69 DEPARTMENTS LARYNGOLOGY AND OTOLOGY. IN CHARGE OF WILBUR W. BULETTE, M. D., PUEBLO, COL. Laryngologist and Otologist to Pueblo Hospital; to Pueblo Children's Home; Member American Medical Philadelphia, etc. Intra-Nasal Growths as Factors in Aural and Laryngeal Catarrh.Snow (Medical Record, Aug. 18, 1894,) says that he has found no case of post-nasal, middle ear, or laryngeal catarrh, which was not accompanied by marked evidence, past or present, of pressure or contact of some of the surfaces in this region. Many of these cases have shown a perfectly normal condition of nose in lower third, both inferior turbinates apparently healthy, and patients claimed that they had no trouble in breathing, each nostril being perfectly free; their complaint, as they say, "is further back or down," sometimes in the ear, sometimes in the larnyx, and oftener their only symptom is of "something dropping into the throat." A close examination of the upper portions of the nose will show, almost invariably, some point or points of contact between the middle turbinated and the septum, or the outer wall of the nose, which, though slight in many instances, is, in the author's opinion, the cause of a great, and perhaps the whole part of the trouble, particularly if the contact be persistent. (Annals of Ophthalmology and Otology, Oct., 1894.) Ear Faints and Epilepsy.-Hobby (Annals of Ophthalmology aud Otology, Oct., 1894) calls attention to the frequency with which persons affected with ear trouble faint, and manifest such peculiarities, which often distinguish the loss of consciousness in these cases from ordinary syncope, as to suggest a relationship to the minor forms of epilepsy. He thinks there. must be some physiological reason why syncope should occur so often in ear cases. In ordinary syncope there is usually more or less anticipation, as pallor, sighing, etc., but in the peculiar form mentioned the patient without warning slides down in the chair, the eyes roll up, unconsciousness supervenes without pallor, a slight stiffening of the body follows, sometimes preceded by one or two slight contractions of the extremities; sometimes there is grating of the teeth, then a gentle sigh, a look of surprise, and attack is over. Absence of pallor, of dilated pupils, of nausea before and after; presence of contractions, rigidity and the rapid recovery, mark distinction between such an occurrence and ordinary syncope. These phenomena are often observed when the ear is syringed, wiped with cotton, etc., and with little reference to amount of pain suffered. 70 Diseases of the Ear as a Complication in Epidemic Influenza.-Turnbull (Medical and Surgical Reporter, July 28, 1894, concludes the result of his observations in ear diseases following influenza, thus: 1. There is a peculiar inflammation of the ear termed influenzal otitis. 2. It almost always commences with hemorrhage, dark-blue or black bullæ are seen in the lower posterior segment of the drum-head. 3. After a time a perforation of the membrana tympani takes place, with a discharge of bloody muco-serous fluid. 4. The pain, which is severe before perforation, is not entirely relieved by it, and continues assuming more of a neuralgic character. There are subjective noises (tinnitus aurium) such as pounding, hammering and roaring, and if not properly treated by inflation, remain after all the inflammation has ceased. 5. Fatal results may follow from meningitis, abscess of the brain, and more frequently sinus phlebitis. Such cases we are called on to diagnose, being sent to our clinic as abscess of the brain. Incipient Inflammation of the Ear in Early Life.-Smith (N. Y. Medical Journal, July 21, 1894,) directs the practitioner's attention to the management of primary aural diseases, as the majority of ear diseases (except traumatism) have their incipiency in infancy and early life. The following pertinent suggestions are offered: 1. It is well to always examine the external auditory canal of the new born, and if it be free from accumulated material, the membrana tympani is found congested, the tympanic cavity. should be inflated by Politzer's method. Should this fail to relieve the symptoms, the drum-head may be carefully punctured and inflation again practiced, when immediate relief will follow. 2. It is the imperative duty of every physician to be able to promptly recognize an acute suppurative inflammation of the tympanic cavity. 3. Deaf-mutism is not of itself a distinct disease, but must be accepted as a symptom, or better still, as a sequel of an existing disease. 4. Out of 51 deaf mutes who consulted the author in the past few months, 37 acquired their affliction, while the remaining 14 were congenital. Of acquired ones, 21 resulted from scarlet fever, 9 from diphtheria, 5 from measles, and 4 from traumatism; 9 were between the ages of one and two years, 16 between two and three, and 12 between three and five. He thinks it safe to assert that most of these acquired cases would have been prevented if the pus in the tympanum had been promptly evacuated at the proper time, followed by mild antiseptic irrigation of the external auditory canal, inflation of the tympanic cavity, blood-letting and the proper care of the throat. Insane in Peril.-The Southern Illinois Insane Hospital, at Anna, too k fire at midnight January 4th, and it was not until 3 o'clock in the morning that the flames were under control. The center section and the south wing, comprising over half of the entire building, were destroyed. The north wing, machinery, laundry and kitchen departments were saved. The south wing contained the quarters of the female patients, the male patients being quartered in the north wing. All the patients to the number of 500were, it is thought, safely removed to the other building. 71 PEDIATRICS. IN CHARGE OF HUBERT WORK, M. D., PUEBLO, COL. President of the Colorado State Medical Society; Ex-Member Colorado State Board of Medical Examiners Boiled Water for School Children.-(Memphis Medical Monthly.) - The prefects in the several French departments have issued orders to the various schools, requiring that all drinking water supplied to the pupils shall be boiled, and that the cleansing of the floors, desks, etc., of the school rooms be no longer done with dry dusters and brooms, but with moist cloths, to prevent spread of dust. Once a week a thorough cleaning is to be carried out with an antiseptic. The Displacement of the Membrane During Intubation, etc.-Boaki (Budapest). (Archives Kinderheilkunde, B. xvii., H. v. vi.)—The author concludes as follows: A displacement or pushing down of the membrane during intubation occurs but seldom, and almost never produces fatal results. Rapid removal of the tube will usually be followed by expectora tion of the membrane. When this does not take place artificial respiration and tracheotomy are to be performed. The plugging of the tube is also a rare occurrence, and when it happens, the tube with the membrane is usually removed by a violent coughing paroxysm. The results, in general, were most satisfactory. The dangers are but trivial. Objective Diagnosis in Children.-It has been tacitly agreed that children cannot locate pain. Wholly true of the very young, but their ability to do so after the second semester of infancy is, I believe, not generally appreciated. A child incapable of words will rub the teething gums, or point to the ear in otitis, and to the anus if seat worms be present. The boring into the nose in the latter trouble would seem less causeless if the facility with which those parasites may be carried from the one location to the other were better remembered. Pulling at the genitals would seem to argue against this theory, since it is caused by the nervous unrest incident to teething, and to a lesser degree by cerebral irritations. But the possibility of reflex sensations from these causes is not more improbable than the dilating of the pupils which can be produced by tickling the soles of the feet. Inflammatory conditions of these parts are more often due to selfinflicted injury suggested by reflex stimuli from the irritation of some more or less distant organ, and to harsh attempts at cleanliness, than to the pathologic actions of the natural secretions. Reference to teething as a feature in diagnosis is perhaps pardonable, since there are yet in practice physicians who encourage the belief that this purely physiological process occurring to the young of the other mammalla, without being a source of local irritation even, and to a large per cent of children without any disturbance, is capable of causing in other children diseases of fatal gravity. Independent, how 72 ever, of individual belief, the fact remains that very meager success awaits the pediatricor who is not willing to expunge from his mental list of morbid etiologies, that of dentition. Mouth breathing should direct attention to the posterior nares, and suggest the presence of adenoid growths at that point, and should prevent us diagnosing as trivial, conditions which if not relieved are capable of producing permanent physical deformity of the chest. The direct result of obstruction to the entrance of air into the lungs, is of course their deficient development; a consequence of which is the contracted thorax. But a more remote result due to the faulty oxygenation of the blood from this cause, is the mental hebetude and retarded brain development. Less easy to explain is the alleviation of nocturnal enuresis by the removal of post nasal obstructions. None the less a truth because an empirical one. The unilateral purulent nasal discharge should at first glance suggest the presence of a foreign body. If the physician is fortunate enough to witness the vomiting of a child, its peculiarities will be full of meaning to him, but if compelled to depend upon description he will rarely learn more than the knowledge of its occurrence. From the spontaneous and provisional regurgitation of the surfeited nursling, to the continuous and apparently causeless emesis of meningitis, it is a symptom of functional, organic and reflex diseases of every degree of gravity. If occurring only after the child has nursed and been laid upon the left side, it is probably due to the pressure of the liver on the distended stomach. Infants sometimes refuse to suckle for the same reason. That occurring suddenly and repeatedly without nausea, expelled with force and induced by suddenly raising the patient to a sitting. posture is a messenger of menigitis. It does not yield to treatment, because the result of irritation of the pneumogastric nerve center, and from this fact is derived the rule, that little, often no, vomiting occurs if the meningeal inflammation be localized in the convexity, and also explains the equality of the pupils in many cases. Vomiting is a frequent and early prodrome of the acute fevers, including pneumonia, and very commonly is the first symptom of peritonitis. If uninfluenced by the administration of opium the fluid ejected will be spinach-green in color, at one time thought to be diagnostic. The scores of diseases in which vomiting occurs either as a prodrone or as a symptom of the developed disease, precludes their enumeration even, and certainly any attempted description of the vomica. But if it be remembered that the four primary causes of vomiting are: Irritation of the preripheral extremities of the nerves supplying the parts immediately accessory to the act itself; the terminal reference by those nerves, or to centric irritation; to mechanical obstruction of the stomach or intestines, and to sympathy, the foundation for diagnostic appreciation of this symptom is well laid. The time of its occurrence with the relation to the taking of food and the influence of position in provoking it, are each of importance. The nice distinction possible to the observant and the experienced eye, each must learn for himself, and because we can neither have them didactically taught nor read them, too many of us ignore them. And since instruments of precision have come to be so implicitly relied upon, and each organ of the body now has its specialist, the ability to observe, weigh and group symptoms, from necessity the sole reliance of our medical forefathers, has become a lost art to many of us young in medicine. A PRACTICAL MONTHLY JOURNAL of the MEDICAL SCIENCES. HIRAM CHRISTOPHER, M. D., Editor. ASSOCIATE EDITORS: Jacob Geiger, M. D., SURGERY; J. W. HEDDENS, M.D., PATHOLOGY To contributors of Original Articles, a liberal number of copies of the HERALD will be given (or mailed free of expense if addresses are furnished), and the publishers will furnish reprints at cost, application for same to be made when copy is forwarded. Illustrations will be furnished FREE for all articles requiring same, if drawings are furnished. Original Articles, Clinical Reports, Society Proceedings, Correspondence and News invited. Address all articles for publication, books for review and exchanges to the EDITOR. Address all correspondence relating to subscriptions and advertisements to MEDICAL HERALD Co., Sixth and Charles Streets. (See Publishers' Bureau.) Volume XIV } ST. JOSEPH, MO., FEBRUARY, 1895. { Single Copies, 20 ets $2 a Year, in Advanee MEDICAL EXAMINING BOARDS. An examining board, invested with the authority and duty of determining the fitness of graduates in medicine is regarded by some-possibly, by a majority of practitioners-as the prophylactic against the evil of incompetency on the part of graduates, which is to preserve the public from the evils incident to this cause or source. If the members of such boards were themselves as competent in every necessary particular as are some of the unfallen angels, such as Gabriel, we might safely leave the determination of this overtopping question to boards composed of them. Like bank directors, the members of examining boards partake too much of the frailties of human nature to be entrusted with autocratic power. The gospel of Jesus, the Anointed, is the only panacea of which the world knows anything; and if the members of examining boards were Pauls in incorruptible honesty, and thoroughly imbued with his spirit, and were themselves competent in all the branches of medicine, as are men regarded as representatives in the branches, then we might hope for much good to come of such autocratic power. Human nature is capable of many objectionable deeds, and susceptible of many evil influences, and it keeps one on the alert all the time lest he may "fall into divers temptations." A thorn lurks near every rose, possibly to suggest to us that while we are plucking the good, evil is nigh us. The imperfection that attends medical education and the consequent fitting of persons for the practice of medicine, has led to an attempt to avoid. some of its consequences by subjecting graduates to a second examination conducted by persons assumed to be disinterested; fully as competent as the instructors conferring the degree, but not subject to like temptation. This is a necessary assumption and lies at the foundation of the measure, and is really its inspiration; and this in the face of the fact that the examiners are general practitioners, while the instructors are, in the college work, |