even the brain and nervous system, some
of which are due to the direct effect of ob-
struction and others to relex manifestations.

He strongly urges every physician, even
those in the country, to examine carefully
all children that are reported as "snoring at
night," as "getting deaf," as "havingr the
past year been dull at school," and if en-
larged tonsils and adenoids are found re-
move them.

The author cites a number of cases em-
phasizing the importance of this subject.



Some Medico-Legal Aspects of Railroad
Injuries.

This subject must be considered from
three points of view, from the standpoint
of the physician, the claimant and the rail
road, says McCormick in a paper before the
Medic al Society of the District of Columbia.

The first objective is the determination of
the nature and degree of injury, and this
only be done by a complete and painstaking
examination.

He holds up the average expert testimony
as being simply a matter of the highest fee
or which side is paying, and urges that thi
condition of things should be remedied.

To avoid bias he recommends that if the
physician is employed by the claimant, he
should view the matter from the railroad
point of view, and if employed by the rail-
roud then from the claimant's point of view.

It is natural that the claimant should have
an exaggerated idea of the magnitude of his
injury, the surgeon must oftentimes deter
mine what is true and what is false.

He then considers the cases thrown into
court as of one of three classes, first, those
in which liability for damages is disputa
ble ; second, where amount of liability for
damages is disputable ; third, where fraud,
deception, or malingering is employed.

He gives several cases illustrating the
different forms and concludes that the ner-
vous affections resulting from accidents on
railroads do not differ essentially from those



produced by other causes capable of pro-
ducing a like degree of impression on the
nervous system.

That traumatic neurasthenia does not dif-
fer from other kinds, but is a term used
simply to designate the manner of its pro-
ductron. That in all cases where the sub-
jective symptoms are disproportionate to
the lesion care should be exercised in ad-
vancing an opinion based upon one exam-
ination. That many genuine cases develop
neuroses a long time after the injury, which
are not apparent at the time of the acci-
dent.



Empyema in Infants.

Bovaird, in the Medical News for De-
cember 23rd, says that the pathological
records of the New York Foundling Hos-
pital in the last ten years shows a total of
82 cases of empyema.

Of these 69 were under two years of age,
42 being in boys, 27 in girls.

The right side was involved in 28 cases,
the left in 24, both sides in 17.

After a careful study of these cases he
emphasizes the following points :

Empyema is not uncommon in the first
two years of life, and even in the early
months. Of the 69 fatal cases on our rec-
ords II occurred in children under six
months of age, 40 occurred in children be-
tween six months and one year, and 18 oc-
curred in children between one and two
years. The youngest patient was two
months and nineteen days old.

The mortality during this period is very
high.

Empyema in infants is very frequently
mistaken for pneumonia.

The rational signs are the same as those
of pneumonia in children.

The physical signs cannot be relied upon
for diagnosis.

Exploration is called for in every case in
which, with the rational signs of pulmon-
ary disease, we find marked dulness or flat-
ness over any part of the lung, especially
if accompanied by dimunition or absence
of voice and breathing or displacement of
the heart.

That exploration should be made ^with a
large needle and repeated if necessary.
None of our cases has ever shown harm
from the use of the needle : many have been
missed by reason of failure to use it.

Practically all pleural effusions in infancy
are either purulent from the beginning or
soon becomes so.

When pus is found drainage is called for.
Incision in an intercostal space with the in-
sertion of drainage tubes answers this end
thoroughly.



56



THE CHARLOTTE MEDICAL JOURNAL.



The Iminediate Hermetic Sealing of
Wounds. Is It Safe? Is It Advised?

Dr. Marcy presented ;i paper with this
title at the recent meeting of the Southern
Surgical and Gynecological Association.

A paper upon wound technic by Dr.
Marcy, of Boston, will be read by the pro-
fession with more than ordinary interest,
when we recall that he was Mr. Lister's
first American pupil and was the first in
America to make careful laboratory studies
upon the bacteria of wounds. Dr. Marcy
and Surgeon-General Sternberg were the
pioneers in this important field of research,
which has done so much in revolutionizing
medicine and surgery.

Perhaps Dr. Marcy's most important con-
tribution to surgery is the buried animal
suture, desirable as the legitimate sequence
from the ligation of arteries in continuity
by animal structures, first by Dr. Jamesen,
of Baltimore, in 1827, and later rediscover-
ed and placed upon a sure scientific foun-
dation by Lord Lister. Based upon the
practice of closing aseptic wounds by buried
continuous sutures, Dr. Marcy advocated
the abandonment of the drainage-tube more
than fifteen years ago, as not alone super-
fluous, but positively dangerous in all asep-
tic wounds, as the "open door" of infec-
tion. From this came the legitimate de-
duction, that nature's vitalized secretions
were important to be retained in septic
wounds, as the first process of their sepa-
ration. This accepted, the only object of
subsequent dressing of such a wound is to
prevent infection from exterior sources.
This Dr. Marcy believes is best accom-
plished by the use of the collodion seal. He
reviews with care the modern technic of
operative surgery and refers to recent valu-
able papers published in England by Dr.
Granville Bantock, of London, and Dr.
George Wilson.

The key-note of both these papers is that
the constant presence of micro-organism,
now usually regarded as specific causes of
disease, is associated with the disease, only
because they here find the conditions neces-
sary for their development. That is to say,
that their presence is the result rather than
the cause of the pathological condition
found. "The surgeon must not alone be a
scientist, which includes the familarity of
a technic to be carried out with the ante-
matism of a well-mastered ritual, an equal
familiarity of the anatomy of the parts and
their relationship, but to this should be
added other almost equal acquirements, that
of the artisan and the artist. There is no
excuse for bungling over wounds by the
hour, devitalizing their structures by the



application of dozens of strong forceps,
leaving tissues shreddy and half disorganiz-
ed, all done in a so-called painstaking at-
tempt at aseptic technic ; and, on this ac-
count, comes the well-merited, impatient
protests of great surgeons like Dr. Bantock,
with a justification for the appeal, that the
soil is as important as the seed in every
surgical precedure." * * * "Very pos-
sibly this paper could not have been writ-
ten had not a recent visit to a number of
the leading hospitals in America demon-
strated to me that unscientific and very ob-
jectionable methods of wound treatment
were still the routine practice of many sur-
geons." Dr. Marcy gives an illustrative
case, the operative cure for inguinal hermia
on a small boy, where bandage after band-
age was applied and finally splints from
knee to navel. When asked of the distin-
guished surgeon their value, the reply was,
"Doubtful, if any, but it has long been the
practice in this hospital."

The object of the surgeon is to make and
maintain a wound aseptic. Like structures,
should be coaptated and held at rest by
buried aseptic, absorbable sutures, and the
technique is complete in the application of
a dressing to prevent subsequent infection.
"This is secured so simply and easily by
iodoform collodion, strengthened by a few
fibers of cotton, that this dressing reaches
an ideal completion. It is Jiuid-proof in
that no exudate can" escape from beneath it,
and, as a consequent, it is germ-proof in
that by no means is it possible that any
foreign material can enter the wound. Be-
yond this it holds in even coaptation and
at rest with a certain fixity of support the
approximated parts." * * * '.'Iodo-
form is soluble in it and under certain con-
ditions is inhibitary to the development of
the micrococci albus in the proliferating
epithelium, and for this purpose is quite as
valuable as the silver salts, which are much
more difficult of application. To one who
may doubt the effect of a potent agent
seemingly locked up in a collodion film, we
need only to cite the powerful dessicating
effect of cantharidal coUotion. A wound
made and maintained aseptic in well vital-
ized structures, held at rest in easy coapta-
tion by buried tendon sutures, and sealed
with iodoform collodion, will not .suppu-
rate and will be followed by a non-infiam-
matory primary union." * * * The
fear, anxiety, the constant supervision and
watchfulness of the wound by nurse and at-
tendant are entirely abrogated.

Subsequent dressing is of no avail except
to keep the parts from extraneous injury.
The work of the surgeon for good will have



THE CHARLOTTE MEDICAL JOURNAL.



57



its finality at the primary period of manipu-
lative intervention."



Surgery of the Bile Passage-
In the Boston Medical and Surgical Jour-
nal for December 28th, Halsted reports a
number of cases of operations about the
bile ducts.

The first case was one of duodenal steno-
sis from gall-stones, dilatation of the
stomach and duodenum with duodenal ul-
cer giving rise to dissecting abscess.

Patient died on the 3rd day after opera-
tion.

The second case was primary carcinoma
of the duodenal papilla and diverticulum
of Vater successfully removed by operation,
acystico-enterostomy being performed three
months later.

The next case was dilatation of stomach
and duodenum, gall-stones in bladder and
cystic duct with obstruction and hydrops
vesicae. Four weeks after operation patient
discharged cured.

The next case suggested a new operation
with a name too long for this issue, as no
continued articles are allowed.

The next care was one in which chole-
dochotomy was performed twice within
four-and-one-half months with complete
recovery.

The next case was treated by a cholecys-
tostomy with good results.

The next case reported had discharge of
pus and blood by mouth and rectum during
severe gall-stone attack. Two years later
adhesions were so extensive and so dense
that the common duct was reached by a re-
troperitoneal route over the right kidney
with the very best results.



Splenic Anemia.

Osier, in the American Journal of the
Medical Science for January, reports 15
cases of idiopathic enlargement of the
spleen with anemia, which he designates
splenic anemia. Twelve were male and 3
female, all above the age of 35 except a girl
of II. Only 4 had malaria. Important
features were, long duration, enlargement
of spleen preceded the anemia, hemate-
mesis, ascites in 3 cases, no special enlarge-
ment of the lymphatics, high blood
count, low hemoglobin and leucocyte
count.

The ditTerential diagnosis will take into
consideration pernicious anemia, splenic
leukemia of certain cases, Hodskin's Dis-
ease with enlarged spleen, cirrhosis of the
liver with enlarged spleen, alcoholic cir-



rhosis, syphilitic cirrhosis, and hypertro-
phic cirrhosis.

The treatment is that of the severe types
of anemia. Rapid improvement may fol-
low iron, arsenic, sunshine and good food.

In chronic cases with recurring hemor-
rhages the question of removal of the spleen
should be considered.



Flagellated malarial Plasmodia.

Craig, in the New York Medical Journal
for December 23rd, describes two varieties
of this organism, the active plasmodium
of tertian fever and the passive kind found
in estivo-autumnal form.

From his study of the subject he con-
cludes that the flagellate body is not degen-
erative, but rather a very highly developed
vital form of the plasmodium of malaria,
and that these forms are calculated to pre-
serve the life of the parasite outside hu-
man economy because they arise only when
the blood has been exposed to external con-
dition. Consequently this process is an-
other proof of the extracorporeal existence
of the malarial parasite in another form.



Abdominal Surgery in Private Houses.

Hamilton, in a paper before the Tri-
State Medical Society of Alabama, Georgia
and Tennessee, says that surgeons have
trouble with patients in private houses be-
cause they do not take the pains they would
take in a hospital. And so to do good sur-
gery even in private houses it is only neces-
sary to be very careful in every detail.

Bring your instruments sterilized, don't
let the room be swept the day of the opera-
tion, find something clean to boil water in,
see after things yourself, never allow but
two parties, possibly three, to enter the
room for the first seven or eight days after
an operation.

He reports several cases operated on at
private houses that did well.



Gall Stone.

Schrceder, in the Inter-State Medical
Journal for December, reports three cases
of gall-stone and in only one could he get
the patient's consent to operate.

His first case passed from his hands on
refusing surgical aid and died promptly
under homeopathic treatment.

He advises operation in all cases of gall-
stone colic where the jaundice lasts four
weeks, in all recurring attacks followed by
fever and when the gall cyst is enlarged
during the attack and in all cases of con-
stant enlargement of the gall bladder with
or without jaundice or fever.



THE CHARLOTTE MEDICAK JOURNAL.



Cystimiria and Its Relation to Diaminuria.

A case of this exceedingly rare disease
condition is reported by Simon, in the
American Journal of the Medical Sciences
for January, in which the diamines could
be isolated from the urine.

He also mentions three other cases oc-
curring at the Johns Hopkins Hospital
though no examination was made for the
diamines.

The author states that the diaminuria is
neither the cause nor the eflfect of the cystin
in the urine, but both are merely symp-
toms indicating a general disturbance of the
normal metabolism.

All the tissues may be concerned in the
metabolic retardation, but it is likely that
the liver plays the most important role,
as in this organ the greater portion of the
sulphur bodies is formed.

Banman's method was used in his exami-
nations.

He calls attention to an important point
in examining for the diamines, that it may
be necessary to repeat the process of puri-
fication several times before crystalization
begins.

The Abortive Treatment of Gonorrhea.

Hutchinson, in his Archives of Surgery
for October, says that a two-grain-to-the-
ounce solution of chloride of zinc will cer-
tainly cure a case of gonorrhea in a short
while and without danger.

He thinks the use of injections prevents
orchitis rather than causes it.

His plan is to instruct the patient to first
void his urine, then inject with warm wa-
ter, let it run out and then use the solu-
tion.

This abortive treatment also tends to pre-
vent gonorrheal rheumatism.

In addition to the chloride of zinc in-
jection he gives all his cases purgatives and
the bromide of potassium and insists upon
a light diet.

Intubation in the Adult.

Waxham, in the Colorado Medical jour-
nal for December, reports a case of acute
inflammatory thickening of the mucous
membrane of the larynx with sub-mucous
infiltration, in which it was necessary to
intubate the larynx to avoid death from suf-
focation.

The tube was worn for twelve days, the
relief being immediate and permanent after
removal.

There was absolutely no history of syphi-
lis and the case was not tuberculosis.



The Nerve Mechanism of the Pelvis and As-
sociated Regions.

Robinson, in the December number of
the Journal of Orificial Surgery, concludes
an excellent article on this subject.

While this mechanism is very complex,
still its fuller study may aid us materially
in the treatment of disease conditions.

He shows the harmony of the motor
nerves of the skin, muscles, and viscera,
thus explaining the efficacy of nnissage in
constipation.

The sensory relation of the skin and
underlying viscera is also intimate and this
fact is useful in mapping out areas of anes-
thesia or hyperesthesia of the abdominal
wall.

He says that the stomach is one of the
chief organs to suffer reflexly from diseased
genitals through the direct route of the
hypogastric plexus. Practically the sacral
plexus terminates in two branches, the
pudic supplying the genitals und the sciatic
supplying the limb.

The sympathetic nerves are also very im-
portant, being distributed to vessels, glands
and viscera.

He states that the abdominal brain pre-
sides over nutrition, controls circulation,
and gland secretion, presides over the or-
gans of generation and influences in a dom-
nant way the automatic visceral ganglia.



The Oovernment Sanatorium for Consumptive
Soldiers..

Bullock, in the Medical News for Decem-
ber 23d, writes of the senatorium lately es-
tablished by the United States Government
at Fort Bayard, New Mexico, for the treat-
ment of officers and enlisted men of the U.
S. army, suffering from pulmonary tuber-
culosis.

The patients are carefully and plainly
taught that the disease is infectious, and
great care is exercised in the disposal of ex-
pectoration. The spitcup is used all the
time and the sputum burned.

They are instructed to stay out doors as
much as possible, to go to bed early, to take
moderate exercise, to eat slowly and masti-
cate thoroughly, and to refrain from cough-
ing at meal times.

Stimulants and cigaretts are forbidden,
but they are allowed to smoke and chew in
moderation.

Whiskers and moustaches if worn must
be closely trimmed.

The climate of Fort Bayard is ideal, its
elevation is 6040 feet with constant motion
of the air, the total rainfall is less than 15
inches a year.



THE CHARLOTTE MEDICAL JOURNAL.



59



The Prognosis and Treatment of Nephritis.

Hare, in the Therapeutic Gazette for De-
cember 15th, says that as a rule the prog-
nosis of acute diflFuse nephritis is quite
favorable.

He advises mild alkaline diuretics, copious
draughts of pure water and purgatives,
with hydrotherapy, such as cold sponging
and friction, remembering the importance
of friction in connection with cold water.

In the chronic forms the onset is so in-
sidious prophylactic measures can rarely be
instituted and the treatment will be dietetics
and symptomatic medication.

In regard to diet, unless the patient is
markedly gouty, he may have a liberal, if
it is easily digested diet.

In chronic parenchymatous nephritis, if
the administration of eggs and meats in-
creases the albuminuria they should not be
given, otherwise they may be of benefit.

A mixture of bitartrate of potassium and
infusion of juniper berries is an old but
valuable diuretic combined with digitalis or
strophanthus if the heart is unduly feeble.

Iron, purgatives, hot air baths or hot pack
are of decided benefit.

The medicinal diaphoretics he does not
think of any value.

Saline solution and venesection are often
of advantage.

Morphine may or may not be given, de-
pending on the individual case.

r^pitlieliuina of the Lip.

Dowd, in the Medical Record for De-
cember 23d, makes a very reasonable and
timely plea for more thorough work in
operating for epithelioma of the lip.

He describes the submaxillary part of the
operation in which the submaxillary gland
is exposed and its neighborhood carefully
searched for any infected lymph nodes.

He states that these lymph nodes may be
infected, though the growth on the lip is
very small, and that infected nodes cannot
always be detected by feeling with the
finger. So at least three localities should
be explored, first, the region above the an-
terior part of the submaxillary salivary
gland; second, the space under the chin
between the anterior bellies of the two
digastric muscles ; third, the region beneath
the border of the jaw about the posterior
part of the submaxillary salivary glands.
If these be decidedly affected then the re-
gion of the internal jugular vein should also
be explored. The incisions should be made
beneath and parallel to the lower border of
the jaw. The wound may be closed with
the subcuticular stitch with a small opening
in the center for drainage.



Gonorrhea in Women.

Clark, in the American Journal of the
Medical Sciences for January, makes a crit-
ical summary of recent literature on this
subject, though his study appears to have
been confined exclusively to the writings of
Burrim of Basel.

He considers Neisser and Bumm the
epoch makers among the investigators of
this disease.

The varying virulence of the gonococci
is dwelt upon, though this peculiarity is
shared by other germs and is perhaps more
dependent on environment than character.

Noeggerath states that this disease is, as a
rule, a life time affliction in woman, but
Bumm says not.

The pathological anatomy is most logi-
cally and vividly described by Bumm.

He says that the disease is confined to the
epithelial layer, Wertheim and Madlener to
the contrary notwithstanding.

Bumm also states that the peritoneum is
a very poor culture ground for the gono-
cocci and that a general peritonitis cannot
occur from this source, though the cases
reported by Gushing show that the gono-
coccus was the primary cause of a general
peritonitis. The clinical course, diagnosis,
prognosis, and treatment, according to
Bumm, will be continued in the next num-
ber of the Journal.



The Food Problem of Infancy.

Each infant must at its advent into the
vsrorld face two destroying faces — starva-
tion and poisoning says Band in the Mary-
land Medical Journal for December 33d.

And starvation does not mean the with
holding of food but that more subtle form
which follows the use of indigestible food
or an insufficiency of food.

The child may be facing starvation and
poisoning in the same food as improper
food is not only lack of nourishment but
poison.

Only infants nourished fully by healthy
mothers are wholly safe.

Fresh cow's milk he considers the best
substitute. Manufactured food or home
preparation maybe of value in certain cases
but their prolonged use is to be permitied
with reluctance and watched with care.

Rickets and scurvy are the two nutrition
diseases of infants though many are treated
month after month for "rheumatism,"
"paresis," "spinal paralysis," etc., until
death or a change in the diet brings relief.

He concludes with a plea for play-grounds
and recreation for older children and the
abolition of the deforming labor of children
in factories and mines.



THE CHARLOTTE MEDICAL JOURNAL.



Suppurative Ethmoiditis.

In a paper before the New York State
Medical Association, Milburg said that the
treatment of this condition consists in
thoroughly cleansing the nasal cavities with
some antiseptic solution, removing all ob-
struction to free drainage. Among such
are found deflected septi, hypertrophies,
spurs, polypi, etc., which may demand sur-
gical interference.

The wholesale removal of the turbinates,
as practiced by Weakes, is absolutely un-
called for, as is proven by most of the lead-
ing rhinologists of the world. Recent cases
respond rather quickly to treatment, but
those of two or more years' standing are
extremely obstinate, and he is doubtful if
they ever get entirely well, no matter how
cautiously handled. This seems to have
been the experience of most men.

He reports three cases out of thirty-nine
in which cleansing with free drainage was
the principle of treatment.



Disinfection with Fornialdeiiyde Gas.

Fairbanks and Grawitz, in a continued
article in the Boston Medical and Surgical
Journal for December 14th, give the results
of some experiments upon the disinfection
of rooms in the city hospital at Charlotten-
berg, Berlin.

The apparatus used was the ordinary
alcohol lamp and cup instrument of Scher-
ing. The formaldehyde tablets are used
in this instrument instead of the aqueous
solution.

Pieces of material were used infected
with anthrax, diphtheria, typhoid, staphy-
lococci. The results were entirely satisfac-