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times from the true diphtheria bacillus, at other times from a slightly virulent pseudo-diphtheria bacillus. It seems justifiable to think that microscopic examination of the colonies is inadequate, and it is necessary to control the diagnosis by the experi, mental use of antidiphtheritic serum.-Brit. Med. Jour.
A CONTRIBUTION TO THE PATHOLOGY OF EPILEPSY.
A report of two cases in which a portion of the brain cortex was excised and Examined (Brain, 1896), by Joseph Collins, M.D. Microscopical examination of the first case by A. Wiener, M.D.
The first patient reported had only had three epileptiform attacks before the operation was performed. These began in the fingers of the right hand and were associated once with loss of consciousness and biting of the tongue. There was no history of recent injury to the head of any import, although four or five years previously the patient had been thrown against a wall. The diagnosis of Jacksonian epilepsy was made, and, as there was absence of the optic neuritis, headache, vomiting, etc., the cause was supposed to be meningo encephalitis and not brain tumor. At the operation the dura appeared normal. A portion of the central convolutions, which previously on being irritated with the faradic curent had given rise to contractions in the hand, was excised. Two pieces of cortical tissue each about the size of the terminal phalanx of the thumb were removed.
Within a week the paralytic symptoms produced by the operation had become comparatively slight, but paralysis of sensation seemed to develop in the right index finger and thumb and considerable ataxia in the movements of the hand was noticed.
Somewhat more than a year after the operation, and very nearly a year after the last epileptic attack, the dynamometer in the right hand registered 30, in the left, 100. Myolatic irritability of the right upper extremity was increased. Muscular sense was somewhat diminished in the right hand and the sense of position was not perfect. The hand had the tendency to remain in a semiflexed position. There had been no mental deterioration and nothing that resembled an epileptic attack. Bromide of potassium had been given.
The cortical tissue was submitted to microscopical examination. The pia was found to be thickened and adherent and in
some places had grown into the cortex. The neuroglia was increased in certain areas. The blood-vessels were distended and their walls were thickened and infilterated with cells. Some of the vessels were occluded. Cellular infiltration and softening were also found within the cortex. Many of the ganglion-cells were altered.
In pieces of cortex removed from another case of epilepsy of the idiopathic focal type numerous hemorrhages, probably resulting from the operation, and altered large pyramidal cells were found. International Med. Magazine.
THE TREATMENT OF EPILEPSY BY SULPHATE OF DUBOISINE.
In La Riforma Medica Cividali and Giannelli states that they have found that the sulphate of duboisine diminishes the number and intensity of epileptic the attacks. They obtained the most favorable results in those forms of epilepsy which were associated with psychical disorders. The dose they administered was 1-120 grain, which might be increased to as much as 1-60 grain if the first dose did not seem sufficient. They do not find that the drug produces too much local irritation, provided strict antiseptic precautions are taken when it is injected.—Atlantic Med. Weekly.
THE TREATMENT OF CARDIAC FAILURE.
Dr. T. Grainger Stewart believes that the most important agent is rest, next the element of hope, and finally diet. Here excess of fluids is to be guarded against. Alcohol as an article of diet must not be used, even to habitual slight excess, nor in any form which gives rise to dyspepsia. Massage in the great majority of cases of cardiac dilatation diminishes the area of cardiac dulness. The character of the cardiac sounds and the rhythm and strength of the pulse correspondingly improve, the patients usually experience a sensation of comfort and feel the better for the treatment, although rarely the opposite effect may be produced. Although the immediate effects pass off in a few hours, they frequently do not pass off completely. Repeated applications bring about a permanent diminution of the area of dulness, with improvement of the pulse and patient's sensations, although the effect rarely may be deleterious. Movements with limited resistance show in a proportion of cases immediate im
provement in the condition of the heart, as shown by percussion and ausculation, the sounds becoming more distinct and the area of dulness diminishing to a greater or less extent. In many cases the rhythm of the pulse improves and the heart becomes more vigorous. While the immediate effect is in so far temporary, the heart rarely goes back to its previous condition of dilatation, but remains somewhat smaller than it was before the exercises, and gradual improvement of a lasting kind sets in, so that the heart recovers its tone and the area of dulness diminishes. The saline bath (five pounds of sodium chloride with eight ounces of calcium chloride in a forty-gallon bath), in which carbon dioxide in large quantities is liberated, produces a most striking diminu. tion of the area of cardiac dulness, with slowing and strengthening of the pulse, changes just as definite as those produced by the exercises above me tioned.-British Med. Jour., 1896, No. 1684, p. 701.
TREATMENT OF BED-SORES.
Dr. Henry Roth makes the following suggestions concerning hed-sores (American Med. Review). Bed-sore is a complication liable to occur during a prolonged decubitus. The position of the patient should be frequently changed where this is permissible. Prophylaxis here is very important, and if the nurse is competent, this painful complication will rarely require treatIt is advisable to rub the parts upon which the patient rests with alcohol, and here I wish to mention the fact that daily sponging of the entire body with warm water and then with alcohol, will greatly add to the patient's comfort. Should a suspicious spot of redness present, we can remove the pressure from the affected parts by using air-cushions or a water-bed. We should prevent the folds of the linen pressing upon the patient. At every call it is important to look for the presence of bedsores; should they appear despite all care, dry dressings are preferable to moist. Oxide of zinc in powder or ointment is one of the most valuable remedies. Acetate of aluminum has also a very beneficial effect. At times considerable loss of substance is found, giving rise to a very foul odor. In these cases a charcoal poultice acts remarkably well.-Clinical Recorder.
THE EXTERNAL APPLICATION OF PILOCARPINE IN THE TREATMENT OF NEPHRITIS.
Julia (Lyon Médical, December 6, 1896) reviews the treatment of nephritis by the external application of pilocarpine, introduced by Mollière in 1894. This treatment consists in rubbing into the dorso-lumbar region, every morning, an ointment, composed of three ounces of vaseline and from three-fourths of a grain to one and a half grains of pilocarpine nitrate. The surface is subsequently covered with a layer of cotton, which is allowed to remain on during the day. Eighty patients were subjected to this treatment; some of these had acute nephritis from cold, some infectious nephritis, and others chronic nephritis. The acute cases were rapidly restored to health, and the chronic cases were generally much improved. Albumin often disappeared from the urine entirely during the treatment. The inunctions were invariably followed by marked diaphoresis and diuresis. -University Medical Magazine.
TREATMENT OF RETRODISPLACEMENT OF THE UTERUS.
Kuestner (Ibid.), after an exhaustive review of the statistics. of various operators, using all the different methods of treatment, arrives at the following conclusions:
1. Although none of the operations for the cure of retroversion restore the uterus and adnexa to an absolutely normal position, the new relation of the pelvic organs is preferable to the former displacement.
2. A sharp distinction must be drawn between cases of movable and adherent retroversion. The adhesions must first be separated, after which the treatment in both cases is the same.
3. The abdominal cavity should not be opened for the purpose of separating adhesions unless these are too firm to permit detachment of the uterus by massage or Schultze's method.
4. Cœliotomy is preferable to anterior or posterior colpotomy,
since adhesions may be more thoroughly and safely separated by the abdominal route, and, moreover, conservative operations on the adnexa can be carried out more satisfactorily.
5. The test of the value of any given method of fixing the uterus anteriorly is that it should keep the organ in a normal position, and that its functions should not be interfered with.
6. The results obtained by retroversion and vagino-fixation and by Alexander's operation prove that the uterus may be maintained in a good position, but it has been shown that after vagino-fixation the functions of the organ are disturbed.
7. The latter operation should, therefore, not be performed in the case of women who are likely to conceive subsequently; in those who are not liable, vagino-fixation has given excellent results, especially when supplemented by colporrhaphy.
8. When the adhesions are extensive the best operation is cœliotomy with ventro-fixation according to Olshausen's method. Conservatism should be practiced as far as possible, especially in young subjects, in whom a portion of ovarian tissue should be left. If the tubes and ovaries are not seriously affected, it is sufficient merely to separate adhesions.
9. Alexander's operation is preferable in cases of movable retroversion, since it restores the uterus as nearly as possible to a normal position.
10. The indications for the operative treatment of retrodisplacement are furnished by the duration of the trouble, the negative results from the use of pessaries, and the aversion of the patient to palliative measures. A condition of the vagina which prevents the use of pessaries furnishes a positive indication. 11. Since prolapsus is generally the result of retroversion, the maintenance of the uterus in a normal position is the essential object to be aimed at. This is best attained by ventro-fixation, supplemented by plastic operations on the vagina.
Dr. Katz reported the following case at a meeting of the Society of Internal Medicine of Berlin: A woman, aged 32 years, of a healthy family, not neurotic, had always enjoyed good health, and, as a rule, was regular in her monthly periods. A year ago she was suddenly attacked by asthma with orthopnoea