cussion and auscultation.
Always examine the posterior chest wall
and be familiar with the use of the stetho-
Among the important early signs dis-
covered by a careful physical examination
he mentions the prolonged respiratory mur-
mur indicative of incipient tuberculosis of
Another sign of importance is conveyed
heart sounds. The relation of heart im-
pulse to pulse tension deserves careful study.
The changes from the normal that are the
easist overlooked are often the most impor-
tant, because they are the earliest signs ot
Some points in the diagnosis and treat-
ment are discussed by W. B. DeGarmo, in
the Post-Graduate for February.
The history is more or less important, local
pain is not a safe guide, the characteristic
pain is usually across the abdomen just below
the navel and is intermittent. Extreme
pain means that action prompt and radical
is essential in order to save life.
Temperature and pulse are not safe
An irreducible tumor, hard, sensitive to
pressure and perhaps hot, general abdom-
inal distress, vomiting and intestinal ab-
struction means strangulation.
In the treatment, medicine means delay
and delay means death. Cold and opium
may be used preparatory to operation.
Taxis may be resorted to, but without an
anesthetic, as the insensibility of the patient
is a dangerous point.
The real treatment is radical and includes
a surgical operation.
The location of the incision he considers
important, in inguinal hernia from r little
below the external ring to little above the
internal, in femoral hernia the incision is
made directly over the center of the tumor.
In opening tlie sack great cai-e is neces-
sary, as the intestine may be adherent to
its inner surface.
If the bowel is destroyed resection or ar-
tificial anus is indicated, the latter being
safer for the patient.
The Determination of Sex at Will.
A new theory is advanced in regard to
this subject by J. Griffith Davis, in the
New York Medical Journal for February
24. She holds that the sex depends upon
the time of conception, if it occurs ten days
or longer after menstruation the child will
be a boy, if from three days before to eight
days after menstruation the child will be a
girl. The ninth day after menstruation is
the neutral period when either boys or girls
may result. She states a woman does not
conceive from fifteen days after the cessa-
tion of the menses till three days before an
She relates several cases to support her
contention and regards the idea a thorough-
ly practical one. The only condition is the
practice of absolute continence for a certain
number of days. If a male child is desired
then no intercourse from three days before
the appearance of menstruation to ten days
after, if a girl is the desired addition to the
family, then self-denial from the eighth day
after to the third day before the expected
Sterility and Pelvic Deformity.
In cases of sterility we should make a
careful pelvimetric examination of the
pelvis before instituting means to render con-
ception possible, according to J. B. Cooke,
in the Medical and Surgical Monitor for
February. Sterility is a symptom only and
it may be indicative of conditions render-
j ing pregnancy and labor not only undesira-
ole, but actually dangerous to the patient's
life and it should be so regarded until the
contrary has been positively shown.
He reports an instructive case where the
uterus was small and antiflexed with pro-
fuse leucorrhea. The cervical canal was
dilated and curetted and the parts treated
with ichthyol and glycerine tampos for
about ten weeks.
Conception occurred witliin two months
after the discontinuance of the treatment.
At the beginning of the fourth month of
THE CHARLOTTE MEDICAL JOURNAL
pregnancy the pelvis was measured and
found too small to allow the child at full
time to be delivered, so labor was induced
at the 23d week. An attempt was made to
save the child in an incubator, but it died
five hours after birth.
The pelvic measurements showed the ex-
ternal conjugate 4 cm. below the average,
the anterior superior spine 2 cm., the iliac
crests 3^, the intertrochanteric 3 and the
posterior superior spine 2.8 cm. less than
Fractures in Infancy.
Two cases of fracture in young children
are reported by T. Halsted Myers, in Pedri-
atrics for February 15th. One was frac-
ture of the neck of the femur in a child 6^
months old which came to autopsy and ex-
axination revealed the break ^ of an inch be-
low the epiphyseal line with displacement
of the lower fragment directly inward. The
periosteum was stripped off for| of an inch
and a large amount of callus had been
formed both inside and outside the perios-
The fracture was perhaps a month old,
no history being obtainable as to the na-
ture of the accident or when it occurred.
The second case was one of fractare of
the left humerus in the middle of the shaft
and a transverse fracture of the tibia and
fibula which latter simulated anterior cur-
vature of syphilitic orign and it was only
by means of the X-ray that the break was
found with moderate callus formation, but
The little patient was 18 months of age.
Secondary Hemorrhage Associated with Seri-
ous Fracture or Amputation.
Three methods for the control of second-
ary hemorrhage in such conditions are dis-
cussed by Thos. H. Manley, in the Vir-
ginia Medical Semi-Alonthly for February
First, immediate compressions over the
seat of leakage; second, ligation of the
bleeding vessels in the wound; third, the
The first method is both suitable and val-
uable in superficial oozing or venous leak-
In free bleeding from arteries ligation is
better and safer, though if the artery be de-
ficient in vitality the ligature may quickly
cut through and will have hemorrhage as
free as ever.
Compression and the ligature being in-
effectual, we turn to the potential cautery
which he considers the most powerful and
prompt hemostatic known.
With the modern thermo-cautery of Paq-
uelin or the galvano-cautery, we have at
our command an agent which may be safely
relied On when the seat of hemorrhage can
be accurately determined and reached.
However, the use of such a powerful
agent requires caution to avoid excessive
damage to healthy parts.
Hot water he does not think much of in
amputations, at best, it is only a fluid cau-
tery and acts by parboiling and coagulating
not only the corpuscles in the blood, but all
the albuminous elements in the adjacent tis-
sues as well.
Transfusion may be employed, but he
doubts the efficacy of saline solutions.
The patient should be in a prone position,
at perfect rest, cool drinks freely and alco-
Rigidity of Maternal Soft Parts During
There may be three varieties of rigid os
uteri, according to J. J. Mulheron, in the
Physican and Surgeon for January, the
anatomical due to hypertrophy of the trans-
verse fibres of the cervix, the pathological
due to cicatrices, cystic or fibroid growths
or malignant deposits or it may be caused
by sexual abuse or by methods employed
to prevent the legitimate results of sexual
congress and the spasmodic which is prob-
ably the most frequent.
In the case of anatomical rigidity a
masterly inactivity on the part of the ac-
concher is all that is required.
In the treament of the pathological va-
riety the means employed must vary
with the cause of the condition, but when
interference becomes necessary the only
remedy is the knife.
In the spasmodic form active interference
is imperative as laceration of the cervix is
the very common sequel of this complica-
The first thing to be done is to restore
the uterus to its proper axis by bimanual
manipulation — one finger hooked in the
OS and applying counterpression with the
other hand over the fundus.
Morphine and atropine hypodermically
to relieve spasm and quiet the nervous
All psychic excitement should be avoided
as far as possible.
In obstinate cases he recommends 30
grains of chloral hydrate in a pint of warm
water by the rectum as better than chloro-
THE CHARLOTTE MEDICAL JOURNAL.
In rigidity of the perineum when it is
evident that the parts are about to give way
he advises episiotomy thus substituting for
an irregular tear a clean cut incision where
it can do no harm. The incision should be
made with a blunt pointed bistomy intro-
duced on the flat with the index finger as a
guide, the cut being made from within out-
The edges of this incision will show a
tendency to approximate each other instead
of gaping as in a tear and a few interrupted
sutures w^ill hold them snugly in place.
The practicability of episiotomy is so
manifest that he considers spontaneous rup-
ture of the perineum to be absolutely inex-
General Exploration of the Abdomen Opened
for an Operation.
A routine examination of the abdominal
contents has been recommended in all cases
requiring abdominal section, but John
Homans, in the Boston Medical and Sur-
gical Journal for February 23, advises it
only when it is not necessary to enlarge the
incision to do so.
If the incision has been made only an
inch and a half long for an appendectomy
or for the removal of ovarian tumor or for
an easy chlolecystomy he would not length-
en it. But if for any reason we have made
an opening large enough to get the hand in
he thinks it a good plan to always explore
the cavity, especially the region of the gall
bladder and appendix.
This is especially wise if we have any
unexplained symptoms of pain and discom-
He reports three cases operated on for
disease of the pelvic organs and the kidney
in which further exploration showed the
presence of gall stones vv^hich were re-
moved at the time of the primary opera-
He concludes that exploration in certain
caaes is not only justifiable, but that prob-
able conditions should compel us to make
A clinical lecture on a case of chicken
pox, by John V. Shoemaker, is reported
in the Medical Bulletin for February.
The patient was a bov ten years of age
and presented a rash upon his breast and
forearms which had been present four days.
Small scabs were scattered about upon va-
rious parts of the body caused by the burst-
ing of the vesicles from scratching.
Temperature was 100 3-5 and some fever
had lasted for the past four days.
Ir. the diagnosis attention was called to
the fact that varicello occurs before the tenth
year of life, that the rash appears as small
rose-colored spots becoming vesicular in 24
hours and then dry up at the end of three
or four days. All the vesicles are developed
by the second day and commence to dessi-
cate on the third day. The whole course
of the disease is about a week.
The incubation period is from eight to
eighteen days and the rash appears first on
the chest or abdomen.
The treatment is simple, saline laxative,
tincture of aconite or gelsemium. and locaily
the following prescription :
Yji Hydrarg. chlor. corros.,gr. i
Chloral, hydrat., gr. xx
aq. destillat., a. a., gii
Sig — For external use.
Fifty per cent, of all the recoveries from
diphtheria before the advent of antitoxin
were cases of fallicular tonsillitis, says G.
H. Thrailkill, in the Westcn Medical
Journal for February, He further states
that 30 per cent, of all deaths frem so-called
diphtheria were the result of some of the
grave forms of tonsillitis or their sequela.
He recognized three clinical varieties,
acute catarrhal, fallicular, and porencly-
matous or quinsy.
He recommends ammoinated tincture of
guaiac in dram doses, nitrate of silver 12
grains in an ounce of alcohol as a local ap-
.Scarification is good when the tonsils are
much swollen and abscess does not form or
is very slow in forming.
Of course, after abscess formation we
must open at once and clean out the
He believes in a form of the disease
which may be called pseudodiphtheria,
diphtheretic tonsillitis or diphtheroid sore
throat, but does not enter any discussion
in regard to it.
Ossification of the Uterus.
A case not of simple colcification, but of
true osteoma of the uterus, is reported by
C. Jeff Miller, in the New York Medical
Journal for March 3rd.
The patient was a girl 16^ years old, of
robust appearance and unusual develop-
ment for her age, consulted a physician for
pain in the hjrpogastric region and delay of
the menstrual appearance.
After careful examination a laparotomy
THEGHARLOTTE MEDICAL JOURNAL.
was done and a large mass found occupy-
ing the site of the uterus which was removed,
no ovaries could be found.
In the mass was found an asscous tumor
enveloped in thin tough fibrous capsule,
2-| inches in length, 2^ in width, i-^ thick.
On further examination this was found
to be composed throughout of compact bone
structure presenting all the histological ele-
ments and arrangement of normal bone.
The point of special interest in regard to
the turmor is its origin and the tissues pos-
sibly involved. Whether it is simply a
growth resulting from matamorphosis of
connective tissue or some organ or displace-
ment of osteogenetic matrices has not been
positively determined. The vagina was
entirely absent and the ovarian and Fallop-
pian-tube structure not recognizable with-
out the aid of the micfoscope. Whether
the uterus alone developed and underwent
these changes is difiicult to decide, but the
position of the growth, its dimensions, and
exact resemblance to that organ gives every
reason to believe it to be ossification of the
Typhoid Fever Complicated by Cancrum
A case of typhoid fever in a boy four
years of age complicated by cancrum oris
is reported by Barksdale in the Richmond
Journal of Practice for January.
• About the tenth day of illness a phlegmo-
' nous swelling was noticed on the left cheek
I later a spot on the right cheek went through
the same process.
The slough was removed and the wound
touched with nitric acid. The swelling
then subsided but the fever continued from
loi to 104 while the pulse and respiration
rapidly increased despite active stimulation
and supportive treatment. The patient
died on the 25 day from exhaustion.
Fracture of the Patella.
The operative treatment of this condi-
tion is discussed by Charles Greene Cum-
ston, in Medicine for March.
The incision should be made so as to give
plenty of space, especially if the fracture
is old, the flap should be well supplied with
blood at its base and the latter should be
broad in proporiion to it heigt and the cu-
taneous incision should be as far away as
possible from the cicatrix in the bone.
For recent fractures he recommends sub-
cutaneous wiring which must be aseptically
In old cases the open method is the best.
When one of the fragments is very small, the
wire should be passed through the ligament
of the patlla or the tendon of the triceps.
When the fracture is of longstanding and
the fragments separated by a certain amount
of fibrous tissue, the latter should be freely
excises, the border of the bone freshened
and then held in opposition by the wire
As the operation involves a serous cavi-
ty we should be just as careful in regard to
asepsis as if operating within the plura or
Laryngo-Hyoidectomy for Carciuoma.
Jacob Frank, in Medicine for March re-
ports a case in a man age 39,
In removing the larynx and separating
the trachea from the esophagus, it was
necessary to remove a small portion of the
esophagus at its upper end on account of
involvement. The epiglottis and hyoid
bone being implicated in the disease pro-
cess they were also removed, together with
portions of the thyroid glands.
The edges of the divided trachea were
sutured to the lower angle of the wound.
Rectal feeding was used for the first few
days and then nourshment was taken
through the stomach tube.
On the 17th and 20th days several small
glands were taken from the sides of the
neck which showed carcinamatous growth
upon microscopical examination.
Nearly three months after the operation
the patient was able to take solids and
liquids by the mouth, but owing to the
esophageal fistula, a piece of gauze had to
be held against the opening. His speech
is intelligible, but is a hoarse monotone.
Diagnosis and Treatment of Fractures of the
In making a diagnosis we should always
compare the injured elbow with the op-
posite side, says Duncan Eve, in the South-
ern Practitioner for-March.
In fractures just above the condyles it
is necessary to exclude dislocation of the
ulna and radius backward.
The great swelling that quickly follows
the injury often prevents a satisfactory ex-
When this supracondyloid fracture is
combined with intracondyloid running into
the joints, the fragments may or may not
He advises treatment with a rightangled
In the condyloid fractures very slight
flexion answers as well as the right-angled
Obscure or severe fractures should de-
THE CHARLOTTE MEDICAL JOURNAL.
mand exploratory incision for replacement
of fragments and he thinks such incisions
are not employed as often as they should
Irrigation in Acute Gonorrhea.
The Valentine apparatus is recommended
by George M. Coon in Gaillard's Medical
Journal for March.
He first uses i to 20,000 of bichloride for
two days if the discharge is still muco-pur-
ulent and the mucous membrane but slightly
When the case has passed to the stage of
pus discharge he then uses i to 6000 per-
manganate of potash, which should be as
hot as the patient can stand it and not less
than one quart at each treatment. The
strength of the solution is increased each
dav until for anterior irrigation i to 1000
causes neither pain nor irritation,
Intra-vesical treatment should be always
preceded by thorough flushing of the ante-
rior urethra, and they should be made late
in the day, as there is commonly some irri-
tation and a frequent desire to micturate,
so the treatment should be given after busi-
If the meatus is small it should be en-
larged so as to take an 18 American sound.
Lipoma of the Foot.
A case of this rare tumor of the foot is
reported by F. Jeanbrau, in Nouveau
Montpellier Medical for January 7th, which
occurred in the surgical clinic of M.
The patient was a boy 11 years of age
with a negative personal and family his-
tory. The tumor was on the right foot
immediately over the metatarsal bones of
the first and second toes and was about the
size of a large orange.
The growth first made its appearance
when the child was six years old. It was
removed under chloroform anesthesia and
involved the periosteum of the metatarsal
bones. The cavity was packed with iodo-
form gauze and the boy made a good re-
covery. On examination the tumor was
found to be a pure lipoma with here and
there fibrous tissue predominating.
The author concludes that the case was
one of lipoma of the foot of congenital
This disease might be called painless
rheumatism but for the rare exception that
occasionally people with it do suflFer pain,
says B. C. Loveland, in the New York
Medical Journal for March 3rd.
The characteristic changes and luxations
in the bands are well shown by illustration.
The treatment suggested is dietary, hy-
gienic and hydrotherapeutic and medicinal.
An average diet will allow meats of the
lighter kinds, such as lamb, mutton, white
meat of poultry or fish, once a day. Bread-
stuffs should be of entire wheaten flour.
Green vegetables are valuble and should be
used freely. Not less than 2^ quarts of
water should be drank in every 24 hours.
Exercise in the open air, massage and
e'ectricity, Swedish, movements, packing,
sweating or counter irritation about the
joints, cool tonic baths freely hot baths
with caution. The Turkish bath with large
amount of rubbing is valuable.
The medicines most useful are solicylate
of sodium and iodide of potassium.
The Leading Editorials of the Month.
Carrier Pigeons and the Country Prac-
We are living in a very progressive age
and all the progress is not by any means in
town, and even the country is being har-
nessed in with a net of wires.
The perfection and cheapness of the long
distance telephone and its consequent in-
stallation in many country neighborhoods
have done much to lessen the anxiety, if not
the labor, of the country doctor, says Pe-
As the greater part of our country, how-
ever, is as yet unprovided with telephone
service, a practical suggestion in regard to
the use of carrier-pigions which ^ye find in
the recent number of the Gazette des Hopi-
taux may prove of value to some of our
readers. The writer, after having trained
a number of pigeons, leaves one or two at
the house of his patient to be dispatched
with a message should an emergency arise,
or to state the morning and evening condi-
tion in a critical case. This means of com-
munication gives the patient a sense of se-
curity and often serves to lessen the labors
of the physician. So well satisfied is the
doctor with this that he has establised a
station in each of the villages in his- neigh-
borhood so that he may be promptly sum-
moned for new cases. He finds that he can
leave two pigeons, always of the same sex,
in a post for about a week. The longer
the birds have been absent, the more quick-
ly do they return.
After having been away for a week, they
are allowed a week's sojourn at home. The
pigeon house has an opening for the en
trance of the home-coming birds arranged
THE CHARLOTTE MEDICAL JOURNAL.
like the entrance to a mouse-trap. The ar-
rival of a bird in its cote is made known
by an electric connection which rings a bell
in the doctor's hall. The birds if gotten
young are easily trained. They will not
fly at night. "This latter peculiarity," the
doctor naively remarks, "has its advant-
ages, for the farmer, ordinarily, isprone to
wait until the day's work is done before
going for the doctor." When he knows
that pigeons are at his disposal and that
they will not fly at night, he comes by and
by to change his habits in this regard. Thus
numerous midnight drives are rendered un-
necessary for our overworked confrere.
Successful Filtration of Large Water Supplies.
This is of vital importance to the inhabi-
tants of cities and in many places the prob-
lem is getting more and more serious each
According to the International Medical
Magazine, at a recent meeting of the Ameri-
can Society of Civil Engineers, in New
York City, Mr, Allen Hazen read a paper
describing in detail the new filters erected
at Albany, N. Y. Heretofore, there has
been an excessive typhoid fever rate, and
the Hudson River water showed other evi-
dences of pollution by the sewage of the
city itself, as well as by that of Troy,
Schenectady, Utica, Rome, aud other
smaller towns above. As all other plans
for getting a pure water-supply had failed,
it was decided to employ slow sand filtra-
tion with an intake further up the river, a
low lifting pumping station, a settling
basin, a slow sand filter and a conduit to
the present pumping station. The con-
struction of the plant was started in April,
1898, and a part of it was in operation in
July, 1899, and since September, 1899, all
the water used in Albany has been filtered.
There are eight filters, with an area of
seven-tenths acre each. With one filter
daily out of use, while being cleaned, the
other seven were supposed to yield 14,700,-
000 gallons daily, and this rated i^apacity
has been reached with perfect ease, and on
several occasions the filters have been ope-
rated to deliver one-third more. Exclusive
of the real estate and engineering, the whole
plant cost lest than $500,000. The cost of
operation for 118 days showed an average
of $4,19 per 1.000,000 gallons delivered
from the filters, which, as small as it seems
when placed against the enormous hygienic
advantage, is even much greater than in
some continental cities, as, for instance,
The scientific control of the filters is re-
garded as one of the essentials to the best
results, and a laboratory building has been