Billeder på siden
PDF
ePub

the case of a woman suffering from a stiff thumb following an injury. The author makes the injection into the cicatricial tissue, and as this necessarily causes a certain amount of pain, he advises that a preliminary injection of cocaine should be made. It is not suggested that this bloodless treatment should replace massage and passive movements, but that it should supplement it.

G. E. GASK.

TOURNEAU. Three Cases of Tetanus. Deutsche med. Wochenschr., 1904, p. 347.

DETAILS of three cases of tetanus, all treated with injections of Behring's antitoxin; all three died. The seat of inoculation was treated locally or excised and the antitoxin was introduced early, in one case eight hours after and in another twelve hours after the first sign of the disease. Out of 117 cases of tetanus collected, which have been treated with antitoxin the author reckons a mortality of 504 per cent., while the mortality in 209 cases occurring in the Austrian Army between the years 1861 and 1893 has been put at 44.6 per cent. These figures, the author states, must not be relied on, as the tendency is to report only favourable cases.

G. E. GASK.

LUCKSCH (FRANZ). A Case of Diaphragmatic Hernia. Prager med. Wochenschr., 1904, p. 145.

THIS is an interesting account of a post-mortem performed on a man, aged 26, who had died after an operation for intestinal obstruction, and where the cæcum and ascending colon had been found to be gangrenous. The chief points of the examination were as follows:The gut was distended, the loops being glued together and the peritoneum reddened; the cæcum, ascending colon and the hepatic flexure of the colon were discoloured and gangrenous; there was a small adhesion between the gall-bladder and the hepatic flexure. In the left pleural cavity was a swelling about the size of a child's head, which had compressed the left lung. This swelling contained loops of intestine and great omentum, which had entered the cavity through a small hole in the left side of the diaphragm. Evidently then a case of diaphrag matic hernia, which had become incarcerated and given rise to gangrene of the cæcum. As regards the explanation of the occurrence of the hernia, it was discovered that two years previous the patient had attempted suicide by shooting himself with a revolver in the left side, and since that time he had experienced abdominal pain. The writer thinks that in all probability this is a case of diaphragmatic hernia, traumatic in origin.

G. E. GASK.

ROSENHEIM. The Diagnosis by Palpation and
Carcinoma in the Upper Part of the Rectum.
Wochenschr., 1904, pp. 377, 422.

Endoscopy of
Deutsche med.

SINCE Kraske's introduction of his radical method of the treatment of carcinoma of the rectum the interest in the subject has much increased, and the results of treatment have so far been encouraging. The object of surgeons is now to still further reduce the mortality due immediately to the operation itself, and also from the recurrences, and the most important thing to secure is the power of making an early diagnosis. For various reasons many cases of carcinoma of the rectum do not come under the notice of the surgeon or are not recognised until they are too advanced to be treated radically, and often these cases would be most suitable for such an operation, if only they could be treated earlier, seeing that they are often scirrhus in nature, of slow growth, not widely infiltrating and seldom, or only in a late stage, giving rise to metastatic deposits. The practical value of any reliable method of making an early diagnosis of these tumours is evident, and it is the object of the author in this paper to describe how this may be arrived at. The clinical history, the examination of the stools and palpation are the methods ordinarily employed in the examination of such cases. All these methods are extremely useful, and in a certain number of cases are sufficient to put one on the right track, but in others, especially in those where the growth is situated high up, they fail. The author recommends that the method of palpation should be more thoroughly carried out, and to attain this he advises the bimanual method as being the most efficient. The patient should lie on the right side with the knees drawn up and the pelvis slightly raised; the surgeon, then standing behind the patient, inserts the forefinger of the left hand into the rectum, while with the right hand he can exert pressure on the lower part of the abdomen, and in this way can often discover a growth which would otherwise be imperceptible to him. These methods, however, often prove insufficient, and it is to improve on them that the author urges the use of the endoscope. He says that the use of it is at present little understood, but if brought into practice would prove of great value. The instrument he recommends is a simple metal tube 25-35cm. long with a lumen of 16-2cm. This tube is provided with a Casper's electroscope, and in the majority of cases, with the patient in the knee-breast position, it can be introduced into the rectum without any difficulty. In this way a direct view of the affected parts can be obtained and any swelling of the mucous membrane or ulceration or bleeding point examined, and so a diagnosis obtained. where all other methods have not sufficed. The writer describes at some length several cases where he was enabled to perform this satisfactorily, and in one case he made the diagnosis twelve months before the symptoms, in the opinion of other surgeons, were sufficiently clear to justify operation.

G. E. GASK.

MAGNUS (VILHELM).

Pathology.

Motor Localisation of the Inferior Extremities in the Spinal Cord. Norsk. Mag. f. Lægevidenskaben, 1904, p. 296. MAGNUS gives an account of the appearances presented by the spinal cord of a malformed male child, and the work was carried out under

[ocr errors][ocr errors][merged small][ocr errors][ocr errors][merged small][merged small][ocr errors][subsumed][ocr errors]

Edinger, at the Senckenberger Institute, in Frankfort-on-Maine. The infant was born at full term, and while its total length was 38.5cm., the circumference of the head measured 31cm. Both inferior extremities

[merged small][ocr errors][ocr errors][ocr errors][ocr errors][merged small][ocr errors][merged small][ocr errors]

were absent; the left upper extremity was shorter than the right, and possessed only one finger, while a skiagraph showed that the humerus. was defective in its upper part only, the lower end being developed.

E

The right hand had only three digits; the radius and metacarpals were absent on both sides, and there were numerous anomalies of the muscles of the shoulder, of the chest and of the arms.

[blocks in formation]

The accompanying illustrations, for which I am indebted to Dr. E. Wang, Editor of the Norsk. Mag., show the appearances of sections of the spinal cord at various levels compared with similar sections made from the cord of a fully developed child. They are sufficiently self

« ForrigeFortsæt »