Dental Caries as a Factor of Disease.

J. R. LESSON. Edinburgh Medical Journal, December, 1900.

Attention is called to the great evil resulting from decayed teeth. The general practitioner pays little attention to this subject, and little is taught about it in the medical schools. Many people are going about with rotten teeth, "carrying small cess pools in their mouths filled with fetid abominations of stinking food debris." The mouth cavity forms an excellent incubator for bacteria, which are liable to contaminate everything passing their way. The author makes it a point to examine the mouths of all patients complaining of neuralgia, bad breath, dirty tongue, disordered stomach, etc., and has made some striking recoveries by merely referring them to a dentist to have the offending members extracted. In cases of anæmia he finds that very often the application of iron to the teeth is far more efficacious than to the stomach. Many diseases of the naso-pharynx extend from carious teeth. A man with a decayed molar rarely has a clean tongue. Throat complaints are frequently septic in their origin, and most ear troubles extend from the throat. Dentists tell us our teeth are becoming progressively weaker and more and more liable to decay, and certain it is that nose and throat disorders are not growing less frequent. Prophylaxis is most important. The teeth should be cleaned twice a day and always the last thing at night. A stiff brush with long bristles should be used. Children should not be allowed to eat candy or biscuits on going to bed. More frequent visits to the dentist should be made for inspection of the teeth. The writer concludes: that physicians should look more frequently into their patients' mouths; that the public need educating upon this question, and are yet hardly aware of its importance; that by teaching our children the methods and principles of oral hygiene, they will constantly be saved from much suffering, and probably from illness, in their lives; that few, even of the enlightened ones, care for their teeth as they really should do; and that we as a profession do not yet recognize the important part bad teeth play as factors of disease.

MEDICINE

Edited by Samuel B. Ward, M. D., and Hermon C. Gordinier, M. D. A Case of Pneumopyo pericardium. (Ein Fall von Pneumopyopericardium.)

SIEVERS. Berliner klinische Wochenschrift, March 25, 1901.

The patient with this rare condition was a female servant, thirty-two years old, who had had syphilis some years before. She entered the hospital, complaining of weakness, dyspnoea, persistent cough with a rusty foul-smelling expectoration. She had herpes labialis. Examination showed nothing abnormal in chest except that at the apex of the left lung the note had a tympanitic quality, and that over the scapula and axilla of the same side fine moist rales were evident. Nothing abnormal was noted about the heart or abdominal cavity. The diagnosis was gangrene, following a pneumonia in a person who had had severe syphilitic

infection. Fourteen days later examination revealed absence of cardiac dullness and over the anterior aspect of the left chest the percussion note had a box tone as in emphysema. The erect position made no difference in the percussion. The heart sounds had a metallic character and at times there was a pericardial note with an amphoric echo. In addition, at the apex a metallic splashing was heard coincident with the cardiac activity. This splashing consisted of small and medium sized rales, at times abundant and at other times less abundant. It had the sound of a water-wheel. The temperature was 39°. The pulse weak, regular, 120-130. The autopsy showed a gangrenous cavity of the left lung, following a pneumonia. The process had extended to the surface of the lung, close to the left of the pericardium where it had produced a small encapsulated pyopneumothorax. From this air and pus had passed into the pericardial sac by an opening in its lower part.

The Origin of Poisoning by Meat. (Zur Frage noch der Entstehung von Fleischvergiftungen.)

BAIL. Prager medicinische Wochenschrift, February 14, 1901.

Although formerly the different forms of poisoning after the consumpand nervous symptoms occur, these are due to the common products of puseek to make a sharp differentiation and to reserve the term botulismus for a well-marked morbid entity.

After the eating of food which has undergone putrefaction, if intestinal and nervous symptoms occur, these are duse to the common products of putrefaction; if in food which has not undergone putrefaction, a microorganism is found and this grows within the body of man; this is not a true poisoning, but a specific infection. It is of no importance if the infecting organism existed in the animal before its death, or if it appeared after its death. In contradistinction there is a small but well-marked group of poisoning by meat and sausage. In this group a bacterium develops in the animal food and develops specific and powerful poisons without itself being able to grow. It is characterized by its specific action and by the intensity of the poison producer. It is of interest to determine the way by which these poison-producing micro-organisms gain access into the food. In one epidemic the food was supposed to have been infected by flies from a nearby glue factory. The deductions are that there should be extreme cleanliness in regard to food and food utensils; more common use of fly netting and the prevention of the exposure of food in the sumCare should also be exercised as to conditions which might lead to an increase of flies, as glue, fertilizer and sewage reducing factories.

mer.

Intermittent Fever as a Sign of Mediastinal Tumors. (Intermittirendes Fieber als Symptom eines mediastinal Tumors.)

WITTHAUER. Münchener medicinische Wochenschrift, February 5, 1901. Mediastinal tumors are not rare conditions. Although they may be diagnosticated in life, there are many doubtful cases in which the differ

ential diagnosis from aortic aneurism and tuberculosis of the glands may be difficult. The writer gives the history of a girl, twenty-four years of age, who entered the hospital with left pleurisy. After aspiration of the fluid, her temperature for five months showed a most remarkable course. She would be free from fever for three or four days, then her temperature would go to 103° or 104°, gradually decline and reach normal on the third day. When her temperature was normal her general condition was good, while at the time of fever she was weak and complained of pain, dyspnoea and cough. Malaria, tuberculosis and streptococcus infection were excluded. The post mortem examination revealed a sarcoma of the posterior mediastinum with extension into the auricles and the right lung. There was no evidence of malaria and no indication of pus. Malignant tumors induce fever, but not with the regularity of this case. It is probable that the fever was due to toxines from the tumor and its regularity may have been affected by its extension to the auricles. The case is reported with the hope that this temperature curve may be found to be a symptom of a condition difficult to recognize.

Clinical Observations on the Use of Carbon Dioxide Baths in the Treatment of Heart Diseases. (Klinische Beobachtungen über die Anwendung von Salz und Kohlensaürebadern in der Behandlung der Herzkrankheiten.)

BATTISTINI and ROVERE. Zeitschrift für diätetische und physikalische Therapie, Band 4, Heft 7.

The authors employed the Schott method of carbon dioxide baths in thirteen cases of various forms of heart disease. Sodium chloride was added and they were very particular about the duration of the bath and the temperature. The arterial tension was taken before, during and after the baths with the Riva Rocci instrument. In cases where there was an increased tension before the bath they were unable to detect any fall, as is claimed by some observers, but in other cases there was an observable increase after the bath. The authors conclude that these baths are only serviceable when they bring about an increase in tension. In nearly all the cases there was decrease of from ten to twenty beats in the pulse rate after the bath, but there was no relation between the pulse rate and the arterial tension. They were unable to detect the decrease in the size of the heart dulness claimed by some observers. In most cases there was a noticeable improvement in the dyspnoea and cardiac action. In uncompensated cases of heart disease these baths are contraindicated and also in cases of angina pectoris and arterio sclerosis. The baths seem to have the best effect in cases of mitral disease. Each patient must be studied and in the right class of cases there is no doubt in the minds of the authors that the carbon dioxide baths form an important therapeutic agent in the treatment of heart disease.

NEUROLOGY

Edited by Henry Hun, M. D.

The Crossed Phenomenon of Sciatica. (Ueber das gekreuzte Ischiasphänomen.)

J. FAJERSZTAJN. Wiener klinische Wochenschrift, 1901, No. 2..

For some years the French have recognized, under the title of “signe de Laségue," a well-known symptom of sciatica, which has been given a place in the German text-books as the "Ischiasphänomen." This symptom consists of the fact that when the affected limb of a patient suffering with sciatica is flexed at the knee, the thigh may be also flexed upon the abdomen without causing pain, thus offering a contrast to the result obtained by flexing the thigh when the leg itself is extended. In the latter case pain results, which varies in intensity with the degree of neuritis present. The pain is distributed along the course of the nerve, and most frequently is localized in the region of the sacro-sciatic notch, at the so-called point of exit of the nerve, in the popliteal space, the calf muscles, or at all of these points. The pain may also be accompanied by paræsthesia. The author discusses at some length experiments made to determine the cause of this phenomenon, and believes that it is due to stretching of the nerve, and not to the pressure upon the nerve exerted by the muscles when in a state of contraction. It is shown that in the ordinary movements of walking, which involve a simultaneous flexion of the leg and extension of the thigh, the sciatic nerve is not put upon the stretch, but adjusts itself to the conditions; whereas the combined extension of the leg and flexion of the thigh do not constitute a common movement, and the nerve is subjected to an unaccustomed strain, which, during its inflamed state, produces pain.

The author then discusses a symptom which he calls the "crossed sciatic phenomenon." He has observed that passive movements in the unaffected limb, similar to those necessary to elicit the sciatic pain as above described, will be followed by pain and paræsthesiæ in the affected side, identical with these manifestations when the diseased limb itself is tested. The patient is placed upon his back, and the healthy limb, extended at the knee, is slowly elevated to an angle of from thirty to one hundred degrees. If no pain is elicited, the movement is repeated more energetically, and is accompanied by the characteristic pain in the affected side. It is thus shown more forcibly that the tension of the nerve is the factor in producing the symptom, as in this case no muscular pressure can be assumed.

The Significance of the Argyll-Robertson Pupil.

HARRIS. British Medical Journal, September 29, 1900.

The loss of the pupil reaction to light may be looked upon as an almost certain sign of antecedent syphilis, acquired or congenital, and is met with unassociated with tabes or general paralysis in syphilitics, showing otherwise no symptom of syphilis. The writer has found it in juvenile loco

motor ataxia, general paralysis with congenital syphilis, progressive muscular atrophy, lead poisoning, aortic aneurism, hemiplegia, syphilitic meningitis, ataxic paraplegia, nuclear ophthalmoplegia, choroiditis, and in other patients with no ataxia or anesthesia and with normal knee jerks, but with a clear history of syphilis. It has been described as occurring in poisoning by bisulphide of carbon and in diabetes mellitus. He has never seen it in Friedreich's disease or in disseminated sclerosis, and in only one case in which a history of syphilis seemed to be fairly excluded. The pupils may be very small, large or intermediate in size, and are frequently unequal. The very small pupils cannot be explained simply as paralytic myosis, but are probably due in part to a contracture of the sphincter muscle. The loss of reaction may be unilateral and this is probably only a stage in the complete loss of the reflex in both eyes.

PATHOLOGY

Edited by George Blumer, M. D.

Sputum Disinfection. (Zur Sputumdesinfektion.)

A. WEBER.

Kurse Erwidering auf den Artikels "Zur Sputum desinfection," von A. Weber.

A. MELLER. Zeitschrift für Tuberculose und Heilstättenwesen, Bd. II, Heft 5, 1901.

These two articles contain a discussion on the practical methods of disinfecting tuberculous sputum.

As regards chemical disinfectants, both corrosive sublimate and carbolic acid are condemned; the former combines with the albumen in the sputum to form an insoluble albuminate of mercury, the latter coagulates the albumen on the surface of sputum masses and prevents the action of the germicide on the interior portions. If chemicals are to be used, a five to ten per cent. solution of lysol or else pyroligneous acid are recommended, both of these substances render the sputum liquid and hence can act in a diffuse manner. The objection to chemical disinfectants is that their smell sometimes nauseates the patient.

Both authors agree that the best method is the use of inflammable spitcups, and the burning of the cups and their contents. This is not always possible on account of the expense.

After this method they consider best exposure to live steam for at least one-half hour. This usually liquefies the sputum and kills the bacilli. At times the sputum, especially the nummular form, is not completely liquefied, and the addition of caustic alkali is suggested in such cases. Boiling is not effective except when kept up for long periods.

Their discussion touches mainly on the disinfection of sputum in sanatoria, but their conclusions are necessarily also of importance in connection with private cases.