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at the floor of the nose. 3. Overlap cut edges and introduce splints. 4. Treat antiseptically for two weeks.
[For all practical purposes, and what really gives us most promise of obtaining relief in these troublesome cases, it seems to us that the Asch operation presents claims above them all. For simple deviations, however, Bosworth's method of removing the redundancy with a fine saw is satisfactory to a degree.-ED.]
Transplantation of Cartilage into the Larynx.
At the German Surgical Congress Dr. von Branegoldt, Dresden (Med. Press & Cir., vol. 67, no. 3134), gave a note on this subject in connection with some cases of stenosis of the larynx. In some cases of stricture dilatation did not always lead to recovery, and scarcely to improvement. In such cases success could only be attained by resection and the implantation of fresh firm tissues into the stricture. The transplantation of hyaline cartilage had not, up to now, been attempted, but he had practiced it in four cases with success, where there was defect of cartilage. In one case, that of a child, there was extensive papillomatous growth on both vocal cords. Laryngofissure was performed, the papillomata removed, and the surface cauterized. After five or six weeks stenosis was apparent, which could not be overcome by dilatations, nor could it be kept from getting worse. It was not possible to implant soft tissue, as on inspiration it would have been drawn in like a flap. He then attempted to implant rib cartilage with the perichondrium. The cartilage was first of all implanted into the skin, and then the skin made firm by the cartilage into the larynx. Intubation was also performed. The success was complete. The patient breathed and spoke well. He had endeavored to discover whether the cartilage had remained alive or not after the implantation. Some weeks ago he implanted some cartilage from a rabbit under the skin of the back, and showed in a microscope specimen young vessels passing into the cartilage, a proof that it remained alive. A Case of Multiple Nodules of the Vocal Bands.
Compaired (Revue Hebdomad. de Laryngologie, &c., vol. 20, no. 19) reports having found in a barytone singer of the Madrid Opera Comique, aged 32, two double singer's nodules on both vocal bands, two to each band. Joined to this was an intense subacute laryngitis, and a cystic tumor on the right side of the epiglottis. The neoplasms were removed with a Jurasz forceps. Recovery was complete, the singer shortly afterward resuming his vocation.
Compaired regards this case as interesting on account of the multiplicity of the lesions, the fact that this condition was present in a barytone singer, and on account of the resistance of the vocal organ, which permitted the patient, despite the condition present, to pursue his vocation.
UNDER CHARGE OF T. J. CROFFORD, M.D.
Consulting Gynecologist to St. Joseph's Hospital, Memphis, Tenn.
Treatment of Endometritis by Drainage and Irrigation.
Dr. Augustin H. Goelet, of New York, in a paper presented to the Section in Gynecology of the American Medical Association, drew attention to the error of regarding every uterine discharge as evidence of endometritis, and treating such conditions by caustic and astringent applications which coagulate the secretion and defeat drainage by blocking the orifices of the glands. This and destructive curettage he designates unscientific. Hyperemia with hypersecretion, often mistaken for endometritis, requires no local application, in fact is often converted into an endometritis by such treatment.
The danger of inserting instruments into the uterus, either for the purpose of diagnosis, treatment, or for operations, when there is a so-called catarrhal endocervicitis, was pointed out. He declared that the staphylococci, streptococci and gonococci are often found in the cervical secretion when it is most inoffensive in appearance, and that their presence or absence can only be determined by microscopical examination of the discharge. He insists that this method of examination should always be made use of in these cases before the cavity above the uterine os is invaded, either for the purpose of diagnosis, treatment, or operations within the uterus.
In endometritis the disease is not confined to the surface, but has invaded the glandular structure beneath, and he believes the rational treatment is to free the orifices of the glands and drain them until the infection process is exhausted, at the same time employing repeated irrigation with a non-astringent, non-irritating solution, to remove the expelled secretion from the surface and prevent migration of infective germs. This may be accomplished by a carefully executed curettage, done in a manner not to destroy the mucous membrane but merely for the purpose of removing projecting granulations upon the surface or superfluous tissue which may be blocking the orifices of the glands and preventing drainage. The dull curette, with rigid shaft, he thinks, is sufficient; and the sharp curette should not be used upon the endometrium in endometritis. It is both unnecessary and unwise to attempt to remove the entire mucous membrane, and caustic applications should not be used after curettage. They cause necrosis and atrophy of the mucous membrane, or agglutinization of the sides of the cavity may result.
He urges that curettage should only be regarded a preliminary step in the treatment, and that more attention be given to the after treatment, which he deems most important. This to consist of persistent drainage and irrigation until all evidence of disease, as revealed by microscopical examination of the discharge and inspection of the endometrium by means of the uterine endoscope, has been effaced.
He also urges endoscopic examination of the cavity, both before and after curettage; before, to decide the actual necessity therefor, and after, to determine the completeness or incompleteness of the work. In this way only can errors
He exhibited a perfected uterine endoscope with a small electric lamp placed at the extremity of the tube for direct illumination of the interior of the uterus, after the plan of the Valentine urethroscope. A megaloscope is attached for bringing out more prominently the details of the surface. By means of this instrument satisfactory inspection of the uterine cavity, including the orifices of the tubes, is made possible.
Organotherapy in Inoperable Carcinomata.
Dorland (Therapeutic Gazette, vol. 23, no. 5) reviews the literature of the subject of organotherapy in inoperable carcinomata. This plan of treatment was first suggested by Dr. George Beatson, before a meeting of the Edinburgh Medico-Chirurgical Society in 1876. Since then several other investigators have experimented with the method of treatment suggested by Beatson. Dorland has treated three cases of inoperable carcinomata after Beatson's plan, and from his observations deduces thusly:
1. The ovaries exert a curious and as yet incomprehensible influence over the tissues of the body, and especially over the mammary glands.
2. This ovarian influence is in part neutralized by the action of the thyroid gland or of thyroid substance introduced into the body.
3. The administration of thyroid extract alone to patients suffering from cancer of the mammary gland or of the cervix uteri which has passed beyond the possibility of extirpation by the knife exerts a slight inhibitory action upon the growth, and results in a decided relief of the two prominent symptomspain and discharge. This action, however, appears to be but temporary.
4. The removal of the ovaries in cases of inoperable carcinomata, provided these organs be actively functionating, will result in many cases in an arrest of the progress of the malignant disease, or even in a total destruction of the neoplasm and an apparent cure of the condition.
5. This inhibitory action of oöphorectomy in inoperable carcinoma is more decided if at the same time as much of the cancerous growth be excised as is possible, and the operations be supplemented by the administration of thyroid extract in full doses.
6. In older women, in whom there has already occurred an atrophy of the ovarian stroma, excision of these organs does not result as promptly nor as favor ably as in women who are passing through the period of sexual activity.
7. The relief afforded by the employment of Beatson's method appears in from twenty-four to forty-eight hours, and in favorable cases is r. pidly progressive. 8. The dose of the thyroid extract that may be safely employed varies from 10 to 15 grains daily.
9. It would seem that even though this method should not result in an abso lute cure of the malignant disease, it would afford a longer lease on life and more effectual relief from suffering than would any other palliative operative procedure as yet devised.
Simultaneous Disease of the Appendix and Female Pelvic Organs.
At a recent meeting of the Berlin Surgical Society, Dührssen (Med. Press & Cir., vol. 67, no. 3133) read a very interesting paper in which he said it was the duty of the gynecologist to treat other diseases of the abdomen in the course of operation for disease of the female pelvic organs. For years he had turned
his attention to the relations of the gall bladder, and also to changes in the vermiform appendix, which he had removed nine times in a total of 320 abdominal operations. He had noticed that in disease of the adnexa, appendicitis and attachments of intestine to the adnexa and the broad ligament were not infrequent. The appendicitis was always simple. Sometimes in the case of large pelvic abscesses he had removed the adnexa, the vermiform appendix and the uterus. He recommended the incision in the linea alba.
OBSTETRICS AND PEDIATRICS.
UNDER CHARGE OF E. P. SALE, M.D., MEMPHIS.
Peruvian Balsam and Scabies.
The common employment of balsam of Peru in the treatment of scabies lends additional interest to this report of two deaths in children following its use. The Medical Press & Cir., vol. 67, no. 3129, is our authority.
At the Societé de Dermatologie M. Hallogeau related two cases of death in children after the application of the treatment of scabies by balsam of Peru. He thought that these fatal results were due to impurities of the drug, but it was possible that the child presented as regards that agent a much greater susceptibility than an adult.
M. Fournier said that he constantly employed pure balsam of Peru in the treatment of scabies in adults and children, and never met with an accident. Another speaker said that he had renounced the use of pure balsam on account of its too adhesive properties, in favor of a 30 per cent. mixture with vaseline. Acetanilid Poisoning from External Absorption in an Infant.
Westcott (Pediatrics, vol. 7, no. 12) reports a case of acetanilid poisoning in a female infant, 4 months of age, the child of a brother practitioner. She was a fat, well-developed baby, nursed entirely upon the breast; and during the hot weather of last summer she perspired freely and became chafed in the folds of the groins and the creases of the thighs, a mild eczematous condition existing in a small portion of the areas affected. For this the father had ordered a dusting powder of pure acetanilid. Three hours after the drug was applied the whole surface of the body showed a peculiar grayish pallor, and the lips were bluish, though the surface temperature was not thought by the mother to be lower than usual. The cyanosis increased for an hour and a half, the face became pinched and drawn in appearance, and the baby was in a profound slumber, from which she could not easily be aroused. When the father first saw her, four or five hours after signs of poison were first noticed, the cardiac action and respiration were not appreciably disturbed. The remains of the powder were not removed till this time. Recovery gradually ensued without any more active treatment than small doses of whiskey once or twice repeated.
In this case the actual amount of surface capable of directly absorbing the drug was very small, and in no way comparable to the area of surface exposed in other cases so far recorded. The report concluded by deprecating the free use of so dangerous a drug under any conditions in young children, and considered that the existence of any break in the surface should demand the greatest caution in its use, if indeed this should not be judged a positive contraindication.
SYPHILOLOGY AND NEUROLOGY.
UNDER CHARGE OF C. TRAVIS DRENNEN, M.D., HOT SPRINGS, ARK.
The Justus Test for Syphilis.
Cabot and Mertins (Boston Med. & Surg. Journal, April 6, 1899) record their experience with the method of Justus, of Budapest, who some two or three years ago originated a test which he claimed would determine a diagnosis in doubtful cases of syphilis. The test, in short, depends upon the sensitiveness of the red blood corpuscles in syphilitic persons to the action of mercury administered by inunction or by subcutaneous or intravenous injection. Justus holds that this sensitiveness is greater in syphilis than in any other disease-so much so that the administration of the drug is followed a few hours afterward by a sudden fall in the percentage of hemoglobin. In 300 cases of syphilis observed by Justus in which mercury was given, a sharp fall of 10 to 20 per cent. was recorded in the hemoglobin, while among control cases, in which syphilis was not present, no such fall was noticed.
This article by Cabot and Mertins is quite a valuable contribution to the subject. The authors state that in the summer of 1898 they tried the test in the out-patient department of the Massachusetts General Hospital in 98 cases of undoubted syphilis, 4 cases suspected of being syphilitic, and 33 control cases of various other diseases. a total of 44 cases. From fifteen to forty grains of the unguentum hydrargyri were "inuncted" into each patient, with the result that all the syphilitic cases reacted strongly and characteristically, while in 33 control cases there was but one genuinely positive reaction. In 7 active syphilitic cases the loss of hemoglobin after one inunction averaged 21 per cent.
The experiments of these two observers tended to confirm the conclusions at which Justus had arrived, with two exceptions. One was the case of a girl suffering from chlorosis. Despite the fact of the complete absence of syphilis in her, a typical positive reaction was obtained with a loss of 13 per cent. of hemoglobin. The other was in a case of tertian ague, where a loss of 10 per cent. of hemoglobin was noted. The latter condition, the authors believe, can be accounted for by the agueish attack occurring just after the administration of the mercury.
The authors offer no explanation as to the cause of the loss of hemoglobin in the first case, but express the opinion that so far as it goes the case certainly tends to diminish the value of the test which Justus has introduced. It is to be hoped, however, that further investigation may be made in this same direction. Ossificating Role of the Dura Mater.
At the Academie de Medecine M. Chipault (Med. Press & Cir., vol. 67, no. 3128) spoke on the role of the dura mater in repairing the osseous tissue of the cranium. He said that he was always opposed to cranial operations leaving intact the dura mater subjacent to the osseous orifice. He had the conviction that those of his patients he had trephined, and in whom he had removed this membrane, gave him results much superior to those in whom he had left it intact or sutured after incision. He was glad to be able to state clinical facts confirmed his opinion, for they showed that in those operations where the dura mater had