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into convalescence. Roseola was found in one hundred fifteen out of the two hundred ten cases, but seldom before the sixth day of the disease. The average duration of the temperature in all cases was 17.3 days. The Widal test was positive in eighty-six of the ninety-six cases examined. The mortality, as usual lower in children, was 5.2 per cent. Intestinal hemorrhage occurred in thirteen patients, four of whom died. Details of the fatal cases are given. The treatment was symptomatic and hygienic. The author believes that the enlargement of the diet of typhoid patients advised by many is unadvisable so far as children are concerned. Milk diluted for infants and very young children with albumen water and the usual cereal gruel diluents, such as barley water and rice water as drinks, he thinks, are best for this class of cases. Care in diet during the early part of convalescence is as important as during the height of the attack. Hydrotherapy was employed : tubbing in practically all cases, the temperature being the usual guide to its employment; also the nervous symptoms, which it seemed to benefit. In cases of severe intoxication enemas of salt solution were used with advantage. Intestinal antiseptics-salol, acetezone, et cetera,—did not seem to be of any particular advantage. Four patients died from perforation, two of whom were operated on.
THE WEIGHTS OF THE VISCERA IN INFANCY AND
CHILDHOOD. David Boviard and Matthias Nicoll, Junior ( Archives of Pediatrics, September, 1906), recognizing the need of some definite standard of the weights of the viscera in infancy and childhood have, for some years weighed all the larger viscera in their autopsies and tabulated their results. The conclusions they arrive at are as follows:
(1) The study of the average weights of the viscera in infants and children, up to the age of five years, shows that there is constant relation between the weights of the more important viscera, thus:
(a) The weight of the liver will average seven times that of the heart.
(b) The weight of the spleen will average one-tenth that of the liver.
(c) The weight of the kidney will average one-ninth that of the liver.
(2) That the weight of the thymus gland as commonly given is excessive, owing to the acceptance of pathologic glands as the standard for normal conditions.
(3) That the average weight of the thymus at autopsy is approximately 6.0 grams.
(4) That there is no evidence of a growth of the thymus after birth under ordinary conditions, but that under special conditions the gland does grow and even hypertrophy enormously.
ETIOLOGY AND DIETETIC TREATMENT OF INFANTILE
ATROPHY. WENTWORTH says (Jama, August 26, 1905) it is generally believed that infantile atrophy is usually produced by a combination of errors in feeding, though the way faulty feeding leads to it is unknown. Nothnagel and Baginsky believe a constant derangement of digestion causes atrophy of the intestines. Heubner and Block dispute this theory and believe that the only change is that in Paneth's cells in Lieberkuhn's ducts these cells do not contain the granules which are supposed to be evidence of their functional activity. The strongest evidence against the intestinal atrophy theory is the rapidity of improvement when the infant is given a suitable food. Probably impaired intestinal functions are of chief importance in producing the atrophic condition. The chronic intoxication theory is not proved. The feeding with breast milk restores the function very quickly, and possibly there are some ferments present in human breast milk which stimulate digestion. As regards feeding, three
, courses are open: Proprietary foods, cow's milk mixtures, and human breast milk. The first are generally unsuitable and are often the cause of rickets and scurvy. Cow's milk mixtures are better; they should be given regularly and at frequent intervals, but they too, are usually unsuitable. The human breast milk is by far the most reliable in the author's experience and the improvement is often so marked that even a temporary change to breast milk will enable the infant to regain enough digestive power to allow it to thrive on a cow's milk mixture.
TREATMENT OF ACUTE PURULENT OTITIS MEDIA
AND MASTOIDITIS WITH BIER'S HYPEREMIA. KOPETZKY, of New York City, in the Archives of Otology, Volume XXXV, Number IV, reviews the history, case reports, and technic of this therapeutic agent and discusses several of his own cases, with the following conclusions:
(1) If used early it will greatly increase the probabilities of curing the condition without resort to major operative measures.
(2) In cases cured under its influence the reestablishment of ear function will occur quicker than under the usual line of treatment.
(3) Its use by the inexperienced is absolutely dangerous.
(4) Its employment should be limited to the young and the otherwise healthy.
(5) Finally we submit that when the indications are kept in mind and when properly and intelligently used, induced hyperemia will be found a measure destined, when its scope and limitations are better understood, to find a permanent place in otologic therapeutics.
M. L. C.
ETIOLOGY, DIAGNOSIS, AND TREATMENT OF AURICU
LAR CHONDRITIS AND PERICHONDRITIS. DEUCHFIELD, in The Laryngoscope, Volume XVI, Number VIII, states that aside from the so-called idiopathic cases as seen in the insane, this condition is almost always due to trauma, and questions with Kirksbride and Cumen that even in the insane, were the truth but known, the etiologic factor is some punitive or self-inflicted blow and not a lesion of the restiform bodies as stated by BrownSequard.
The diagnosis may be made from the history of trauma and the appearance of the auricle, erysipelas, frost-bites, and new growths easily being differentiated.
The endeavor should be, first, to secure absorption by means of heat, cold, iodin or ichthyol and these failing, incision into the lower border of the mass with drainage of its contents and application of pure carbolic acid followed by absolute alcohol, should be made.
M. L. C.
WILLIS SIDNEY ANDERSON, M. D.
INFERIOR RETROPHARYNGEAL ABSCESS, FOLLOWING
THE REMOVAL OF ADENOIDS IN AN ADULT. Doctor AKA (Revue Hebdomadaire de Laryngologie, D’Otologie, et de Rhinologie, September 22, 1906) reviews first the complications which may follow the removal of adenoids, and then gives the history of a very interesting and unusual case of retropharyngeal abscess.
The patient was a woman, aged twenty-six years, who was operated upon for adenoids. All the usual aseptic precautions were taken, and nothing unusual occurred at the time of the operation. Fourteen days after the operation the patient returned with the history of gradually increasing difficulty of swallowing and evidences of septic infection. Examination showed nothing unusual in the nasopharynx, with the soft palate, or with the posterior pharyngeal wall. On depressing the tongue firmly a swelling of the lower portion of the pharyngeal wall could be detected, which hid from view the arytenoid cartilages and completely blocked the opening into the esophagus. A diagnosis of abscess of the lower portion of the pharyngeal wall was made, and it was opened by the galvanocautery knife. Considerable pus was evacuated, the cavity was washed out and a cure resulted.
The author does not believe that the infection resulted from any faulty operative technique, but rather that the chronic inflammation of the nasopharynx furnished the germs for the acute infection. The operation allowed the germs to enter the lymphatics, or the veins of the pharyngeal wall.
Prompt evacuation of the pus from an abscess in the lower portion of the pharyngeal wall is imperative, as infection of the posterior mediastinum may readily take place. Such an infection is serious because of the difficulty in draining an abscess of the mediastinum.
REPORT OF A CASE OF POLYPOID LIPOMA OF THE
TONGUE. ADOLPH O. PFINGST (The Laryngoscope, September, 1906) reports a very unusual case in a girl, aged fourteen years. The growth was first noticed by the mother when the patient was about three weeks old, and had been allowed to grow gradually larger.
The growth was attached to the tongue at a point corresponding to the foramen cecum, and consisted of a large pedunculated mass of a peculiar shape which could be aptly compared to a fetal chicken or duck. It had a smooth though slightly irregular surface, was pink in color, and rather firm to the touch. Serious difficulty in speaking, swallowing, and breathing resulted from the presence of the tumor. The growth was removed with a Peters' snare. The hemorrhage was profuse for a few minutes, but subsided promptly. The patient made a good recovery. There was a marked tendency on the part of the patient to sleep after the operation, and there was a noticeable improvement in the voice and general health.
The tumor immediately after the operation weighed just one-half ounce. It was two and one-fourth inches long, one and one-fourth inches across its broadest part, and one-half inch at its apex. Its pedicle measured three-fourths of an inch. Microscopic examination proved it to be a lipoma.
The author reviews the literature of the subject.
THE BACTERIA IN SCARLATINAL AND NORMAL
THROATS. GUSTAV F. RUEDIGER (Jama, October 13, 1906) quotes a number of observers on the subject, gives his method of study, and the results from a study of one hundred fifty-four throat cultures. His conclusions are:
The streptococcus pyogenes is constantly found in great abundance on the tonsils of patients suffering from tonsillitis and scarlet fever before the inflammation of the throat has subsided. These organisms rapidly decrease in numbers with the subsidence of the throat symptoms.
The streptococcus pyogenes cannot be considered a normal inhabitant of all healthy throats, although it was found in small numbers in fifty-eight per cent of the normal throats in this series.
Pneumococci of low virulence was found in one hundred thirty-five of this series of one hundred fifty-four throats.
A large group of organisms which lie between the typical streptococcus pyogenes and pneumococcus was found in normal throats and in nearly all diseased throats. These organisms have very little virulence for rabbits, and, as they are found in great abundance in nearly all throats, they appear to be normal inhabitants of the throat.
The streptococcus pyogenes from normal throats appears to have a slightly greater virulence for rabbits than these organisms from scarlatinal throats.
PERSISTENT UNILATERAL HEADACHE DUE TO NEVOID CHANGES IN THE ANTERIOR EXTREMITY OF
THE MIDDLE TURBINAL BONE. WYATT WINGRAVE (Journal of Laryngology, Rhinology and Otology, August, 1906) cites an interesting case in a man, aged thirty-eight, who had a severe and persistent frontal pain of three months' duration, dating from a severe attack of influenza. He had frequent attacks of coryza, which generally afforded partial relief. The right nostril was found to be free, but the left was obstructed, in part, by a slight septal deviation, but mainly by hypertrophy of the middle turbinal, which completely blocked the meatus. The sinuses were found to be clear on transillumination.
Local sedatives, general depletion, and bromides for a week affording no relief, the anterior end of the middle turbinal was removed by means of a Krause's fine wire snare. Complete cure with the relief of the pain.
On microscopic examination of the specimen the mucous membrane appeared normal, but the bony cancelli were found to contain very thin vessels distended with blood and pressing on the walls. There was no evidence of lymphocyte infiltration, nor any osteoplastic activity such as is usually found in inflammatory sinusitis involving the bone. The morbid condition may be regarded as a passing nevoid state of the spongy bone, possessing no semblance whatever to any inflammatory process such as rarefying osteitis, necrosing ethmoiditis, suppurative sinusitis, et cetera.
The author very properly advises against the use of the cautery in these cases, and favors the removal of the anterior end of the middle turbinal. A strong and fine wire should be used, and if pushed upwards and backwards will readily engage and rapidly cut through both bone and mucous membrane.