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The question of peritonitis is import- Case 2 gave rise to eleven others. Case ant. A stone near the papilla is a for- 3 arose from drainage alterations in a eign body, and as such, it irritates and neighboring street and gave rise to eight leads to the establishment of peritonitis, others, all in one street, and among inwhich may become purulent. Chills, mates of houses supplied with pails; 30 fever, sweats, etc., occur here. Inflam per cent. of ihe pail and 6 per cent. of mation may result in perforation of the the water-closet houses in the one street gall tract, setting up peritonitis thus. became infected. Case 4 infected two From malaria, differentiation is some others. Case 5 infected the mother, times impossible. Dr. Taylor said he four daughters, a son and a neighbor, could recall cases in his own practice in seven persons, all of whom assisted in which diagnosis was only made by the nursing him.
nursing him. Case 6 probably infected autopsy. Solvents are myths and the eight members of the same family or only medical indication is to relieve friends nearby. He says that he could pain.
cite from his note-book many other Dr. J. S. Wellford reported cases of cases that can only be explained in the cholelitbiasis. Most cases, said he, of same or in a similar manner; we must gout commence with violent pain, espe work along these lines as well as upon cially in the right hypochondriac region, the well-recognized lines of water-borne and this should be borne in mind in di infection. agnosing gall-stone and appendicitis. MARK W. PEYSER, M. D.,
LANCING CHILDREN's Gums.--So good Secretary and Reporter.
an authority as J. Lewis Smith has recently spoken against the practice of
lancing infants' gumis. In a paper read MEDICAL PROGRESS.
before the New York County Medical Association (Medical Record) he said
the belief still prevails to a wide extent DIRECTLY INFECTIOUS NATURE OF that the cutting of teeth is a common TYPHOID FEVER. – Dr. Jos. Priestley cause, not only of painful gums and (British Medical Journal, August 31 ) says poor appetite, but also of enterocolitis in 1892-4 there were in Leicester 634 cases and other serious maladies, which are of typhoid fever. Careful investigation often allowed to run along until beyond negatived the idea of spread by milk or the skill of the physician. Our ancestors. water. The number of pails to water in the profession were to blame for the closets in Leicester is as i to 2, whilst widespread impression that much dis. three times as many cases occurred in ease is due to dentition, since at one houses provided with pails. He ex time it was a common custom to incise plains this by specific infection of the
As to lancing the gums, he pails, which then become the direct me thought one could get along as well dia of conveyance of the disease. The without it. If the gums are red and pails in Leicester are emptied once a irritated, there must be some other conweek, but occasionally this rule is neg dition to account for the irritation. He lected. A case occurred when the pe did not think the physiological process riod was prolonged to four weeks and of normal dentition was to be interfered the pail was overflowing. There were with any more than any other physioeleven inmates of the house all using logical process. the pail ; of these, nine took sick during the months of March and April, 1895, TREATMENT OF The GRAVEST FORMS with symptoms of typhoid fever, all ex OF CARDIAC DILATATION.—Sir Dyce cept the first being notified as such. Duckworth ( The Practitioner, 1895, LIV, The ordinary channels in this case were p. 193) says: In a large majority of wanting. The author had traced sev
venous engorgement, anasarca, eral similar groups of cases, viz. : Case nausea, gastro-enteric catarrh, etc., are 1, imported, gave rise to nine others. coincident with and dependent on the
dilatation of the cardiac cavities. Such lieved by the mercurial pill. Persistent patients are admitted into hospitals in dropsy occasionally requires puncture. extremis, too ill even for examination ; Dyspnea and insomnia are best relieved a physiognomical diagnosis shows what by morphine. Paraldehyde is also useis necessary to be done at once. The ful. Constipation is best treated by heart beats tumultuously, no murmurs drachm or half-drachm doses of comcan be detected, the two sounds closely pound jalap powder in milk. A diuresembling each other. We can almost retic drink is lemonade to which bitarcertainly predicate mitral stenosis. The trate of potassium, one drachm to the prime necessities are rest, adjusted pils pint, is added. Easily digestible and lows, warm bed and warmth to the feet. nutritious diet should be given ; tender Large doses of spir. aetheris co. are ex mutton, meat, fowl and fish finely ceedingly useful. Forty to one hundred minced, milk, eggs, broths and custard minims may be given every three hours pudding ; cocoa and coffee, toast and in an ounce of camphor or peppermint rusks, potatoes well mashed, and spinwater. An excessive lividity of the ach. In the majority of cases digitalis surface or turgescence of the jugular is the best drug. Strophanthin is useful veins demands venesection. The symp when digitalis is not well borne. Caftoms may be distinctly relieved by the feine in four- to five-grain doses, comremoval of not less than six nor more bined with strychnine, is valuable. In than ten ounces of blood. In lieu of cases with an aortic reflex, digitalis must venesection one may place six or ten be guardedly used. The diastole may leeches over the precordia. Subsequent be prolonged too much for the left venexamination will reveal anasarca, swol tricle to bear. When the case is not len liver, etc. The tumultuous action under constant supervision, it is best to of the heart having subsided, we may rely on strychnine. find dilatation, superadded to hypertrophy, with pericardial or pleuro-pericardial adhesions. In a few days we may “ IT ALL GOES OFF IN THE BAKING." find marked improvement in response to - The secrets of the baking trade, says rest, careful diet, saline aperient (mist. the British Medical Journal of August sennæ co., I to 1/2 oz., with tinct. ja 17, are manifold, and as one by one they lapae, i dr.) with occasional doses of are made public our faith in the pastrycitrate of ammonium and potassium. It cook is not enhanced. From the reports is wisest not to give digitalis during the in the St. James Gazette of a case tried tumultuous heart action. A feeble, irreg at the Lambeth police court it appears ularly acting heart, with a feeble flut that damaged tinned milk is used up in tering pulse, demands digitalis. Ten the making of pastry. The inspector, to twelve minims of the tincture of digi- finding the milk in a very decomposed talis, three or four times daily, will pro state, asked the defendant whether he long the diastole and make the heart thought the milk was fit for use.
The steady and regular; not infrequently a defendant thereupon took up a piece of free flow of urine and a subsidence of pastry for the witness to smell, and exthe dropsy supervene. In many cases, claimed, “Oh ! it all goes off in the after a return to the usual conditions of baking." This is purification by fire life, a relapse occurs. The same meas with a vengeance.
We have long ures may again succeed, but often known that curiously stale eggs were benefit is derived from restricting the used by pastry cooks; lately, in fact, the amount of fuids in cases of dropsy (of practice has sprung up of importing cardiac origin) and a pill of two grains from abroad contents of eggs instead of of bluepill with one each of powdered the eggs themselves, the whites and digitalis leaves and squill. Two or three yolks all mixed together being sent over ounces of brandy or gin in twenty-four in closed canisters. It is easy to imaghours, given in milk, are very useful. ine the mustiness of this egg mixture The hepatic engorgement is greatly re by the time it reaches its destination in
the kitchen. We suppose, however, it proper formation of the hymen, malposialso “all goes off in the baking.” At tion or diminutive size of the genital any rate, in regard to milk such seems opening, and abnormal position or vioto be the expert opinion, for the pastry lence during coition may lead to rectocook, in answer to the magistrate, is re vaginal fistula. ported to have said that “ a little bad The author believes that vesico-vagimilk would bake out," while his fore nal fistula due to coitus is almost an man stated that, “ In the event of one anatomical impossibility, even in a short tin being slightly 'blown,' it would bake vagina, as the penis never enters entirely out;" to which Mr. De Rutzen made when in the natural position. A disthe obvious comment, “ Then of course tended bladder might be thought to aid you would'nt mind putting it in ?" In in the production of such a fistula, but the end each defendant was fined £10 it presses the uterus backward and upand costs, which from the consumer's ward, thus lengthening the vagina and point of view is satisfactory.
stretching its anterior arch, and the only possibility is the detachment of the an
terior fornix from the uterus. Lesions LESIONS OF THE FEMALE GENITALIA of the upper part of the vagina do not PRODUCED DURING Coitus. — Y. Lvow occur if it is healthy and of normal elas(American Journal of Obstetrics) says: ticity and extensibility, despite the relaThis subject is of importance from a
tive size of the male and female organs medico-legal as well as a gynecological and the violence of intercourse, except standpoint. The hymen may remain occasionally when in an unnatural posiintact after coitus either because the tion. In the author's two cases the male organ has not penetrated the vagina, pathological condition was furnished in or when the solidity of the hymen or one by atrophy associated with the clinarrowness of the vagina from imperfect macteric, in the other by chronic atrodevelopment prevents intromission, or phic parametritis. in cases which present a very elastic Intercourse by the urethra occurs only hymen with a large opening. Usually, in cases of atresia hymenalis when it is during the first union this organ is rup locus minoris resistentiae. Usually in tured by a single blow, the line of tear this case the urethra is slowly dilated being single, double, or radiating from by persistent efforts, but rapid dilatation the opening; more rarely the hymen is may result in its rupture. torn away at its attached margin and remains hanging by one side. In violent intercourse, especially when the hymen RECENT PROGRESS IN CEREBRAL SURis annular and thick, the tear may ex GERY.-Von Bergmann says Journal of tend into the vaginal wall. The hymen Nervous and Mental Diseases, August, is not merely a fold of mucous mem 1895) owing especially to the difficulty brane, but contains muscular tissue and or impossibility of diagnosis in many may be well supplied with blood vessels. cases, the field will always be limited. As a rule the hemorrhage following its In tumors operation is practicable only rupture is slight and soon ceases ; if in 29 per cent. and three-fourths of these serious the bleeding vessels should be cannot be operated on because of impostied ; if parenchymatous a tampon is sible diagnosis. Considerable advance effectual. The tear usually heals in has been made by the introduction of two or three days, but acute inflamma extensive osteo-plastic resections of the tion may arise from infection of the skull, which render possible the extirpawound or too frequent coitus.
tion of large tumors. Nothing is of Laceration may occur in the region more importance than speed and this between the clitoris and the meatus uri. could be obtained by the use of a circunarius, or severe hemorrhage may be lar saw set in extremely rapid motion caused by rupture of the turgid blood- by a small electric motor. With this a vessels of the neck of the uterus. Im- large bone flap may be sawed out in a
few moments, the operation being com the middle portion of the latter. The pleted by means of a sharp chisel, to operation consists in incision of the avoid injuring the dura mater. Opera- sinus after exploratory puncture, evactions for epilepsy have succeeded only in uation of the clots, disinfection and lesions of the cortical motor centers. It plugging, and lastly ligature of the inis necessary to be cautious in drawing ternal jugular vein. Of thirteen cases conclusions from results, as cases of six recovered ; death is generally due to temporary recovery from simple trephin- pyemia or suppurating leptomeningitis. ing or excision of a cicatrix of the scalp Quincke has attempted to relieve intraare frequent. He has seen attacks cease cranial pressure by tapping the lumbar during healing after amputation. It is cord in basilar meningitis. Some imimpossible to approve of operations of provenient of short duration only has extirpating portions of apparently been obtained. Death has not been healthy cortex which are considered to averted but it has proved useful as a be the starting point of epileptic seiz- diagnostic measure because if bacterioures. Extirpation is only justified where logical examination of the fluid witha distinct lesion-an abscess for exam drawn show the tubercle bacillus the ple—is found. Great success has been meningitis is tubercular. obtained in abscess, and surgeons have even attacked thrombosis of the sinuses and suppurating leptomeningitis. The DISINFECTION OF TUBERCLE-INFECTED diagnosis is often impossible. The most Houses. — The experiments of Mr. frequent cause of abscess is suppurating Sheridan Delépine and Dr. Arthur Ranotitis media and in one-fourth of cases some (British Medical Journal) led to the thus produced, the otitis arises from a following conclusions : cholesteatoma of the middle ear. De The disinfection of rooms which have veloping thus, by continuity, abscesses been contaminated with tuberculous are either intra- or extra-dural, or in products cannot be obtained by means the cerebral substance, most frequently of the fumigation methods, such as are in the temporal lobe. They are com generally used at present. Sulphurous paratively accessible and, as a rule, lo- acid, chlorine, and euchlorine, as used cated above the tympanum. To reach under supervision by experienced muthem he prefers this method to trephin- nicipal disinfectors, have proved practiing : resecting a quadrangular portion cally useless. of the wall of the skull, immediately The only other method of disinfection above the external aud. meatus.
which seemed to promise more satisfactaneo-musculo periosteal flap, left ad- tory results was the direct application herent at its upper part, is made by of a solution of chlorinated lime to the three incisions, one horizontal, begin- walls to be disinfected. This method ning above the zygoma and ending be has given so far satisfactory results, but hind the mastoid process, the others is attended with discomfort on the part vertical and perpendicular to the former, of those who have to carry out the disone in front of the tragus, the other be infection. hind the mastoid process, both being Light is, in the case of the tubercle carried upward to a height of about four bacilli, as it has been proved by several centimeters. Removal of the bone be observers to be in the case of other orneath this flap gives unobstructed ac ganisms, the most important natural cess to the interior of the skull and disinfecting agent. greatly facilitates the task of the oper Simple drying was shown to be in itator.
self enongh to reduce and ultimately In thrombosis of the sinuses surgery entirely destroy the virulence of tuberhas given unexpected results. The ob- culous products. Mere ventilation in ject is to reach the transverse sinus, the dark suffices only to diminsh and the one usually involved, through the not to destroy the power of the mimastoid process, being situated beneath crobe.
a year he had scraped together enough money
to enable him to go to Philadelphia and atMedical Journal. tend a course of lectures at the University of
Pennsylvania. Not until eleven years later
did he again visit Philadelphia to receive his PUBLISHED WEEKLY.
diploma at a special commencement held purposely for him more than a month after
the regular commencement. At the age of TERMS OF SUBSCRIPTION, $3.00 a year, payable
31 he received his first call to a professorship in advance, including postage for the United States, Canada and Mexico. Subscriptions may
at Lexivgton, Kentucky, and altogether he begin with any date.
had no less than thirteen calls to professional DATE OF PAYMENT.-The date following the sub
chairs and he actually occupied nine separate scriber's name on the label shows the time to chairs in five distinct institutions. These which payment has been made. Subscribers are earnestly requested to avoid arrearages.
were Transylvania University, at Lexington, CHANGES OF ADDRESS.–When a change of ad
Kentucky, the Medical College of Ohio, of dress is ordered, both the old and new address niust be given. Notice should be sent a week in
which he was the founder in 1819, Jefferson advance of the change desired.
Medical College at Philadelphia, Cincinnati TO CORRESPONDENTS. Original articles are so
College, which he organized in 1835, and the licited from members of the profession through Medical Institute in Louisville, Kentucky. out the world. Reprints will be furnished in payment of accepted articles if the author's wish is “In all ” says Professor Pepper," he strove so stated at the time.
earnestly for the adoption of a higher standCORRESPONDENCE upon subjects of general or ard and for stricter methods. He promptly
special interest, prompt intelligence of local mat ters of interest to the profession, items of news, sacrificed his personal feelings and interests etc., are respectfully solicited. Marked copies of other publications sent us should bear the notice
so soon as it appeared that the conditions were “ marked copy" on wrapper.
not favorable to honest and thorough educaAddress: MARYLAND MEDICAL JOURNAL,
tion." In 1822 he founded the first medical 209 Park Ave., Baltimore, Md.
journal in the West. He died in Cincinnati WASHINGTON OFFICE:
in 1852. Room 22 Washington Loan and Trust Co. Building. Dr. Pepper possesses peculiar qualifications
to estimate the character and abilities of Dr. BALTIMORE, SEPTEMBER 28, 1895.
Drake, having long been a student of his works and having read all that he ever wrote
for publication and nearly all of the many Professor PeppeR of Philadelphia takes publications concerning him which appeared this as the subject of his scholarly and inter after his death.
esting address delivered before His character was lofty and attractive. He Daniel Drake. the Mississippi Valley Medical was naturally gifted with rare charms of
Association at Detroit, on Sep style and the power of expressing in pure and tember 4. Daniel Drake was a distinguished brilliant language the lofty ideals, the clear western physician who emigrated in 1788, thought, the graceful fancies of his ardent when a child, from New Jersey to Kentucky, nature and powerful mind. Nature spoke to and subsequently became one of the most him as to a favorite son and opened his eyes noted men of that section. Yet few physi to her infinite charms and inspired him with cians of this day know him even by name. a love for herself which never lost its ardor. Let us see what manner of man he was and It was this which sustained him through a what he achieved.
long life, into which were crowded far more His youth was passed amidst the toils and than an usual number of severe trials and hardships and dangers of the frontier and at disappointments, and kept his spirit to the fifteen he was sent to study medicine under end as fresh and buoyant and enthusiastic as Dr. Goforth, in Cincinnati, then a village of a boy's. His character is known to us with a 500 inhabitants. He manifested so much rare fulness and yet there does not appear ability that he was admitted to partnership in it a single vice. He was ambitious, but with his preceptor after four years. Without his aims were never selfish or personal. His a diploma and without even having listened proper self-respect was untainted with vanity. to a lecture, he now engaged in practice. In
His desire for office was to secure larger op