« ForrigeFortsæt »
osis, and, finally, dissociation sensory phenomena, indicate with fair clearness the diagnosis. It is not a leprous neuritis, as the nerves show no bulbous enlargements and the skin is quite free from the characteristic plaques. Tabes has been suggested, but there is little in the symptom picture to sustain such a suggestion. Absence of the Argyll-Robertson pupil, the persistence of one knee-jerk, with absence of true ataxic gait and characteristic pains were collectively conclusive in negation.
BY GEORGE DOCK, A. M., M. D., D. SC., ANN ARBOR, MICHIGAN.
PROFESSOR OF MEDICINE IN THE UNIVERSITY OF MICHIGAN.
DAVID MURRAY COWIE, M. D., ANN ARBOR, MICHIGAN.
FIRST ASSISTANT IN MEDICINE IN THE UNIVERSITY OF MICHIGAN.
CHARLES F. CRAIG ("International Clinics," Volume IV, Fifteenth Series, page 89) gives a brief but very valuable study of this interesting disease, based upon twelve cases observed by himself. One of the twelve seems to have acquired the disease in Washington, District of Columbia, the first recorded as originating in the United States. None were fatal; all but one had had one or more previous attacks; seven presented acute exacerbations, five, chronic symptoms. Craig finds the symptomatology so complex that no case can be considered as absolutely typical. The most marked symptom and the one most complained of is severe pain in the muscles and around the joints. In acute cases it was most intense in the lumbar regions and the extremities. In chronic cases it was generally localized around one or more joints, was paroxysmal, often leaving one joint and appearing in another. The temperature curve is not so characteristic as has been believed. In first attacks the undulant type occurs, with a gradual rise, gradual fall, and several days of normal temperature. But even in acute cases such temperature curves are the exception. "In the majority of cases the temperature curve, instead of being an aid to diagnosis is the reverse, and is the chief cause of mistaken diagnosis." There is an anemia, with leucocytosis, the white count ranging from 16,000 to as high as 28,000, the increase being in the polynuclears. The kidneys seem to escape injury; even albuminuria is rare. Pain and swelling of the joints do not usually occur in first attacks, but during the second, third or fourth; rarely not at all. There is moderate swelling, with some reddening of the skin. The skin is hot; there is great tenderness on pressure, but no effusion can be detected. The most valuable aid to diagnosis is the agglutination test with micrococcus melitensis, first observed by Wright, of Netley, and in high dilutions-preferably 1:75.
The reaction is marked and immediate. Craig has never found the reaction in any other disease; it failed him once in an undoubted case. Malaria, typhoid fever, tuberculosis, pneumonia, septicæmia and pyæmia, relapsing fever, and Hodgkin's disease and articular rheumatism must be differential. The author suggests a wider distribution for Malta fever, even in temperate latitudes, than is generally supposed.
BY FRANK BANGHART WALKER, PH. B., M. D., Detroit, Michigan.
PROFESSOR of surgeRY AND OPERATIVE SURGERY IN THE DETROIT POSTGRADUATE SCHOOL OF MEDICINE;
CYRENUS GARRITT DARLING, M. D., ANN ARBOR, MICHIGAN,
CLINICAL PROFESSOR OF SURGERY IN THE UNIVERSITY OF MICHIGAN.
SCOPOLAMINE AS AN ANESTHETIC AID.
WITHOUT championing any anesthetic or mode of anesthesia, Royster sums up in Surgery, Gynecology, and Obstetrics for February, 1906, his experience with fifty cases. He believes: (1) That ether is our safest general anesthetic; (2) That ethyl chloride secures the pleasantest primary narcosis; and (3) That the preliminary use of scopolamine with morphine increases the patient's mental resisting power and lessens the quantity of ether.
From its use clinically the writer does not regard scopolamine identical with hyocine. He believes it safe in proper doses, not to exceed one one-hundredth of a grain. This dose he has sought to use with one-sixteenth grain of morphia about one hour before the time set for the operation. When the patient is brought in, primary anesthesia is induced in about one minute by ethyl chloride sprayed on several layers of gauze folded over nose and mouth. The ether cone is then used and the patient is ready in four or five minutes. This method, apparently complicated, he states is really simple and produces sleep safely, swiftly, and sweetly. He does not regard scopolamine harmless, however, two cases having caused his anesthetizer to doubt whether he should proceed.
F. B. W.
BY REUBEN PETERSON, A. B., M. D., ANN ARBOR, MICHIGAN.
PROFESSOR of GYNECOLOGY AND OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.
CHRISTOPHER GREGG PARNALL, A. B., M. D., ANN ARBOR, MICHIGAN.
FIRST ASSISTANT in Gynecology AND OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.
THE TREATMENT OF ABORTION.
BOLDT (Journal of the American Medical Association, Volume XLVI, Number II) considers at length the treatment of abortion in its various stages. He divides abortion into four classes, that is: (1) Imminent abortion, in which the symptoms may subside on treatment;
(2) Progressing abortion, when the expulsion of the ovum cannot be prevented; (3) Incomplete abortion, when the contents of the uterus. are partially expelled, some portion still being retained; (4) Complete abortion.
The treatment of imminent abortion consists in absolute rest in bed and the administration of morphine or codeine as necessary. Tampons, ergot, and ice-bags are to be avoided on account of the liability of starting up uterine contractions.
Progressing and incomplete abortion, in the absence of symptoms of sepsis, are to be treated by first giving a hot antiseptic vaginal douche and then firmly packing the vagina with gauze. After twenty-four hours the gauze is removed and usually the products of conception are found free in the vagina. In case the os is well dilated and the ovum still remains in the uterus it may be possible to introduce the finger and effect a manual removal, or the vaginal packing failing, the cervix and lower uterine segment may be tamponed and the vagina filled with gauze; the subsequent procedures being the same as after vaginal packing alone. Should the bleeding be severe when the patient is first seen, it is inadvisable to adapt the above plan. Instead, the cervical canal should be dilated sufficiently if not already patulous and the ovaum or retained decidua removed by the finger or with a placenta forceps. Ergot may then be given.
Complete abortion requires no treatment except rest in bed, vulvar irrigation, and the usual measures carried out with puerperal cases. Curetment to remove the decidua is unnecessary and hence inadvisable.
If there is bleeding several weeks after a supposed abortion the uterine cavity should be examined and, if necessary, curetted. When evidences of infection are present, the uterine cavity should be emptied as completely as possible, whether the ovum has been spontaneously expelled or not. A curet should be used to remove adherent infected membranes or decidua, and an antiseptic intrauterine douche carefully given. Great caution is always necessary in curetting the uterus after an abortion.
The general tenor of the article is in advocacy of a conservative, expectant method of treatment in all noninfected cases of abortion. The author is of the opinion that much harm has come from a tendency on the part of many practitioners to adopt really dangerous methods of interference in simple cases.
C. G. P.
BY ARTHUR DAVID HOLMES, M. D., C. M., DETROIT, MICHIGAN.
ORIGIN OF TUBERCULOSIS IN CHILDREN.
HYNDS (Virginia Medical Semi-Monthly, May, 1905) observes that tuberculosis in children is more frequent occurrence than is commonly supposed. Fisher says that one-third of the deaths of childhood are due to tuberculosis in some form or another, and more frequent under
the age of four years. The bones, joints and lymph glands are the parts most frequently affected. Its great prevalence in children during the milk-drinking age and the predominance of other types than the pulmonary would seem to indicate a bovine origin and in communities where the milk was Pasteurized the percentage of intestinal forms was less than in districts where the milk was fed raw. The British Commission found that the tuberculosis produced in cattle by material from human and bovine sources was identical in its general effect and in detail. Walbach and Ernst came to the conclusion that there was no difference in the specificity between tuberculin made from human and bovine. bacilli and that there was no essential difference in the disease processes caused by bacilli from these sources. Rau believes that primary intestinal tuberculosis and tabes mesenterica are of bovine origin and conveyed by milk. Woodhead believes the same. Still thinks that tuberculosis of the intestines is often secondary, caused by the swallowing of the sputum. Behring says "The milk fed to infants is the chief cause of consumption." The evidence as to the communicability of bovine tuberculosis to infants is so conclusive that there is no longer any room for doubt. The only point in question is as to the comparative frequency of this mode of infection. This source of infection is no doubt very frequent. It is our duty to guard against tubercular infection in every possible way and to insist on milk absolutely free from tubercle bacilli for infant feeding. The cows should be tested with tuberculin and those which react positively should be separated from the herd.
BY IRA DEAN LOREE, M. D., ANN ARBOR, MICHIGAN.
FIRST ASSISTANT IN SURGERY IN THE UNIVERSITY OF MICHIGAN,
SOME DEFORMITIES AND THEIR PREVENTION.
DAVID T. BOWDEN, M. D., in the International Journal of Surgery for February, 1906. Under this heading he describes some of the more common congenital deformities of the lower limbs, their causes, and treatment; also some of the acquired forms of deformity, in different parts of the body.
The valuable part of the article must be summed up in the paragraphs devoted to the responsibility in neglected cases. The family physician as well as the parents must be educated to know the value of early intervention in all cases of deformity, especially those of congenital origin. Much can be gained even in those cases that reach the orthopedic surgeon late, yet complete obliteration of the marks of neglect is often impossible. The surgeon must be given the best chance and this necessitates early supervision of the treatment. The inconvenience and mental suffering of these patients should be impressed upon the parents and the family physician should be in a position to detect these abnormalities at once.
BY WALTER ROBERT PARKER, B. S., M. D.
PROFESSOR OF OPHTHALMOLOGY IN THE UNIVERSITY OF MICHIGAN.
INJURIES OF THE EYE FOLLOWING PARAFFIN INJECTIONS IN THE NOSE.
PROFESSOR W. UHTHOFF, of Breslau (Berliner Klinische Wachenschrift, December, 1905), gives the following reports concerning frequently practiced injections of paraffin in the nose.
A married woman, aged forty-five, exhibited saddle-nose. While there was a history of traumatism, examination rendered a specific origin not improbable. There was a history of rheumatism. The heart was normal. In all there had been three injections of paraffin, at intervals of eight and five months, for the treatment of the nose deformity. During the third injection the patient suddenly noticed the left eye becoming blind. There was no pain, but some lachrymation and several attacks of vertigo were experienced on her way home. There were no material inflammatory manifestations, but there was, however, on the day following the injection, an ophthalmoscopic picture of embolism of the central retinal artery. Vision nil. The diagnosis was confirmed eight days later. A puncture on the left side of the anterior chamber, followed by massage of the globe, did not change the findings of the examination.
Doctor Uhthoff thinks there is no doubt that a small particle of paraffin was the real obstacle that beclouded the arteria centralis retinæ, and it must be assumed that the foreign body passed through the pulmonary circulation prior to entering the artery. Cases of this kind. must be regarded as exceedingly rare occurrences.
An analogous case is that reported by Hurd and Ward Holden ("A Case of Blindness Following a Paraffin Injection Into the Nose," New York Medical Record, July 11, 1903), in which, after the third injection, loss of vision likewise occurred in the corresponding eye under the picture of embolism of the central retinal artery. In explanation of this case Hurd and Holden are inclined to presuppose a persistent foramen ovale between the two atria, enabling the particle to pass from the right atrium into the left, thus obtaining direct access to the arterial circulation.
This assumption seems to Uhthoff somewhat arbitrary, and he does not claim the same for his case. The most probable explanation, according to the writer, is that in this case paraffin found its way during injection into the venous system and after passing through the pulmonary circulation entered the arterial system and consequently also that particular arteria centralis retina.
A similar case was reported by Moll (Ann. des Mal. d'Orielle du Lar. et du Phar., 1902), also one by Rohmer (Ann. d'Occuliste, 1905). In Leiser's case, which was reported in the Deutsche medicinische