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condition. An entire rest from business and a prolonged stay in the country finally brought on the desired change. In two of the cases observed no local treatment was applied, as there were other conditions of greater importance which had to be looked to.
The author states that the diet should be arranged to correspond with the state of gastric secretion after the general well-known rules. Very coarse articles of food and highly-seasoned dishes should, however, always be avoided.
Lastly, Einhorn calls attention to the following points mentioned in a previous article: "Cold ablutions, light gymnastics, outdoor life, are to be warmly recommended. Of medicaments, condurango and nux vomica are frequently, and a good, easily-assimilated iron preparation always, appropriate."
Oxaluria - Its Clinical Significance.
Williams (Maryland Med. Jour., vol. 41, no. 20) has been induced, by having a number of cases in which the presence of calcium oxalate crystals in the urine was a marked symptom, to make a study of these cases, from which he derives the following deductions:
1. Whereas the appearance of oxalates in the urine, excluding their ingestion in foods, is due to a derangement of digestion or metabolism, this derangement probably has its cause in many cases in functional nervous irregularity, which may or may not be so great as to produce general nervous symptoms, and if these be present they are not necessarily caused by the oxalates.
2. The condition causing the appearance of oxalates in the urine may produce symptoms closely simulating the constitutional symptoms of Bright's disease.
3. The excretion of oxalates by the kidney for a short while may occasion no local disturbance of that organ, but if continued may, by irritation, cause the appearance of albumin and casts, with lessened urine, corresponding to the urinary symptoms of Bright's disease, and if unchecked may lead to permanent destruction of kidney tissue and true Bright's disease.
4. In all suspicious cases in which the nephritic symptoms are accompanied by the appearance of oxalates in quantity, diagnosis should be held in abeyance and the oxaluria overcome by appropriate remedies, to exclude this as a possible cause of the symptoms, before making a positive diagnosis and pronouncing a necessarily hope-dispelling prognosis.
UNDER CHARge of W. B. Rogers, m.d.
Professor of the Principles and Practice of Surgery and Clinical Surgery,
Traumatic Aneurism of the Dorsalis Pedis Artery.
Manley (Int. Jour. of Surg., vol. 12, no 5) says that traumatic aneurism is a condition rarely encountered, and almost invariably proceeds from a punctured or an incised wound of an artery. In the former the vessel walls are pierced through; in the latter, only the adventitia and muscularis are divided, when a vertible hernia of the serosa makes its way up through the incision, becoming somewhat thickened by inflammatory deposits.
The arteries of the hand and foot are deeply lodged, interposed between osseous structures, and are so fixed by the ligamentous structures through which they course that retraction of their divided lumina is not ample, to permit the free inversions of the intima necessary to serve as a tampon. Want of judgment and skill in treatment is an important contributing factor. The wound of a large branch, or of one communicating with the palmar or plantar arches, gives immediate issue to a hemorrhage of dangerous magnitude.
Watery, impoverished, aplastic blood is a serious impediment to surgical hemostasis, and atheroma or interstitial degeneration of the muscular coat of an artery diminishes the vessel's resiliency or contractibility and favors leakage; besides, these pathological states retard, or render repair imperfect. It is, therefore, probable that in some instances after the puncture has closed in the cervix the cicatrix later gives way and a sacculation of the vascular wall follows.
The site of injury has an important bearing, as the greater number, for various anatomical reasons, appear in certain regions; thus, in the days of blood-letting, Dupuytren declared that he had met several cases of arterio-venous aneurism at the elbow every year, and Brechet noted that punctured wounds over the dorsum of the hand or foot were a frequent site of arterial hematoma. That these aneurisms were much more common in olden times than now, can hardly be doubted, because of painful manipulation in the search for the punctured vessel, the danger of infection, and the want of an absorbable suture.
The dominant etiological factors in these lesions are four:
1. The condition of the blood (hemophilia).
2. The condition of the blood vessel.
3. The site of hemorrhage.
4. Injudicious treatment.
The author reports a case of aneurism of the dorsalis pedis artery occurring in a woman, due to injury of the wall of the vessel by a large fragment of an exploding beer bottle. In operating this case no Esmarch bandage was employed, for the reason that the pulsating vessel was somewhat depended on for a guide. A free incision was made through the integument and fascia, down to about the depth of the vessel. This was extended well forward and through the webbing of the two first toes and plantar fascia. This permitted free inspec tion and manipulation when the toes were well separated. There was now no difficulty in seizing the dorsalis pedis and ligating it, but there was a large communicating branch coming up from the plantar arch between the roots of the toes. This was sought out with difficulty and finally ligated. Then the artery was divided and the aneurism displaced.
After the deep gash was well cleansed and dried it was closed completely by catgut suture, without drainage. The wound healed promptly, and since then there has been no further trouble.
The features of special interest in connection with this case are:
1. Its unusual character and the importance always, when a deeply-lodged artery is wounded, of searching for and ligating the bleeding vessels at the first dressing.
2. The importance of always making a free incision when we search for a bleeding artery, and of avoiding the employment of elastic constriction, unless there are some special reasons for being economical in the loss of blood.
3. It has been noted that since this woman was exsanguinated a marvellous change has taken place in her general health, her sleep, appetite, and digestion. This is of significance, as pointing out the satisfactory effects which will quite invariably follow vascular depletion in many disordered conditions of the system. In the author's experience there is no single therapeutic agent which renders more decisive and salutary effects than the local or general abstraction of blood, for many both chronic or acute inflammatory conditions.
UNDER CHARGE OF A. G. SINCLAIR, M.D.
Professor of Ophthalmology, Otology and Laryngology, Memphis Hospital Medical College; Ophthalmic, Aural and Laryngeal Surgeon to St. Joseph's Hospital; Ophthalmic and Aural Surgeon to the City Hospital,
Ocular Evidences of Hysteria.
Wood (Amer. Jour. Med. Sci.) points out the fact that the ocular evidences have not received the attention which they are entitled to in hysteria. He reviews and discusses the various eye signs of hysteria, illustrated by the history of a number of examples, and concludes as follows:
"1. Most cases of hysteria present well-marked, easily - detected eye signs and symptoms.
"2. A few ocular symptoms, such as reversal of the relation of the color fields and the field for white, the tonic form of blepharospasm, spasm of accommodation and convergence, and pseudo-paralytic ptosis, may be regarded as pathognomonic of hysteria.
"3. Defects of vision (in the absence of refractive errors, accommodative anomalies and fundus lesions) are, generally speaking, hysterical if accompanied by photophobia and any form of blepharospasm.
"4. No examination of a patient for hysteria should be regarded as complete without considering the condition of his optical apparatus.
"5. Where there is no conclusive external evidence of the neurosis present, the perimeter should be carefully used, the range of accommodation should be noted, and the ophthalmoscope employed.
"6. It should always be remembered that ocular hysteria is common in children and men.
"7. Organic disease (traumatism, especially) of the eye, may accompany purely functional disturbances of that organ."-[Annals of Ophth.
Danger to the Eye from Ligation of Common or Internal Carotid. Siegrist gives two cases: 1. Ligature of the common and internal carotid for hemorrhage following operation for carcinoma of the tongue; sudden blindness on the side of the ligature, presented the feature of embolism of the central artery of the retina, section six days later; ascending thrombosis from the site of the ligature and extending six millimeters into the ophthalmic artery; central artery blocked near its origin by an embolus, the latter being overlaid with a thrombotic mass. The retinal changes concern the inner layers. Infiltration
advancing from periphery to center of cornea, with small central ulcer, and pecu liar changes in the epithelium.
2. Pulsating traumatic exophthalmos, ligature, blindness on the same side embolic in character; five months later, atrophy of the papilla; choroidal vessels all visible, partly normal, partly sclerosed; fine pigmentation of the retina. After a year and a half the macular region showed no sclerosis, but still fine flecks of pigment; in the upper part of the fundus the choroidal vessels were completely sclerosed, and the retinal pigment was heaped up in masses around this area. [Annals of Ophth.
The Absorption Power of Potassium Iodid After Cataract Operation. Wicherkiewizc, Krakau, recommends the exhibition of iodid potash in all cataract cases after operation where the cortical substance is not freely absorbed, as well as in discission cases, and especially during the operative treatment of high myopia. It is necessary to give large doses, ordinarily from 3.00 to 5.00 grams, and sometimes as high as 10.00 grams, a day. Under exhibition of this medicine in sufficient quantity, the necessity for so many operations following cataract extraction is eliminated.-[Annals of Ophth.
NOSE, THROAT AND EAR.
UNDER CHARGE OF RICHMOND MCKINNEY, M.D., MEMPHIS.
Laryngologist to the East End Dispensary.
Serum Therapy in Ozena.
The vogue given the serum therapy of ozena by the announcement of the results obtained by Belfanti and Della Vedora in the treatment of this condition with injections of anti-diphtheritic serum has resulted in the publication of the observations of various other observers. The latest of these is Frankenberger, who, in the Klinische Therapeutische Wochenschrift, nos. 39-40, 1898, as abstracted by S. Jankelevitch in the Revue Hebdom. de Laryngol., etc., for December 17, 1898, reports thusly:
The author has treated three cases with injection of anti-diphtheritic serum after the method of Belfanti and Della Vedora. The first patient received, from October 9, 1897, to February 14, 1898, thirty injections, representing 26,600 units. These injections did not arrest the crust formation, but after January 11, 1898, the patient could not take the injection every two days, and once was obliged to rest four days without treatment. The crusts formed in good quantity in the nose, but gave off no odor; the membrane appeared redder and more swollen. A similar result was noted two and a half months after treatment closed.
The second patient received, from October 12 to December 14, 1897, eighteen injections, 14,200 units. During the treatment the nose was douched twice a week. The nasal condition improved to the extent of diminution of crust formation and entire freedom from any odor The patient was seen five months after treatment was stopped. Neither crusts nor odor were detectable; the membrane was very red, entirely normal in appearance.
Similar results were obtained in the third case, which is still under treatment, but has received thirteen injections, 13,000 units. With no desire to attribute a specific value to these injections, it must be admitted that their action on the mucous membrane was very favorable, both in modifying the secretion and in lessening its tendency to desiccation, and that although crusts are formed, they are freed from the specific odor of ozena.
Despite these results the author does not believe that the favorable action of these injections proves the parasital origin of ozena, nor that this affection is caused by the bacillus of Loeffler. In one case the author has obtained results exactly similar to those derived from serum therapy by injections of a saline solution. The patient, who had been affected with ozena for eight years, received, in all, fifteen injections of the saline solution, which were followed by considerable improvement. If this last observation can be confirmed by others of a similar nature, our conception of the serum-therapy treatment will have to undergo considerable modification, in the sense that the conclusion would have to be formed that in ozena, as in other infectious maladies, the serum solutions act not on the microbe, the cause of the disease, but on the human organism, its nervous system, by stimulating its power of resistance.
Non-Diphtheritic Pseudo-Membranous Rhinitis.
Price-Brown (Jour. Amer. Med. Assn., vol. 32, no. 18) reviews the literature of pseudo-membranous rhinitis, and cites cases to prove that there may be a non-diphtheritic form of this disease. Two cases of his own are related in this connection. In closing his paper the author draws the following conclusions:
1. That non-diphtheritic pseudo-membranous rhinitis does sometimes occur; and, though a very rare disease, it is probably as frequent as primary nasal diphtheria.
2. That on clinical grounds alone it is possible, in a majority of cases, to distinguish it from genuine diphtheritic disease.
3. That owing to a possible mistake in diagnosis, isolation in all cases should be imperative, until a reliable bacteriologic examination can be made.
Apropos is a paper on the relation of fibrinous rhinitis to diphtheria, contributed by Middlemas Hunt to the meeting of the British Medical Association held last year, an abstract of which we find in the Revue Hebdomadaire de Laryngologie, D'Otologie et de Rhinologie, of April 29, 1899, in which, after reviewing three cases observed by him, Hunt formulates the following conclusions:
1. While admitting that other microorganisms besides the bacillus of Loeffler may cause a membranous exudate in the nasal fossæ, the majority of the cases are due to the bacillus of Loeffler.
2. It is impossible to alone clinically distinguish this rhinitis from the mild nasal diphtheria.
3. Every case of fibrinous rhinitis ought to be considered diphtheritic, even though the contrary has been proven by a bacteriological examination worthy of belief.