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The case is doing well. The operation was an absolute necessity, and was very difficult; had it been done early it would have been very simple. On account of the pus it was necessary to leave most of the incision open, a grave disadvantage, that would have been obviated a week earlier. There was absolutely nothing in this case prior to operation that I have not seen duplicated in simple catarrhal appendicitis; yet here was pus and here was also a patch of gangrenous cecal wall, not covered by any adhesion, that would in a few hours have permitted the contents of the gut to have escaped into the peritoneal cavity.
The question of the proper management of appendicitis is capable of any amount of argument, but I am entirely convinced that the disease is purely a surgical one, that the only safe treatment is operation. Other therapeutic measures will avail in perhaps a majority of cases, at least in the first attack, or possibly in the first few attacks. I know, however, that any other means of treatment will be marked by a mortality-rate, and this must be true until we are able to separate catarrhal from suppurative cases. This, I repeat, cannot be done at present. Then why not operate at once in all cases? Such a course, in properly qualified hands, is as nearly absolutely safe as any operation can be. Suppose some cases are operated on that would have gotten over the attack without operation; better this than to run so grave a risk as we must encounter when we wait.-J. W. Hickman, M.D., of Tacoma, in New York Medical News.
Extracts from Home and Foreign Journals.
A careful consideration and trial of the various methods of treating the syphilodermata has led me to the following conclusion:
1. In the primary stage, when only the chancre is present, no general treatment; calomel locally.
2. As soon as the secondary period sets in, as shown by the general adenopathy, angina, cephalalgis, and eruption, the internal treatment for mild cases should be one-fourth to threefourths of a grain of the proto-iodide of mercury t. d., continued for three months, or until symptoms disappear. In severer cases, with pustular eruptions, severe anginas, persistent headaches, etc., a course of six to ten intra-muscular injections, of 10 per cent, calomel-albolene suspension, five to ten minims at intervals of five to fifteen days, should be employed.
3. After completion of the course and cessation of the symptoms, employ tonics, etc., without specific treatment, for three months.
4. Thereupon a second calomel course, as above, plus a small dose (fifteen grains) of iodide of potassium in milk after meals. This to be given whether later secondary symptoms of the skin and mucossa appear or not.
5. Second intermission of treatment lasting three to six months, according to the presence or absence of symptoms.
6. In the second year, if tertiary lesions marked by deeper and more localized ulcerations are present, give the iodide of potassium in increased doses (60 to 600 gralns daily, as may be necessary.) Combine with it occasional courses of calomel injections. If no lesions appear, give a mild course of both.
The best local treatment of the syphilodermata is with the mercurial plaster-mull.-Abstract of Clinical Lecture, delivered by Wm. S. Gotheil, M.D., at the New York School of Clinical Mediine, Nov. 25, 1896.
THE TREATMENT OF WARTY GROWTHS OF THE GENITALS.
William S. Gottheil, in a paper on "Epithelioma of the Penis," read before the Society for Medical Progress, November 14th, 1896, (International Journul of Surgery, January, 1897,) concludes as follows:
1. Warty growths of the genitals, more especially in the male, are always to be suspected of malignancy, no matter how innocent they seem:
2. They should either be left entirely alone, or be thoroughly removed by knife or cautery.
3. Imperfect attemps at destruction, as with nitrate of silver, carbolic acid, etc., are especially to be avoided; there being many cases recorded in which they have apparently stimulated a benign growth into malignant action.
COCAINE IN THE TREATMENT OF SALIVARY FISTULA.
Guerra (Annali di medicina navale, October, 1896) relates the case of a soldier who had received a wound implicating Stenson's duct and the parotid gland, which had left a fistula that proved rebellious to treatment. Finally he painted the whole parotid region with equal parts of glycerin and a five-per-cent solution of cocaine in water, and within a very few days the flow of saliva subsided. At the same time the wound was treated with the galvano-cautery, and it healed in a few weeks. The author imputes the effect of the cocaine to its vaso-constrictor action, in consequence of which less blood was carried to the acini of the gland and less saliva secreted.-N. Y. Medical Journal.
A NEW TEST FOR ALBUMIN.
Reagents for the detection of albumin in the urine must be colorless, and must reveal the presence of albumin even when
the amount is too small for quantitative estimation. has published a new and delicate test, consisting of:
Chloride of mercury.....
In the process of testing, 4 c.c. of the filtered urine are mixed with 1 c.c. of acetic acid, and 4 c.c. of the above reagent are added with shaking. In a second glass similar quantities of urine and acetic acid are mixed with pure water instead of with the reagent. This test yields a cloudiness of albumin in cases in which the ordinary tests fail to give any result at all.-The Lancet.
TREATMENT OF FIBROID TUMORS BY ERGOT.
Prof. W. H. Byford begins his chapter on this subject as follows: "1. When properly administered ergot frequently greatly ameliorates some of the troublesome and even dangerous symptoms of fibrous tumors of the uterus, e.g., hemorrhage and copious leucorrhoea. 2. It often arrests their growth and checks hemorrhage. 3. In many instances it causes the absorption of the tumor, occasionally without giving the patient any inconvenience; at other times removal of the tumor by absorption is attended by painful contractions and tenderness of the uterus. 4. By inducing uterine contraction it causes the expulsion of the polypoid variety. 5. In the same way it causes the disruption and discharge of the submucous tumor."-N. Y. Medical Record.
AN EXTRAORDINARY RETENTION IN UTERO OF THE FETAL HEAD.
In the Centralblatt f. Gynäkologie, 1896, No. 24, is mention of a case reported by Toth, of Budapest, in which the attending physician pulled so vigorously upon the breech of an eight month fetus that its neck parted, and the head remained in utero, despite all his exertions to remove it. The mother, a young III
para, recovered with some fever, and enjoyed good health for a year. During this time, irregular hemorrhages and foul-smelling discharge continued, followed by the occasional discharge of bones. At the end of sixteen months, the cervix was dilated, and the large bones of the skull, which remained, were removed. They were extensively adherent to the uterus, and the free hemorrhage which followed their removal was controlled by tamponade. The patient made a quick recovery, Such tolerance on the part of the uterus must be very unusual.
CARCINOMA OF THE CERVIX UTERI IN A GIRL OF FOURTEEN.
Dr. W. L. Little (New Orleans Med. and Surg. Jour.,) December, 1896 reports that he was called to see the patient in question, on May 15, 1895. She was anæmic, had but little appetite, and every month would complain of headache, backache, and general languor. He diagnosticated the case as one of chlorosis. After treatment, menstruation set in. Soon after this she suffered from menorrhagia and dysmenorrhoea, and subsequently had leucorrhoea. An examination was made, and cancer was suspected. After consultation this diagnosis was confirmed, but, because of extensive adhesions involving the cer vix uteri, vaginal walls, and surrounding tissues, operation would have been futile. Later, the tissues began to break down from ulceration and the discharge became more characteristic, the rectal walls becoming implicated. These conditions became more aggravated, until the patient died, on October 23, 1896.