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shortly, without the production of an abscess or other complications. Patients who had previously experienced a number of relapses previous to this method of treatment were entirely freed from further attacks, fifteen patients having had no relapses during two years and a half since treatment, while many others had had no relapses, although the treatment was of late date.-Am. Jour. Medical Sciences.
THE TREATMENT OF DISABLED JOINTS RESULTING FROM THE 80-CALLED RHEUMATOID DISEASES.
Goldthwait (Boston Medical and Surgical Journal, January, 28, 1897, p. 79) reports a series of cases which for convenience sake he considers under two types-rheumatoid arthritis and osteo-arthritis, to the differentiation of which he attaches much importance from a therapeutic point of view. Rheumatoid arth. ratis is said to be much more acute than osteo-arthritis; it occurs in the middle and advanced life and in early life as well. During the acute stage the joints present a spindle-shape swelling, which finally subsides, leaving the joint much atrophied and usually ankylosed. In the treatment of cases belonging in this category the joints should be manipulated after all acute symptoms have disappeared. The character of the manipulations is of much importance. Osteo-arthritis is a much more chronic condition, occuring only in middle life or old age, and is characterized by a proliferation of the articular cartilage, with the formation of nodes about the joints. In cases of this kind manipulation should not be practised, as any injury or undue violence is likely to stimulate a more rapid developement of the cartilage. It is this tendency that explains the impairment of function that so often results after comparatively simple injuries to a joint. Under such circumstances protection and immobilization are of are of importance.-Medical Record.
EXTIRPATION OF THE RECTUM.
Among the advantages of the vaginal method might be mentioned:
1. The vagina can be made to take the place of the extirpated portion of the rectum.
2. The incision can be done as high up as by the the sacral method and with less traumatism, and in case the peritoneal cavity is opened with less danger.
3. An intraperitoneal exploration of the tissues about the rectum can be made before disturbing the rectum.
4. If the operation has to be abandoned after the incisions are made, the wound is less formidable and in a better place.
5. The patient is more comfortable than after the sacral methods.
Dr. Price's abdominal method posesses nearly all of these advantages, but is more dangerous, necessitates a removal of the uterus, and cannot be adopted to cases extending low down in the rectum. McArthur's method is more dangerous in cases high enough up to involve an opening into the peritoneal cavity, and in all cases involves more traumatism. Henry T. Byford, in The Cincinnati Lancet Clinic.
SAFEGUARDS IN CHLOROFORM ADMINISTRATION.
Arnold (British Medical Journal, December 12, 1896) calls attention to the fact that a patient may take in a sufficient quantity of chloroform-vapor in one or two deep inspirations, over which the anesthetizer has no control, to endanger the centres of respiration. He therefore advises the use of an inhaler, which regulates the amount received by the patient. The secret of safe administration, then, lies in the following two points:
1. A very gradual increase supplied to the patient while putting him under. If this be carefully regulated, so that the quantity of vapor reaches the maximum by almost imperceptible degrees, two disagreeable and dangerous symptoms (struggling and vomiting) are almost invariably done away with. This is attained by attending to the amount of compression given to the bulb. At the start, during several respirations, only the slightest compression is used. A slightly deeper compression of the bulb is made for several ensuing respirations, and so on until a full compression is reached, which is kept up until the reflexes are abolished.
2. Once the patient is under the amount must be reduced to the minimum, or something approaching it, and by continuing to supply him constantly with this minimum dose complete anæs
thesia may be maintained continuously for hours with perfect safety. Am. Journal Med. Sciences.
Since the introduction of eucaine hydrochlorate into the Out-patient Surgical Department of the Jefferson Hospital, cocaine has been placed on the shelf. At one time this Department used cocaine quite extensively as the means of inducing local anesthesia; but alarming symptoms from its use in some of the cases caused its banishment, and not a drop of cocaine solution has been used in this Department since last July. Prof. Brinton admires eucaine hydrochlorate because it is rapid in action, safe, produces positive and prolonged anesthesia, and causes no serious after-effects. He never misses a chance to use it in minor surgical operations before the class. In minor surgical operations, such as the removal of a toe-nail or small tumor, the amputation of a finger or a toe, the extraction of a splinter, etc., he recommends the use of from one to two drachms of a five per cent. solution hypodermically, and insists on waiting five minutes after the injection is made for complete anæsthesia. Last month Dr. J. Chambers Da Costa operated on a case of Albert's disease (bursitis of the retrocalcaneal bursa and periostitis at the insertion of the tendo-Achilles). The operation consisted of incision of the bursa, removal of osteophytes from the os calcis, curetting of the bursal sac, etc., and closure of the wound with four stitches. The operation was entirely painless and made a good impression on the class.-Dunglison's College and Clinical Record.
EUCAINE AS A LOCAL ANESTHETIC IN OPHTHALMIC SURGERY.
Numerous reports of the advantages of eucaine over cocaine as a local anesthetic surgery have attacted a good deal of attention to this drug. It is reported to be about equal in effectiveness to cocaine, and to be free from danger of poisonous effects.
A recent report by Wüstefeld tends to show that it is not as free from ill effects as previous reports have shown. Wüstefeld noted a temporary smarting on instillation of a five-per-cent. solution of eucaine followed by injection of the conjunctiva. The anaesthesia produced was complete, and lasted about as long as that produced by cocaine.
The statement of Vinci, that no dilatation of the pupil or disturbance of accommodation results from its use was not borne out by the observations of Wüstefeld, who found that in almost all his cases dilatation of the pupil and paresis of accommodation ensued.
Although microscopically no effect upon the scleral surface was noted (the eye was uniformly protected by a wet cotton com-. press after the operation), experiments upon animals showed a distinctly destructive effect of the drug upon the scleral epithelium. Microscopical sections of the eyes of a guinea pig into which eucaine had been instilled, and the eye subsequently pr tected, showed the epithelial cells swollen and lifted out of position, the outer layer being partially desquamated. These results seem to Wustefeld to militate against the use of eucaine as a substitute for cocaine in ophthalmic surgery.
The claim that it is entirely without toxic effects can not be said to have been clearly established. Dr. Thomas H. Shasted, of Galesburg, Ill., publishes in the Journal of the American Medical Association, the account of a case in which the transitory amblyopia followed the employment of a five-per-cent. solution of eucaine as an anesthetic for the cauterization of the inferior turbinated bones.-Boston Med. and Surg. Journal.
THE DIRECT TREATMENT OF TUBERCULAR CAVITIES.
Suitable cases for operation are those in which the tubercular mischief in the lung is isolated and is progressing slowly. The presence of adhesions between the parietal and visceral layers of the pleura is favorable. The operation of pneumectomy the writer dismisses as being unjustifiable, though he admits that Lowson, of Hull, and Tuffier, have published successful cases. His remarks on pneumotomy, or simple incision into and drainage of the lung cavity, are as follows: Only a limited area of lung is accessible to the surgeon, the proper field for operation being bounded by the clavicle above, by the manubrium sterni internally, by the pectoralis minor externally, and by the second rib below. The incision is parallel with the first rib, and the pleura in the first intercostal space is freely exposed. The lung tissue is divided with a Paquelin's cautery-knife and the cavity opened, but not explored. The opening should be gradually
dilated by plugging with gauze, and the wall of the cavity cauterized on several subsequent occasions.-Med. and Surg. Reporter.
THE USE OF MANOL IN WHOOPING COUGH.
Dr. Otto Ringk (Algemeine medicinische Central-Seitung, 1896, No. 56; Centralblatt für die gesammte Therapie, January, 1897) states that manol, or ozonized anise juice, should be diluted with from one to three and a half times its bulk of water, and from a teaspoonful to a tablespoonful of the dilution should be given every one, two or three hours, according to the child's The urine must be closely watched throughout, lest carbolic-acid poisoning should occur. The drug is described as the expressed juice of the fruits of ordinary anise and star-anise and of althæa root, prepared with sugar and ozonized by Ringk's process. A little alcohol is added to preserve it. The ozoning process is not described.-N. Y. Med. Jour.
THE TREATMENT OF INFECTIOUS NEPHRITIS BY TINCTURE
Myszynska (Revue de Therapeutique, January 1, 1896.) concludes from a number of observations that the tincture of cantharides is very useful in the treatment of acute epithelial nephritis either with or without edema, especially in young persons at the beginning of the disease. Under these conditions it is a remarkable diuretic, and decreases the amount of albuminuria even if the patient is not placed upon a milk diet. It also improves the appetite and the feelings of the patient. The dose is from 9 to 12 drops. It is contraindicated in interstitial nephritis occurring in alcoholic individuals and in those whose arteries are sclerosed.-New York Medical News.
Very important drugs in the treatment of pneumonia are the four alkaloids-strychnine, cocaine, atropine, and caffeine