CONDITIONS MODIFYING THE PASSAGE OF HARD SUBSTANCES THROUGH THE BOWEL. In the proceedings of the physiological society of Cambridge, Dr. J. Theodore Cash made a communication regarding peristaltic movement in the small intestine of a dog up on which a fistula had been established. He enumerated the various causes which he had found effective in modifying the occurrence of contractions in, and in varying the speed of transmission of a solid body through the fistulous intestine. Amongst these causes were mental impressions, the act of deglutition, the introduction of food into the empty stomach, the condition of active digestion, exercise, etc. The animal was not subjected to the action of any narcotic, nor was it in any way bound or restrained. During the course of the proceedings Mr. Sherrington exhibited a rabbit, in which he had placed a ligature round the optic nerve of the right side nine weeks previously. The ligature used was catgut, about one twenty-fifth of an inch thick, and was tied as tightly as possible. On the evening of the day of operation, the retinal vessels, as compared to those of the healthy side, were reduced to very fine streaks, perhaps a tenth of their previous diameter. No pulsation could be produced in them by compression. Observation of the fundus was impossible for the next fortnight, because of and on account of opacity of the media, but during the whole of that time the tension on the ligatured side was never so great as on the healthy side. At the present time, as was demonstrated, the tension was still lower than in the normal eyeball. Moreover, the retinal circulation has become re-established, although the vessels, especially the arteries, are smaller than in the opposite side. The right eye is completely blind, and the iris does not react to light. Otherwise the eye, to cursory examination, would appear normal. ON THE CONDITION OF THE UMBILICAL VEIN AFTER BIRTH. E. Wertheimer confirms the statement of Baumgarten that in the majority of cases there is a small vein in the center of the round ligament of the liver in the hepatic part of its extent, but regards this as a newly formed vessel, and not as a persistent part of the umbilical vein. In the infant the lumen of the umbilical vein speedily becomes closed by a plug of connective tissue, and this plug is subsequently excavated by the central vein, for which the designation centro-umbilical is proposed, and which is continuous with similar small veins in the per pheral portion of the round ligament. The centro-umbilical vein opens above into the left branch of the portal vein, either directly or by the intervention of the upper end of the umbilical vein, which, as obserevd by Sappey, may remain pervious for a distance of one or two centimeters. In certain rare cases of anomaly, such as those described by Monro, Ménière, Manec, Klob and others, the umbilical vein and its communication with the epigastric remain patent, giving rise to a channel uniting the portal and iliac veins, homologous with the anterior abdominal vein of batrachians. [In the anastomotic arrangements of the veins of the superficial portions of the liver with those of the diaphragm and abdominal wall, and in the existence of the centro-umbilical veins, and more particularly in the rare cases mentioned above, in which there is a channel of communication between the portal and iliac veins, we find an expla nation of those occasional cases of profound cirrhosis of the liver with no accompanying abdominal dropsy. The normal anastomosis found between the portal and systemic venous circulation, formed by means of the hemorrhoidal veins, is insufficient to relieve the obstacle to the onward flow of blood in the portal vein, when no other communication exists; but with an anomalous vein as above mentioned, and the centro umbilical with its anastomosis between the portal vein and those of the abdominal wall, there is a sufficient number of channels to relieve the obstructed passage, and thus prevent the transudation into the peritoneal sac, which otherwise takes place.] THE LUMBAR Curve of THE SPINE IN SEVERAL RACES OF MEN. The characteristic lumbar curvature of the human spine is the result of the conformation of the vertebral bodies and of the inter-vertebral discs. Sir W. Turner finds that in Europeans the first and second lumbar vertebræ are generally thicker behind than in front; the lower ones,and particularly the fifth, thicker in front than behind. In negroes, Andamanese, and especially Australians, the upper lumbar vertebræ show a greater preponderance of the posterior vertical diameter, while the fourth and fifth are relatively shallower in front, so that the lumbar spine is less curved in those races. [Knowing that of all the points which distinguish man anatomically from the animals below him in the scale, the lumbar curve is one of the most prominent, as it permits of his erect carriage, which gait cannot be permanently assumed by any other animal, and taking into consideration other points in which the so-called lower races bear a resemblance to those animals below them, such as projection of the canines, prehensile powers of the great toe, prognathism, etc., we may well hesitate and consider whether these races are low only in the social scale or in the evolutionary scale as well, and whether they are not one step more closely related to link No. 21, the so-named Pithecanthropus, (alalus) in that scale. The nearer approach they present to the lower animals, in all those points which so widely separate the European from them, tends to make it worthy of ob servation, to say the least.] lation to the amount of the lesion of the fibres of the commissure. Complete destruction of the commissure is followed by loss of function of the oculomotorii which is as complete as if the nerves were cut. A DECEREBRized Frog. Would In the society proceedings of the American Neurological Association, Dr. Wilder exhibited a frog which he had decerebrized more than seven months ago. The movements of the frog are superinduced, for after remaining in one position for some time, he will change his position. If placed upon a convex surface, and this be slightly revolved he will endeavor to balance himself. sometimes wink with one eye, but when irritated would wink with both. It was a question with Dr. Wilder whether the animal ever slept, as upon the least jar, when apparently asleep, he would instantly open both eyes. The questions of ability to procreate his species, and capability of hypnotization were discussed by the members. RELATION BETWEEN CALIBER OF BRONCHI AND VOLUME OF Lungs. W. Braune and H. Stahel (Amer. Jour. Med. Science) describe a series of experiments in reference to determining the relation between the caliber of the bronchi and the size of the lungs. The trachea and bronchi were removed from the body and hardened in chromic acid or frozen. Transverse sections were then made at certain definite spots, and the area of these carefully measured. In five cases the average weight of the right lung to that of the left was in the proportion of 100: 74.9, the section of the right bronchus to that of the left as 100:75.5. They summarize as follows: FUNCTION OF THE POSTERIOR CEREBRAL COM- The trachea is smallest immediately below MISSURE. Darkschevitsch, of Moscow, has arrived at the following conclusions: A lesion of the posterior commissure is always followed by a lessening of the excitability of both of the third cranial nerves, oculo-motorii. The degree of depression in excitability bears a re. the larynx; its caliber increases gradually to about the middle of its length, and then diminishes to about three centimeters above the bifurcation, from which spot it again enlarges to its termination. The sum of the sections of the two bronchi at their beginning is greater than the sections of the trachea, three cm. above the bifurcation, the average proportion being 107.9:100; in only two cases out of the ten were the bronchi together smaller than the trachea. The caliber of the right bronchus at its origin to that of the left is on the average as 100:77.9, the extremes in eleven cases being 100:71.6 and 100:83.3. The caliber of the left bronchus usually diminishes from its origin to its termination. There is a constant relation between the weight of the lung and the caliber of its bronchus, the capacity of the lung being directly proportionate to the caliber of the bronchus. An emphysematous lung or lobe of a lung has an enlarged bronchus or primary bronchial branch, while affections causing a reduction in the respiratory capacity of the lung are accompanied by a diminution in size of the corresponding bronchus. The caliber of a bronchus depends upon the volume of air passing through it; if the volume of air increases, the caliber of the bronchusa lso increases and vice versa. SOME ANATOMICAL CONSIDERATIONS OF THE In the July number of the New Orleans Medical and Surgical Journal, Rudolph Matas begins a lengthy article on "Iliac Phlegmons," with some anatomical considerations of that region. He cites this region as exhibiting the influence of tradition upon anatomical authorities, which so frequently blinds authors to the true anatomy of parts, and perpetuates indefinitely a marked error. Descending face of the cecum is not uncovered by peritoneum and connected to the right iliacus muscle by areolar tissue, bnt is completely covered by it, and not only entirely covers the cecum, but extends upward over the lower inch or two of the ascending colon. Mr. Treves draws his conclusions from the examination of one hundred specimens, in none of which did he find the posterior surface of the cecum uncovered. THE INTERNATIONAL MEDICAL "Our latest The London Lancet of July says: Qui siccis oculis monstra natantia, Nevertheless, many on this side are anxious to return the visits so generously made from the other. And whatever the discomforts of the voyage or the severity of the mal de mer, we are likely to have the advantage of much brotherly assistance and advice. It may mark a new era in the treatment of sea-sickness, when so many zealous physicians and surgeons are set in competition for their own relief. Be this as it may, great preparations are being made in Washington and elsewhere, and it only remains for Europe to see that the guests are forthcoming. It is the great element in all such gatherings that they be well "furnished with guests," and we would now urge on the profession and its leaders that they will do a great service by an early decision to attend, and still more by an early intimation of it to those concerned. There are American physicians who have visited England annually for thirty or forty once in the year. The late Dr. Flint, whose absence will be acutely felt at Brighton this year and at Washington next, had come of late years to think nothing so refreshing as a run to the old home of his forefathers. Let us reciprocate the from one book to another, a statement soon begins to assume an air of weight and authen-years, and on rare occasion perhaps more than ticity which deters observers from correcting it, they inclining rather to think themselves wrong, or an anomalous disposition of the parts to exist, when their observations fail to agree with the traditional description of it. Dr. Matas holds that this is true of the description of the peritoneum covering the cecum,and quotes from the lectures of Frederick Treves in support of his view. According to the last named author, the posterior sur compliment on this high occasion, and make the very Atlantic the measure of our desire to cultivate international science and friendship." -The Neurological Review, edited by Prof. J. S. Jewell, of Chicago, is one of our most welcome exchanges. ORIGINAL ARTICLES. NOISES IN THE HEAD AND EARS. BY ROBERT BACRLAY, A. M., M. D. Read before the Mississippi Valley Medical Society, at Quincy, Ills., July 13, 1886. Noise in the head and ears, commonly called autophonia, is the perception by audition of entogenetic vibrations produced in performance of the physiological functions of phonation, respiration, circulation, mastication and deglutition. This symptom, so frequently complained of, is of important significance in differential diagnosis and treatment of diseases of the ear. Until quite recently it was supposed to depend upon vague lesions of the inner ear and auditory nerve center. This error and the existence of published theories, which differ materially from each other, have led to indifference and indecision on the part of physicians in regard to these symptoms. Three of these theories deserve special mention First, that of Dr. Gustav Brunner, which holds that the "alterations in the hearing of one's own voice," are a phenomenon "of resonance, a vibration of air in the middle ear, shut in by closure of the tubes," and that it seems 66 most natural to seek the cause of its frequent alterations in a stoppage of the tubes; "and Dr. Brunner calls this supposed condition "tympanophony." In addition to this he names, as factors in the production of autophonia, processes which "favor the conduction of noises to the nerves," and which give "abnormal reinforcement of the blood noises," and "hyperesthesia of the auditory nerve, or of the central nervous organs." The second theory is that of Dr. Gruber, which holds that autophonia is a "consonancephenomenon, caused by swelling of the mucous membrane of the middle ear.' Neither of these theories answers to conditions found in every case suffering from noises in the head and ears. The third and last theory of autophonia to which I shall call your attention, is that of Dr. Samuel Sexton, of New York; this holds that "the phenomena of autophonia are due to a disturbance of the normal equilibrium of tension of the transmitting mechanism of the ear." Vibrations from the vocal chords and from musical instruments played in contact with any part of the head reach the drum-head by two routes, one being through the tissues of the head, the other through the surrounding air into the external auditory canal. Owing to the peculiar saddle-like articulation between the malleus and incus, which permits the former to move outward slightly without drawing the latter after it, vibrations by the tissue route pass out unperceived when the ear is in a healthy state. In the same way vibrations from circulation, respiration, etc., pass out by this route unperceived, otherwise confusion of hearing would result. When normal tension of the transmitting mechanism is disturbed in any form of ear disease, autophonia is almost invariably present. The two most frequent conditions of the transmitting mechanism producing this symptom are dislocation of the malleo incudal joint and alteration in tension of the drum-head. The former occurs more frequently and persistently in the chronic than in the acute affections of the ear; the latter is found most frequently in manometric restoration of the drum-head. The construction of the malleo incudal joint is such that, when dislocation takes place, sound waves from without by aerial conduction are not transmitted to the perceptive center, while those from within by tissue conduction are perceived, for they act upon the stapes and incus irrespective of the malleus and drum-head. In chronic aural catarrh accompanied by catarrh of the Eustachian tubes, air does not gain free access to the tympanum as in a state of health. The atmospheric pressure from without, not being counterbalanced by equal pressure from within the tympanum, drives the drum-head gradually inward until dislocation, partial or complete, of the malleo-incudal joint is produced. This condition is accompanied by the phenomena of autophonia. On examining the drum-head in such cases, we find foreshortening of the handle of the malleus, extreme prominence of the short process from which umbrella-like folds of membrane extend forward, backward, and sometimes upward; the pyramid of light is absent, the drum-head retracted, sometimes so much so that it rests upon the promontory, and the stapes and long process of the incus are seen beyond and through the drum-head. When such conditions obtain and are not of too long standing, Politzer inflation often gives relief from the annoying autophonia, provided normal tension is reestablished in the parts. In acute inflammation of the middle ear accompanied with great secretion, the drum-head is forced outward and the malleus and incus are partially separated at their joint. This is attended with autophonia, from which relief is usually experienced when the secre tion is removed by operation or by reabsorption of the secretions. Permit me, at this point, to call your attention to the fact that immediate relief in these cases may often be afforded by extracting the secretions through the Eustachian tube with a soft rubber Eustachian catheter attached to a suction syringe. A case so treated successfully has been reported in the medical press by Dr. Samuel Sexton, of New York, his patient being the well known surgeon, Gen. J. D. Bryant, of that state and city. Ignorance of the modus operandi of sound transmission and of the cause and nature of autophonia has led many aurists to condemn the tuning-fork as unreliable and useless in differential diagnosis of diseases of the ear. In middle ear disease the tuning fork is better heard through the tissues proportionately to an increasing defect in aerial transmission, while if the perceptive apparatus of the inner ear alone be affected, it is better heard, if heard at all, by aerial conduction. We may formulate this thus: "Perception of vibration by tissue conduction varies inversely as that by normal aerial transmission." Knowledge of this fact enables us to afford relief to totally or partially deaf patients, who can hear the sound of their own voice. In many cases we find the otacoustic fan, mouth-trumpet, etc., useful for conversational purposes or in instruction. Where some hearing power remains in both ears, perhaps the most serviceable instrument for teaching the patient to use his own voice is one invented by Dr. Sexton and presented by him to the American Otological Society, at its last annual meeting. This instrument resembles a binaural stethoscope which is self-retaining in the patient's ears. It has two receiving trumpets each of which independently communicates by flexible tubes with both of the metallic stethoscopic tubes. Into one of these trumpets the teacher speaks, after which the pupil repeats into the other the sounds or words which he has just heard and which he is striving to imitate. In many cases the tension of the transmitting mechanism is altered by change of posture of the head, coughing, blowing the nose, yawning, swallowing, eructation, etc., producing alteration of audition and irregular autophonia. Confusion and uncertainty of audition and mental distress are increased by such changes, especially where both ears are affected and while both are unequally affected, the patient is often troubled with double hearing. Where such patients require unimpaired hearing in order to earn their livelihood the trouble has more serious import. Actors, singers, and performers on musical instruments, are unable to act their part, or play, or sing with accuracy, and are often apt to think that others are in discord instead of themselves. Singers and actors so affected are often led to suspect trouble with their vocal organs and seek relief in vain from treatment directed against those organs. Variations in the tension of the transmitting mechanism from time to time produce alternate perception of entogenetic and ectogenetic vibrations, and consequent indecisions as regards their subjective and objective nature; a fact to be borne in mind by those who practice auscultation, for, when pressing the ear against a surface, the examiner must of necessity hear subjective vibrations, those propagated from within his own head, as well as those objective ones given forth by the patient. A failure to recognize and differentiate such subjective sounds leads to serious confusion and grave errors in diagnosis. Varying audition and uncertainty as to the subjective or objective origin of sounds heard, if associated with mental weakness or worry, may lead to aural hallucinations, and these may become even delusions. I have seen three such cases in which relief was afforded by treatment directed against the existing ear-disease. In such cases treatment directed against the central nervous system, will prove impotent to cure, unless attention be paid and proper treatment directed to removal of the periph eral aural excitant. The prognosis in autophonia, under proper treatment, is favorable, complete cure being the rule in acute cases, while great relief may be afforded in the more chronic ones. 3101 Olive Street, St. Louis, Mo. -Jonathan Hutchinson's Advice to Medical Stu dents (Peroration to introductory at London Hospital).—If now I were to sum up in one sentence what I have been enforcing it would be this: The secret of all noble life lies in belief, and the characteristic of all noble minds is the vigor with with which they believe that which is true. Try to attain belief in the reality of all things, so shall you never want for motives, so shall you be able to live and work without hurry and without sloth. Finally, permit me to commend to you this formula: Prize strength, love the beautiful, practice self-denial and be patient. -Dr. Morrell Mackenzie writes us that he is pleased that there will be a Laryngological Section in the Congress, and that if he cannot be present he will endeavor to send a paper. |