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Jonathan Wright, to whom it was sent, to be from a case of chronic pemphigus vulgaris. Frequent outbreaks occurred after the original observation.
Pemphigus is a varied form of skin affection characterized by the formation of bullæ, and whether of the benign or malignant form is considered a very rare disease. The eruption on the mucous membrane of the upper air passages, which is usually secondary to the skin eruption, is noticed in all forms of the disease, being more common in the chronic than in the acute variety.
The only remedy supposed to have the slightest influence on the disease is arsenic, either in the form of the Asiatic pill or Fowler's solution. This latter remedy acted well in Bryan's case.
Atmospheric Changes and the Hearing.
Oppenheimer (N. Y. Med. Journal, vol. 70, no. 17) gives the results of his observations of the effects of atmospheric changes on the hearing of fifty patients under his observation. His investigations permit him to arrive at these con
1. The hearing in at least 70 per cent. of cases with chronic catarrhal deafness becomes worse under adverse weather conditions.
2. The degree of impairment of audition as influenced by atmospheric changes is determined to a great extent by the location and character of the pathologic process in the tympanic cavity.
3. The morbid alterations most susceptible to barometric variations are those of hyperplasia.
4. In purely atrophic changes in the middle ear, weather variations have little or no effect upon the auditory function.
5. Atmospheric influences also impair the hearing by unfavorably affecting catarrhal processes of the upper respiratory tract and Eustachian tube.
6. All things being equal, the impaired audition in chronic catarrhal otitis is diminished more (under unfavorable weather influences) in those whose general health is below par than in those otherwise healthy.
Treatment of Malignant Tumors of the Nasal Fossa.
Moure (Revue Heb. de Laryng. d' Otol. et de Rhin., vol. 20, no. 45) says, despite the large size of certain malignant tumors of the nasal fossa, despite the hemorrhage which this so readily causes, he operates in all of those tumors which are susceptible of removal, not by the exterior method, but through the natural passages. This method is simple, easily executed, without danger, and may therefore be repeated as often as is necessary, without causing the least trouble in the general functions of the patients, while it permits, much better than the external route, the complete removal of all degenerated portions. This method of procedure also admits of a view of and destruction of the point of insertion, this being done in the most of the cases by curettage or cauterization with the actual cautery, these serving to control the hemorrhage. Finally, it enables the operator to attentively observe the healing process, and therefore, in the event of recurrence, to quickly remove the reappearing growth.
UNDER CHARGE OF T. J. Crofford, M.D.
Professor of Gynecology, Memphis Hospital Medical College.
Cancer of the Womb.
Baker (Ga. Jour. of Med. & Surg., vol. 5, no. 4) says:
1. Do not rely upon pain or pronounced subjective symptoms to indicate the presence of malignant disease. If so, the knowledge may come too late to save the patient.
2. In cases of married women of child-bearing age coming under observation, when there has been absence of pregnancy for a number of years (say five or six), even though they do not complain of pelvic trouble, advise an examination, more especially if she has once borne a child.
3. Where there is lacerated cervix found and the laceration has not healed, insist upon its repair, as there is a justifiable belief that these lacerations are starting points of cancer. Treat uterine catarrh for the same reason. After labor repair any laceration that may exist.
4. Where cancer is present operate early, preferably by the vaginal route. If an abdominal section has to be made and the uterus is so bound down as not to be lifted up at all from its bed, it is best not to attempt to remove it, but sew up the wound and let the woman get what comfort she can from the short time left to her.
Surgical Treatment of Fibro-myomata of the Uterus.
Doyen (St. Louis Courier of Med., vol. 2, no. 4) arrives at these conclusions: 1. The surgical treatment of fibro-myomata should consist in their removal. 2. The bilateral removal of the adnexa by laparotomy has been generally abandoned and is only indicated as a complement of ovariotomy when uterine fibromata exist which do not cause grave symptoms.
3. The removal of fibro-myomata should be made through the vagina when the operation is easily made by that route.
4. Laparotomy is preferable when vaginal hysterectomy appears to present real difficulties.
5. Myomectomy and vaginal hysterectomy should be made by an anterior simple hemisection of the uterus or in a V-shape.
6. Large interstitial tumors are scooped out by a cutting tube and removed by lozenge-shaped morcellation.
7. The removal of large pedunculated fibromata by laparotomy presents special indications. Abdominal myomectomy is only rarely indicated.
8. The operation of choice for large and multiple interstitial fibromata is complete abdominal hysterectomy by subperitoneal decortication of the lower segment of the uterus, with closure of the pelvic peritoneum.
OBSTETRICS AND PEDIATRICS.
UNDER CHARGE OF E. P. Sale, m.D., MEMPHIS.
Cohn (Med. Press & Cir., vol. 68, no. 3140) relates two cases of this disease under his care from the same family, in which the parents were addicted to drink, one of them being tuberculous. The two brothers when children developed progressive tendencies towards ataxia. Cohn gives the following symptoms present static and locomotor ataxia, absence of patellar and Achilles reflex, cutaneous sensibility intact, though the feeling of location was disturbed, bladder and bowel normal, nystagmus, slight disturbance in speech, with Friedreich's symptomatic foot, and one of them had atrophy of the optic nerve. He differentiated the diagnosis from chorea infantilis, multiple sclerosis, tabes, hereditary syphilis, ataxic paraplegia, cerebral tumor, or hérèdo-ataxie cérébelleuse. Cohn adds the optic atrophy to the symptoms of Friedreich's ataxia. The head symptoms were tic-like, while the fingers reminded one of athetosis or chorea by their irregular movement, but partially present during repose as in the ataxia of tabes.
The disposition to the disease is assigned to the drunken habits of the father and an attack of scarlet fever which they had had when young; but drinkers are notably common origins of the disease. The therapeutics he recommends are nourishing diet, massage, and compensating exercise similar to that of Fraenkel.
The Causation of Night Terrors.
Little (Pediatrics, vol. 8, no. 8) from a careful study of the subject, deduces thusly:
1. Night terrors are in the great majority of cases caused by disorders productive of moderate but prolonged dyspnea.
2. A preponderating number of cases are found in rheumatic subjects with early heart disease.
3. A considerable proportion of cases is due to obstruction of nasal cavities and fauces.
4. Digestive disturbances do not play the important part in causation that is often assigned to them.
5. The evidence for their causal connection with epilepsy or allied neurosis is scanty.
6. The attacks occur in the subconscious stage of early sleep, and are confined to young children under puberty.
Pneumonia in Infants; Diagnosis and Treatment.
Northrup (Medical Age, vol. 17, no. 20) says the best three signs of obscure beginning pneumonia in infants under two years are:
1. Disturbance of pulse-respiration ratio, so that it departs from the normal of 4 to 1 and approximates 3 to 1.
2. Fever: continuous, intermittent, or remittent.
3. Râles: fine.
Treatment. (1) Hygienic fresh air. (2) Dietetic: avoiding indigestion and flatulence. (3) Hydropathic: baths or packs.
Poultices, for pain only, should be used intermittingly.
Heart stimulants: strychnine, nitroglycerine, alcohol, digitalis, when needed. Antipyretics (coaltar products) are mentioned only to condemn them absolutely.
CLIMATOLOGY AND PHTHISIOLOGY.
UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., BOULDER, COLORADO.
State Aid in the Treatment of the Tuberculous Poor.
[The following editorial from The Outlook, a weekly magazine of news and literature, published in New York, shows that the intelligent laity have learned the need of a vigorous campaign against tuberculosis, and are ready to co-operate with the profession in an effort to make an end of the ravages of this dread disease. The campaign of education which the profession has been waging has not been in vain. The time for a campaign of active warfare is approaching. Let every State take up the work that is already inaugurated in New York. Let there be a forward movement all along the line.-L. P. B.]
The New York State Legislature will, during its coming session, be asked to consider many bills of vital importance to the people of the State. None will surpass in importance those presented to provide State aid for consumptives. The yearly death-rate in this State from consumption is placed at thirteen thousand; the same authorities place the number of consumptives found yearly within the bounds of the State at fifty thousand. The health boards of the cities have called attention again and again to the constant recurrence of this disease in the same houses, especially in the tenement-house section. Maps have been issued bearing marks to show houses where the disease is always found in the city of New York. Such measures as the health boards can take to prevent the spread of the disease are taken, but the victims go about in workshops, stores, street cars and boats, ignorantly spreading the danger. The time has come for the people of the State to urge the establishment of small cottage colonies, where those who have a chance to recover may live under conditions most conducive to that end. Other colonies should be established, not too remote from our large cities, where those who cannot be cured may live in comfort under the best medical supervision and care, no longer a menace in home and work-shop, spreading a disease that uncontrolled is a scourge. The disease can be stamped out if science and intelligence, supported by public funds, are used to protect the health of the people."
Biers' Treatment of Early Joint Tuberculosis.
Biers' method of treating early joint tuberculosis is attracting considerable notice, and is worthy the attention of the general practitioner because of results claimed and because of its simplicity. The treatment consists simply in ligating the member above the affected joint with an elastic bandage of medium width. This is applied several times a day for a period varying from ten minutes to one hour, the bandage being only sufficiently tight to impede the venous circulation. The curative principle of the method seems to be in the fact that the locally increased carbonic acid gas and an increased phagocytosis attacks the microorganisms. The results of this treatment have been so prompt and so universally good in tuberculous joint disease, and so decidedly negative in joint disease due to other causes, that it is considered to be of great value for diagnostic purposes. It is said that if considerable relief is not given after two or three applications, it may be assumed that the joint is not tuberculous.
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THE PRESCRIBING OF PROPRIETARY REMEDIES. Recently there was held in this city a joint meeting of the members of the Memphis Medical Society and of the local druggists (see page 571). The object of this meeting was to discuss matters of mutual interest and to promote fraternal relationship between the two elements, but, finally, the only question that received much consideration at the hands of the meeting was that of the prescribing of proprietary remedies. Several good papers were read, which had this subject as their motif, and after some little discussion the pièce de résistance came in the way of the introduction of a resolution by a prominent member of the Society which was, in the event of its adoption, to bind the members of this Society to an agreement that they would not, in future, continue to use proprietary remedies. This resolution, very naturally, was not adopted as originally read, but the introduction of an amendment to the motion secured its adoption in the sense that the Society acknowledged the practice of prescribing such agents as reprehensible.