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THE AURAL AND NASAL HISTORY OF SOME SYPHILITIC CHILDREN.
Doctor William A. Dayton mentions first the preponderance of deaths at birth or shortly after due to syphilis. Hutchinson's three elements in diagnosis-notched teeth, interstitial keratitis, and otitis media suppurativa-may not be present at all. An editorial in the Medical Record, August 26, 1893, is quoted as follows:
"Protuberances and hyperostoses are found at the level of the epiphyses, especially noticable at the upper extremity of the tibia and the lower extremity of the radius and ulna. But the tibia is the direct revelation of syphilis. Its form alone will reveal the disease. It is large, thick, and misshapen, much widened and depressed in its middle portion. The crest is so much increased in size as to present a plane face. In general effect the bone is like the blade of a sword. This conformation is never found in any condition other than hereditary syphilis, of which it is the pathognomonic sign."
As to local involvement in heriditary syphilis, the parts of least resistance are the first to surrender. The nasal mucosa shows venous rather than arterial passive congestion, accounting for its bluish appearance. The inferior turbinates may show a white, waxy-looking degeneration at the distal end. Such cases, untreated, may show this degenerated mass of mucous membrane completely filling the postnasal spaces by the eighteenth year. In the vault of the pharynx the coloring is again significant, the lymphoid tissue will be found rather purplish. The gummous appearance of the lymphoid growth is the expression of a syphilitic cervical periostitis and is frequently wrongfully curetted. Many cases of recurrent "adenoids" may be of specific origin. The ear is usually the last region to yield to the inroads of syphilis, but once invaded there is never spontaneous recovery. This occurs, if at all, only under the heroic exhibition of mercurial medication. This may often be preceded to advantage by the use of iodin, and for this purpose Dayton prefers the plain tincture of iodin to potassium iodid. He combines it with muscilage of salep in the proportion of from one to three drams of the iodin to three ounces of the salep, the dose of which is a teaspoonful. He thinks that potassium iodid energizes, if it does not precipitate, syphilitic coryza. Surgery is contraindicated.
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SOME SYPHILITIC AFFECTIONS OF THE EYE AND EAR.
Doctor Sterling Ryerson says no part of the eye is exempt from syphilitic invasion. It may be affected primarily, when the lesion is usually found at the conjunctivo-cutaneous border. In the secondary stage mucous patches may occur on the conjunctiva and ulcerations of the lids may occur during the tertiary stage. It is the iris, however, which is the most common seat of ocular syphilis. It is attacked in four per cent. of all cases (Jules), and thirty to sixty per cent. of iritis is due to syphilis (Webster Fox). It usually occurs during the first six months after infection and is rarely painful. The prognosis is favor
able under proper treatment. Keratitis sometimes occurs in acquired syphilis. The interstitial keratitis of hereditary syphilis usually appears about the time of puberty. Both eyes are usually affected. Iritis usually accompanies the corneal inflammation. The duration is from nine to twelve months. There is usually a permanent loss of vision. short of blindness. Choroiditis and retinitis are late secondary or early tertiary symptoms. With the opthalmoscope a fine haze may be seen, but there are usually no large floating opacities in the vitreous. This fine haze Ryerson considers as pathognomonic of syphilitic retinochoroiditis. Prognosis is favorable as regards blindness, though some defect in vision is sure to occur.
The treatment is the exhibition of mercury. Locally the subconjunctical injection of cyanide of mercury, atropin, leeches to the temple and rest of the eyes.
Syphilis may cause atrophy of the optic nerve, more frequently in connection with locomotor ataxia. The paralytic affections of the ocular muscles are frequently of syphilitic origin. J. F. B.
DAVID INGLIS, M. D.
PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE DETROIT COLLEGE OF MEDICINE.
IRWIN HOFFMAN NEFF, M. D.
ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM.
THE CLINICAL HISTORY AND POSTMORTEM EXAMINA
TION OF FIVE CASES OF MYASTHENIA GRAVIS.
BUZZARD (Brain, Autumn and Winter, 1905) gives in detail the clinical history of the five cases and the autopsic findings are analyzed. The article concludes with a discussion on the pathogenesis of the disease. A short bibliography is added. His opinions, as given in his conclusions, are as follows:
(1) That myasthenia gravis is a disease in which the symptoms are not always confined to the motor symptoms, but may include others of sensory, mental, or other origin.
(2) That in all probability it has a definite and constant morbid anatomy, constituted by the presence of widely distributed cellular, and sometimes serous exudations (lymphorrhages) in the tissues and organs of the body.
(3) That slight muscle-fiber changes are frequent and severe muscular atrophy rare occurrences in the disease.
(4) That proliferative and degenerative changes in the thymus gland are frequently but not constantly met with.
(5) That the symptoms of the disease are best explained by assuming the presence of some toxic, possibly autotoxic agent, which has at special influence on the protoplasmic constituent of voluntary muscle, and a less specialized influence on the function of other tissues.
(6) That the relation of this toxin to the incidence of lymphorrhages and to thymic alterations is not clear.
I. H. N.
DELOS LEONARD PARKER, PH. B., M. D.
LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.
COCILLANA ÅS AN EXPECTORANT IN PULMONARY TUBERCULOSIS.
DOCTOR GEORGE WILLIAM NORRIS, of Philadelphia, in a paper with the above heading (The Therapeutic Gazette, June, 1906), says:
"The employment of expectorants in pulmonary tuberculosis is justly falling more and more into disuse, their place being supported by the administration of remedies calculated to correct the digestion and increase the general tone of the patient's system. Nevertheless, times occur, especially when a bronchitis or some other acute infection supervenes upon a tuberculous process, when an expectorant is necessary in order to facilitate the expulsion of an inordinately large quantity of secretion, and thus allay exhausting cough. Having always been somewhat skeptical as to the value of the majority of drugs currently classified as expectorants, I was, notwithstanding, led to try the administration of the fluid extract of cocillana in a number of tuberculous patients, through the cordial indorsement given to this drug by Doctor E. S. Bullock, of Silver City, New Mexico."
The extract of cocillana is from the bark of the Sycocarpus Rusbyi, a large tree of Bolivia. The physiologic action is said to resemble somewhat that of ipecacuanha. Besides being an expectorant the drug is said to have laxative and heart tonic properties. The dose of the fluid extract is from five to twenty-five drops, which may be repeated every three or four hours. Full physiologic doses cause vomiting, purging, sneezing, frontal headache, and nasal discharge.
Doctor Norris studied the effect of the drug in thirty-one cases of tuberculosis of the lungs. The cases comprised early, secondary, and advanced conditions of the disease. The drug was administered in various ways and in various doses. The best results were obtained from giving five-drop doses of the fluid extract well diluted with water at intervals of three hours. Complete records were kept. In the thirty
one cases in which it was used marked improvement occurred in seven; slight improvement in fourteen; no improvement in eight; and condition made worse in two. The improvement that occurred consisted most commonly of a lessening in the viscidity of the sputum with increased ease in expectoration. Cough as a symptom was but slightly affected. In one case nausea and vomiting was caused by each administration of the drug. The patient in which this occurred was suffering from chronic indigestion. No effect was observed upon the heart and pulse None of the patients developed sneezing, coryza, frontal headache, or looseness of the bowels. This freedom from disturbing effects was doubtless owing to the smallness of the dose.
On the whole, Doctor Norris found that the results were not so satisfactory as those obtained from the following mixture, which is largely used at the Phipps' Institute, where the work was carried on: B Ammonii chloridi, 4 drams.
Spiritus glonoini, I drop.
Spiritus ammoniæ aromatici, I fluid ounce.
THE SAN FRANCISCO EARTHQUAKE AND THE DOCTORS. PHYSICIANS, as well as others, will be interested in the "earthquake numbers" of some California medical periodicals. The earthquake took place while the California State Medical Society was in session in San Francisco. A number of the Los Angeles profession wrote up their personal experiences and these were published in the May number of the Southern California Practitioner. One of the most interesting is by Doctor Ernest W. Fleming, a graduate of the University of Michigan. Numbers five and six of the Pacific Medical Journal appear in a single number as the first publication since the disaster. The whole number is a striking evidence of the catastrophe, the destruction of property that followed and the undaunted courage and tireless energy of the Californians. The Journal has sixty pages of reading matter and almost as many of advertisements. The brief introductory states that the entire Journal plant was destroyed; then follows a concise but very clear account of the earthquake, with some mention of previous historic earthquakes; the fire and the ravages caused by it are also concisely described. More than three-fourths of the city was burned and three hundred thousand people rendered homeless and without food and water; probably as many as one thousand lives were lost; the
destruction of property is estimated at $300,000,000 to $400,000,000, with insurance amounting to less than $150,000,000. The remarkable. spread of the fire is explained by the intense heat in the upper air igniting the tops of buildings at a great distance from burning houses. Most of the tall buildings were burned from the top downward. The air was so hot that it could be felt across the bay, a distance of several miles, and large fire brands were picked up ten miles from the city. Window panes were cracked blocks away from the fire. The hospital of Doctor Winslow Anderson, editor of the Journal, containing one hundred seven rooms and filled with patients, was very little damaged by the earthquake. During the course of the fire the patients were first removed to Doctor Anderson's residence, and sometime afterwards. the former building caught fire and burned down. The fire approaching the improvised hospital, the patients were moved again to towns across the bay or to the Presidio hospitals, and the moving was so successfully accomplished that not one of the patients nor any of the nurses received the slightest harm. The editorial offices of the Journal were in the hospital, and a library of several thousand volumes, and this was entirely destroyed. Much of the damage in various parts of the city was caused by dynamiting. This did very little in many cases to stop the spread of the fire, but caused tremendous destruction of private property. One physician, for example, worked all day burying his books and instruments. The dynamiters blew up the building. From the downward tendency by exploding dynamite the buried treasures. were destroyed, but the surrounding houses escaped both fire and dynamite. The heroism of the medical profession is briefly alluded to and other details of the work after the fire are duly described. Among other interesting items in the article are those in regard to Chinatown, earthquake psychoses, marriages and births after the shock, both of the latter being unusually numerous. Doctor H. D'Arcey Power has a short article on the "Psychic Effects of the Earthquake;" the work of other physicians is described more or less fully. Many personals furnish information that will doubtless be appreciated by friends of local physicians. Altogether the Journal is a striking monument to the extraordinary and appalling calamity and to the heroism of the men who went through it. It is one of the most interesting souvenirs that a medical man could possess.
A SCORE FOR RADIUM IN SURGERY.
SOME time ago the success of Baird with trypsin in the treatment of cancer and allied growths was announced in medical literature. Now, Robert Abbe proposes an entirely different therapeusis for the treatment of carcinoma, granuloma, lupus, epithelioma, and sarcoma,