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the general peritoneal cavity. 4. Those in which the blood has been more or less absorbed, the products of conception and exudate remaining. 5. Those in which the products of conception have escaped from the tube and continue to develop. In determining the course to be pursued when hæmorrhage has occurred, rare judgment, fortified by experience, is essential. Accumulated experience demonstrates that if there is free blood in the peritoneal cavity the sooner an operation is undertaken the better the chances for rescuing the patient. The management. of this condition demonstrates literally

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PEDIATRICS.

UNDER THE CHARGE OF

VANDERPOEL ADRIANCE, M.D.,

Consulting Physician to the New York Orphan Asylum and Pathologist to the Nursery and Child's Hospital.

Parathyroid Findings Yanase (Wiener in Galvanic Hyperir- Klin. Wchschrft., ritability of Children. No. 39, 1907). Anatomical examinations of the parathyroids were performed in 89 cases, the most common pathological change being found to consist in hæmorrhages into the glands (33 cases, or 37 per cent.). These hæmorrhages are acquired at the beginning of post-foetal life, perhaps during birth, and cannot as a rule be demonstrated after

the first year. Healing takes place in such a way that the extravasate first becomes encapsulated, and is then gradually removed by phagocytes. Traces of iron-containing blood pigment persist in the connective tissue, where the author was enabled to demonstrate them up to the fifth year of life. Among 50 children who were submitted to electrical examination only 13 presented a normal behavior of the irritability, and in none of these cases could a parathyroid hæmor

rhage be demonstrated anatomically. Among 22 cases with anode hyper-irritability 12 cases, or 54 per cent., presented these hæmorrhages, including all those children who had died within the first year (nine cases). In the cases of kathode hyper-irritability (13 children), hæmorrhages existed in eight cases, all the negative cases being over one year of age. Two children who had suffered from convulsions likewise presented parathyroid hæmorrhages. thyroid hemorrhages. The author interprets his findings according to the modern view, which claims that the parathyroid glands neutralize a poison formed in the normal metabolism. F. R.

Thyroid Insufficiency Hertoghe (Bull, de and Nocturnal Enuresis l'Acad. Roy. de Med. de Belge, April, 1907). According to the author, the thyroid gland principle, meaning its cellular product, is of such importance for practically all the or

gans and functions of the organs in that an excess as well as a deficiency will lead to disturbances of a serious character. The thyroid gland presides over the growth and regulates the assimilation and decomposition of foodstuffs. An uninterrupted influence is exerted by it upon the muscles, nerves, brain, skin, the epithelium of the mucous membranes and glands; also the sexual organs are subordinate to it in regard to their urinal or pathological development and function. Hæmorrhages, abortions, malformations, as well as the imperfect or normal development of the foetus; the entire period of lactation, and with it the thriving or failing of mother and child, are controlled by the thyroid gland principle. The growth of the child, adolescence, puberty, sexual maturity, etc., are all under the same influence. Nocturnal enuresis is usually due to a deficiency in the thyroid principle. An excess may harm the mother during pregnancy, to the advantage of the foetus. Under these conditions the importance of the thyroid principle as a therapeutic agent is constantly on the increase. F. R.

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the course of the past year 14 children were operated upon by the author on account of inguinal hernia, with a successful outcome in all but one of the cases. Among these 14 children were 12 boys and 2 girls; five patients were less than one year old, seven less than two years and two less than three years of age. The operative technique employed was as follows: A small incision, 21⁄2 to 3 cm. in length, was made over the inguinal ring; the cellular tissue was then opened bluntly; the hernial sac was isolated at the outer side of the spermatic cord, which was held on the finger. The sac was then ligated high up, and the inguinal ring was closed by means of suture. This was followed by the application of a skin suture and the wound was then dressed. The entire procedure requires only a few minutes' time. Operation should be reserved for those cases, however, where the patient can be kept in the hospital or where the surroundings of the child are of a character to permit antiseptic conditions of the site of operation; otherwise it is preferable to wait till the child is a little older, because the patient is then more tractable and the after-treatment also is simplified. F. R.

NERVOUS AND MENTAL DISEASES.

UNDER THE CHARGE OF

WILLIAM B. NOYES, M.D., Attending Neurologist, Demilt Dispensary.

Tumor of the Frontal F. X. Dercum, M.D. Lobes Simulating (Journal of Nervous Paresis. and Mental Disease, July, 1908), reports the following case: The autopsy showed an enormous tumor of both frontal lobes, dense, firm, and separating the frontal lobes widely and involving them both, though but feebly adherent to surrounding brain tissue; size, 234x23x14 inches. Microscopic examination proved it to be a sarcoma. The clinical history is interesting. Three months before the patient had suffered from impairment of vision, and later from headache, more marked on the right side. but no vomiting or nausea.

Friends noticed a change in his disposition, characterized by appearing "easily pleased" and "taking everything as a joke." He became careless in regard to his business, and did various erratic things, and his moral character changed. He worried over his business. His gait was normal, but he had a tremor of his tongue; no change in reflexes or sensation. Examination of his eyes showed an optic atrophy secondary to a neuritis. Of the special senses, only smell was lost. He later developed gestures of an epileptic nature, and after a few weeks died.

The diagnosis had been made of a prefrontal tumor, but the close resemblance to paresis is noteworthy.

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the condition is not a local suppuration, the clinical picture being governed by the general infection. Against the latter the local interference with the inflammatory products in the meninges is powerless. This view is supported by statistics. Onethird of the patients recover without surgical treatment, whereas the operative cases hardly reach a similar percentage. The mortality was found to be lowest in those hospitals where no surgical interventions were performed.

There is one exception, consisting in the hydrocephalus of certain chronic cases. The removal of this hydrocephalic complication would appear to be advisable, and the author for this purpose performed drainage of the two lateral ventricles in two cases, and further recommends simultaneous drainage of the fourth ventricle by opening the atlanto-occipital ligament. The danger of this drainage consists in secondary infection during the after-treatment. In order to guard against this risk, the author employed for drainage purposes small silver-wire frameworks, 4 cm. in length, which held parallel threads of cotton wick. By means of the successive pulling out of these threads it was possible to re-establish the drainage, after an obstruction had resulted, with a favorable influence upon the outcome. F. R.

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tion of cyanide of potassium and soaking his hands and forearms in it. September, 1906, he developed acute symptoms characterized by diarrhoea, headache, stiffness of the neck and general malaise. His legs and arms became weak, and finally paralyzed, and he developed incontinence of urine for a week.

The condition eight weeks after the onset was atrophy of various muscles of shoulder, arms and legs, which persisted. The knee jerk was feeble, and the general condition of anterior poliomyelitis remained permanent.

Experimental injections of a solution. of cyanide of potassium were made in a series of rabbits, and examination of their spinal cords showed lesions of the anterior horn cells, marked by central cleromalolysis and general shrinkage or destruction. of the cells; also marked changes in the peripheral nerves.

Dementia Præcox.

Purdum and Wells (Journal of the American Medical Association, July 4, 1908) report in the histories of 200 cases of dementia præcox some mental or nervous defect in the family in 65 per cent. The majority of the cases appeared normal in body and mentally well endowed; in fact, with unusual ability in school. At the pubescent period many complained of nervousness and loss of ambition; others were shy, seclusive, and showed vasomotor irritability; others developed exaggerated sexual feelings and masturbated. These symptoms usually passed almost unnoticed by the other members of the family for a year or two. The patients

became restless, complained of dull frontal headache, anorexia, insomnia or disagreeable dreams. Exaggerated reflexes were usually found at this time, vaso-motor disturbance and loss of weight. To the prodromal symptoms just enumerated were now added the first real signs of mental aberration or the true onset of the psychosis.

Definite perversions in the emotional field and alterations in the special senses were now evident. The patients heard unnatural sounds and voices; delusions. of persecution or grandeur appeared. Under the influence of hallucinations and delusions the patients usually became irritable, suspicious and egotistic. Lack of ambition and inability to perform simple tasks were common. Up to this point the various psychic symptoms were common to all the cases of dementia præcox studied, but variations in the psychic field affected now appeared, and the volitional, emotional field or the field of judgment became predominently affected, causing certain alienists to classify as catatonic, belephrenic or paranoid forms. Of the paranoid type a large variety of eccentrics, anarchists or criminals are developed, and only recognized in the later stages of the disease, after having passed through prisons for short terms.

Careful blood examinations were made, and a prevailing mild leucocytosis, with increase of eosinophile and large mononuclear cells, was noted.

The above facts point strongly to a physical basis for the disease, possibly an auto-intoxication of intestinal or glandular origin.

DERMATOLOGY.

IN CHARGE OF

HOWARD FOX, M.D.,

Clinical Assistant in Dermatology, New York Skin and Cancer Hospital, and the College of Physicians and Surgeons.

Malignant Syphilis.

Rost (Dermatolog. Zeitschr., 1908, 5 and 6). The writer dscribes six cases of malignant syphilis and then discusses the clinical features and treatment of the disease. In one of the cases an ulcer of the throat produced a fatal hæmorrhage fatal hæmorrhage through arrosion of the superior thyroid artery. In three cases it was impossible to demonstrate the spirochata in the lesions of the skin and mucous membranes. This agrees with Hoffmann's experience that in typical ulcerations of malignant syphilis the spirochaeta either cannot be found or at least is present in very small numbers. In one case the glands were scarcely able to be felt, agreeing with claims of some authors that in malignant syphilis glandular swelling is markedly slight. In three cases there were joint manifestations, involving in one case nearly all the joints and lasting for years. The changes appeared to affect the capsule of the joints, and no great disturbance of function was noted.

Brain symptoms, such as headache, depression, sleeplessness, deafness, numbness, etc., were present in two cases. These manifestations the writer considers to be due not to destructive processes in the brain, but to the result of action of toxines.

Lumbar puncture, made during severe cerebral symptoms in one case, showed that the pressure in the brain was not increased, and that the cerebrospinal fluid. contained neither leucocytes, spirochætæ nor bacteria. If the brain symptoms had been due to lesions instead of toxæmia, the cerebrospinal fluid, the writer thinks,

would have shown some pathological change.

For the local treatment of ulcerating syphilis the writer advises warm compresses of a I per cent. solution of bichloride of mercury. Bier's hyperæmic treatment also is to recommended, excellent results being had in one case from this method. The opinion that mercury fails to cure or even actually aggravates malignant syphilis is not subscribed to by the writer. He considers the choice of the mercurial preparation and the length of time for its employment to be a matter of great importance. The soluble preparations are not very powerful. The "Hirsch injection” and “Hydrargyrum colloidale" failed to give good results. Large doses of unguentum cinereum are very efficacious when the condition of the skin admits of their employment. The insoluble preparations are to be recommended above all others. The salicylate of mercury is especially useful in the beginning of the treatment to ascertain the patient's reaction to the drug and later for aftertreatment. Calomel injections are, however, the best, and are productive of excellent results in the severest cases.

(Med. Klinik, 1908. The Cure of Leprosy. No. 8). A case of leprosy practically cured is reported by Lakurane. The patient was a man 24 years of age. The disease appeared in his twentieth year as a spot on the forearm the size of a finger nail. Three years later nodules were scattered over the entire body. The treatment was continued almost without interruption for five years,

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