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mends it, combined with acetanilid and codein in intestinal stricture and obstruction. “Perhaps the easiest and quickest way to remove ranula is by means of 1-6 grain doses of pilocarpin hypodermatically. Safrantini reports one case."

Sexual Hygiene.-HOERSCHELMANN's contribution to a symposium upon sexual hygiene held at the meeting of the German Medical Society in May, 1899, is given in the St. Petersburger medicinische Wochenschrift of 5 October, 1899. Hoerschelmann discussed the relation of the physician to the patient as the adviser of the latter, and his conclusions are summarized as follows:

1. It has not been proved, and from the medical standpoint it is not established, that sexual continence is injurious to the health of a physically and mentally well young man or woman.

2. Sexual continence under normal conditions does not induce the development of onanism or masturbation.

3. From the medical standpoint it is not justifiable to advise a mentally and bodily healthy young man for the preservation of his health to practice illegitimate cohabitation, nor is such advice allowable under any conditions.

Circulatory Disturbances in the Brain Following Ligation of One Internal Jugular Vein.—By Dr. E. KUMMER. (Revue de Chirurgie, April, 1899). The writer reports a case of cysto-adenoma of the inferior maxilla in the removal of which it was necessary to ligate the external carotid artery and the internal jugular vein.

For three or four hours after the operation, the patient's condition seemed good, the patient appearing to be in deep sleep. Suddenly almost five hours after the operation the pulse became bad and patient died, without having regained consciousness since operation. At autopsy the veins of the pia-mater were markedly congested. No increase in the tension of the cerebro-spinal fluid. Near the middle of each frontal lobe there was a diffuse reddish area 2 or 3 c. m. in diameter. This reddish discoloration extended through the gray matter and into the white matter. There was a small quantity of reddish Auid in the lateral ventricles, quite a marked quantity in the third ventricle, and less in the fourth ventricle. Nothing else abnormal in the brain and rest of the body.

In explaining the cause of death, the writer thinks intoxication from chloroform, morphine or the antiseptics can be excluded. He thinks that ligation of the internal jugular vein can produce circulatory disturbances and can be followed by cerebral paralyses. Rohrbach has reported 91 cases of ligation of the internal jugular vein and in only one case could death be attributed to a disturbance of cerebral circulation. In this case death occurred seven days after operation and at autopsy two areas of softening were found in the frontal lobes corresponding in size and situation to those described by the writer in his case. There were also hemorrhagic areas in the dura and pia-mater. The intact jugular vein was found to be of much smaller calibre than normal and death seemed to be due to cerebral stasis. It must also be borne in mind that the surgical dressing

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may compress the internal jugular vein on the sound side and thus assist cerebral stasis. The writer calls attention to the fact that after ligation of one carotid there is an initial period of anæmia which is followed by pronounced venous stasis. Either lateral ligation or vascular suture is the method to avoid the circulatory disturbances of the brain following ligation of one internal jugular vein.

Influenza and Appendicitis.-GAGNIERE in the Gazette Des Hopitaux for the 7th of November 1899, writes concerning his experience with appendicitis in a recent influenza epidemic. . The epidemic lasted from the end of December to the end of May. During that time Gagniere observed about 300 cases of influenza of which number 1.3 per cent. showed the complication of appendicitis. The author gives the history of the eleven cases which he observed, two of which were fatal. Most of these cases began as the ordinary attack of influenza and after several days showed signs of appendicitis. In two instances a fatal issue resulted from the appendicitis. The author states that the cases of appendicitis were all of them contemporaneous with the period covered by the epidemic of grippe, that before the epidemic and since its disappearance he has not observed a single case of appendicitis in spite of the lapse of time and the fact that he has since examined about 1,000 patients, and that in most of the patients the coexistence of grippe and appendicitis was very sharply defined.

Muscular Tuberculosis. -LEJARS in the Revue de la Tuberculose for October 1899, writes on this subject. He states that the history of primary tuberculosis of muscle only dates back about 10 years, and that there are not a great many cases on record. Lejars relates the history of a man of 36 years of age, who entered hospital complaining of swellings in one thigh. The illness had begun with weakness and stiffness of the limb, and then gradually multiple tumor nodules had formed in the lower part of the thigh above the knee. The man's general health was good; there were no signs of phthisis and the knee joint was uninvolved. On entrance into the hospital the skin about the knee was reddened, and beneath it in the muscle were numerous nodules, sharply localized, and varying in size from a pea to an olive. Operation showed these to be hard or caseous tubercle nodules which infiltrated the muscle substance, and even the tendon. No involvement of the inguinal glands was present. Histological examination showed typical tuberculosis both in the intermuscular tissue and in the muscles themselves.

Pilliet who examined the tissue believed that the tubercles originated in the intermuscular tissue, and only secondarily involved the muscle. The thigh muscles according to Lejars are the favorite sites for primary muscle

tuberculosis.

Intra - Muscular Osteoma of Traumatic Origin. — Paul Boudin in the Gasette des Hopitaux for November 2 and 4, 1899, gives a very complete review of this subject. He refers, he says, to osteomata developing within muscles after injury and not to traumatic exostoses or hyperostoses. These cases were first described by Mascarel in 1840, but later on Billroth, Virchow and others published cases. The affection is relatively rare. It occurs most frequently in young people between 20 and 30, nearly always in males and usually in soldiers. Cavalry men are mostly affected, the adductor thigh muscle being the favorite site of growth. The great etiological factor is trauma. Three main theories are advanced to account for formation of the bone after the trauma.

The hematic theory holds that the hematoma is the original change, and that this becomes first cartilaginous and then osseous. This theory has been abandoned as it is contradictory to the principles of osteogenesis.

The myositis ossificans theory is that the first change is a myositis and that the inflammatory products result in the formation of bone. This theory has been disproved experimentally. Finally we have the periosteal theory which holds that with the muscular injury there is also periosteal injury with the transplantation of small particles of periosteum into the injured muscle where it goes on to bone formation. This view has been supported by experimental work and seems the most probable of the three. The osteomata develop almost exclusively in the muscles of the limbs, particularly in the lower limbs, as these are especially liable to injury. In the arms they appear in the brachialis and biceps and are called by the Germans "Exercier Knocken.” They are always in connection with bones and are never found in the muscles over the viscera. They may be single or multiple, but are usually single. They vary in diameter from 4 or 5 to 19 or 20 centimeters, and their form is usually irregular. Histologically they consist of islands of true bone surrounded by inflamed muscle, from which they may be separated by granulation tissue. Very rarely islands of cartilage are present. Clinically the cases show first a history of trauma, which is generally associated with loss of function, then a hematoma forms at the site of injury, and finally a bony tumor which may appear after 15 days, but usually does not form for one or two months. Pain is present at the time of injury and may persist all through the disease. Complications, particularly suppuration, are rare. The prognosis is benign and the treatment is essentially surgical and operative.

MEDICINE

Edited by Samuel B. Ward, M. D.

Koplik's Spots in Measles.— By J. WIDOWITZ, in Gratz. (Wien. klin. Woch., No. 37, September 14, 1899.)

The writer publishes the results of his observations of Koplik's sign as evidenced in a recent epidemic of measles in Gratz.

He calls attention to the fact that Flindt and Siegfried Weiss had described this condition in 1880.

Filatow, in 1895, described a slight patchy degeneration of the epithelium of the mucosa of the lips and cheeks, which appears before the other prodromal symptoms. Frequently a vesicle is observed, situated at the middle of the red patch on the mucosa, and when this is ruptured the slight necrosis gives rise to the grayish-white appearance. In 158 cases of measles observed by the writer, Koplik's sign was present in 140 and absent in 18.

In 115 of the 140 cases there were also other signs and symptoms of measles. In 25 cases Koplik's sign was of great assistance, because there were no other definite signs or symptoms of the approaching measles, and in all these cases measles subsequently developed. The failure to observe the sign in the 18 cases may have been due to its transitory character.

In an epidemic of rötheln, in 135 cases, the writer observed Koplik's sign in 10 cases, and these were cases in which the existence of measles was excluded. The writer concludes that the so-called Koplik's spots occur in most cases of measles, and in many cases they occur at the same time as the other prodromal symptoms. They are occasionally observed in rötheln and other diseases, as catarrh of the respiratory mucous mem branes and follicular angina. They are a very valuable, but not an absolutely certain, sign of approaching measles. It is, therefore, not possible, from Koplik's spots alone, to conclude, without reference to the general condition of the patient, that measles is developing.

Diagnosis of Uremia and Concerning Albuminuria in Diabetes Mellitus.—By Dr. Ludwig Herzog. (Deut. med. Woch., August 3 and 10, 1899.)

The writer first describes two cases of hemiplegia, in which, at autopsy, contracted kidneys were found. In the one case brain examination was negative, while, in the other, there was an apoplectic condition.

He calls especial attention to the difficulties of diagnosis of uremia. The presence of various forms of paralysis used to be considered the chief diagnostic point against uremia. To-day, however, the view is quite different. Senator divides the uremia paralyses into three groups: 1. Paralysis of the external muscles of the eyes. 2. Hemiplegia. 3. Bulbar paralysis. Ulrich Rose distinguished four classes of uremic cerebral paralysis: 1. Pure uremia, without demonstrable changes in the brain. 2. Uremia, with capillary apoplexy, visible only with the microscope. 3. Nephritic apoplexy, with many small foci. 4. Extensive nephritic cerebral hemorrhage.

Aphasia is a well-recognized condition in uremia, and it may occur without any other of the symptoms of uremia, and without a demonstrable lesion, and is of a transitory character. As a result of uremia, there may be convulsive seizures resembling Jacksonian epilepsy. They may, however, be chronic in character, and usually involve the muscles of the extremeties, and may be the only symptoms of uremia. Uremic amaurosis is a well-recognized condition, usually transitory. Pupil reaction is usually retained. As to the pathoganicity of uremia, Traube's theory is not so generally held to-day. The chemical theory is the one most generally accepted, and of this there are three groups: Ist. Those who believe uremia to be due to an excess of potassium salts. 2d. Those who believe it to be due to a decrease in the alkalinity of the blood. 3d. Those who believe uremia to be due to organic urinary poisons, i. e., Bouchard's toxic theory.

With regard to the frequency of the presence of both sugar and albumen in the urine, statistics vary greatly.

Pollatschek investigated the urine in 1,187 cases of diabetes mellitus and found albumen in 437, or 36.7 per cent.

R. Schmitz investigated the urine in 1,200 cases of diabetes mellitus and found albumen in 824, or 68.7 per cent.

Grube investigated the urine in 473 cases of diabetes mellitus and found albumen in 181, or 38.3 per cent.

Casts are also found very frequently in diabetic urine. The albuminuria in diabetes is, however, not always an indication of severe nephritis. Numerous observers have described arears of necrosis in the renal epithelium, associated with diabetes, but there is nothing specific about this degeneration.

Grube distinguishes five groups of diabetic albuminuria:

1. The albuminuria in severe cases of diabetes, especially those ending in coma.

2. The albuminuria due to heart weakness.

3. The albuminuria of old age, due to arterio-sclerotic changes in the kidney.

4. Functional albuminuria, due to the secretion of diabetic urine. 5. The albuminuria of diabetics, due to chronic nephritis.

Some observers believe that the absolute meat diet often used in diabetes is a cause of albuminuria. The individual with kidney changes in diabetes is thus exposed to the dangers of both uremia and diabetic coma.

The Value of Casts in the Diagnosis and Prognosis of Nephritis. -Penu in the Revue de Med. divides casts into three groups according to their origin. Transudate casts-hyaline, hæmoglobin, fibrin and erythrocyte-which owe their origin to substances contained in the blood which passes through the wall of the urinary canaliculi as a result of chronic or acute circulatory changes. Desquamatory casts—colloid, fat, amyloid and epithelial—which are formed from the desquamation of the degenerated cells of the tubules. Fermentative casts—which are produced by the productive activity of the epithelium linig of the tubules. These are the granular casts and they are characteristic for epithelial nephritis. The other forms of casts have no specific significance, even the hyaline casts found most commonly by circulatory changes. Free cells of epithelial origin are the usual accompaniments of these casts. In the acute stage of parenchymatous nephritis are numerous small casts with compact granules. In the subacute form they are very much scarcer, less covered with granules and thicker. In the chronic forms only occasional casts are present and without substance. They disappear with the albumen out of the urine in the healing process. When it passes to contraction a variable, generally slight quantity of albumen is excreted and casts are absent.

The Plague in Eastern Mongolia.—ZABOLOTNY in the Annales de l'Institut Pasteur for Nov, 1899 describes a new endemic focus of the plague in Eastern Mongolia. It is in a mountainous district, 14 or 15 days northwest travel of Pekin. The region is occupied by Chinese and Mongols

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