THE SURGICAL TREATMENT OF EXOPHTHALMIC GOITER. While surgery is admittedly contraindicated in many cases of exophthalmic goiter, F. J. Shepherd, Montreal (Journal, A. M. A., September 1), maintains that in a certain proportion operative measures are curative or lead to decided improvement. The probable cause is hyperactivity of the thyroid, but the part played by the thymus and other causes in this disease complex can not be entirely ignored. Shepherd thinks that early operation is safest and that the class of cases most likely to be benefited are not the most severe ones, but those in which the gland is more enlarged on one side than on the other, with more definite tumor formation, and in which the gland is not excessively vascular and the enlargement has preceded the symptoms by years. In those early cases of enlarged thyroid with mild symptoms in which the gland is soft, vascular and evenly enlarged throughout, the results of operation are usually good. With large vascular thyroid and symptoms of marked toxemia from thyroidism operations should be avoided. He notes the disinclination of most physicians to operate and gives statistics from various operators showing good after-effects and low mortality. Nor does he consider general anesthesia as specially dangerous in selected cases. Fourteen cases of his own and three of certain of his colleagues are reported. There were three deaths, all in desperate cases, nine complete cures, three patients were much improved, one relapsed and one has been lost sight of, though improvement followed operation. Sixteen of the patients were females. In all, the operation was called for on account of distressing symptoms. The diagnoses were clinical. He does not believe the pathology of the disease is sufficiently definite to make the microscopic examination of first importance. THERAPEUTIC PROGRESS. T. F. Reilly, New York City, in his chairman's address before the Section on Pharmacology and Therapeutics (Journal A. M. A., September 1), reviews the principal facts of therapeutic progress during the past year. Few new useful remedies have been introduced; the increasing use of ethyl chlorid as a preliminary anesthetic in ether anesthesia is noticed, while the claims of scopolamin-morphin anesthesia have, in a measure, he states, been discredited by experience. A considerable impetus has been given to the use of the soluble salts of mercury by hypodermic injection in the treatment of syphilis, and Reilly predicts that the use of inunctions in the treatment of this disease will soon be a thing of the past. No new organic silver salt has been launched during the past year; a few cocain substitutes are awaiting trial, but he thinks from personal observation that their advantages are more than counterbalanced by their disadvantages. Creosote and its congeners seem to be losing public confidence for the treatment of pneumonia, and in the east the brilliant results from massive doses of quinin that are reported from the southwest have not been seen. The faith in drugs for pneumonia has not generally increased; strychnia, he says, is the only agent used with any constancy in the large metropolitan hospitals. The tendency to seek animal remedies has increased, and in this connection he notices the Mobius and the Beebe and Rogers serums as promising to be of value. There has been little added to our knowledge of the therapeutic properties of the extract of suprarenals, but there have been some warnings of the dangers of hypodermic use of its various preparations, and its possible effects on the arterial walls must be kept in mind in its continued use of human beings. The number of diseases considered benefited by x-ray therapy has been reduced rather than enlarged by later experience. The use of large doses of diphtheria antitoxin in diphtheria is increasing. Its value in postdiphtheritic paralysis has been confirmed, and while the intravenous use of this agent has not had much favor it may be worthy of trial in some cases. Reilly does not speak favorably of its utility outside of diphtheria. The prophylac tic value of antitetanic serum is confirmed; it may be regarded as a specific. There is some reason to think that polyvalent sera can also be of prophylactic value in suitable conditions. No confirmation of Behring's antituberculous sera has been reported. Mention is made of the probable value of a more systematic study of the medicinal value of our native plants. The new edition of the Pharmacopeia and the greater than usual interest taken in it by the profession is noticed and the suggestion is offered that in future editions, which will need to be more frequent, the American Medical Association should take a part by selecting the medical members of the committee on revision, thus bringing the Pharmacopeia more closely in touch with the profession of medicine. The most noteworthy and most lasting in its effects of the therapeutic advances is the campaign against nostrums, and the Council on Pharmacy and Chemistry is mentioned as being, next to The Journal, the most valuable asset of the Association. STENHOUSE AND FERGUSON'S EPITOME OF PATHOLOGY. By John Stenhouse, M. D., of the University of Toronto, and John Ferguson, M. D., Toronto, Canada. 12mo., 285 pages, amply illustrated. Cloth, $1.00 net. Lea Brothers & Co., Publishers, Philadelphia and New York, 1906. (Lea's Series of Medical Epitomes. Edited by Victor C. Pedersen, M. D.) Drs. Stenhouse and Ferguson devote the first half of their work to General Pathology, after which the Special Pathology of the various organs and systems is considered. This arrangement conforms to the modern method of handling the subject, so that this excellent epitomization will serve not only the student in acquiring a well assorted knowledge, but also the practitioner who desires to post up on the leading points. Mastery of the information so easily presented in this compact volume will qualify its readers on the essentials of the subject and facilitate the work of those who desire to pursue it further in the larger treatises. The volume on Pathology is the twentieth in the Medical Epitome Series, which is to comprise twenty-three manuals authoritatively covering the whole field of medical education, leaving only the volumes on Nose and Throat, Gynecology and Hygiene to be published shortly. A MONTHLY Magazine of Medicine aND SURGERY. EDITORS. JAMES U. BARNHILL, A. M., Ph. D., M. D., 248 E. State Street. WILLIAM J. MEANS, A. M., M. D., 715 North High Street. D. N. KINSMAN, M. D. ASSOCIATES. V. A. DODD, M. D. H.H, SNIVELY, M. D. Communications relating to the editorial department should be addressed to Dr. J. U. Barnhill, 248 East State Street; those relating to business management should be addressed to Dr, W. J. Means, 715 North High Street. Per annum, in advance, subscription price, including postage.. Bound volumes. Single copies... $1.00 2.00 .15 cents. Original articles, scientific and clinical, n emoranda, correspondence and news items are cordially solicited from the profession. DECEMBER, 1906 ANESTHETICS. In the December first issue of the Medical Record there appears a very interesting article on "Anesthetics," by J. E. Lumbard, Anesthetist to the Harlem Hospital. The article is based upon an extended experience of his own and upon that of seventy-nine surgeons in twenty-three states. As results of his own experience he summarizes the following advantages of ether: (1) The first and all important advantage is safety. (2) It is stimulating, whereas chloroform is depressing. This can well be demonstrated when you have a flagging pulse under chloroform, and change to ether. (3) Ether will stand more abuse than chloroform, which is a great advantage when one is obliged to have a novice administer the anesthetic. (4) Ether usually gives warning of approaching danger, which chloroform seldom does. (5) The practical working range of ether is much wider and there is less fear of accident from an overdose than when chloroform is used." On the comparative merits of ether and chloroform, he says: Ether is slower in its effect, less pleasant to inhale, more bulky and more expensive; it is inflammable, sometimes irritating to the air passages, and is often followed by nausea and vomiting; however, it usually gives warning of danger, and is safe under ordinary circumstances. On the other hand, chloroform is quicker in its effect, pleasant to take, less irritating to the mucous membrane, less bulky and less expensive; it is not explosive, and usually causes less nausea and vomiting; it does not always give warning of danger, and is not always safe. The merits of each case must be carefully considered when selecting the anesthetic, and neither chloroform nor ether should be used exclusively. Ether, however, being the safer, should always have the preference when it is not contra-indicated. After all is said, it is experience that counts more than the anesthetic, or the apparatus that is used. Dr. Lumbard addressed letters of inquiry to a hundred surgeons throughout the entire state, from seventy-nine of whom he received replies. His letter contained the following questions: "1. Which anesthetic do you prefer in general surgical work? (a) Ether? (b) Chloroform? 2. Which method of administration? 3. As preliminary to the use of ether, do you prefer (a) Nitrous oxide? (b) Ethyl chloride? 4. In your opinion, do you think anesthetics and their method of administration receive proper attention in the curriculum of our medical colleges? 5. How many deaths have come under your observation from the administration of (a) Ether (b) Chloroform?" In answer to Question 1, sixty-seven preferred ether; 7 chloroform, 1 anesthol; 4 were noncommittal. 2. In the case of ether, 38 used the drop method; 16 the Bennett inhaler; 11 the cone; 8 the Allis inhaler; 1 the Blake inhaler. If chloroform were used, 11 preferred the drop method, 1 the vapor method. 3. Forty-eight nitrous oxide; 3 ethyl chloride; 3 morphine hypodermically; 1 morphine and scopolamine hypodermically; 1 A. C. E. mixture; 1 anesthol occasionally; 20 nothing or noncommittal. 4. Sixty-eight answered in the negative. 5. Ether, 53 deaths; chloroform, 91 deaths. The answers indicate that ether, except under special circumstances, is very generally preferred. Another change in reference to the administration of anesthetics is that at the present time most surgeons give ethyl chloride or nitrous oxide to secure preliminary narcosis. |