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correspondingly lengthened, with a pro The application of this law is subject portional lengthening of their circum to certain modifications due to the anaferences and separation of their meridi tomical and architectonic peculiarities ans, so that the direct depressing force of the skull, its coverings and contents, is converted into an indirect disruptive and to certain exceptions due to the force acting at right angles to the direc amount and velocity of the force applied tion of the former. The effect is to pro as well as to the coming into play of duce a fissure or fissures, which will peculiar counter-forces. have a general meridianal direction.



LICHEN PLANUS OF THE HANDS AND The above detail I have recently carFeer.— Hallopeau (American Medico ried out in twelve cases. To eleven chloSurgical Bulletin) says that lichen planus roform was administered, to one ether. may have for its seat of election the The time required to complete operation palms of the hands and the soles of the varied from ten to fifty-five minutes. feet, constituting a form of hyperkera. Whether the case was one of sclerotic tosis. The parts are surrounded by an ovaries or a pus case with universal aderythematous zone, and accompanied hesions of all the pelvic structures, the by an intense pruritus.

result has been uniform and highly satisfactory, thirst being allayed and

excretion stimulated (a very essential THIRST AFTER CELIOTOMY.-Dr. Wil condition to prompt recovery). liam H. Humiston of Cleveland, Ohio, I believe this method will prove to be reports in the American Journal of Ob efficient in the hands of abdominal surstetrics his method of preventing thirst geons generally, and I publish it early after celiotomy, which is as follows : with all confidence that the twelve cases

The patient should have the usual I have had will soon be fortified by the preparation for celiotomy — i. e., diet, reports of many hundreds, and that by daily baths, cathartics, etc. For three it we may avoid a condition that is and days prior to operation, order the patient has been distressing alike to patient, to drink one pint of hot water an hour surgeon and nurse. before each meal and on retiring, thus drinking two quarts of water each twenty URINE FILTRATION. - In the Boston four hours, the last pint to be taken Medical and Surgical Journal, Dr. L. F. three hours before the time set for oper Bishop gives a quick method for filterating. Do not omit to give the water ing small quantities of urine. A small the day previous to the operation, while quantity of the cloudy urine is placed the patient is restricted to a limited in a test-tube, the mouth of the testamount of liquid nourishment and the tube plugged with cotton with a moderbowels are being unloaded. We thus ate degree of firmness. A second testrestore to the system the large loss of tube is placed with its mouth to the fluid occasioned by the free catharsis, first. The position of the tubes is now and we have the great satisfaction of reversed so that the one with the urine seeing our patient pass through the try is bottom upward. The upper tube is ing ordeal of the first thirty-six hours now carefully and gently heated over after operation in comparative comfort, the flame of a Bunsen burner or alcohol with no thirst, a moist tongue, and an flame, and the expansion of the air active renal function, represented by an above the urine immediately forces it excretion of from twenty-eight to fifty through the cotton plug, and the filtered fluidounces of urine during the first urine collects in the lower tube. In twenty-four hours, catheterization being this we imitate to a degree the rapidseldom necessary. This is in keeping filtering apparatus of laboratories, but with the full character of the pulse use pressure above the fluid to be filtered noted.

instead of an air-exhaust below.



The prognosis in pneumonia depends more upon the age of the patient than

upon any other single element ; occur. THE CLINICO-PATHOLOGICAL

ring in the young child, or in a very old SOCIETY OF WASHINGTON, D. C.

person, it is almost certainly fatal.” Again, as regards the limit of tempera

ture, the same author says: “A temAt the meeting of the Clinico-Patho perature of 104° F. must be regarded as logical Society, held May 7, 1895, at the the limit in a mild case of pneumonia.' office of Dr. Holden, the following path Loomis says in his introduction of treatological specimens were presented by ment that “perhaps there is no disease, Dr. Kelley: Large stone taken from the the treatment of which has been so bit. bladder through the abdomen. A case terly and earnestly discussed, as the one of acute peritonitis, in which was found now under discussion. It has been the a fibroid tumor of the uterus, an ovarian battlefield of the advocates of heroic cyst, a pelvic abscess, and appendicitis. measures on the one hand and of the ad.

Dr. Wellington read a paper entitled vocates of expectant plan of treatment CROUPOUS PNEUMONIA IN CHILDREN. on the other. (See page 305.)

Dr. Wellington refers in treatment Dr. Stone opened the discussion. He to reduction of temperature by “spongsaid : It is sadly lacking in taste, to ing, wet-packs or even the plunge bath say the least, to open any discussion (cold).” Of course, heroic diseases and with an excuse or apology, but here I symptoms require heroic measures but think I am justified in so doing for the it appears to me that this should be a scope of the evening's paper is far with dernier ressort even if ever used. I do out my bailiwick and again, as my li not believe the children of the rich brary only contains works (on general and better classes could nor would stand subjects) which the advance of time such severe measures. Loomis is quoted have relegated to the past, any criticism in this connection as saying: "The I may possibly advance would be in the Germans believe that in pneumonia the nature of (if I may be pardoned the use temperature can be reduced by the apof slang)"back-numbers."

plication to the chest of cold compresses; It has always appeared to me that the 'a cloth of some thickness is to be wrung treatment of children with their many from cold water and applied every five disorders required a little more than the or ten minutes to the affected side. It usual care and ability. In the adult is claimed for this measure, that not undoubtedly, we are dealing with intel- only does it relieve local symptoms but lect and reason which will suggest and it lowers the body temperature and aid the physician in diagnosing, but in hastens the day of crisis. There can be the infant it is different. I have heard no doubt that the pain in the side and physicians say they preferred the treat the dyspnea will be relieved in this way; ment of childreu for the reason that they but it is also certain that the reduction (the children) never or seldom ever lied. of temperature and relief of local sympThis is very true for it is more natural toms are only temporary. My own exfor a child to be up and bright enjoying perience (Loomis) would lead me to beits play, than the adult, who may wish a lieve that pneumonia treated in this way few lazy days in bed. Still, in the in- is more liable to extend ; besides, unless fant one must absolutely be certain as a great care is exercised in the application diagnostician and keen observer to gain of the compress, the patient is quite the coveted reward of success. I shall likely to be chilled, and as the measure in nowise attempt to discuss the entire is only temporary he does not regard it paper, but only here and there. Al as a safe measure." though in well managed cases all au Again, in treatment Dr. Wellington thorities agree in the favorable progno- prefers antipyrine. I do not know sis, still Loomis in the prognosis says : what experience he may have had with

the drug, but am almost certain that jacket used to be considered a pathoit will be but a matter of time be gnomonic sign of pneumonia. He thinks fore he will meet his Waterloo. Some there is considerable difficulty in makyears ago during an attack of typhoiding the differential diagnosis between my wife's temperature being 103° and the capillary bronchitis and this disease; it doctor desiring reduction, resorted to is certainly more difficult than one this drug for its accomplishment. Only imagines it to be. The cold bath and five grains were given. There was dan- pack is not so rational as it seems at first gerous heart failure and at the same sight. time a reduction of temperature sub Dr. Glazebrook said the relief follownormal in less than two hours. At that ing the use of the cold pack or bath was time, strange as it may seem, the drug marvelous. was more universally used in the west Dr. Stone asked if the cold pack is and southwest than here in the east. used in private practice as much as it is I agree most heartily with him in used in the hospitals. that frequent and careful watching is Dr. Olin Leech said that the oiled absolutely necessary. I regret most silk vest and cold pack and sponging sincerely that I am unable to discuss are favorite remedies of his. He also the paper as it deserves, but I am fully thought well of the practice of mixing aware that abler hands than mine will quinine with vaseline and rubbing it in open all avenues and the subject and the skin ; he does not use antipyretics paper will receive the praise and inter

or expectorants, the latter working est it most justly demands.

more harm to the stomach than beneDr. Glazebrook said that in regard to fit to the patient. croupous being more prevalent than ca Dr. Tompkins said that the principal tarrhal pneumonia in children he was of question under discussion was whether the opinion that it was just the reverse. cold packing or hot applications to the

Dr. Wellington said that about one chest should be used. If he had pneuthird of all cases of pneumonia are monia he would prefer hot applications croupous. As to differential diagnosis, to the chiest. a large majority of the cases of croupous Dr. Mackall said that the old flaxseed pneumonia brought to the Children's meal poultices should not be altogether Hospital, say 90 per cent., were previ- discarded. The cold plunge and pack ously diagnosed as cases of meningitis ; are valuable, but no routine treatment the movements of the alae nasi muscles ought to be recommended. clinched the diagnosis of pneumonia. Dr. Glazebrook said that the cold The cold pack and bath are to be pre- pack and sponging are to reduce the ferred to antipyretics in the treatment temperature. Sometimes the hot appliof this disease; this was the preferred cations agree with patients better than treatment at the Children's Hospital. cold.

Dr. Frank Leech said that he had Dr. Tompkins said that the applicasome experience with croupous pneumo tions to the chest are to promote resolunia in the Children's Hospital but did tion and not to affect body temperature. not see so many cases as those of catar. Dr. Olin Leech said that the cold acts rhal pneumonia. After leaving the hos as a stimulant to the circulation, as well pital and engaging in private practice as to the nervous system. He uses flaxthe order of things seemed to be re seed meal poultices; sometimes they did versed. The oiled silk jacket is a valu not have time to remove the oiled silk able adjunct to the treatment of this jacket. disease. He prefers the application of Dr. Deale said that if it is a specific cold to the use of antipyretics.

disease the local applications should not Dr. Sprigg said he was glad to hear affect it at all. The oiled silk jacket the oiled silk jacket recommended in offers more of a protection than any the treatment of pneumonia.

curative power. Unless the temperature Dr. Snyder said that the oiled silk is excessive it is better to let it alone,


as it has been shown that the pneumo eminent authorities declare that it forms cocci cannot exist at a temperature one-third of all cases. He advocates above 104°-105° F. Sponging, or cold cold pack, and sometimes poultices. pack if it is allowed, is the better remedy Quinine in his experience has little for reducing temperature. As to anti effect in pneumonia. pyretics ; antipyrine is by far the most Dr. Tompkins read a paper entitled depressing; phenacetine is to be pre- CEREBRAL HEMORRHAGE, with speciferred-if followed by quinine it is quite mens, the discussion of which was postefficacious. Diagnosis is sometimes poned until the next meeting. quite difficult. Mortality is consider R. T. HOLDEN, M. D., Secretary. able, somewhat greater than he ima: gined, according to Dr. Wellington's

PHILADELPHIA ACADEMY OF paper. Treatment: Nitroglycerine is a valuable remedy.

SURGERY. Dr. Clark said that in the treatment of cases, baths would not be used in Dr. Thomas G. Morton, the President, children who are weak or exhausted in the chair. Heagrees with Dr. Mackall about routine Dr. Charles W. Dulles read a paper on treatment, and with Dr. D. O. Leech as FRACTURES OF THE SKULL. (See page to using as little medicine as possible. 308.) Aconite in incipient pneumonia is the The President: Has the alteration in most valuable drug for reducing temper- the conformation of the skull, I mean ature. Quinine is valuable after the the shortening of the axis in the directemperature has been reduced by aconite. tion of the applied force and the lengthIt should not be used by the mouth, but ening of the transverse axes, been acrubbed in with lanolin or in suppository. curately determined by measurement ? A great deal of the treatment depends Dr. Dulles : Yes ; the alteration has on the stage at which you see the pa- been carefully measured and there is an tient. The shock to most children of appreciable difference, the amount of the wet sheet is considerable. The which is mentioned in my former paper. bath at about body temperature is to be Dr. Hewson : In connection with the preferred, and we can gradually lower remarks upon the fractures of the clinoid the temperature of the water. If shock processes, have you taken into considerensues, brandy or other stimulants are ation the fact of the difference in the indicated. Poultices are not to be dis- height of the free concave margin and carded, in properly selected cases; if the anterior attached extremities to the nursing is good, and the patient a strong posterior clinoid process ? Owing to child, improvement will follow their this, the portion of the tentorium open use. In weak children the poultices by for the passage of the nervous substance their weight do harm.

is triangular, with curved sides, and Dr. Muncaster wished to mention one this is much higher than its attached point in the examination of the heart in anterior extremities to the posterior pneumonia; it is found that the radial clinoid processes. The direction of the pulse will not indicate the exact action free margin of the tentorium is pointed of the heart. The examination of the upward over the superior vermiform right side of the heart, and the use of process of the cerebellum, this margin trinitrin, is important.

being higher than its anterior attachDr. Wellington in closing said that ment. I only wish to ask if the direcDr. Stone quoted Dr. Loomis, who is at tion of the traction upon the posterior variance with most authors in treatment clinoid processes contribute anything to and prognosis of croupous pneumonia. the fracture ? The point I wish to ask He regards cold as valuable; he uses is, have you observed any laceration of both the sponging and pack. As to the margins of this opening ? frequency his experience is that it is Dr. Dulles : Whether or not the posa comparatively infrequent disease, but terior clinoid processes are higher than

the arch of the tentorium depends much diagnostic as well as prognostic importon the way in which the skull is held. ance in those cases of gastric disorder I should think that under ordinary cir accompanied by an entire absence of cumstances, when the head is held erect, free hydrochloric acid. In these cases they are about on the same level.

(chronic gastritis or carcinoma) there is Dr. Hewson : The tentorium arches marked diminution of the zymogen upward.

Go-o), depending upon the severity and Dr. Dulles : I have not overlooked extent of the disease. In cases of nerthis fact in my study of fractures of the vous dyspepsia, as well as in secondary skull. Under ordinary circumstances catarrh, the zymogen is present in northe curve of the tentorium would supply mal proportions in dilutions of from 150 an amount of slack material which would to do. We can, therefore, readily deprevent any pull on the clinoid processes. termine whether there is actual disease But it must be remembered that the of the gastric mucous membrane or tentorium rests upon the cerebellum and simply a nervous or congestive condition. is held tense by the cerebrum above the 4. In those cases in which there is an cerebellum, and is so attached that the absence of free hydrochloric acid, and latter occupies a closed, unyielding case. in which the labzymogen falls between The brain-substance is so largely made to and do, it is impossible to determine up of water that it is almost as incom at once whether there is a catarrhal conpressible as water (which is practically dition or nervous dyspepsia present. entirely incompressible) and the cere Several examinations must be made to bellum will hold up the tentorium al determine whether the labzymogen most as effectually as if it were made of ranges above to or below to. marble, and so cause a pull at its pos 5. In cases of chronic gastritis the exterior part to be transmitted to its an amination for the labzymogen is of conterior attachments. This I say only by siderable prognostic importance. In way of suggested explanation of fractures those cases in which the labzymogen is of the processes ; I have no demonstra diminished from is to o there is no tion of the theory to offer.

chance of recovery ; in those in which it is diminished from to do there is

a possibility that judicious treatment MEDICAL PROGRESS.

may result in recovery.

DIET IN PREGNANCY.- Dr. Eichholz RENNET-ZYMOGEN AND STOMACH of Kreuznach, in the British Medical DISEASES.- Dr. Julius Friedenwald of Journal, maintains that a large proporBaltiniore has made a very exhaustive tion of the discomforts and difficulties study in the Medical News of the quan preceding, attending and following partitative estimation of the rennet-zymo turition might be avoided by a rigid adgen and its diagnostic value in certain herence to some simple dietetic rules. diseases of the stomach, from which he Excess of albumen and of water are, he sums up the following conclusions : considers, the errors against which preg

1. Under normal conditions the milk. nant women should be warned, as tendcurdling ferment may be present in di ing respectively to excessive developlutions up to to, the zymogen up to 150.

ment of the fetus and secretion of am2. In those cases in which there is niotic fluid. His rules are : Meat only a normal or diminished percentage of free once a day, and that in small quantity hydrochloric acid, the milk-curdling fer and rarely if ever salted ; green vegement and its zymogen may be present tables, salad, potatoes, bread and butter, in normal quantities or may be markedly but avoiding as far as possible eggs, diminished. Their estimation, there peas and beans, as being too rich in fore, in these cases is of little value. albumen. Thirst to be quenched by

3. The estimation of the milk-curd milk or water in moderate quantities, ling ferment and its zymogen is of great and cocoa in preference to tea and coffee.

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