Billeder på siden

would seem justifiable to assume that the changes in the retina in quinine amblyopia are due chiefly to deficiency of nutritive supply, and, to a lesser degree, to alteration in the quality of the nutritive supply.

"These changes, however, cannot be regarded as being specific for, or solely characteristic of quinine poisoning. No doubt many functional and organic disturbances of the circulatory system and many morbid conditions of the blood may give rise to similar pathologic changes of the retina.

"The ultimate purpose of pathologic investigation is, of course, to devise means of correcting pathologic changes, and it seemed to me that the present study could not be considered finished without some therapeutic experiments. "Treatment. The therapeutic indication in quinine amblyopia is to bring about relaxation of the constricted vessels. For this purpose de Bono tried inhalations of nitrite of amyl some weeks after the toxic injection, but he obtained no improvement in vision. From the preceding examinations it was evident that the irreparable damage is done to the retina in the first day or two after the injection, and that therapeutic efforts to be of value must be undertaken early. Furthermore, other remedies are known to be more lasting in their effects than the nitrite of amyl."-[Annals of Ophth.


Laryngologist to the East End Dispensary.

Acute Suppurative Processes in the Faucial Tonsils.

Goodale (N. Y. Med. Jour., vol. 70, no. 15) has made a study of eight cases of acute amygdalitis, characterized by the presence of intrafollicular abscesses, occurring as complications of the usual proliferative changes, with a hope that some light might be thrown upon

1. The etiologic relationship of these intrafollicular abscesses to special microorganisms.

2. Their relationship to peritonsillar inflammation.

3. Their prognostic significance, and the possibility of recognizing their presence from clinical appearances.

The phenomena of the eight cases may be summarized thus:

1. In cases with numerous intrafollicular foci of suppuration, the streptococcus pyogenes was found to be more abundant than forms of staphylococci. 2. The intratonsillar abscesses were found in two cases with, and in six cases without, circumtonsillar inflammation.

3. The cases represented clinically a severe infection, as shown by the fever, constitutional disturbance, joint pains, and acute cervical lymphadenitis. They unquestionably showed, as a whole, more disturbance than was present in twenty cases of simple proliferative amygdalitis observed by the writer.

4. The tonsils in most cases presented no clinical appearance that would enable one to determine the presence of the intrafollicular abscess. In a few cases subepithelial white spots were seen, which were conjectured to be abscesses situated immediately beneath the epithelium of the exposed surface.

5. Histological phenomena:

1. The suppurative foci were few in some tonsils and numerous in others. They varied often in size in the same specimen, being in some follicles small and barely recognizable, in others occupying most of the interior of the follicle, while in still others the abscesses were seen to have already broken through the lymphoid ring and to have discharged their contents into the adjacent crypts. 2. The amount of fibrinous exudate in the crypts was more marked in these cases than generally exists in simple proliferative amygdalitis.

3. In the six cases not attended by circumtonsillar inflammation, the intrafollicular lymph channels and connective tissue spaces near the base of the tonsil contained few or no polynuclear neutrophiles. On the other hand, in the two cases accompanied by peritonsillar inflammation, the connective tissue spaces and adjoining reticulum were crowded with polynuclear neutrophiles, and in one of these cases these cells were seen to extend in direct continuity from an abscess situated in the interior of the tonsil toward the base of the organ.

The author says the number of cases thus far observed is too small to justify definite conclusions regarding their etiology or significance. Nevertheless, the ́following hypotheses suggest themselves as possessing a reasonable degree of probability:

1. The pyogenic infection of the follicles is probably secondary to a previous infection of the crypts by the streptococcus pyogenes. This assumption is based upon the results of the cultures, upon the different ages of the abscesses as observed in the same tonsil, and also upon the fact that a marked proliferative inflammation may exist for several days and the tonsil show on excision only a few incipient abscesses. If the follicular infection were of embolic origin, we should expect the abscesses to be more nearly alike in size and to antedate the proliferative inflammation.

2. In the two cases accompanied by circumtonsillar inflammation, this complication may have been due to the discharge observed of an abscess into the efferent lymph channels.

The Bacteriology and Histology of Ozena.

Cozzolino (Annal. des Maladies de l'Oreille, du Larynx, du Nez et du Pharynx, July, 1899) contributes a most interesting paper upon this so-little-understood subject. From his clinical and histologic investigations, the author is confirmed in the belief that the veritable essence of ozena resides in the bone, and not in the mucous membrane. The affection is rebellious both to antiseptic treatment and to curettage.

Cozzolino believes that ozena begins in the bone, and that no case of ozena arises without a favorable individual predisposition-a certain morbid state of the organism which has been designated by the term scrofula. While he does not regard the bacillus mucosus as a specific microorganism of the disease, Cozzolino calls attention to the fact that it is nevertheless met with in nearly all the cases where ozenous crusts are present. The author thinks that the bacillus mucosus is the etiologic factor in the production of two of the most disagreeable symptoms of ozena-viz., fetidity and crusts-but it is by no means to be classed as the specific etiologic agent of ozena. The etiology of the bone atrophy, and, in consequence, of the mucosa also, can be found in a nutritive alteration of the

tissues of the turbinate bodies, or of one turbinate body. This change begins in the bone, and is often associated with a congenital, general, systemic disorder. The ozenous patient is born ozenous; that is to say, the child which afterward suffers with the full manifestations of the ozenous affection comes into the world with a special predisposition for these nutritive changes, which determine an erosion of the bone and its ultimate destruction, and an atrophy of the mucosa of the turbinate bodies.

The Results Following Removal of Adenoid Vegetations.

Brindel (Revue Heb. de Laryngologie, D'Otologie et de Rhinologie, vol. 20, no. 38) concludes an interesting article on the results following the removal of adenoid growths with the following observations:

1. The reflexes engendered by the presence of the vegetations disappear with the tumor which gave rise to them.

2. Persons afflicted with auricular lesions, consecutive or concomitant with the presence of the vegetations, benefit largely by the adenotomy, whatsoever be the form of the affection, with the exception of diseases of the external ear. 3. Adenotomy frequently produces a swelling of the mucous membrane of the turbinated bodies; in some patients it favors the causation of a purulent coryza; in others it provokes the healing of an atrophic coryza, with or without ozena. 4. In nearly one-half of the patients suffering constantly with hypertrophy of the faucial tonsils and adenoids, the mere removal of the pharyngeal vegetations will be followed by a spontaneous regression of the hypertrophied faucial tonsils.

5. There undoubtedly may be a return of adenoid vegetations after operation, but they are rare, in a series of 1300 operated cases there being but 1.7 per cent. of recurrences. From a clinical point of view the recurrences are to be regarded the same as the primitive vegetations, since they are identical, histologically speaking. They are susceptible to the same treatment.


UNDER CHARGE OF T. J. Crofford, M.D.

Professor of Gynecology, Memphis Hospital Medical College.

Menstruatio Precox.

Hofacker (Medical Press & Circular, vol. 68, no. 3148) reports a singular case of a girl, æt. 9, who began to learn her letters when twenty months old. About the end of the first year she began to menstruate regularly every four weeks, each period lasting three to five days, before each of which she became languid and dull. She was as tall in her second year as a girl of seven years, but since that time this rapidity of growth has ceased, so that at the present time she is only at the normal height for her age. The breasts are well developed; a rich crop of hair in the armpits and mons veneris; the labia minora and majora larger than normal; while the mental condition of the child seems to be retrograding.

In such precocities there is usually to be found some pathologic change, and this is no exception to the rule, as rachitis had been diagnosed.

The Importance of a Diagnosis of Uterine Cancer in Early Stages. Ashby (Maryland Medical Journal, vol. 42, no. 13) says:

1. Cancer of the uterus is a very insidious disease, and may reach an advanced stage before its symptoms are alarming.

2. Its early symptoms simulate those of simple functional disturbances in the menstruating woman. Hemorrhage and foul discharge are always suspicious


3. Hemorrhage during or subsequent to the climacteric period should be promptly investigated.

4. All forms of uterine disease not responding to judicious local treatment should arouse suspicion and lead to a microscopical examination of uterine scrapings.

5. Lesions about the cervix should be corrected. When not corrected they should be examined at short intervals.

6. When in doubt as to the cause of any uterine disease, investigate for cancer

The Diagnosis of Tubercular Peritonitis.

Gallant (Amer. Jour. Obstet., etc., vol. 40, no. 262) says:

1. Tubercular inflammation of the peritoneum is met with at all ages, and is most common in early and adult life.

2. It is most frequently met with in women, and between the ages of twenty and forty years.

3. It most often originates in the pelvic sexual organs, and from that point may extend to the visceral and parietal abdominal peritoneum.

4. As a primary lesion of the peritoneum, it resembles, in its inception, subsequent history and final outcome, the various forms of the same disease in other serous cavities. It may be secondary to tubercular disease in any other part of the body, especially the lungs and pleura.

5. The most distinctive features of this disease are: (a) a rather constant subnormal morning temperature, rising to the normal in the late afternoon, reaching a little above at night; (b) hypogastric pain on pressure, on walking, and when urinating; and (c) the presence of tubercle bacilli in the pulmonary, cervical or vaginal secretions.

6. Anesthetic examination in pelvic cases will often aid in clearing up the diagnosis, but when the abdomen is tensely distended with encysted fluid, unless immediately preceding operation, it will only subject the patient to useless discomfort.

7. A positive diagnosis other than by exploratory incision is in some cases impossible.

8. Early abdominal section, evacuation of the fluid, removal of the original focus, carefully avoiding any attempt to break up intestinal adhesions, thorough irrigation of the cavity with saline solution, and closure of the abdomen without drainage of any form, has been shown by later operations for other conditions, and on autopsy, to have resulted in permanent cure.

9. When confined to the pelvis, removal of the original focus usually results in a permanent cure of the disease.

10. Where fluid reaccumulates a second celiotomy will be curative or prolong life.

11. Tubercular disease in other parts, especially the lungs and pleura, is not a contraindication to operation, which will be followed by a more or less prolonged abeyance or retardation of the disease.


Obstetrician to the City Hospital.

Observations on the Morbid Anatomy of Tuberculosis in Children.

Still (Pediatrics, vol. 8, no. 8), after exhaustively considering the above subject, concludes as follows:

1. The commonest channel of infection with tuberculosis in childhood is through the lung.

2. Infection through the intestine is less common in infancy than in later childhood.

3. Milk, therefore, is not the usual source of tuberculosis in infancy, perhaps owing to the precautions taken in boiling, sterilizing, etc.

4. Inhalation is much the commonest mode of infection in the tuberculosis of childhood, and especially in infancy.

5. The overcrowding of the poorer population in the large towns is probably responsible for much of the tuberculosis of childhood, and prophylaxis must be directed to the prevention of this overcrowding, the improvement of ventilation, and the inculcation of the extreme importance of fresh air during the earliest years of life.

Treatment of Puerperal Fever by Injections of Salt Solution.

Eberhardt (Med. Press & Cir., vol. 68, no. 3148) recorded great success with injection of sodium chloride in cases of puerperal fever, and more particularly in those septic cases where vomiting is persistent and no fluids can be retained on the stomach, whereby the fluids of the body are reduced and poison more concentrated.

From the report of many experiments he showed that one liter of this 0.9 per cent. solution effectively produced diuresis which promptly eliminated the bacteria with effete nitrogenous products. After this start the circulation of the kidneys became more vigorous, and averted all future danger of concentration in the kidneys. He was supported in this favorable report by Sahli, who could vouch for the beneficial effects of the solution.

He strongly recommended the treatment to practitioners by whom it could be easily applied without any danger to the patient, which was also a serious consideration in these days of highly forced esthetics.

« ForrigeFortsæt »