Page images
PDF
EPUB
[ocr errors]

opponents. Several of these are quoted in this article. The author says that, as regards his own examinations, he must disregard the pathological, anatomical side of the matter and content himself with this question: "How does the smootto atrophy of the root of the tongue present irself clinically?” with special respect to this further question: "Is sich atrophy valuable clinically as a pathognomonic symptom of syphilitic disease ?"

His conclusion is that the existence of smooth atrophy is not a trustworthy symptom; that fatness of the region of the glands at the root of the tongue may be coincident with imperfect development of the entire tongue, and that therefore the tongue, like any other organ, may participate in the general degeneration of the general organism, and that, on the other hand, there are cases in which there is no tertiary syphilis, but in which, although the tongue is otherwise as well developed as in the average case, there may be found a greater or less atrophy of its root.

Remarks about Bad Breath.- B. FRAENKEL. (Archiv. f. Laryngol. %. Rhinol., Heft. 1, 1900.) The author states that in some cases the offensive odor does not really exist, but is a pure delusion, a subjective sensation, as in paranoia and hypochondriasis. If for example, a person one of these hypochondriacs happens to be talking to, should turn away the head. he imagines that it is on account of the bad smell he is distributing. The author only considers that class of cases in which an odor is perceptible during expiration. In order to make a correct diagnosis it is important to determine whether the odor comes from the nose or mouth. The patient is told to keep the mouth tightly closed and to blow, first through one nostril and then the other. The examining physician brings his own nose close to that of the patient, and is then able to detect any odor in the current of air. The patient then repeats this process by closing the nostrils and blowing out of the mouth. After it is determined that the odor comes from the mouth or pharynx, the suspicious places are touched with cotton so as to find out whether the odor originates in some particular part of the mouth or pharynx. Carious teeth are of course frequent causes. Retained decomposing secrctions in the crypts of the tonsils frequently cause the odor. This is particularly true of secretion behind the plica tonsillaris. Applications of antiseptic solutions to the tonsils or amputation of the tonsils is the remedy. Sometimes the entire secretion of the nasal and charyngeal mucous membrane has the disagreeable odor. In such cases ant:septic douches and mouth washes must be used. It must also be determined whether the odor does not originate in the deeper respiratory passages of the esophagus.

The Pathology of Intracranial Suppuration of Otitic and Rhinitic Origin.W. MILLIGAN. (Internat. Centralbl., January, 1900.) The author first thoroughly considered intracranial suppuration following pathological conditions of the ear, ar.d then the intracranial complications resulting from suppurative processes in the frontal, ethmoidal and sphenoidal sinuses. Degeneration of the mucous membrane in these cavities, exposure of the bone with u'ceration, and a: times perforation of the same, is followed by meningitis extradural abscess, abscess of the frontal lobe, or thrombosis of the sinus cavernosus. The pathological organisms may also be transmitted by way of the vessels or through the perivascular canals without any erosion of the bone. The poor drainage favors the retention of the causes a possibility of infection of the cranial cavity at this point. In one case reported by the author an abscess of the frontal lobe followed an empyema of the frontal sinus, and in a second case a basilar meningitis and septic thronbosis resulted.

Gonorrheal Stomatitis — In L'Independance Medicale for December 13, 1899, Petit reports an interesting case of gonorrhæal stomatitis and reviews the literature of this subject. Petit refers to cases reported by Horand, Cutler, Rosinski, Leyden, and Jesionek, in some of which the stomatitis was secondary to a go rrhæal ophthalmia, and in some oi which it was due to coitus ab ore. His own case was that of a young man of thirty who consulted hiin for an inflammatory lesion of the mouth, presenting as an erythematous condition with a good deal of desquamation, There was a well marked glossitis with great swelling of the tongue, and the presence of numerous small superficial ulcerations on the removal of the desquamated epithelium. The symptoms were pain, difficulty of mastication, and fever. The breath was extremely fetid and there was swelling of the submaxillary lymph glands. The patient admitted buccal coitus, but an examination of the genitals of the woman with whom he cohabited failed to show either clinically or bacteriologically any signs of gonorrhoea. Cover slips from the mouth of the man showed many biscuit shaped intra-cellular diplococci, which easily decolorized by Gram's method. Attempts to cultivate them on the ordinary culture media were entirely negative; no attempt was made to cultivate them on special media. The author is unable to account for the infection except on the grounds thać the woman had a latent gonorrheal infection which lighted up from time to time, and had been in a condition of activity at the time of the infection of his patient.

Lupus of the Nose Cured by the New Tuberculin.- HERON. Internat. Centralbl. f. Laryngol. th. Rhin., January, 1899. Patient was a young man aged 27, with lupus vulgaris of left side of nose, internally and exter. nally. Nodules were also present in the lip and ear. Author treated the cases with Tuberculin R. Whole amount injected in three months was 126.5 mg. in sixty-two injections. There was very little rise in temperature after the injections. The diseased parts got entirely well.

CLINICAL MICROSCOPY

Edited by Arthur W. Elting, M. D. Leucocytosis in Acute Lobar Pneumonia.- LOEPER, in the Archives de Médecine Experimentale for November, 1899, contributes an article on this subject based upon an examination of twenty-one cases of pneumonia. After carefully studying the different phases of the subject he comes to the following conclusions:

a

Absolute leucocytosis in acute pneumonia comes on rapidly with a chill, oscillating slightly during the disease, and disappears at about the time of the crisis. This disappearance of the leucocytosis is one of the critical phenomena of the disease, The leucocytosis in acute pneumonia is above all a polynuclear leucocytosis. The polynuclear averages about eight-five per cent in moderately severe cases, ninety-two per cent in serious cases, and ninety-five per cent in fatal cases. The gradual ascent of the polynuclears indicates an almost fatal prognosis. There is a parallelism between the crisis of the leucocytosis and the urinary crisis; i. e., the reappearance of the chlorides in the urine. There is a relation of cause to effect between the leucocytosis, the peptonuria, and the elimination of uric acid. These two phenomena are directly produced by the setting over of leucocytic nucleins and the resolution of the exudate.

Tho rare forms of cells which are found in the blood of pneumonia are abnormal forms which appear on the sixth day, the basophile after them, and the eosinophile which appear after them more or less rapidly. The abnormal form and the basophile announce the cure which the eosinphile affirm. The author states that he does not wish to insist upon the absolute character of these deductions, but states that they are of almost absolute certainty, or at any rate are extremely probable.

The author concludes by stating that he considers the increased number of polynuclears not as an indication of resistance, but as one of invasion of the organism. It is a measure of invasion and not a measure of resistance.

The Detection of the Typhoid Bacillus.-E. H. HANKin in the Centralblatt für Bakteriologie for November 16, 1899, calls attention to a method for isolating the typhoid bacilli from drinking water. The method consists in adding one, two, three or four drops of Parietti's solution to tubes containing ten cubic centimetres of neutral bouillon. Each tube is then infected with a few drops of the suspected water. According to the old method of using Parietti's solution, the tube showing the most cloudiness after the end of twenty-four hours would have been picked out for examination for the typhoid bacillus. Hankin, however, does not pick out the most cloudy tube, but the one next below this in cloudiness, and from it he inoculates a second group of of bouillon containing Parietti's solution. In this second group of tubes the smallest amount of Parietti's solution added is that equivalent to the amount present in the tube of the original set from which the culture is taken. In the second set of Parietti's tubes, as in the first, the one next below the cloudiest one is selected, and from this cultures aro made on litmus sugar agar. At the end of forty-eight hours these organisms which have not turned the litmus agar red are examined. Only those which morphologically resemble the typhoid bacilli are tested. The author was able by this means to isolate the typhoid bacillus in several instances, from drinking water which had caused typhoid fever, something which, as is well known, has seldom been done. The bacilli so isolated were subjected to careful tests, and were also submitted to Pfeiffer and Wright who confirmed the author's diagnosis of typhoid bacillus.

The Antibacteriological Value of Acrolein. In the Centralblatt für Bak teriologie for November 16, 1899, Koch and Fuchs give the result of their examinations of this new antiseptic. The substance belongs to the same group as formaldehyde, but differs from it in being an aldehyde of allyl alcohol, whilst formaldehyde is an aldehyde of methyl alcohol. The new substance acrolein boils at 52.5° centigrade, and is easily soluble in a strength of twenty-five per cent. in water. The authors tested the substance in one-quarter, one-half, one, two and five per cent. solutions upon various micro-organisms, such as the bacillus pyocyaneus, the colon bacillus, and the pus cocci. They conclude that one can say in general that acrolein is a stronger disinfectant than formaldehyde, and that as far as it has been tested it also gives good results in the disinfection of large rooms.

Pathogenic Micro-Organisms in the Air.-E. CONCORnotti in the Central. blatt für Bakteriologie for November 7, 1899, discusses the question of the number of pathogenic organisms found in the air. He examined in a large number of cases the air from private houses, hospitals, railroad cars, and various other places. His examinations were conducted by exposing culture media to the air for a given length of time, allowing bacteria to develop, washing the surface of the media with sterile water, and then inoculating animals. In forty-six inoculated rabbits fifteen died of infection of the staphylococcus aureus. Of the same forty-six rabbits, eight died of infection with the staphylococcus albus, six of infection with the bacillus coli communis, and two of infection with the diplococcus of pneumonia.

From his studies the author concludes that by inoculating animals intravenously with washings from agar plates, pathogenic organisms are much more easily detected than by some of the old methods. Pathogenic organisms which are found in the air are in accordance to the order of their frequency, the staphylococcus aureus, the staphylococcus albus, bacillus coli communis, and diplococcus of pneumonia. These pathogenic organisms occur most frequently in places with dirty surroundings, whether these be public or private.

ALBANY

MEDICAL ANNALS

Original communications

[ocr errors]

THE PREPARATION OF TUBERCULIN, ITS VALUE AS A DIAGNOSTIC AGENT, AND REMARKS ON THE HUMAN AND BOVINE TUBERCLE

BACILLI.*

BY VERANUS A. MOORE, M. D., Professor of Comparative Pathology and Bacteriology, N. Y. State Veterinary College,

Cornell University, Ithaca, N. Y. The hope formerly entertained that tuberculin, or, more correctly speaking, Koch's old tuberculin,t possessed a specific therapeutic value has been dissipated in the realization of the fact that its unquestioned usefulness is that of a diagnostic agent. While its character and properties are generally understood by the medical professions, there are still those who doubt the experimentally tested and practically demonstrated possibilities of this substance. Of the bacterial products which in recent years have come into prominence, few if any occupy a place, either in human or comparative medicine, where an accurate and widespread knowledge of the conditions limiting their effectiveness is more urgently demanded than for tuberculin. The important position it holds in sanitary medicine, and the powerful agent it may become in tne hands of those who have to do with bovine tuberculosis, emphasize the necessity of such a knowledge.

Within the limits of this paper, it will be impossible to discuss in detail the numerous questions which naturally suggest them

Read by invitation before the Medical Society of the State of New York, Albany, January 30, 1900. + It is important not to confound the tuberoulin which was discovered by Koch in 1890 with the new tuberculin described by him in 1897. For a brief description of this new product see appendix.

Maragliano (Berliner klin. Wochenschrift, May 1, 1899) describes a watery extract of tuberclo bacilli which he calls aqueous tuberculin.

« PreviousContinue »