MAPLE SYRUP. The sale of maple syrup is not controlled by any specific legislation, and INTUBATION : A REPORT OF TWENTY-EIGHT ADDI TIONAL CASES. consequently any of its substitutes is A Paper read before the Cincinnati Medical considered under the general food and drug law. The standard of quality adopted for discrimination is that set forth in the third annual report, by Prof. H. A. Weber. Analysis of maple syrup: SAMPLE NO. 1, SERIAL NO. 33. Society, May 3, 1892, BY B. P. GOODE, M.D., CINCINNATI, May 29, 1891, I read a report before this Society of twenty-eight cases of intubation. To-night I present twenty1.90 per cent. eight additional cases. The former re49.58 port covered a period of four years, the latter eleven months. For the benefit 4.00 66 66 66 Conclusions: The large percentage of chloride indicated the addition of molasses, and is further verified by the percentage of dextrine. The compound is a mixture of molasses, cane sugar and glucose. SAMPLE NO. 2, SERIAL NO. 34. 32.00 0.50 Ash (sulphate, chloride)....... 0.50 of those that may not have heard my report, I will remark briefly that I was fortunate in my high per cent., eight deaths and twenty recoveries. My report to-night will even up the first report, and make the entire result 7.80 per cent. satisfactory to the most exacting. The deaths are double. Dividing the table at December 6 you will find that the maple number is equal before and after that period. Please observe again the cases before December. Only four deaths; ten 10.00 per cent. recovered. After December the case is reversed: twelve deaths and two recoveries. It is hardly necessary to call to mind the wonderful prevalence of catarrhal troubles from December, 1891, to the present time. Dr. O'Dwyer, in his report of post-mortems made in cases of death after intubation, says that 75 per cent. are from lung complication. In private practice there is little chance 10.00 0.50 Conclusions: Mixture of glucose, maple for post-mortems. I have operated in and molasses. every case where laryngeal stenosis was the prominent symptom, without regard 0.52 per cent. to hopelessness of the case. 13.07 Conclusions; Maple deprived of its sugar, brane; pharynx lined with same; stenosis called "skimmed maple syrup." To Remove Aniline Stains from the Skin. To remove aniline stains from the skin, Unna recommends washing first with a 5 per cent. solution of salt in water, then with the same strength of hydrogen peroxide, and finally with alcohol. of larynx extreme; face dusky, lips blue. After intubation the child looked up at its mother and said: "I feel better." No. 30 developed general bronchitis. No. 35.-The tube was filled with broken-down membrane. Twelve hours before I considered the case doing well. No. 37 was beyond the death-line. I hoped to restore the child by artificial There was nothing of special interest in the remaining fatal cases, except Nos. 49, 50, 51 and 55. No. 49.-The attending physician had endeavored to procure some one to perform intubation six hours before I saw the case. When I arrived the father of the child thought it was useless to do anything. Life had almost relinquished its hold. I quickly inserted a tube. Respiration was not fully established until a full hour. At that time I removed the string, and in half an hour the child was showing great improvement. The damage to the lungs must have been very great, and collapse of parts of same had undoubtedly taken place. Pulse a short time after intubation was 140; temperature 1022/50. Next morning the pulse was 132; temperature 10240. At 6 p.m. the pulse was 140; temperature 1033°; respiration 32. Pulse increased in frequency until death, which took place forty-two hours after intubation. respiration. There were twelve full | intubation. When I saw him his pulse respirations after intubation. Color was 150; temperature 1031/50; respicame again to the lips, but two much ration 46. Very little air was entering damage had been sustained by the the lungs. I found it necessary to use a lung's. tube for a child of two years. There was amelioration of the dyspnoea, and when the child was seen twelve hours later his condition was thought better than before intubation. Post-mortem by Dr. Oliver. The case was not supposed to be diphtheria, but to put this subject entirely at rest the family permitted the autopsy made. The larynx was found to be occupied by the intubation tube, and no false membrane could be found either here or in the trachea. The trachea and larynx were very small, and imperfectly developed. The vocal cords could scarcely be made out, so imperfect and illy formed The were they. lungs showed a collapsed condition, but no evidence of active or acute disease. Case No. 55, a boy two years and a month old, had been seen by Dr. Kindel a few hours before I was called. Very rapid, croupy breathing developed. There was everything to indicate impending death. Child blue and perfectly indifferent. Respiration almost ceased. Tube introduced with the least possible inconvenience. Artificial respiration practiced immediately for fear air would not enter lung naturally. In a few minutes the child was breathing as well as in perfect health. Twenty-four hours later the child was seen, and we were told that a few minutes before our arrival labored breathing came on. It had the appearance of an obstructed tube. The tube was removed and found clear. The child almost perished before the tube could be replaced, and it required considerable effort to revive the child. After an hour respiration was still embarrassed, and the case looking more hopeless, it was determined to perform tracheotomy. There was diphtheritic membrane in the trachea, but no detached portions could be observed. The tracheal tube was introduced, but no improvement resulted in respiration over intubation. This is the first time I have combined tracheotomy with intubation. was my belief that some detached mem No. 50 coughed up tube and died before it could be replaced. Dr. Juettner was called, and found the child breathing with great difficulty, same as before intubation. The patient was doing well six hours before. The child was cared for by an old lady, and in her effort to administer drink the child was taken with coughing, followed by difficult breathing. When I arrived the child was dead, and I was informed that the tube had not been coughed up. I was sure that was not the case, and search discovered the tube under the bed. I have one satisfaction to think that without doubt this life had been prolonged eighteen hours by intubation. No. 51 was a child four years and one month old, undeveloped in every particular, mentally and physically; never talked; often had catarrhal troubles, attended with croupy symptoms; was also a subject of convulsions. Drs. Oliver and Mackenzie were in attendance on a very severe attack of croup, and, as a dernier ressort, advised It brane was producing the difficulty, and the making an opening in the trachea would be justifiable. Of those that recovered, five had no complication. Five coughed up tube. Nos. 33 and 39, after first intubation, did well. No. 42 had a small tube, which was coughed up the fourth day. In two hours dyspnoea returned, and tube was reintroduced, remaining five days longer. No. 44 coughed up tube at the end of two days. The stenosis did not become troublesome for two days. Continued intubation four days longer. In No. 46 the tube was removed at about the ordinary time, and after three days the croupy symptoms returned in full force. The tube was reintroduced, and at the end of two days and a half the tube was coughed up. No. 36 became restless at the end of four days, and seemed to be having some obstruction in the tube, and it was removed. One-half of the lumen of the tube was filled with a tough material. The child well, and tube was not replaced. No. 34 was almost lost by general bronchitis. This was a brother of No. 33. In this latter case no membrane could be seen in the pharynx, but it is probable that it was present in the larynx. There are some accidents in performing intubations that constitute the common heritage of all. For instance, pushing down the membrane before the tube. This has come to me once, but was observed before the removal of string. The withdrawal of the tube brought also the offending body. The Result of Treatment of the Upper nent Relief in Asthma. Dr. F. H. Bosworth (N. Y. Med. four., March 26, 1892) reports eightyeight cases of asthma in addition to the eighty reported in 1888 treated by correcting a co-existent nasal lesion. Their treatment is based on the theory that the asthmatic paroxysm is dependent on three conditions: first, a general neurotic habit; second, a diseased condition of the intra-nasal mucous membrane; and, third, some obscure atmospheric condition (the exciting cause). Forty-two of these cases were cured, thirty-three improved, two unimproved, and in eleven the results are not known. In the large majority of cases the lesion was either nasal polypus, deflected septum, or hypertrophic rhinitis. Only those cases that have had at least a year of immunity are considered cured. Some of those noted as improved went for months without an attack, and in all the paroxysms were notably mitigated. The neurotic habit should not be neglected in treatment.-Intern. Med. Magazine. Treatment of Small-pox by Means of Darkness. Seven years ago Gallavardin drew attention to a plan of treatment for small-pox, originally suggested and carried out by John of Gaddesden and Waters. The treatment consisted in keeping the patients absolutely away from all solar light. This solar darkness had to be complete and uninterrupted, otherwise no beneficial results were obtained. The same writer now One accident happened to me that I have not seen spoken of anywhere. After introducing a tube with great ease, as I thought, and waiting a due time, I removed the string. The finger was hardly out of the mouth before I observed respiration almost arrested. The difficulty seemed to be in inspiration. I removed the tube none too soon to save the life of the child. As I (Lyon Médical, June 12, 1892) gives the held the tube in the extractor, I found result of his experience since 1876, and the extractor passing through a mem- finds that if this treatment be carried brane about the size of a silver dime. out the disease presents no period of This acted as a valve, preventing in- suppuration, and that in consequence spiration. The membrane had been the subsequent scarring is infinitesimal. perhaps partially detached, and was-British Med. Journal. Society Reports. THE CINCINNATI MEDICAL OFFICIAL REPORT. Meeting of May 3, 1892. The President, F. W. LANGDON, M.D., in the Chair. L. S. COLTER, M.D., Secretary. DR. PHILIP ZENNER presented a specimen of Brain Tumor (Tumor of the Pineal Gland). This specimen is a very rare form of brain tumor, being a tumor of the pineal gland. A clinical report of such a tumor has appeared only nine times, as far as I am able to learn. Cases of this kind have so much similarity that one could almost draw a clinical picture of them all, because they all produce the same physical changes. A tumor in that neighborhood usually compresses the aqueduct of Sylvius or veins of Galen, and in that manner produces a large internal hydrocephalus, and it is chiefly from that that the symptoms occur. In part, it is probably due to pressure upon the corpora quadrigemina. There is a very rapid impairment of intelligence, an impairment of far greater extent than in most forms of brain tumor. There is blindness in a majority of cases, and impairment of gait. There is sometimes paralysis of some of the muscles of the eye, coming from a lesion of the corpora quadrigemina. This tumor does not present the appearance that it had in the beginning. It was rather oval in form, about one and three-quarter inches in diameter, as soft as the brain substance itself, and somewhat lobulated in appearance. I saw this case with Dr. Murphy about six weeks ago. It was a boy fourteen years of age, who was well until last July. The symptoms began with headache, which was not persistent, but occurred principally in the morning. Shortly afterwards there was disturbance of gait the mother described it as a reeling gait. Within a few months he became so bad that he was put to bed, and he remained in bed for six months prior to his death. He became blind four or five months after the first appearance of symptoms. Hearing became impaired about the same time. In addition there was a contracture of the left arm, which was held forcibly against the body, the elbow flexed at about right angles, the fingers flexed also. The head was thrown back. Speech became impaired. When Dr. Murphy first saw him, three or four months ago, he could scarcely speak a word. When I saw him there was but one word uttered, which sounded something like mamma. He appeared to be in a very demented state, was entirely apathetic, passed urine and feces in bed. When I saw him there was also a very rapid pulse, and it had been so for months previous. He lay quiet all day long, taking what was given him. There had been at one time a little difficulty of swallowing. My diagnosis was an acute hydrocephalus, produced by a tumor in the posterior fossa of the skull, a tumor which I supposed to be cerebellar merely because cerebellar tumors are followed by those symptoms more frequently than any other. I urged trephining the skull and perforating the lateral ventricles to remove the fluid. All interference was, however, refused. It was very easily demonstrated, postmortem, that such an operation could have very easily given him relief. The tumor was found lying freely in the ventricles. It had no attachments whatever, excepting very slight, to the lining membrane of the ventricles. The ventricles were enormously dilated. The whole brain was enlarged, and had a pale appearance. The optic nerves appeared to be flatter than normal. That is almost always found in these cases, and probably explains the blindness. The deafness was probably produced by the general pressure. There appeared to be no symptoms on the part of the ocular muscles; the eyes moved freely in all directions. |