tumors is not noticed until pregnancy has
advanced some months, being accounted for
by the fact that the enlarging uterus pushes
them up out of the pelvis to a position in
which they are more readily discovered, or
it may result from the unusually rapid
growth of tumors of the ovary or the uterus
taking place during pregnancy, which has
become an established fact.
i>i.ethylene Blue in Malaria.
While quinine is a very good medicine in
malaria, we are always looking for some-
thing a little better than the best.
J. W. P. Smithwick, in Merck's Ar-
chives for February, calls attention to the
value of methylene blue as a substitute for
quinine in malaria. He gives it in two
grain doses six times daily, and on account
of its bitter taste, in capsules. He finds it
a very quick and efficient remedy for all
forms of malaria, producing none of the
unpleasant effects of quinine. After the
treatment of fifty cases of malaria with this
agent he concludes that it is a perfect suc-
cedaneum for quinine, and may be given
whenever the latter drug is indicated in the
treatment of malaria of every form and un-
der all conditions, with the same confidence
that has always attended the administration
of quinine.
THE CHARLOTTE MEDICAL JOURNAL.
Patients need not be selected on account
of idiosyncracies, as no bad effects ever fol-
low the use of methylene blue, if given in- |
telligently. It is the remedy to use in ma-
laria wfith hematuric complications, as it
acts in a tw^o-fold manner.
It is the remedy to be given in malaria
occurring during the pregnant period, as it
has no oxytoxic effect and will cause a freer
action of "the kidneys, which is also bene-
ficial.
Vaccination.
A safe rule is to vaccinate in infancy, a
second time when the child starts to school,
a third time at the age of puberty, and a j
fourth time between 20 and 25 years of age, j
according to W. H. Wilder in the Ala- :
bama Medical and Surgical Age for Feb- 1
ruary, and in this way he thinks that im- ;
munity can be established for life. i
Morrow's mortality rate is, in the uii-
vdccinated 35 per cent., one good scar 7.73
per cent., two good scars 4.7 per cent., j
three good scars 1.95 per cent., and four or i
.more scars ^ of one per cent. â–
Antiseptics are of no special use, simply ;
wash the place with soap and water, I
Do not draw blood, if you do dry it off
before applying the 1/mph. |
He thinks a larger amount of virus neces-
sary in secondary adult vaccination than in
children for the first time. i
The mortality of the complications of i
vaccination is given as one in 65,000, all of 1
which complications are preventable. 1
The vaccinated limb requires little care
other than some mechanical contrivance to
protect the scab. For excessive inflamma- j
tion he recommends hot carbolized solutions
and a powder of equal parts of boric acid .
and acetanilid to dust on the granulating!
wound.
As a rule the dose is increased to 15 grains
three times daily.
The best criterion of the tolerance of the
drug is its action on the genito-urinary
tract. With the yellow urine there is some
irritation of the kidney and bladder.
Frequent and painful micturition is the
most important clinical feature.
Of course, caution is necessary in the ad-
ministration of so powerful a drug, and the
increase should be gradual.
Bromides may be used in connection with
santonin, as 60 grains of bromide of soda
at bed time and the santonin during the
day, or the two remedies may be given alter-
nately.
Santonin in tlie Treatment of Epilepsy. j
G. Frank Lydston, in the Therapeutic
Gazette for February, says that upon the
average, epileptic patient shows better re- j
suits under santonin than under the bro-
mides, that santonin acts well in cases in
which the bromides for one reason or other '
are not tolerated at all, and that santonin-
gives distinctly beneficial results where the
bromides fail altogether. Further, santonin '
is free from injurious effects which cannot I
be said of the bromides. j
In the adult he begins with a dose of
from two to five grains of the powdered
drug, and this is gradually increased to the j
point of tolerance. He states that many
patients will tolerate 20 grain doses three
times daily for some weeks.
Posterior Uretliritis and Prostatic Abscess.
The relation between posterior urethritis
and prostatic abscess is that the latter is
usually an extension of the former along
the prostatic ducts savs Ramon Guiteras in
the Therapeutic Gazette for February.
Posterior urethritis usually begins at the
end of the second week of an acute attack
of gonorrhea. The symptoms are : Fre-
quent and precipitate urination, tenesmus
and pain in the deep urethra after micturi-
tion, and perhaps rectal tenesmus, together
with a feeling that there is more to come a-
way after the act has been apparently com-
pleted, and perhaps bleeding after expell-
ing the last drop; pus in the urine; dimi-
nution of discharge by the meatus; pain
and sensation of heaviness in the perineum.
Constitutional symptoms : General depress
sion, headache, loss of appetite, constipa-
tion, and more or less fever.
The treatment is laxatives, the balsams
as copaiba, cubebs, santal oil, etc., salicy-
lates and benzoate, austisposmodics as mor-
phia, codeia, belladonna, hyoscyamus and
the bromides. Hand injection should be
discontinued. Irrigation with permanga-
nate of potash in acute stages and nitrate of
silver in later and chronic cases. Hot sitz
baths are also useful.
The treatment of prostatic involvement
follow along the same lines especially dur-
ing the stage of pus formation, but surgical
interference may be required in addition.
Quinine and whisky are recommended if
the patient is septic. As a rule these ab-
scesses open into the urethra or the rectum.
Perineal incisions into the prostate to
evacuate abscess content are dangerous but
if desirable a simple semilunar incision in
front of the anus is best.
Prostatic massage very useful after the
abscess has burst.
Retention due to abscess is due to the
pouting of the abscess into the lumen of the
THE CHARLOTTE MEDICAL JOURNAL.
275
urethra, and should be treated by frequent
catheterazation. If after careful efforts the
catheter cannot be passed aspiration is in-
dicated.
The injection of local anesthetics as co-
caine or eucaine is not worth much in re-
lieving spasm. The author closes by em-
phasizing the value and importance of the
hot rectal douche in active stages of prosta-
tic disease and in combination with rectal
massage in the later stages.
Compound and Comminuted Fracture of
the Leg and Ankle.
Three cases of this fracture are reported
by E. H, Griswold in the Fort Wayne
Medical Journal-Magazine for January in
which he used a bar iron interrupted splint
with the very best result.
The first case was a compound commi-
nuted fracture about two inches above the
ankle joint. After cleaning the wound
sawing off the sharp edges and wiring the
bones the leg was put up in the iron splint.
A bar of iron was procured one inch wide
and jf of an inch thick and long enough to
reach from the toes to the heel and to make
a curve to the thick part of the calf and
then to the middle of the thigh. Three
pieces of thick webbing was riveted to this,
one piece for the foot, one for the calf and
one for the thigh.
The splint was then secured with plaster
bandage from the toes to the heel and from
the calf to the middle of the thigh leaving
the leg entirely uncovered from the ankle
to the middle of the leg.
I Continous irrigation was used for ten
' days when all discharge ceased and rapid
repair ensued.
I The second case was a compound dislo-
: cation of the ankle with crushing of the
astragalus and the third was a comminuted
fracture of the leg extending into the ankle
joint. They were both treated with the
i bar iron interrupted splint and made good
recoveries considering the gravity of the in-
jury.
He contends that this splint as a dressing
for fractures of a severe nature of the low-
half of the leg and of the ankle answers all
the demands of a perfect fixation splint, in-
sures the absolute comfort of the patient
and when swung by a "Hodgen or other
; swing, permits the patient to move about
in the bed with perfect ease, allowing the
changes of linens and even the bedding
without discomforture. The seat of injury
is left free for inspection and the carrying
out of such treatment as the circumstances
of the case may demand, without distur-
bance of any part of the fixed dressing or
any possibility of disturbing the relation of
the parts comprised in the injury. Tempo-
rary dressings may be supplied as often as
required and perfect cleanliness of the per-
manent dressing maintained against all ef-
fects of driiinage or irrigation.
It obviates the necessity of any extension
appliance or the use of a fracture box
which is no small consideration in the in-
terest of the patients' comfort, and the plea-
sure of the surgeon and nurse in caring for
the limb. It possesses all the advantages of
other splints devised for the treatment of
this class of injuries and none of their dis-
advantages. There are a few cardinal
principles which should ever be our rule
and guide in the treatment of this class of
injuries. They may be enumerated thus :
Life of the partially severed member; anti-
sepsis ; removal of all foreign substance ;
perfect coaption and fixation ; drainage and
maintainence of perfect cleanliness ; secure
the comfort of the patient.
Diffuse Infective Peritonitis.
The source of the infection has much to
do with the activity of the inflammation
according to Charles H. Goodrich in the
Brooklyn Medical Journal for March.
Other modifying circumstances are the
number of bacteria introduced, the virulence
of the particular germs, the particular
ptomaines produced, the part of the abdo-
men invaded, the general health of the
patient when the inflammation ensues, the
presence of good culture media as effused
blood or exuded serum and in post-opera-
tive cases the excessive handling of peri-
toneal surfaces.
The author then reports 28 cases of diffuse
infective peritonitis; seven recovering
(twenty-five per cent.)
Three of these cases were moribund
when admitted to the hospital.
The majority of these cases and a large
proportion of all cases of diffuse peritonitis
are due to previous disease of the appendix
vermiformis.
The majority of fatalities were due to un-
wisely prolonged medical treatment.
Pancreatitis is too often overlooked.
The appendix should be removed when-
ever the abdomen is opened for an inflam-
matory condition.
It is a question whether artificial drainage
of these cases is wise when on necrotic
abscess-wall ("pyogenic membrane")
exists.
There are many niceties of technique,
which may be saving elements in any case.
No measures for prevention of infection
can be too extreme, despite the ridicule of
THE CHARLOTTE MEDICAL JOUKI'^AL.
those who are satisfed with the ordinary
aseptic and antiseptic precautions.
However scientific the thorough mopping
of the serous coat of the intestines may
seem, the important element of shock must
not be forgotten.
100 Peritoneal Sections.
A study of lOO cases in which peritoneal
section was done is made by Emory Lan-
phear, in the Regular Medical Visitor for
February, with special reference to mor-
tality.
All the cases occurred in his own practice
during the past year and the mortality rate
was 15 per cent. There were 19 cases of
appendicitis, 16 recovered, 3 died ; 8 cases
of hernia, 7 recovered, i died; 7 vaginal
sections, with no deaths ; 43 abdominal
sections, with 7 deaths; 16 vaginal hyster-
ectomies, with 3 deaths ; 7 abdominal hys-
terectomies, with I death.
His rule in appendicitis is: "operate
when symptoms indicate it," and he does
not believe in operating as soon as the diag-
nosis is made in all cases. His mortality
rate in this disease was 9 per cent.
Several of his deaths he claims was caused
by the condition of things at certain of the
St. Louis Hospitals, and he thinks when
St. Louis gets a truly modern hospital he
may possibly do better.
Simple Fractures about tlie Elbow Joint.
Fractures near or involving the elbow
joint are common and ten varieties are re-
cognized by Samuel Lloyd in the Post-
Graduate for February. They are, supra-
condyloid fracture of the humerus, separa-
tion of the epiphysis, T- fracture of the
condyles, fracture of the internal and frac-
ture of the external condyle, fracture of the
epicondyle, of the olecranon process, of the
coronoid process, of the head of the radius,
and of the neck of the radius.
Three of these are usually extra-capsular
and do not involve the joint.
In all these fractures it is well to warn
the patient in the presence of witnesses
that there is very decided risk of the motion
of the joint being impaired, perhaps com-
pletely lost.
In the supracondyloid fracture, the arm
should be put up flexed to an angle of about
40 deg, the angle being measured on the
anterior surface.
In T- fracture of the condyles the arm
may be first put up on a straight splint, but
as swelling disappears the arm should be
flexed and the dressing reapplied until a
full degree of flexion is obtained without
disturbing the fragments.
In fracture of either condyle, if it is im-
possible to get the fragment into place, it
is better to cut down and remove it rather
than to allow it to become fixed in a posi-
tion that will not permit of future free use
of the arm.
For fracture of the olecranon an anterior j
splint is used after having first bandaged '\
the hand and forearms, and the fragments
should be drawn together with adhesive
plaster and all closely watched to see that
there is no separation. If the fragments
can not be made to approximate they should
be wired.
In fracture of the coronoid process, the
head of the radius or its neck, the arm
should be flexed and fixed in plaster or
splint.
In applying plaster in recent fracture he
recommends cotton batting to envelope the
limb so as to allow for the swelling, after
the swelling has subsided the plaster should
be removed and put on anew over a roller
bandage.
Tlie Nervous System and Albuminuria.
J. H. Brownlow in the Medical Times
for March discusses the influence of the
nervous system in the pathogenesis of al-
buminuria. After a critical review of the
generally accepted etiological factors in
acute and chronic albuminuria he concludes
that all the alleged causes of acute albumi-
nuria, with the exception of the toxins of
scarlet fever and diphtheria, are devoid of
specific pathogenic power, and should not
be accepted.
That the opinion of leading .authorities
that these toxins primarily act on the tissue
elements of the kidneys, causing inflamma-
tion of these organs and resulting in acute
or chronic albuminuria, is unwarranted and
controverted by anatomical and physiologi-
cal principles.
That in the highly organized and sus-
ceptible nervous system, with its primary, l
perpetual and controlling dominion over
metabolism, is to be found the primary j
morbid process from which all the other
grosser lesions are the direct results. I
That as in acute albuminuria the true â–
etiological factors are the toxins of scarlet j
fever and diphtheria, so in the chronic 1
form auto-toxins are the active pathogenic i|
factors, and their specific action is primarily J
evidenced on the nervous system.
That severe meiital strain, intense worry,
deep and profound sorrow, the silent grief }
of domestic and financial misfortune, are 1
the most active predisposing causes in al-
buminuria. I
THE OHARLOTTE MEDICAL JOORNAL,.
277
That the obscure and constant nervous
manifestations are more reasonably account-
ed for on this theory than upon any other.
That the pathological conditions found
in the renal organs, arterial system, brain,
spinal cord, and sympathetic ganglia are
local manifestations of a deranged and
deseased nervous system, developed by
auto-intoxication and resulting in deranged
metabolism.
The Stomach Tube.
In a previous article in Treatment, F.
Hampson Simpson discussed the use of the
stomach tube for the purpose of diagnosis,
and in the same journal for February 23d,
he considers the use of the tube as a thera-
peutic measure.
As such it may be used for the mechanical
empting of the stomach after acute poison-
ing, for lavage or forced feeding, and for
the alimentation of the patient in dysphagia
from paralysis.
He states that gastric lavage was first
proposed and practised by Kussmaul in
1867 for dilatation.
The conditions in which lavage is indi-
cated are evidence of marked motor insuffi-
ciency (retention) iriespective of the size
of the stomach ; chronic gastric catarrh ;
acute fermentative dyspepsia ; in Reich-
mann's disease or the continuous form of
hyperchlorhydria ; in so-called acute dila
tion of the stomach (gastroplegia) ; to ar
rest severe hemorrhage from the stomach
in the vomiting of pregnancy ; in all forms
of chronic vomiting of gastric origin in in-
fants and for the prevention of vomiting
during and after the administration of anes-
thetics.
The tube may be used to apply intragas-
tric electrical treatment, and for intragastric
douching, and for performing so-called "in-
ternal massage" of the stomach.
He reports ten cases, six being sigmoid
hernias with complete sac, and in two cases
it was necessary after freeing the bowel
from its bed to cover it with the peritoneum
of its incomplete sac, and then finally re-
duced.
Four cases were of the cecal variety, three
having a complete and one an incomplete sac
which were treated as the sigmoid cases,
with good results.
Sliding Hernia of the Large Bowel.
Robert F. Weir, in the Medical Record
for February 24th, calls attention to the
treatment of the sliding hernias of the cecum
and signoid flexure.
He says that the natural looseness of the
peritoneum in the iliac regions often allows
the slipping of the large intestine into the
hernial sac. In such cases the peritoneal
sac of the hernia may be deficient usually
on its posterolateral aspect. This, of
course, does not happen in all ci.ses of
hernia of the large bowel, but when it does
occur he recommends the covering of the
intestine be made by peritoneum from the
incomplete sac after the bowel has been
freed.
X Ray Examination in Children.
Francis H. Williams, in the Journal of
Electro-Therapeutics for February, calls
attention to the better results obtainable in
X ray work in children as compared with
adults. Especially in examining the large
cavities is this true. The thorax and abdo-
men can be examined with ease, in fact we
must be careful not to have the light too
strong or the exact outline of organs may
be vague and indistinct. The border of the
heart, for instance, might not be well de-
fined because the edges are penetrated by
the rays, and the shadow of the heart cast
upon the screen would be smaller than the
heart itself.
He mentions a case of a child six years
old in which a diagnosis of cerebro-spinal
meningitis had about been made when an
X ray examination showed pneumonia.
In 3,000 examinations he has had no un-
toward symptom following the use of the
ray.
Dying Declaration.
The physician is often a witness in such
cases and at times the sole witness of such
declarations. Andrew J. Hirschl, Esq., in
the Medico-Legal Journal for December
suggests that physicians should have the
power to administer oaths and so be able to
place the patient under the responsibility of
an oath while arousing in him the hope of
recovery.
Provision might be made that the physi-
cian thus take the statement of the patient,
and if time and circumstance permit, that
the party to be affected be notified of the
same, and have afforded him an opportunity
either before the same physician, or before
some one else authorized to administer oaths,
to cross-examine the declarant. If the party
to be affected be not known or not accessi-
ble, some public oflicial, as for instance the
State's Attorney, or perhaps some justice
of the peace, or judge of a Court of Record,
or perhaps some commissioner to be ap-
pointed by such judge, should be charged
with the duty of such cross-examination,
and the same should be put at the disposal
of all parties who may be found in interest.
278
THE CHARLOTTE MEDICAL JOURNAL.
Or yet again, the physician himself
might, by force of law, if no other plans be
practical, be authorized to conduct some-
what of a cross-examination, at least to the
extent of testing the mental capacity, the
motive, the memory, the perceptive powers,
and in general the truthfulness and accura-
cy of the declarant.
The Bacterioiosv of Pneumonia.
In normal lungs and in many diseased
lungs we frequently find the pneumococcus
present according to R. B. H. Gradwohl
in the Interstate Medical Journal for Feb-
ruarv. It needs then no further multiplica-
tion'of bacteria to set up a pneumonia, but
only the existence of conditions which low-
er the resistance of the lungs and permit
them to be attacked by an acute inflamma-
tion of tl.e kind seen in pneumonia. He
concludes that the micrococcus lanceolatus
is responsible for seventy-five per cent, of
the cases of acute lobor pneumonia.
That the pneumo-bacillus of Friedlander
is not often the case of pneumonia, but is
to be regarded more in the light of an acci-
dental micro-organism.
That suitable conditions must prevail be-
fore the micrococcus lanceolatus can excite
a pneumonia — systemic depravity, in other
words.
That the pneumococcus is a resident of
nearly all normal lungs, and that it only re-
quires lowered resistance on the part of the
lungs and body to set up a typical pneumo-
nia.
That the pneumococcus, although ubiqui-
tous in its localizations in the body, is es-
pecially active when brought in contact
with serous surfaces ; and, finally, that the
pneumococcus is not the cause of epidemic
cerebro-spinal fever, the diplococcus intra-
cellularis being the specific agent in that
disease.
Malignant Tumors of the Kidney in Children.
The most common tumor of the kidney
in childhood is sarcoma, says J. Thomas
Kelley, Jr., in the American Journal of
Obstetrics for February, and it usually de-
velopes in the first two or three years of life
and often grows to an enormous size.
Among the causes assigned are, trauma,
heredity, calculus irritation, following in-
fectious disease, as an exanthem and mis-
placed embryonic tissue.
The most characteristic symptoms are the
tumor mass, hematuria, pain and cachexia,
with a number of secondary symptoms
caused by pressure, as vomiting, dyspnea,
edema, jaundice, etc.
Medical treatment is of no avail, but if
operation cannot be done Coley's serum is
advised.
If the tumor is small it should be re-
moved by the extraperitoneal method, but
if large the peritoneum may be opened as
for other tumors. He reports a case in a
child 8 years old, and on operation the tu-
mor was found adherent to the liver and
adjacent viscera, and was separated with
difficulty.
The patient died on the afternoon of the
third day from shock and exhaustion.
The microscope showed the mass to be
small round cell sarcoma.
Traumatic Popliteal Aneurism.
A case of popliteal aneurism in a man,
aged 39, resulting from a 48-caliber pistol
wound is reported by J. T. Dunn in the
American Practitioner and News for Jan-
uary I St.
On operation the artery was found shot
almost entirely in two. It was tied above
and below the injury with No. 4 chromi-
cized catgut.
After further examination an opening
was found in the popliteal vein, and fear-
ing the risk of ligation he attempted to su-
ture the rent, but without success. The
artery forceps were then used, catching up
the walls of the vein in the middle of the
rent, which closed the opening without
much reduction of the caliber. The wound
was then closed on each side close up to the
forceps with the exception of the portion
occupied by the forceps, a small piece of
gauze being carried down to the bottom of
the wound.
The patient made a good recovery, the
circulation soon being re-established though
there was some sloughing of the foot and
sensation, and motion did not fully reap-
pear until five or six months later.
Diphtheritic Secondary Sore of the Lip with
Involvement of the Throat.