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LOUIS JACOB HIRSCHMAN, M. D.

CLINICAL PROFESSOR OF PROCTOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

PROCTOLOGY.

STERILE WATER ANESTHESIA IN OPERATIVE TREATMENT OF DISEASES OF RECTUM AND ANUS.

OPERATION.

GANT, in a paper with the above title, read before the New York Academy of Medicine, and published in the New York State Journal of Medicine, Volume VI, Number X, summarizes the statistics and views of the leading proctologists of the country as to their experience with this form of anesthesia. He has collated eight hundred seventynine cases up to May 1, 1906, as follows:

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NUMBER

OF CASES.

Total.....

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AND

25 129

320

NUMBER OF FAILURES TO
GET SATISFACTORY
ANESTHESIA.

One failure in a fissure case.

879

Almost without exception, the above men are entirely satisfied with this method, and some state that the anesthesia is fully as satisfactory as that produced by chemical means.

A few cases but not very
satisfactory.

One case of shock.
Three failures.

Six felt some pain.

One failure.

Only partially successful in 17, but well satisfied. Failure in 27 cases, some pain in 35 cases.

DERMATOLOGY.

WILLIAM FLEMING BREAKEY, M. D.

CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.

JAMES FLEMING BREAKEY, M. D.

ASSISTANT IN DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.

EXPERIMENTAL STUDY OF SOME CASES OF URTICARIA.

THIS article, by Erasmus Paramore, in the British Journal of Dermatology, Volume XVIII, Numbers VII and VIII, is founded upon the suggestion of Wright that urticaria is of the nature of a serous hemorrhage associated with a defective blood coagulability and due to a diminution of calcium salts in the blood content.

Wright's methods of estimation of the lime salts in the blood content and their relation to coagulability are given.

A short series of cases are reported with a study of the lime content and coagulation time and the results of shortening the coagulation time by the administration of calcium chlorid. Some of the patients experienced almost immediate relief under the treatment and were permanently relieved by its continuation. Others were improved and recurred or remained unchanged. In one of these an attempt was made, by the administration of citric acid, to prolong the coagulation time (also to secure an increased action of the kidneys) in order to wash out, as it were, any noxious substances that conceivably lay concealed in the subcutaneous tissues and which by their continued presence served to maintain a condition of inflammatory irritability and hence an increased transudation of plasma. Citric acid was administered in dram doses, thrice daily, for six days. Under normal circumstances this dosage should have reduced the lime content by one half. For constipation the patient took mixture alba one ounce, and four hours later the lime content had doubled, being four times the expected amount. It was found in this case that an urticaria slight in intensity and of a papular character, was by the exhibition of a decalcifying agent replaced by an urticaria of some considerable intensity, the lesions appearing in the form of wheals all over the body. On the restoration of the previous lime content the papular type was again reproduced with corresponding alleviation of symptoms.

In two cases, efforts were made to produce urticaria by a rapid decalcification of the blood with oxalic acid in ten-grain doses. In the first (the author) severe itching developed all over the body within two or three days, worse at night. In the other case no symptoms developed. In these two cases, though there was a considerable diminution in lime salts in the blood content there was no prolongation of the coagulation time. "In consequence an urticaria of this type cannot be held to be a serous hemorrhage dependent on a diminished lime content. An urticaria produced under such conditions must bear a similar relation to a decalcification urticaria that an active inflammation bears to a passive exudation. In other words we have to consider a toxic or inflammatory urticaria."

After reviewing the early cases Paramore says: "It seems, therefore, permissible to consider that an attack of urticaria may be due to a diminution in the content of the blood in lime salts associated in consequence with defective blood coagulability-that is to say, is of the nature of a serous hemorrhage, a decalcification urticaria. That such a condition of blood does not in the majority of cases mean urticaria is more easy of proof. That an urticaria should develop in one man while no such manifestation is apparent in another exposed to the same conditions may quite well depend upon the ease with which toxic and decalcifying substances are excreted by their respective kidneys."

An urticaria the result of insect bites, nettles, et cetera, is neces

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sarily local; limited by the area in contact. Such a condition cannot be considered as a modification of the blood as a whole, a local alteration must be sought in the tissues in the immediate neighborhood, this is found in the effects of the toxine upon local lymph spaces.

In conclusion, urticaria may, then, in consideration of the altered relationship of the chemical constituents of the blood, be divided into three main groups:

(1) Decalcification urticaria.

(2) Urticarias due to an alteration of the salt content of the blood. (3) Inflammatory or toxic urticarias, general and local.

J. F. B.

RADIOLOGY.

VERNON JUSTIN WILLEY, M. A.

INSTRUCTOR IN ELECTROTHERAPEUTICS IN THE UNIVERSITY OF MICHIGAN AND DIRECTOR OF THE UNIVERSITY HOSPITAL ROENTGEN LABORATORY.

NOTE ON THE USE OF THE MILLIAMPERÈMETER IN ROENTGEN RAY MEASUREMENT.

JONES (Archives of the Roentgen Ray, Volume XI, Number I) presents this review of our present position in the measurement of the volume of Roentgen rays so far as the use of the milliamperèmeter in the tube circuit is concerned.

The author first states that no one who has used a milliamperèmeter (in connection with the Villard valve) for regular work will doubt the value of that method as an index of the working of the Roentgen tube. Yet many practical workers doubt its reliability as a method of precision. He also calls attention to the fact that an instrument, which will indicate the volume or quantity of rays by the simple movement of a pointer on a scale is much to be desired. He states that the following questions must be settled before the milliamperèmeter can be accepted as reliable for Roentgen ray volumetric measurement.

(1) Does Roentgen ray production bear a direct relationship to the magnitude of the current through the tube?

(2) What difference may be expected to exist between the amount of Roentgen ray production within the tube and the amount available for use outside?

(3) Can the milliamperèmeter be trusted to give a measure of that part of the current through the tube which is concerned in the production of Roentgen rays, and of that part only?

(4) How may the readings be interpreted to suit different distances of the radiant point from the surface irradiated?

In his answers to these questions the author concludes:

First, that a high hard tube gives out more x-rays than a lower one, the current measurement being the same through both tubes.

Second, that the milliamperèmeter fails to take any account of the rays absorbed by the walls of the tube, and in that instance is not as reliable for measuring the volume of rays delivered outside the tube as are the pastilles of Holzknecht, or the pastilles of Sabouraud and Noiré. In very soft tubes a large percentage of rays are absorbed by the glass, as has been shown by the experiments of W. Seitz, using a tube with an aluminium window, through which soft rays readily pass.

The third question can be answered affirmatively only for tubes of equal Roentgen ray efficiency.

The answer to the fourth question involves the measurement of the distance from anode to skin or photographic plate and a comparison with some other method of measurement such as either a photographic method or the use of the Holzknecht pastille. V. J. W.

NEUROLOGY.

DAVID INGLIS, M. D.

PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE DETROIT COLLEGE OF MEDICINE
AND

IRWIN HOFFMAN NEFF, M. D.

ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM.

"THE SURGICAL TREATMENT OF TRIGEMINAL
NEURALGIA."

MOSCHCOWITZ thoroughly reviews (Medical Record, September, 1906) the operative treatment of trigeminal neuralgia, considering the advisability of the different surgical methods which have been in The article is critical, but comprehensive and instructive. A description of the author's work in this respect is given, and the writer makes the following conclusions:

use.

(1) Eliminate any possible etiologic factors, such as tumors, carious teeth, antral disease, malaria, syphilis, et cetera.

(2) Determine accurately the nerve branch or branches involved.

(3) The operation should be performed as near to the periphery as possible.

(4) The operation should be performed early. This is important, because the earlier the case, the more chances there are that a peripheral operation will be of benefit.

(5) Whatever the character of the operation may be, the dominant principle must be the prevention of regeneration of the affected More specifically, the operations may be classed under two headings, depending on the nerve or nerves affected:

nerve.

(a) Peripheral operations.-If the supraorbital, infraorbital, mental, malar, or inferior dental branches, either singly or collectively are involved, the operation consists in division of the nerve, and plugging up of the foramen by a gold or silver button or wire.

(b) Central operations.-If the neuralgia involves the upper teeth and palate (superior maxillary division) or tongue (inferior maxillary division), existing either singly or together wth the other nerves described above, the operation as outlined by Abbie must always be performed, substituting, however, celluloid or a gold button instead of rubber tissue.

(6) Finally, I believe that if the above principles of treatment of trigeminal neuralgia are carried out, the operation of extirpation of the Gasserian ganglion will become entirely unnecessary.

"THE CEREBRO-SPINAL FLUID IN HEALTH AND
DISEASE."

ARCHAMBAULT has reviewed (Albany Medical Annals, May, June, July, 1906) all literature to date on this subject, and has appended a valuable and complete bibliography. The article is well written and affords a ready and reliable reference to this important clinical procedure. As the article is written in the nature of a review a summary is impossible.

I. H. N.

THERAPEUTICS.

I. H. N.

DELOS LEONARD PARKER, PH. B., M. D.

LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.

PROGRESS IN SERUM THERAPY DURING THE YEAR ENDING JUNE 1, 1906.

DOCTOR EZRA READ LARNED, of Chicago, in the September number of the Therapeutic Gazette, presents a general review of the standing and position of the different curative sera that is interesting and instructive, especially to the general practitioner.

At the outset the statement is made that no matter how great the value of a remedy may be made to appear by test-tube reactions, or the results of experiments applied to animals, it is only when the agent accomplishes what is expected of it by the doctor at the bedside that its. reputation is fully established.

Doctor Larned classifies curative sera as follows:

(I) All whose efficacy have been proven.

(II) Those whose value is not definitely proven. (III) Those proven worthless for clinical purposes.

A year ago in a paper which was reviewed in these columns, Doctor Larned included in Class I antidiphtheric, antitetanic, antistreptococcic, and antiplague sera. In the present paper he says he is not able to extend this list. He says that much information has been gained concerning these and other sera during the past year, but that the list as presented in the former paper is not lengthened by such information.

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