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Infection of operation wounds by drops of saliva from the operator: Hotta performed experiments similar to those of Hubener, but modified them in view of the special conditions present in eye operations. He found that a veil of doubled muslin does not absolutely prevent the spraying of the saliva. But he believes that in eye operations this is certainly sufficient to prevent infection from the mouth. The possibility of infection from the saliva during the operation cannot be absolutely denied, yet it must be so rare that in eye operations in general a special measure to prevent it does not seem necessary.
BY WILLIS SIDNEY ANDERSON, M. D., Detroit, Michigan. ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE DETROIT COLLEGE OF MEDICINE.
REMARKS ON THE MACROSCOPIC DIAGNOSIS AND GENERAL INDICATIONS FOR TREATMENT OF
CANCER OF THE LARYNX.
DOCTOR JOHN NOLAND MACKENZIE (Annals of Otology, Rhinology and Laryngology, March, 1906) makes some positive statements in regard to this much dreaded disease. He states that in the present state of our knowledge there are three principal methods of diagnosis in laryngeal cancer:
(1) The naked eye method, or diagnosis by direct inspection, supplemented by clinical phenomena.
(3) The microscope.
Take it all in all, the first method is the most practicable and satisfactory of the three. The author insists very strongly on the application of the naked eye method of diagnosis in the case of malignant tumors of the larynx. Every recourse and refinement of clinical diagnosis, including the exclusion of syphilis by the iodides, and tuberculosis by tuberculin, should be resorted to before appeal to the microscope is made. By following the lead of the general surgeon, with the means of clinical diagnosis at our command, together with the more exact information concerning the naked eye appearances of the cut surface of laryngeal neoplasms, we will soon be in a position where we will be more and more independent of the pure pathologist for help in diagnosis.
The objections urged against the indiscriminate removal of tissue for examination, especially when done through the natural passages, are as follows:
(1) It subjects the patient to the danger of autoinfection at the point of incision and to metastasis elsewhere.
(2) It stimulates the local growth of the cancer.
(3) Finally, the method is often inconclusive, misleading, and sometimes practically impossible.
In practically all cases of laryngeal cancer, death is due to metastasis. In neighboring organs (the neck and mouth) metastasis takes place with certainty and at an early date. It is, therefore, probable that the glands of the neck are affected in cancer of the larynx, although perhaps not recognizable by the senses of sight and touch, at a much earlier period than is generally supposed. It is at all events safer to assume this to be the fact than to accept the statement, unsupported by definite anatomical proof, that cancer in the interior of the larynx remains for a more or less indefinite period as a purely localized disease, and does not get into the lympathics of the neck until a late stage of the affection.
The author is very much opposed to intralaryngeal operation, and, in a general way, is pessimistic in regard to the permanent cure by surgical measures, although advocating the thorough removal of the growth if seen in the earlier stages.
BY LOUIS JACOB HIRSCHMAN, M. D., DETROIT, MICHIGAN.
CLINICAL professor OF PROCTOLOGY IN THE DETROIT COLLEGE OF MEDICINE.
LOCAL AND REGIONAL ANESTHESIA IN RECTAL
COOKE (Jama, Volume XLVI, Number XXII) states that in the last twenty months he has employed local anesthesia in seventy cases of rectal and anal surgery comprising thirty-eight cases of internal hemorrhoids, two of prolapsus ani, five of fistula, nine of fissure, and sixteen of external hemorrhoids.
Pressure anesthesia by means of injections of sterile water or weak solutions of anesthetic drugs, was employed in all cases. For fissure and external hemorrhoids, 0.25 to 0.5 per cent beta-eucain solutions were used to anesthetize the integument in preference to sterile water anesthesia. From personal experience Cooke feels warranted in claiming for local anesthesia in rectal surgery, the following advantages:
(1) It is simple, safe and effective.
(2) It eliminates the dangers and discomforts of general anesthesia. (3) Pain at the time of operation is usually absent and always so slight as to be easily borne.
(4) Postoperative pain is less by far than after the old methods. (5) Time required for the operation is greatly reduced.
(6) Confinement to bed is rendered a matter of expedience, rather than necessity.
(7) The period of detention from business is diminished fully one
(8) Under this method the hospital becomes a convenience and luxury rather than a dreaded essential.
(9) It is a thoroughly reliable means of affording relief in many cases which would otherwise be unsuitable for operation.
(10) It robs these operations of their terrors and makes it possible to reclaim this work from the hands of the "no knife" advertisers.
BY WILLIAM FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.
CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.
JAMES FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.
ASSISTANT IN DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.
"A NOTE ON THE TREATMENT OF SIMPLE WARTS BY INTERNAL REMEDIES."
UNDER this title Arthur Hall refers (British Journal of Dermatology, March, 1906) to a case previously reported by him in which numerous warts of the scalp, of two years duration, disappeared in two to three weeks' time under the administration of mistura alba thrice daily. Doctor Chalmers Watson had claimed that it was not the drug but the purgation which accomplished the result, and Hall now reports a case seeming to bear out that theory.
A girl, age fourteen, came to his clinic almost incapacitated by reason of warts on wrists, hands, and fingers, she having counted three hundred sixty-seven on one hand and wrist alone. She had always been constitpated. Mistura alba (one-half ounce three times a day) was prescribed and used five days. The bowels still being costive the dose was doubled with still no improvement. After two weeks without change confection sulphur and confection senna (one dram of each) was substituted without result. Eleven days later the sulphur was discontinued and an aloin and nux pill prescribed. Within a week following this the warts began to shrink. The bowels were regular. The treatment was continued for about two and one-half months, at which time the hands and wrists were clean and but slight evidences. of the warts remained on the fingers. This without the use of any local treatment.
J. F. B.
DOCTOR JAMES C. WHITE reports (Journal of Cutaneous Diseases, April, 1906) the following case as of especial interest in view of the fact that he has been unable to find the affection mentioned in any systematic work on dermatology or its symptomatology referred to in chapters devoted to disturbances of sensation.
The patient, a male, age fifty-five years, became aware of disturbed
sensations in the skin of the outer lower two-thirds of the right thigh after his customary walk of four or five miles. The sensation was of a tingling nature. From this time on either standing or walkingthis region became the seat of a variety of perverted sensations, tingling, tenseness, tearing, and sometimes a dull, deep ache. These sensations were often usherd in by a glowing sensation in the part. The disturbances usually ceased on sitting or lying but might recur in these attitudes from overstretching or twisting the leg. Deep pressure over the area might also bring on the sensations. There was always a sensation of something wrong on standing or walking. No pruritus or throbbing or feeling of constriction was noticed. The area complained of corresponded to the distribution of the cutaneous filaments of the external cutaneous femoral.
Inspection of the leg showed little difference from its fellow, perhaps a little paler. Induced hyperemia recedes more slowly than in its fellow. The whole area was partially anesthetized, and over the patella anesthesia was complete. Deep pressure over both legs showed little difference in sensation. Dimensions of legs the same. Habits of patient good.
Meralgia paresthetica is a condition always confined to the area occupied in this case. It was first described about ten years ago by Bernhardt and Roth, and is described in works on nervous affections, but Doctor White presents it as having claims for recognition in the lists of cutaneous diseases. The neurologists have offered little that is definite as to its cause.
Treatment is unsatisfactory, though massage gave partial and temporary relief.
It has no apparent effect upon the general welfare of the patient. J. F. B.
BY DAVID INGLIS, M. D., DETROIT, MICHIGAN.
PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE DETROIT COLLEGE OF MEDICINE.
IRWIN HOFFMAN NEFF, M. D., PONTIAC, MICHIGAN.
ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM.
"TYPES IN MENTAL DISEASES."
WILLIAM A. WHITE has an article in the Journal of Nervous and Mental Disease (April, 1906) on this subject. The author gives a rather cursory review of the insanities, following Kraeplin's grouping of the psychoses. He emphasizes the difficulty of differentiating some of these types, and calls particular attention to the transitional forms, deprecating the custom of analyzing mental diseases with a primary tendency to group the mental trouble. He believes that this method of attempting to group the psychoses before a complete analysis of the syndrome may lead to confusion. White gives a table, dividing the
psychoses into two great groups-dementing and nondementing psychoses. These, with necessary subdivisions, form, as he believes, a practical working classification. In conclusion he makes the following summary:
(1) The necessity for a broad biological viewpoint in considering the problems of mental alienation.
(2) The inconstancy and variability of types in mental disease as shown by
(a) The occurrence of transition and intermediate forms.
(c) The occurrence of special groups of symptoms-syndromes
(3) The desirability of a pause in the universal tendency to the analysis of mental symptoms for the purpose of developing general principles under which to group results.
(4) The suggestion that a great deal could be accomplished in this direction by the study of certain symptom groups apart from the special diseases which they more or less typify.
(5) The illustration of what can be accomplished by this method by its application to the dementia syndrome.
I. H. N.
AMERICAN MEDICAL ASSOCIATION MEETING.
BOSTON is entitled to the glory of being the scene of the banner meet of the American Medical Association, the unprecedented attendance of over five thousand having been registered at the recent gathering of the clans in that city. Whether the national event was the sole magnet that attracted this multitude, or whether the practically coincident annual meeting of the Massachusetts Medical Society, which contributed about one-fifth of the number, was the potential factor in effecting high-water mark on this occasion is immaterial insofar as concerns yielding the palm to Boston for the greatest display of lapel insignia medical since the inception of the national body. From the viewpoint of both scientific and business achievement the meeting was likewise a memorable event, but since the organization seems to be developing a commercial spirit which bids fair to completely overshadow the intent of its original promoters, the business aspects will be accorded preference in reviewing some of the more important questions that received consideration.
Doctor McMurtry, in his address before the House of Delegates, congratulated the association on the removal of every vestige of the old disagreements between New York medical men and the return of the profession of that state as a united body. Attention was directed to the