken from the records of the Massachusetts General Hospital during 33 years, from January, 1872, to January, 1905, Dr. J. Dellinger Barney draws the following conclusions:

EDGAR A. VANDER VEER, Ph. B., M.D.,

Lecturer in Clinical Surgery, Albany Medical College; Attending Surgeon, Albany Hospital.

1. Epithelioma is practically the only kind of cancer attacking the penis, and its frequency forms only from 1 per cent. to 3 per cent. of all cancers.

2. It occurs most frequently during

the fifth, sixth and seventh decades of life.

3. Phimosis is pre-eminently the most important of its exciting causes, occurring in over 85 per cent. of the cases. Circumcision, therefore, cannot be too strongly advised, especially after middle life, in all cases where the prepuce cannot be easily and completely retracted. Syphilis and trauma are to be considered next in importance from an aetiological standpoint.

4. Most cases seek relief during the first and second years of the disease, but

it is not unusual to see cases of from five to fifteen years' duration.

5. Pain occurs in 43.5 per cent. of all cases. It is rarely severe, and usually occurs late in the disease.

6. Enlargement of the inguinal glands occurs in over 75 per cent. of all cases. In 60 per cent. these glands are cancerous. The rest show simple hyperplasia from septic absorption. Glandular involvement may occur early, but from my study of these cases I am inclined to regard it rather as of late occurrence. Inguinal metastases cause death sooner or later. If well advanced, attempts at their removal are to be considered only as "surgical vandalism."

It

7. Invasion of the vital organs occurs in over 15 per cent. of all cases. may occur without involving the inguinal glands.

8. Recurrence takes place up to one year after operation in over 39 per cent. of the cases, up to two years in over 19 per cent., up to three years in over 16 per cent., up to four years in over 6 per cent., and, most notable of all, it occurs over five years after operation in over 12 per cent. of cases.

Its site depends largely upon the original operation performed, and will be local where only palliative operations have been done. It may occur several times.

9. The operative mortality is I per cent. This case died of sepsis, a misfortune which might occur in any opera

tion.

IO.

The gross mortality is 32 per cent. That of the primary cases is 20 per cent., 29 of the recurrent cases 38.5 per cent.

II. Thirty-eight per cent. of all cases are cured; of these the primary cases form 36.5 per cent., the recurrent cases 42 per cent.

12. Early amputation of the penis at

the pubes, with thorough dissection of the groins, is the operation of choice. If taken in the earliest stages, however, amputation alone may effect a cure. The operations of splitting the scrotum and transplanting the urethra into the perineum, or of total emasculation, offer no greater hope of cure.

, 13. The length of life from time of onset in primary cases is three years and four months; in recurrent cases it is eight years and three months.

The length of life after final operation in primary cases is 24 months; in recurrent cases four years and two months.

Cases may live for over 11 years after the onset of the disease without operation.

14. Sexual power is not necessarily destroyed by amputation of the penis.

15. Melancholia (in this country, at any rate) rarely, if ever, follows the loss of the organ.

16. Amputation, even close to the pubes, does not necessarily cause any disturbance of micturition.

17. The patient will be confined to the hospital for about 14 days after the radical operation.

of the Bowel as

Sequel to Mesenteric

Thrombo-Phlebitis.

Hæmorrhagic Infarct Roussel (Thèse de a Paris, 1906). Hæmorrhagic infarct of the bowel through obliteration of a mesenteric artery or vein is a lesion independent of pylephlebitis. The existing venous stasis gives rise to the hæmorrhagic infarct here as well as elsewhere in the body. Mesenteric thrombosis may be the sequel of an adhesive pylephlebitis or it may be primarily located in the branches, the aetiology being usually of an 'infectious character. The infarct affects either the large intestine or the small intestine, the latter being far more frequently the case. The lesions are as follows: Sero-sanguinolent ascites,

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possible after the subsidence of the acute manifestations; in mild cases as soon as the beginning of the third week. Soft bougies filled with lead wire are recommended for the purpose. The treatment should be kept up as long as possible. Strictures coming under observation in the later stages, especially those of a severe degree, will have to be treated according to the state of nutrition of the patient. In half-starved patients, or in strictures which do not even permit the passage of fluid food, the prompt performance of gastrostomy is exclusively indicated for a rapid improvement of the nutrition. After the patient has regained his strength "endless catheterization" is instituted by way of the gastrostomy fistula. The fistula in the stomach must not be allowed to close until the undisturbed permeability of the esophagus has been definitely secured. In those strictures which are not readily catheterized, but which permit the passage of fluids, the patient's nutrition being relatively good, thiosinamin injections may be tried (onehalf to one syringeful of a 15 per cent. solution several times weekly). If this treatment fails, the indications are for gastrostomy and permanent catheterization. In the presence of fresh operation scars, in tuberculous individuals, etc., the thiosinamin injections are contraindicated, since they are capable of softening recent cicatricial tissue not only, but of stirring up an old inflammatory focus. Hence the institution of thiosinamin treatment must invariably be preceded by a careful examination of the entire body.

Catheterization for the prevention of stricture in recent cases (three to four weeks' duration) is at first performed. every day for a short time; later on at intervals of two, three to seven days, for half an hour at a session, or longer. F. R.

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