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different type. In these cases the stridor was mainly expiratory, the larynx did not move up or down with respiration, as it does in cases of intralaryngeal obstruction, and there was much greater respiratory distress. The stridor is probably produced partly in the larynx proper, and partly at the abnormally approximated ary-epiglottic folds.

6. That the neurosis causing the symptoms has not in our experience seemed to depend on the presence of adenoid growths or other obvious causes of reflex irritation.

The authors take issue with Sutherland and Lake, who in a previous paper, ascribe primary etiological importance to the peculiar conformation of the upper aperture found in these cases, and regard it as a congenital malformation. Present authors regard this as an acquired deformity.

Appendicitis and Tonsillitis.

At a recent meeting of the Gesellschaft der Aerzte (Vienna Cor. Med. Press & Cir., vol. 70, no. 3216) Kretz rather amused the meeting with a new idea of tonsillitis being the cause of appendicitis, or vice versa. From a bacteriological point of view, his logic seems rational, and he adduced several cases of angina to demonstrate his argument. He maintains that inflammation of the tonsils so weakens all the various parts of the alimentary canal that inflammation after an attack of tonsillitis is not uncommon, but very easily induced.

Mastoiditis.

Tuttle (Denver Medical Times, vol. 20, no. 7) says:

1. In all cases of otitis media purulenta there is more or less involvement of the mastoid antrum.

2. In acute otitis media, with symptoms of mastoiditis, we are justified in using palliative measures for twenty-four hours. 3. To delay operative measures for more than twenty-four hours, without marked improvement, is not justifiable.

4. An incision in the postero-superior wall of the auditory canal is far superior to Wilde's incision as a depleting measure.

5. All cases of chronic otitis media purulenta resulting in mastoiditis should be operated on at the first appearance of symptoms without resorting to palliative measures.

6. We are justified in opening the antrum for drainage in cases of purulent otitis media of long standing without symptoms of mastoiditis.

OBSTETRICS AND PEDIATRICS.

UNDER CHARGE OF E. P. Sale, m.d., MEMPHIS.
Obstetrician to the City Hospital.

Uric Acid and its Effects Upon Pregnancy.

Hirst, (Int. Med. Mag., vol. 10, no. 1) says:

The effects upon a pregnant woman of uric acid excess in the urine are fortunately not very severe. It is doubtful if the nervous symptoms so commonly seen in these cases can be ascribed to the presence of an excess of uric acid or the xanthin basis. Nervous phenomena are so commonly attendant upon the pregnant state, when in the majority of cases uric acid is not in excess or is even diminished in proportion, due to the moderate polyuria, that it would be rather rash to assume that these symptoms were due to uric acid in the rather rare cases where it was present in excess. Irritability of the bladder, pain and burning upon urination are the rule in the early months of pregnancy, due, of course, to the pressure of the enlarging uterus. Here, again, it would be unjustifiable in the majority of cases to ascribe these symptoms to uric acid; they are the rule and not the exception, and occur in at least 95% of the cases independently of the presence of uric acid in excess. Headache and other cerebral symptoms are very usual during the course of a pregnancy, and are probably usually due to some minor malposition of the uterus or other pelvic condition rather than to an excess of uric acid.

Uric acid in excess increases liability to kidney insufficiency or breakdown. This occurs normally in 6-7% of cases, but in patients with the uric acid diathesis this percentage is doubled or trebled. If in the preliminary examination of the urine of a woman who applies to you for attendance in her approaching confinement, you find uric acid in excess, it would be well to put her upon some sort of a diet, which, while nutritious, would not throw any unnecessary strain upon her

kidneys. Allow her meat only every other day, vegetables in moderation, encourage her to drink large draughts of water at intervals during the day, and if you deem it advisable in any particular case, order some diuretic mixture such as Basham's. Anything which would throw extra work upon the kidneys, such as constipation, chilling of the skin, etc., should be avoided. Examinations of her urine should be made every week at least, instead of every two weeks, and in the latter months, when the strain is greatest, twice a week would be by no means too often. If albuminuria actually appears, its treatment does not differ from that of a case due to the ordinary causes. It might be well to remember that the pathology of these cases is not a true inflammation, but an anemia of the kidney, with fatty infiltration of the cells. This condition of the kidney is known as the kidney of pregnancy, and a predisposition to its development undoubtedly exists in the uric acid diathesis.

Subarachnoid Cocainization in Obstetrics and Gynecology.

Hawley and Taussig (Medical Record, vol. 59, no. 3) have recently undertaken a series of observations, the results of which would tend to support the view that spinal anesthesia is not very dangerous, except perhaps to the child in utero. When it produces disagreeable symptoms, they are usually transient. In the labor cases it usually retarded progress. Finally, the anesthesia it produces is for a fairly definite period of time without affecting consciousness and with full control of the voluntary muscles.

From a study of these cases the use of the lumbar puncture in multiparæ would seem to be less called for than inhalations of chloroform. The results obtained from its use in primiparæ were also not very encouraging, but when good results can be obtained in a few cases the experiments should be continued.

In instrumental deliveries, when urgency is required and the patient is not of a very nervous temperament, the spinal narcosis seems to meet every indication. The delivery would be much facilitated by the patient's aid, which is not obtained under general narcosis, and the dangers of retained placenta and postpartum hemorrhage is lessened.

It is doubtful if the puncture will ever replace general narcosis in abdominal operations. In vaginal celiotomy and minor gynecologic work it seems to have its greatest field of usefulness and will come more in vogue as its merits are more fully observed and understood.

Acute Hydrocephalus, with Recovery.

At the Berlin Society für Innere Medizin, Hermann (Cor. Med. Press & Cir., vol. 70, no. 3214) reported a case of this nature. Very few cases had been recorded in literature. The child was now a year and five months old, and it came under treatment first a year ago. It had suffered from a skin eruption from the eighth to twelfth week of life, and had been treated antisyphilitically, and it still had the yellow-grayish color of the skin characteristic of hereditary syphilis. It was a typical case of hydrocephalus. The child had not developed well mentally. In the belief that the cause of the disease was syphilis, potassic iodide treatment was begun at once, and the success was surprising. Even in thirteen days the circumference of the head had diminished by several centimeters, the sutures, which were wide apart, had drawn near together, the large and protuberant fontanelles had fallen in, the edges of the bone sticking upward, as they could not so quickly follow the falling of the fontanelles. The improvement was permanent, and the child was now lively and had begun to talk when it was eleven months old. The teeth had come forward well, there were already two canine teeth. There was a syphilitic eye affection in addition to the above, with clouding of the retina. There were now only a few white spots on the retina. A quarter of a gramme of potassic iodide was given daily, and a number of mercurial inunctions.

You will find the mere resolve not to be useless, and the honest desire to help other people, will, in the quickest and most delicate way, improve yourself.—Ruskin.

Memphis Medical Monthly

Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880 Memphis Lancet, established 1898.

LYCEUM THEAter Building, MEMPHIS, TENN.

Subscription Per Annum, One Dollar in Advance.

Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR.

W. B. ROGERS, M.D.

DEPARTMENT EDITORS.

A. G. SINCLAIR, M.D.

T. J. CROFFORD, M.D.

E. P. SALE, M.D.

C. TRAVIS DRENNEN, M.D., Hot Springs, Ark.
LLEWELLYN P. BARBOUR, M.D., Boulder, Col.
W. D. HAGGARD, JR., M.D., Nashville. B. F. TURNER, M.D.

THE TREATMENT OF PULMONARY TUBERCULOSIS It is now generally conceded that it is possible to obtain cures in early tuberculosis, and in order to promote resolution and a healing process in the diseased lung tissue, naturally the greatest degree of success is to be found in the cases where treatment is begun before the bacillus has made extensive inroads. Therefore, upon early diagnosis in pulmonary tuberculosis depend the results to be obtained in its curative

treatment.

There exists a prebacillary stage of pulmonary tuberculosis, and if the patient can be taken in hand before the bacilli are manifest in the sputum, we are in a position to offer a much more hopeful prognosis. In The Journal of the American Medical Association for January 12, 1901, Dr. J. M. Anders has a valuable article on the Diagnosis and Treatment of the Prebacillary Stage of Pulmonary Tuberculosis. Dr. Anders writes of the period which precedes the presence of tubercle bacilli in the sputum, variable in length, but often of considerable duration. He gives a grouping of physical signs occurring during the early stage, and which at times are present prior to the discovery of tubercle bacilli, and which may be regarded as characteristic. "Lagging" or defective expansion may be noted on inspiration and palpation. There also occurs at times a localized increase in the tactile fremitus, enfeeblement of the normal vesicular murmur, with (at a later period) prolongation and sharpness of expiration. There is also a click

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