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The question of peritonitis is important. A stone near the papilla is a foreign body, and as such, it irritates and leads to the establishment of peritonitis, which may become purulent. Chills, fever, sweats, etc., occur here. Inflammation may result in perforation of the gall tract, setting up peritonitis thus. From malaria, differentiation is sometimes impossible. Dr. Taylor said he could recall cases in his own practice in which diagnosis was only made by the autopsy. Solvents are myths and the only medical indication is to relieve pain.
Dr. J. S. Wellford reported cases of cholelithiasis. Most cases, said he, of gout commence with violent pain, especially in the right hypochondriac region, and this should be borne in mind in diagnosing gall-stone and appendicitis. MARK W. PEYSER, M. D., Secretary and Reporter.
DIRECTLY INFECTIOUS NATURE OF TYPHOID FEVER. — Dr. Jos. Priestley (British Medical Journal, August 31) says in 1892-4 there were in Leicester 634 cases of typhoid fever. Careful investigation negatived the idea of spread by milk or water. The number of pails to water closets in Leicester is as 1 to 2, whilst three times as many cases occurred in houses provided with pails. He explains this by specific infection of the pails, which then become the direct media of conveyance of the disease. The pails in Leicester are emptied once a week, but occasionally this rule is neglected. A case occurred when the period was prolonged to four weeks and the pail was overflowing. There were eleven inmates of the house all using the pail; of these, nine took sick during the months of March and April, 1895, with symptoms of typhoid fever, all except the first being notified as such. The ordinary channels in this case were wanting. The author had traced several similar groups of cases, viz.: Case 1, imported, gave rise to nine others.
Case 2 gave rise to eleven others. Case 3 arose from drainage alterations in a neighboring street and gave rise to eight others, all in one street, and among inmates of houses supplied with pails; 30 per cent. of the pail and 6 per cent. of the water-closet houses in the one street became infected. Case 4 infected two others. Case 5 infected the mother, four daughters, a son and a neighbor, seven persons, all of whom assisted in nursing him. nursing him. Case 6 probably infected eight members of the same family or friends nearby. He says that he could cite from his note-book many other cases that can only be explained in the same or in a similar manner; we must work along these lines as well as upon the well-recognized lines of water-borne infection.
LANCING CHILDREN'S GUMS.-So good an authority as J. Lewis Smith has recently spoken against the practice of lancing infants' gums. In a paper read before the New York County Medical Association (Medical Record) he said the belief still prevails to a wide extent that the cutting of teeth is a common cause, not only of painful gums and poor appetite, but also of enterocolitis and other serious maladies, which are often allowed to run along until beyond the skill of the physician. Our ancestors. in the profession were to blame for the widespread impression that much disease is due to dentition, since at one time it was a common custom to incise the gums. As to lancing the gums, he thought one could get along as well without it. If the gums are red and irritated, there must be some other condition to account for the irritation. He did not think the physiological process of normal dentition was to be interfered with any more than any other physiological process.
TREATMENT OF THE GRAVEST FORMS OF CARDIAC DILATATION.-Sir Dyce Duckworth (The Practitioner, 1895, LIV, p. 193) says: In a large majority of cases venous engorgement, anasarca, nausea, gastro-enteric catarrh, etc., are coincident with and dependent on the
dilatation of the cardiac cavities. Such patients are admitted into hospitals in extremis, too ill even for examination; a physiognomical diagnosis shows what is necessary to be done at once. The heart beats tumultuously, no murmurs can be detected, the two sounds closely resembling each other. We can almost certainly predicate mitral stenosis. The prime necessities are rest, adjusted pillows, warm bed and warmth to the feet. Large doses of spir. aetheris co. are exceedingly useful. Forty to one hundred minims may be given every three hours in an ounce of camphor or peppermint water. An excessive lividity of the surface or turgescence of the jugular veins demands venesection. The symptoms may be distinctly relieved by the removal of not less than six nor more than ten ounces of blood. In lieu of venesection one may place six or ten leeches over the precordia. Subsequent examination will reveal anasarca, swollen liver, etc. The tumultuous action of the heart having subsided, we may find dilatation, superadded to hypertrophy, with pericardial or pleuro-pericardial adhesions. In a few days we may find marked improvement in response to rest, careful diet, saline aperient (mist. sennæ co., I to 11⁄2 oz., with tinct. jalapae, i dr.) with occasional doses of citrate of ammonium and potassium. It is wisest not to give digitalis during the tumultuous heart action. A feeble, irregularly acting heart, with a feeble fluttering pulse, demands digitalis. Ten to twelve minims of the tincture of digitalis, three or four times daily, will prolong the diastole and make the heart steady and regular; not infrequently a free flow of urine and a subsidence of the dropsy supervene. In many cases, after a return to the usual conditions of life, a relapse occurs. The same measures may again succeed, but often benefit is derived from restricting the amount of fluids in cases of dropsy (of cardiac origin) and a pill of two grains of bluepill with one each of powdered digitalis leaves and squill. Two or three ounces of brandy or gin in twenty-four hours, given in milk, are very useful. The hepatic engorgement is greatly re
lieved by the mercurial pill. Persistent dropsy occasionally requires puncture. Dyspnea and insomnia are best relieved by morphine. Paraldehyde is also useful. Constipation is best treated by drachm or half-drachm doses of compound jalap powder in milk. A diuretic drink is lemonade to which bitartrate of potassium, one drachm to the pint, is added. Easily digestible and nutritious diet should be given; tender mutton, meat, fowl and fish finely minced, milk, eggs, broths and custard pudding; cocoa and coffee, toast and rusks, potatoes well mashed, and spinach. In the majority of cases digitalis is the best drug. Strophanthin is useful when digitalis is not well borne. Caffeine in four to five-grain doses, combined with strychnine, is valuable. In cases with an aortic reflex, digitalis must be guardedly used. The diastole may be prolonged too much for the left ventricle to bear. When the case is not under constant supervision, it is best to rely on strychnine.
"IT ALL GOES OFF IN THE BAKING." -The secrets of the baking trade, says the British Medical Journal of August 17, are manifold, and as one by one they are made public our faith in the pastrycook is not enhanced. From the reports in the St. James Gazette of a case tried at the Lambeth police court it appears that damaged tinned milk is used up in the making of pastry. The inspector, finding the milk in a very decomposed state, asked the defendant whether he thought the milk was fit for use. The defendant thereupon took up a piece of pastry for the witness to smell, and exclaimed, "Oh! it all goes off in the baking." This is purification by fire with a vengeance. We have long known that curiously stale eggs were used by pastry cooks; lately, in fact, the practice has sprung up of importing from abroad contents of eggs instead of the eggs themselves, the whites and yolks all mixed together being sent over in closed canisters. It is easy to imagine the mustiness of this egg mixture by the time it reaches its destination in
We suppose, however, it also all goes off in the baking." At any rate, in regard to milk such seems to be the expert opinion, for the pastrycook, in answer to the magistrate, is reported to have said that "a little bad milk would bake out," while his foreman stated that, "In the event of one tin being slightly blown,' it would bake out; " to which Mr. De Rutzen made the obvious comment, "" Then of course you would'nt mind putting it in?" In the end each defendant was fined £10 and costs, which from the consumer's point of view is satisfactory.
LESIONS OF THE FEMALE GENITALIA PRODUCED DURING COITUS. -Y. Lvow (American Journal of Obstetrics) says: This subject is of importance from a medico-legal as well as a gynecological standpoint. The hymen may remain intact after coitus either because the male organ has not penetrated the vagina, or when the solidity of the hymen or narrowness of the vagina from imperfect development prevents intromission, or in cases which present a very elastic hymen with a large opening. Usually, during the first union this organ is ruptured by a single blow, the line of tear being single, double, or radiating from the opening; more rarely the hymen is torn away at its attached margin and remains hanging by one side. In violent intercourse, especially when the hymen. is annular and thick, the tear may extend into the vaginal wall. The hymen is not merely a fold of mucous membrane, but contains muscular tissue and may be well supplied with blood-vessels. As a rule the hemorrhage following its rupture is slight and soon ceases; if serious the bleeding vessels should be tied; if parenchymatous a tampon is effectual. The tear usually heals in two or three days, but acute inflammation may arise from infection of the wound or too frequent coitus.
Laceration may occur in the region between the clitoris and the meatus urinarius, or severe hemorrhage may be caused by rupture of the turgid bloodvessels of the neck of the uterus. Im
proper formation of the hymen, malposition or diminutive size of the genital opening, and abnormal position or violence during coition may lead to rectovaginal fistula.
The author believes that vesico-vaginal fistula due to coitus is almost an anatomical impossibility, even in a short vagina, as the penis never enters entirely when in the natural position. A distended bladder might be thought to aid in the production of such a fistula, but it presses the uterus backward and upward, thus lengthening the vagina and stretching its anterior arch, and the only possibility is the detachment of the anterior fornix from the uterus. Lesions of the upper part of the vagina do not occur if it is healthy and of normal elasticity and extensibility, despite the relative size of the male and female organs and the violence of intercourse, except occasionally when in an unnatural position. In the author's two cases the pathological condition was furnished in one by atrophy associated with the climacteric, in the other by chronic atrophic parametritis.
Intercourse by the urethra occurs only in cases of atresia hymenalis when it is locus minoris resistentiae. Usually in this case the urethra is slowly dilated by persistent efforts, but rapid dilatation may result in its rupture.
RECENT PROGress in Cerebral SurGERY. Von Bergmann says (Journal of Nervous and Mental Diseases, August, 1895) owing especially to the difficulty or impossibility of diagnosis in many cases, the field will always be limited. In tumors operation is practicable only in 29 per cent. and three-fourths of these cannot be operated on because of impossible diagnosis. Considerable advance has been made by the introduction of extensive osteo-plastic resections of the skull, which render possible the extirpation of large tumors. Nothing is of more importance than speed and this could be obtained by the use of a circular saw set in extremely rapid motion by a small electric motor. With this a large bone flap may be sawed out in a
few moments, the operation being completed by means of a sharp chisel, to avoid injuring the dura mater. Operations for epilepsy have succeeded only in lesions of the cortical motor centers. It is necessary to be cautious in drawing conclusions from results, as cases of temporary recovery from simple trephining or excision of a cicatrix of the scalp are frequent. He has seen attacks cease during healing after amputation. It is impossible to approve of operations of extirpating portions of apparently healthy cortex which are considered to be the starting point of epileptic seizures. Extirpation is only justified where a distinct lesion-an abscess for example-is found. Great success has been obtained in abscess, and surgeons have even attacked thrombosis of the sinuses and suppurating leptomeningitis. The diagnosis is often impossible. The most frequent cause of abscess is suppurating otitis media and in one-fourth of cases thus produced, the otitis arises from a cholesteatoma of the middle ear. Developing thus, by continuity, abscesses are either intra- or extra-dural, or in the cerebral substance, most frequently in the temporal lobe. They are comparatively accessible and, as a rule, located above the tympanum. To reach them he prefers this method to trephining resecting a quadrangular portion of the wall of the skull, immediately above the external aud. meatus. A cutaneo-musculo periosteal flap, left adherent at its upper part, is made by three incisions, one horizontal, beginning above the zygoma and ending behind the mastoid process, the others vertical and perpendicular to the former, one in front of the tragus, the other behind the mastoid process, both being carried upward to a height of about four centimeters. Removal of the bone beneath this flap gives unobstructed access to the interior of the, skull and greatly facilitates the task of the oper
the middle portion of the latter. The operation consists in incision of the sinus after exploratory puncture, evacuation of the clots, disinfection and plugging, and lastly ligature of the internal jugular vein. ternal jugular vein. Of thirteen cases six recovered; death is generally due to pyemia or suppurating leptomeningitis. Quincke has attempted to relieve intracranial pressure by tapping the lumbar cord in basilar meningitis. Some improvement of short duration only has. been obtained. Death has not been averted but it has proved useful as a diagnostic measure because if bacteriological examination of the fluid withdrawn show the tubercle bacillus the meningitis is tubercular.
In thrombosis of the sinuses surgery has given unexpected results. The object is to reach the transverse sinus, the one usually involved, through the mastoid process, being situated beneath
DISINFECTION OF TUBERCLE-Infected HOUSES. The experiments of Mr. Sheridan Delépine and Dr. Arthur Ransome (British Medical Journal) led to the following conclusions:
The disinfection of rooms which have been contaminated with tuberculous products cannot be obtained by means of the fumigation methods, such as are generally used at present. Sulphurous acid, chlorine, and euchlorine, as used under supervision by experienced municipal disinfectors, have proved practically useless.
The only other method of disinfection which seemed to promise more satisfactory results was the direct application of a solution of chlorinated lime to the walls to be disinfected. This method has given so far satisfactory results, but is attended with discomfort on the part of those who have to carry out the disinfection.
Light is, in the case of the tubercle bacilli, as it has been proved by several observers to be in the case of other organisms, the most important natural disinfecting agent.
Simple drying was shown to be in itself enongh to reduce and ultimately entirely destroy the virulence of tuberculous products. Mere ventilation in the dark suffices only to diminsh and not to destroy the power of the microbe.
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BALTIMORE, SEPTEMBER 28, 1895.
PROFESSOR PEPPER of Philadelphia takes this as the subject of his scholarly and interesting address delivered before Daniel Drake. the Mississippi Valley Medical Association at Detroit, on September 4. Daniel Drake was a distinguished western physician who emigrated in 1788, when a child, from New Jersey to Kentucky, and subsequently became one of the most noted men of that section. Yet few physicians of this day know him even by name. Let us see what manner of man he was and what he achieved.
His youth was passed amidst the toils and hardships and dangers of the frontier and at fifteen he was sent to study medicine under Dr. Goforth, in Cincinnati, then a village of 500 inhabitants. He manifested so much ability that he was admitted to partnership with his preceptor after four years. Without a diploma and without even having listened to a lecture, he now engaged in practice. In
a year he had scraped together enough money to enable him to go to Philadelphia and attend a course of lectures at the University of Pennsylvania. Not until eleven years later did he again visit Philadelphia to receive his diploma at a special commencement held purposely for him more than a month after the regular commencement. At the age of 31 he received his first call to a professorship at Lexington, Kentucky, and altogether he had no less than thirteen calls to professional chairs and he actually occupied nine separate chairs in five distinct institutions. These were Transylvania University, at Lexington, Kentucky, the Medical College of Ohio, of which he was the founder in 1819, Jefferson Medical College at Philadelphia, Cincinnati College, which he organized in 1835, and the Medical Institute in Louisville, Kentucky. "In all" says Professor Pepper, "he strove earnestly for the adoption of a higher standard and for stricter methods. He promptly sacrificed his personal feelings and interests so soon as it appeared that the conditions were not favorable to honest and thorough education." In 1822 he founded the first medical journal in the West. He died in Cincinnati in 1852.
Dr. Pepper possesses peculiar qualifications to estimate the character and abilities of Dr. Drake, having long been a student of his works and having read all that he ever wrote for publication and nearly all of the many publications concerning him which appeared after his death.
His character was lofty and attractive. He was naturally gifted with rare charms of style and the power of expressing in pure and brilliant language the lofty ideals, the clear thought, the graceful fancies of his ardent nature and powerful mind. Nature spoke to him as to a favorite son and opened his eyes to her infinite charms and inspired him with a love for herself which never lost its ardor. It was this which sustained him through a long life, into which were crowded far more than an usual number of severe trials and disappointments, and kept his spirit to the end as fresh and buoyant and enthusiastic as a boy's. His character is known to us with a rare fulness and yet there does not appear in it a single vice. He was ambitious, but his aims were never selfish or personal. His proper self-respect was untainted with vanity. His desire for office was to secure larger op