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Obstetrician to the City Hospital.

Rachitic Microcephaly.

Hansemann (Berlin Cor. Med. Press & Cir., vol. 67, no. 3121) exhibited the skeletons of two cases of rachitic microcephaly before the Berlin Medical Society recently. The patients were sisters, who were admitted into hospital on Sept. 22, 1897. Both had necrotic sores on the external genitals resembling noma. They died of sepsis after a short stay in the hospital, the younger, 18 months old, Sept. 23, the elder, 24 years old, Sept. 27. The father showed some possible remnants of rickets. The mother was quite healthy. One child aged 5 has a head like the father, but no rickets, and a later born child was quite healthy. The intellectual development of the children that died was said to be normal, but the speech of the elder one was imperfect. There were abnormalities in the kidneys of both children. The changes in the skeleton were so evident that the children were looked upon as microcephalic, both before and after death. The development of the skull was backward, and showed a resemblance to the birdlike aspect of the Aztec's type. Proportion of the head to the remaining parts as in the dwarf skeleton. The brain very backward in development. The signs of rachitis were very general in both skeletons. The disturbances in the brain corresponded to those of microcephaly; the cerebellum was not covered by the cerebrum, so the sulci and gyri were not sufficiently developed, as for instance, the frontal gyrus. This was present, but not separated from the second sulcus. The temporal lobes were the best developed. The precuneus and cuneus very defective. He could not determine any connection between the microcephaly and synostosis of the cranial vault. The development of the microcephaly must begin in an earlier embryonic stage, before that of rickets comes into question. Fetal rickets, according to recent investigations, were not properly rickets. Hyperemia and slight thickening of the bones were not rickets. Cystowicz had examined 100 fetuses and newly born children, and had never found rickets; neither had the speaker, and even if fetal rickets could be assumed, it could not reach a high development during fetal life, and as the brain developed during that early period there could be no connection between the two. It should rather be assumed that with congenital microcephaly rachitis had developed that had led to the synostosis. He then showed the skull of a 9-year old child with a premature synostosis that had led to idiocy; but in spite of this there was no microcephaly, there was no limitation of the development of the gyri by compression.

Puerperal Eclampsia.

Eishelberger (Woman's Med. Journal, vol. 9, no. 2) thus sums up the main points of an article on puerperal eclampsia :

1. That eclampsia depends upon toxemia, due to overproduction of toxins, and under elimination of the same. That it is found only in the pregnant and

lying-in state.

2. That though we have many remedies, and operations indicated, we have no specific for eclampsia.

3. That in a plethoric patient we first give veratrum viride in large doses,

followed by morphine; in anemic patients begin with morphine, followed by bromide and chloral, all to be assisted by diaphoretics, purgatives and diuretics.

4. To endeavor to bring about delivery as early as the safety of the mother and child will allow; that eclampsia is a condition when further tolerance of the fetus is a question of gravity for the mother and child.

5. That veratrum viride will, in a greater number of cases, make bloodletting unnecessary and accomplish the results desired.

6. That any one line of treatment alone is not to be relied upon, each case perhaps indicating but one remedy, and again refusing to respond to the entire list.



Syphilitic Affections of the Heart.

Before a special meeting of the New York Academy of Medicine, Weber (Med. Record, vol. 55, no. 11) read a paper on the syphilitic affection of the heart. He said that, in the absence of syphilitic stigmata in a given case, it would be almost impossible to arrive at a positive diagnosis in the early stages. From the endocarditis and myocarditis of alcohol and rheumatism, syphilis could generally be excluded. Such signs as weak impulse, accentuated second sound, irregular action of the heart, faintness, dyspnoea on exertion, and angina pectoris, should always arouse the suspicion of syphilis, whether or not the patient admitted such infection. In the absence of any other satisfactory etiology, it was justifiable to assume syphilis provisionally as the cause. Even though antisyphilitic treatment failed to give marked relief, syphilis, as an etiological factor, would not necessarily be excluded.

Only very temporary benefit followed the use of the iodides alone, but if used in conjunction with mercury the effect was more marked and lasting. In a series of one hundred and twenty-five cases of constitutional syphilis that had come under his observation, and had been studied during a long period of years, the combined use of mercury and the iodides had in every instance yielded a satisfactory result.

Chronic catarrh of the trachea and larger bronchi, with proliferation of the connective tissue, he said, had been seen in syphilitics and reported. He had observed cases of pneumonia of probable specific origin occurring in women who had given birth to syphilitic infants. Neither the general nor the local lesions had improved until antisyphilitic treatment had been instituted. The diagnosis of such affections must always remain difficult until the specific bacillus of syphilis has been isolated.

Syphilis of the Liver.

Benda, before the Berlin Medical Society (Cor. Med. Press & Cir., vol. 67, no. 3121) reported the following case: The patient had been a woman, æt. 54, who had died in the 2nd internal klinik in the Urban Hospital. She had also had nephritis, ascites, and general edema. Section showed nephritis on an amyloid base. There was also general syphilis which had led to great changes in the liver. Numerous cicatrices gave an appearance of nessar lobatum thickly strewn with gummatous nodules. There were in addition broken down gummatous nodules on the skull, and several cicatrices on the bones; deep cicatrices at the base of the tongue; no general smooth atrophy, but retraction of the frenulum glottidis; a cicatrix on the external genitals, possibly the remains of the primary sore and smaller cicatrices from a previous papulous syphilide.


UNDER CHARGE of LlewelLYN P. BARBOUR, M.D., BOULDER, Colorado. Summary of the Etiology of Phthisis According to Churchill's Theory. R. W. Gardner, New York City (Journal Amer. Med. Assn., vol. 32, no. 9.) The animal system contains a phosphide element which has never yet been completely analyzed or isolated as a chemic compound. It is clearly distinct from the phosphatic elements in that the phosphorus in it is not yet oxidized. This phosphide element is an essential constituent of the brain and nerve substance, of the blood discs, muscles, spermatazoa, egg-in a word, of all the most important parts of the organism. Of all the elements of the organism it has the greatest affinity for oxygen, and is one of the first, if not the principal, of the primordial initiators of activity. It not only becomes oxidized itself, but probably initiates molecular metamorphosis of other proximate principles. Decrease in the system of this phosphide element either by excessive waste or from a deficiency of reintegration, constitutes a distinct and special morbid condition to which Churchill gives the name "phosphology." This pathologic condition leads to a decrease of oxidation, and consequently to a decrease of all vital action. When this decrease of the phosphide element attains a certain degree of intensity the oxidizability of certain compounds in the system is so diminished that they become incapable of sufficient combustion either to proceed to a higher state of vitality or to go through that process of disintegration which would lead to their excretion from the body.

This want of sufficient oxidizable phosphorus in the system is the initial stage of phthisis. The proof of this cannot be obtained by chemic analysis; 1, because the best process hitherto known for isolating the phosphide principles, cerebrin, lecithin, etc., is complicated and uncertain; 2, because they can only be obtained in such small amounts that their quantitative analysis is difficult and uncertain: 3, because, even if a sufficient quantity of the proximate element itself be obtained, it has hitherto been found impossible to separate the phosphide element without previously oxidizing it or breaking it up.

The evidence that leads to a belief in the phosphologic diathesis is briefly summarized: Certain elements are important to nutrition owing to their molecular activity. As oxidization is the primordial phenomenon of vitality, it is reasonable to conclude that the importance of the constituent elements of the system is in direct proportion to their affinity for oxygen. Of all the elements of the system phosphorus is strongest in this affinity. Again, heat is a result and a condition of activity. The heat-producing power of an element is not always in proportion to its affinity for oxygen. But phosphorus has the highest heat-producing power as well as the greatest affinity for oxygen. Looking further, we are struck with the fact that the phosphide element is especially found in all tissues whose office is to initiate vital action. A decrease of the most oxidizable element of the system leaves these tissues and organs incapable and inefficient in their action, and this makes the system susceptible of invasion by the bacilli tuberculosis.

Again, those animals, the herbivora, whose food contains none of the phosphide element-for the phosphide element does not exist as such in vegetables-are by far most susceptible to tubercular invasion. The flesh-eating animals, whose food contains the phosphide element ready found, are least susceptible. The same is true of birds as of mammals. "Tubercles" are rarely met with in birds of prey. Flesh-eating peoples have less consumption than those races whose food is mainly or wholly vegetarian.

Clinical phenomena support the theory of phosphology. There is always a waste of the phosphorus of the system preceding and during the progress of phthisis, as is shown by the increased amounts of phosphates in the urine. There is also deficient oxidization, as shown by lessened amount of urea and an increased amount of uric acid. Insane people are very liable to phthisis. There is always a great waste of phosphorus during an attack of insanity. Intense sorrow or nervous strain of any kind causes great waste of phosphorus, and it is well known that periods of sorrow or depression or great mental exertion are apt to be followed by phthisis.

Based upon this theory of phosphology was Churchill's advocacy of the use of the hypophosphite salts. But the different hypophosphite salts have different effects and are useful in different conditions of the disease. The salts should always be used singly. The combined use of the salts as in the different compound syrups that are in the market is worse than useless-it is actually often harmful.

The Influence of Dry and Elevated Regions upon the Nasal

Mucous Membranes.

Dr. Melville Black, of Denver (Jour. Amer. Med. Assn., vol. 32, no. 9.) To warm and to moisten the inspired air is the most important function of the nose. The relative humidity of Denver is 50 per cent. less than that of seacoast regions. To bring inspired air to saturation a nose in Colorado must secrete twice as much fluid as one in New York or New Orleans. To enable it to do this there must be an increased amount of blood sent to the nasal mucous membranes. The most of this increased blood supply goes to the vascular plexuses of the turbinated bodies. The diminished atmospheric pressure at Denver-three pounds to the square inch less than at sea level-enables the nose to more quickly meet the demand for an increased supply of moisture.

Increased function leads ultimately to hypertrophy. In any climate hypertrophy of the turbinated bodies finally leads to sclerosis. This occurs sooner in Colorado than in more humid climates. "Sclerosis is not to be confounded with atrophy. There is a contraction of the newly-formed tissue that compresses the vascular plexuses so that there is not sufficient serous transudation. The muciparous glands are operative, but these furnish only 10 per cent. of the necessary moisture. There is a thin, dry secretion of the anterior nares, with accumulated secretion of posterior nares. The latter is due to the effort of the posterior nasal membrane to perform the function of the turbinated bodies. There is no stenosis after the hypertrophic stage is passed. Breathing space is free unless other obstructions are present. This condition of sclerosis of the nasal mucous membrane is typic of an old resident of Colorado. It has no serious consequences.

The Colorado climate has not so happy an effect upon nasal troubles as upon pulmonary troubles Cases of hypertrophic rhinitis sent to a dry, elevated climate will at once suffer more from obstruction, but will sooner reach the condition of sclerosis with free breathing. Atrophic rhinitis is not benefited. Myxomatous degeneration is rarely acquired here, but, having been acquired elsewhere, is not benefited by removal here.

Incidentally, Dr. Black discusses effect of altitude upon vasomotor nerves. Denver is one mile above sea level. The atmospheric pressure is three pounds to the square inch less. As a consequence a person coming to Denver from sea level experiences a dilatation of his entire superficial capillary system. To keep these superficial capillaries under a state of control requires an increased amount of vasomotor nerve force. The time required by the economy to supply this additional vasomotor nerve force varies from a few days to a few weeks.

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A few evenings ago ye editor was sitting in his study looking over a little brown-covered book that he had found hidden. away in a corner of his book case. The volume bore the date 1806, and was titled "A Treatise on the Diseases of Children, and Management of Infants from the Birth." The author, Michael Underwood, M.D., was licentiate in midwifery of the Royal College of Physicians in London; physician to Her Royal Highness, the Princess of Wales; and senior physician to the British Lying-in Hospital. The dedication of the work is to the Princess of Wales, and in the preface the author states that "The very flattering Reception with which the Author's former Labours have been honored, in private Families, has induced him to devote his leisure Hours to adapt a Treatise on the Disorders of Childhood exclusively to their Use."

Carelessly turning the leaves of this book, our eye was arrested by a heading-"The Grocer's Itch." This is described as an eruption which comes in pin - head form, and dies away and appears successively in other parts, sometimes

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