Page images

The case reported by Dr. Simpson is a mysterious one to me. It looks like a case of Duchenne's disease, yet it must be extremely rare for the trouble to come on in that sudden manner. This disease is usually slow and progressive. An acute form is, however, described by some authors. That leads me to speak of a case which I saw last winter. A young woman had paretic lips and tongue; a very "thick tongue;" it was difficult for her to talk on this account. There was also difficulty in deglutition, not very marked, still enough to make me apprehensive as to her condition. Under rest, strychnine, and tonics she made a complete and rapid recovery, and I am inclined to think that the condition was congestive and neurasthenic. She had never been a strong, muscular girl, and was at this time in extremely bad condition, anemic and neurasthenic. There was certainly no lesion in this case. LOUIS FRANK, M. D., Secretary.

SUDDEN DEATH IN INFANTS: "ASTHMA THYMICUM" (?).-Lange (Centralbl. f. Gynak., No. 20, 1898), speaking at Leipzig of a case of sudden death where the thymus was found enlarged, raised a discussion on the whole subject. Kroenig was of opinion that rapid death of an infant should always be attributed to sepsis. It is in newborn infants that the purest examples of "bacteriæmia" are to be found, not a trace of disease being visible at the necropsy, even at the umbilical wound, when the blood is full of colonies of streptococci. Lange's patient died suddenly at 31⁄2 months; it had been treated for gonorrheal ophthalmia in an outpatient department, and had been weighed every week. It was not under weight, and it died suddenly, early in the morning, without any symptoms of acute or subacute mischief in the respiratory tract. The trachea, just one inch above the bifurcation, was contracted so that its lumen, not absolutely effaced, was like the hollow in the sheath of a sword. This contraction was due to the thymus, which weighed over three-quarters of an ounce, measured one inch in thickness, and closely embraced and compressed the trachea. Structural changes were detected in the tracheal tissues. Lange claims that this case is the first recorded in which purely mechanical and persistent compression of the trachea by the thymus was sufficient to kill. He showed the parts, and with them another instructive preparation of hyperplasia of the thymus without visible compression of the trachea, from an infant who had died suddenly from after-attacks of spasm of the glottis. Zweifel had his doubts about the cause of death in Lange's first case, as the lumen of the trachea was entirely obstructed. Asthma thymicum might cause death, but there was great difference of opinion concerning that disease.-British Medical Journal.



[blocks in formation]

A Journal of Medicine and month.

H. A. COTTELL, M. D., Editor.

Surgery, published on the first and fifteenth of each
Price, $2 per year, postage paid.

No. 8.

This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The editor is not responsible for the views of contributors.

Books for review, and all communications relating to the columns of the journal, should be addressed to the Editor of THE AMERICAN PRACTITIoner and NEWS, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky.


Prof. Henry Stelwagon, in the Philadelphia Medical Journal, writes that the itching and burning which are not infrequently felt by persons emerging from the bath constitute a condition which hitherto has not been referred to in dermatological literature. He calls it "BathPruritus," and describes its symptoms as follows:

The sensation varies greatly in the same individual. The feeling is at times one of pricking, burning, or almost intolerable itching. It is usually aggravated if the patient yields to the desire to rub or scratch violently. While it may exceptionally be general, it is commonly seated in the legs from the hips down, and occasionally in the forearms also. The attack lasts from several minutes to half an hour or longer, becoming increasingly intense and then gradually subsiding. It is usually of longer duration when the patient goes directly from the bath to his bed; if his clothing is immediately donned the pruritus will generally be less unbearable, less marked, and usually of much shorter duration, especially if he walks about, so as to get the soothing effect of the gentle rubbing of the under


A satisfactory explanation of the symptoms has not been found. Season, temperature, kind of water used, soaps, and variety of bath seem not to account for the phenomena; "as a rule the active factor is the bath itself," independently of things incident to the bathing.

The writer admits that the affection is an urticaria, the patients having what may be called "an urticarial skin, without meaning that they must have had active and repeated attacks of urticaria."

This irritability of the skin or urticarial tendency being recognized as a factor in bath-pruritus, it can readily be understood that the disposition to the attacks is heightened by any existing or passing digestive disturbance. This element of the affection may explain why such individuals suffer more at one time or for certain periods than at other times, and how occasionally they may be almost entirely free. The individuals affected are distinctly those of a nervous temperament, and those of weak digestion and lithemic tendencies. If the predisposition is temporarily emphasized by overwork, mental worriment or anxiety, dietetic indiscretions or digestive disturbance, bath-pruritus is almost invariably aggravated.

In short, persons whose blood and nervous systems are in that state which constitutes the urticarial diathesis may suffer an attack of nettlerash from almost any kind of gastro-intestinal or cutaneous irritation, and Dr. Stelwagon has simply called attention to a common and practically unavoidable cause of urticarial explosion.

His suggestions, therefore, as to the prophylaxis of bath-pruritus and its management when induced are of some practical value:

As to the manner of treatment, unfortunately very often but little can be done. The water used should be between tepid and warm, neither hot nor cold. Exceptions to this rule will be observed, and some patients find the attack slight or less severe after a cold bath, and some after a hot bath. Soaps should be mild, and used sparingly, and be thoroughly rinsed off. The parts should be wiped or preferably tapped gently dry with a soft towel; it seems that if the skin is allowed to dry itself or is incompletely wiped or tapped dry, the itching is usually much worse. In some cases the introduction of some substance into the bath, such as salt, in order to bring it up to the specific gravity of the blood, is of value. The bath should be of short duration. Application by gently rubbing in of a glycerine lotion or of an ointment of cold cream and lanolin, with or without a minute quantity of carbolic acid or thymol, will frequently lessen the severity of, or exceptionally abolish, the attack. But a small quantity should be employed, the skin being subsequently gently wiped with a soft towel or linen. The free use of a dusting powder following the bath has also at times a palliative influence. The attack will be less unbearable if the bath is taken at such time as the patient immediately dresses and stirs about. Constitutional treatment should be advised, especially if there seems to exist any of the predisposing factors mentioned. The bowels should be kept free, a plain diet enjoined, the digestion carefully looked after, and

[ocr errors][ocr errors][ocr errors]

the nervous system kept in proper tone. In some of the cases upon which this paper is based, antilithemic remedies, especially moderate doses of sodium salicylate, seemed of positive value. The various internal remedies used for ordinary pruritus and urticaria should also be tried in severe and rebellious cases. As a rule, however, treatment may be said to be more or less disappointing.

Notes and Queries.

SOME OBSERVATIONS ON BRAIN ANATOMY AND BRAIN TUMORS.-Dr. William C. Krauss, of Buffalo, read a paper at the ninety-second annual meeting of the Medical Society of the State of New York, Albany, January 25, 1898, with the above title.

He called attention (1) to the difficulty in remembering the gross anatomy of the brain and (2) to the almost universal presence of optic neuritis in cases of brain tumor.

He attempted to overcome the difficulty in regard to the anatomy of the brain by formulating the following rules, which are somewhat unique and original, and at the same time easily remembered:

Rule of Two. I. The nerve centers are divided into two great divisions, (1) encephalon, (2) myelon. 2. The encephalon is divided into two subdivisions, (1) cerebrum, (2) cerebellum. 3. The cerebrum, cerebellum, and myelon are divided into two hemispheres each, (1) right, (2) left. 4. The encephalon is indented by two great fissures, (1) longitudinal, (2) transverse. 5. Into these two great fissures there dip two folds of the dura, (1) falx cerebri, (2) tentorium cerebelli. 6. There are two varieties of brain matter, (1) white, (2) gray.

Rule of Three. 1. There are three layers of membranes surrounding the brain, (1) dura, (2) arachnoid, (3) pia. 2. Each hemisphere is indented by three major fissures, (1) sylvian, (2) rolandic or central, (3) parietooccipital. 3. Three lobes, frontal, temporal, and occipital, on their convex surface are divided into three convolutions each, superior, middle, and inferior, or first, second, and third. 4. There are three pairs of basal ganglia, (1) striata, (2) thalami, (3) quadrigemina. 5. The hemispheres of the brain are connected by three commissures, (1) anterior, (2) medi, (3) postcommissure. 6. The cerebellum consists of three portions, (1) right, (2) left hemisphere, (3) vermes. 7. There are three pairs of cerebellar peduncles, (1) superior, (2) middle, (3) inferior. 8. The number of pairs of cranial nerves, in the classifications of Willis and Sommering, can be determined by adding three to the number of letters in each name; that of Willis making nine, and that of Sommering making twelve (or the name containing the more letters has the larger number of pairs of nerves, and vice

versa). 9. The cortex of the cerebellum is divided into three layers of cells, (1) granular, (2) Purkinje's cells, (3) a molecular layer.

Rule of Five. 1. Each hemisphere is divided externally into five lobes, of which four are visible, (1) frontal, (2) parietal, (3) temporal, (4) occipital; and one invisible, (5) insula (isle of Reil). Roughly speaking, the visible lobes correspond to the bones of the cranium; that is, the frontal lobe is underneath the frontal bone, the parietal lobe beneath the parietal bone, etc. 2. The brain contains five ventricles, of which four are visible-the right and left, or first and second, the third, and the fourth; and one invisible, the fifth or pseudo-ventricle. 3. The cortex of the brain contains five distinct layers of ganglion cells.

Studying carefully one hundred cases of brain tumor in which an ophthalmoscopic examination had been made for the presence or absence of choked disc (optic neuritis), Dr. Krauss announced the following conclusions :

1. Optic neuritis is present in about ninety per cent of all cases of brain


2. It is more often present in cerebral than in cerebellar cases.

3. The location of the tumor exerts little influence over the appearance of the papillitis.

4. The size and nature of the tumor exert but little influence over the production of the papillitis.

5. Tumors of slow growth are less inclined to be accompanied with optic neuritis than those of rapid growth.

6. It is probable that unilateral choked disc is indicative of disease in the hemisphere corresponding to the eye involved.

7. It is doubtful whether increased intracranial pressure is solely and alone responsible for the production of an optic neuritis in cases of brain tumor. The Philadelphia Medical Journal.

[ocr errors]

MISSISSIPPI VALLEY MEDICAL ASSOCIATION.-The following officers were elected at Nashville of the Mississippi Valley Medical Association: President, Dr. Duncan Eve, Nashville, Tenn.; First Vice-President, Dr. A. J. Ochsner, Chicago, Ill.; Second Vice-President, Dr. J. C. Morfit, St. Louis, Mo.; Secretary, Dr. Henry E. Tuley, Louisville, Ky. (111 W. Kentucky St.); Treasurer, Dr. Dudley S. Reynolds, Louisville, Ky. Next place of meeting, Chicago. Chairman of Committee of Arrangements, Dr. Harold N. Moyer. Time of meeting, October, 1899, date to be determined by the executive officers and the Chairman of the Committee of Arrangements.

WESTERN SURGICAL AND GYNECOLOGICAL ASSOCIATION.—The eighth annual meeting of the Western Surgical and Gynecological Association will be held at Omaha, December 28 and 29, 1898. Titles of papers from some of the leading surgeons of the West are already in the hands of the secretary, and the coming meeting promises to be the most interesting yet

« PreviousContinue »