a contribution-entitled "Race and Religion
in Swiss Referendum Votings," by Eltweed
Pomeroy, president of the American Direct 1
THE CHARLOTTE MEDICAL JOURNAL.
361
Leaislation League, and a very thoughtful
paper by the Rev GustavusTuckerman, en-
titled "The Relation of Religious Classes
to Social Regeneration."
Among the features of Scribner's Maga
zine for April, the animal story by Ernest
Seton-Thompson, illustrated by him, will
attract the large audience which has been
fascinated by "Wild Animals I have
Known." In this story is given the life
and adventures of a curious little animal of
the southwest, known as the Kangaroo-
Rat.
The group of eight poems, translated
from the French of M. Henri de Regnier
for The Living Age by Mary D. Frost,
and published in the numbers of that maga-
zine for March lo and 17, are remarkable
specimens of deft rendering from one ton-
gue to another, with the least possible loss
of the rare flavor of the original.
The Puerto Rican tariff question is edi-
torially discussed in the Review of Reviews
for April, and in the same magazine there
is an able exposition of the relations of the
United States Constitution to the Territor-
ies, by Prof. Harry Pratt Judson, of the
University of Chicago.
ABSTRACTS of the One Hundred
Leading Articles of the Month.
Pneumonia Treated with Antipneumotoxin.
Four cases of pneumonia treated with
antitoxin are reported by Charles B. Canby
in the Maryland Medical Journal for March.
One of the cases occurred in his own
practice and was a male age 30, who had
passed the crisis when he imprudently left
his bed, dressed and went into the yard.
The day following this exposure he was de-
lirious, with a temperature of 104, respira-
tion 56, and pulse too rapid to count. There
was severe pain on the right side with con-
solidation of the right lobe.
He was given 12 c.c. of antipneumotoxin
and in three hours his temperature fell two
and a half degrees. The following day his
temperature was 99, respiration 34, and
pulse 96.
In another case there was plain history
of pneumonia, temperature 103, pulse no,
rapid breathing, cough, rusty sputa, with
consolidation of right lower lobe.
On the third day of this condition he was
given 10 c.c. of the antitoxin, and the next
morning his temperature was 99, with pulse
and respiration much improved.
In the third case there was consolidation
all over the right lung, temperature 103,
pulse 108, respiration 40. She received 10
c.c. of the serum, and the following day
her temperature was normal, pulse 80, res-
piration 20. In the evening she had a chill
and temperature went back to 105 with a
respiration rate of 33. 10 c.c. of the anti-
toxin was given, and 34 hours after the in-
jection her temperature was normal.
The fourth case had a temperature of
103.8, pulse 140, and respiration 42. On
the third day, 20 c.c. of the sernm was used
with only partial relief, and 30 c.c. was
given in the night. The following morn-
ing the temperature was 99, pulse 76, res-
piration 38.
This serum is prepared in the same way
as the antitoxin for diphtheria, and if Dr.
Canby's report can only be duplicated a
few times we shall have the same potent
remedy in pneumonia as we now have in
diphtheria.
Sphenoidal Suppuration.
A case of fatal sphenoidal suppuration in
a man age 43 with a specific history is report-
ed by Samuel Lodge, Jr., in the Laryngo-
scope for March.
When addmitted to the hospital the pa-
tient had been suffering constant pain in
right ear and right side of face for six
months. Had syphilis nine years previously.
He improved considerably for a time after
admission but suddenly developed septic
meningitis and died. On post-mortem the
base of the brain was bathed in thick
greenish pus, principally in neighborhood
of pituitary body extended backward over
pons and medulla. Frontal sinuses, cribi-
form plate and ethmoidal cells normal.
Necrosis of walls of sphenoidal sinus, probe
passing readily from base of skull through
sphenoidal sinus into the nose.
The patient bore examination of his nose
badly and the flow of pus from his right
nostril was so profuse and persistent that
its rapid reappearance after cleansing the
nose made anything like a satisfactory
examination next to impossible. The dis-
charge coming away anteriorly and from a
point above the middle turbinal led to the
exclusion of maxillary, frontal, anterior
ethmoidal, and sphenoidal empyemata.
The edema of the right cheek suggested
exploration of maxillary antrum. The
results being negative, the edema was put
down to some condition in the nose imped-
ing the venous return.
Necrosis of the roof of the nose was dia-
362
THE CHARLOTTE MEDICAL JOURNAL.
gnosed, coupled possibly with posterior
ethmoidal sinusitis. The copious flow of
pus and the steady improvement of the
patient for some days after admission led
one to assume that pus was not pent up,
and that to explore more thoroughly the
roof of the nose and posterior ethmdidal
cells would be likely to break down the
natural rampart of granulation tissue and
thus expose the cranial cavity to pathogenic
invasion.
The sudden onset of septic meningitis
dissipated this feeling of security. The
opportunity for successful surgical inter-
ference has been allowed to glide by.
Nevertheless grave risks to live as well as
to important structures (e. g- , contents of
right orbit) would necessarily have been
incurred by the complicated surgical tech-
nique required. But the labors of Macewen
and others in the analogous conditions met
with in destrucrion of the tegmen tympani,
or other parts, in middle-ear disease, have
demonstrated that even in this situation
much, if* not everything, might have been
accomplished by a careful but bold surgeon
operating on similar lines.
Dislocation of the Shoulder and Hip.
An easy method of reducing dislocations
of the shoulder and hip is described by
Lewis A. Stimson in the Medical Record
for March 3d.
The principle involved is that of steady
moderate traction, and for the shoulder
joint the method is as follows :
A round hole about six inches in diameter
is made in the middle of the canvas of a cot,
about eighteen inches from one end. The
patient is placed upon the cot with the
injured arm hanging down through the
hole. The cot is raised upon blocks so
that it will be at a sufficient height from
the floor, and a ten-pound sand-bag is made
fast to the wrist of the dependent arm.
After a wait of a few minutes reduction is
found to have taken place. None of the
patients complained that the procedure is
painful.
Theoretically it would be better to attach
the weight to the arm close above the elbow,
but in practice the wrist has proved to be
the better place, for some of the patients
would grasp the legs of the cot with the
free hand, and thus interfere with the ac-
tion of the weight. Possibly, lacking a
cot, two tables might be used, placed end
to end, the head resting on one, and the
body on the other, with the arm hanging
down between. But the lack of snug sup-
port of the shoulder might induce a mus-
cular effort, which would defeat or at least
delay success.
The same method could be employed in
dislocation of the elbow whenever the joint
can be freely extended without the aid of
anoesthesia, but under such circumstances
traction by the hands alone is usually suffi-
cient.
In dorsal dislocations of the hip the
method is applied as follows : The patient
is placed prone upon a table in such a way
that his thighs extend beyend its end. The
uninjured thigh is held horizontal by an
assistant,, to prevent tilting of the pelvis,
and the injured one is allowed to hang
vertically, while the surgeon, grasping the
ankle, holds the leg horizontal (right-angle
flexion at the knee) and gently moves it
from side to side. If relaxation of the
muscles is slow to appear, a sand-bag — five
or ten poundi, — is placed on the leg close
behind the knee, or pressure is made there
with the hand. This has succeeded in
more than four-fifths of the cases in which
he employed it, and often without the aid
of anesthesia. In the two cases which it
failed, reduction was accomplished by trac-
tion in a line midway between right-angle
flexion and full extension. He thinks they
were cases in which the bone had left the
socket at a higher point than usual, pro-
bably dislocations "above the tendon," so-
called.
Tetanus Treated with Antitoxin and Carbolic
Acid.
Ernest Laplace, in the Medical Bulletin
for March, reports a case of tetanus treated
by subdural injections of antitoxin and
hypodermic injections of carbolic acid with
complete recovery.
On the fifth day of the disease the patient
was trephined and 20 c.c. of antitetanic
serum injected slowly under the dura. The
trismus did not change, and two days after
the first injection the wound was again
opened and 40 c.c. of the serum used.
There was some reaction from this dose,
and in twenty-four hours opisthotonos set
in. By the eighth day it was necessary to
give chloroform to control the convulsions.
On the ninth day the hypodermic injection
of five drops of pure carbolic acid in ten
drops of water was given every three hours
and by the thirteenth day the jaws relaxed
to the extent of one-fourth of an inch,
which gradually increased. The carbolic
acid was continued during six days, making
a total of forty-eight doses of five drops
each. The urine was normal throughout
the treatment.
From the above case we learn :
THE CHARLOTTE MEDICAL JOURNAL
363
That a severe case of tetanus (ten days'
incubation) has recovered after the sub-
dural injection of 60 cubic centimetres of
antitoxic serum, prepared in the Pasteur
Laboratory at Paris. The focus of infec-
tion was removed on the sixth day of the
disease.
That the treatment was combined with
hypodermic injections of 5 drops of carbolic
acid in 15 drops of water, every three hours
until forty-eight doses had been adminis-
tered.
That no untoward brain symptoms per-
manently followed the subdural injections
of this comparatively large amount of fluid.
All symptoms of tetanus had disappeared
on the twenty-first day of the disease.
Normal Saline Solution.
Three cases, all obstetrical, in which the
normal saline solution was used with the
very best results, are reported by Edward
O. Plumbe in the Railway Surgeon for
March 8th.
They were all cases of postpartum hemor-
rhage, in one of which there was profound
collapse with every indication of almost
complete exsanguination. As to the method
of giving the solution, the subcutaneous,
while of course slower in its results than
the intravenous, is by far the safest and
most practicable.
An ordinary fountain syringe and a large
hypodermic needle is all the apparatus
required.
The point of injection should be the intra-
clavicular region, the abdomen, the subaxil-
lary or the submammary.
The rectal method he considers the sim-
plest of all and in many cases it will be all
that is necessary.
The solution should be injected as high
as possible, and very slowly, not more than
a pint at a time, as it may be repeated when
necessary.
The temperature of the solution should
not be less than 108 to 116 degrees Faren-
heit.
Technique of Closure of Wounds of the Ab-
dominal Wall.
In some remarks on the influence of tech-
nique upon the results of closure of wounds
of the abdominal wall, Cha'-les P. Noble,
in the Boston Medical aud Surgical Journal
for March 8th, contrasts the value of differ-
ent suture material.
He considers the through and through su-
ture as being applicable only in certain
cases, as where drainage is necessary, or
where the general condition of the pattent
makes the saving of a few minutes of time
of importance.
For about five years he used silkworm
gut as material for buried suture, but more
recently he has used the catgut for the same
purpose with good results.
To succeed with silkworm gut as a buried
suture he mentions the following points :
rigid asepsis, light weight silkworm gut as
material, the sutures tied without tension,
the knots made with three ties and then cut
short so that as small a body shall be left
for encapsulation as is feasible.
Since May, 1898, he has used the catgut
exclusively for the closure of the abdominal
wound in the following manner : the peri-
toneum is first closed with fine cumol cat
gut, the under surface of one aponeurosis
of the rectus is sutured to the upper sur-
face of the other aponeurosis, the subcuta-
neous fat is closed with fine catgut and the
skin is closed with the intracuticular stitch
of catgut.
He concludes that in celiotomy wounds
that can be closed without drainage sup-
puration should be two per cent, or less,
postoperative hernia should be only a frac-
tion of one per cent.
Suppurative Hepatitis.
A case of suppurative hepatitis which
came to autopsy is reported by A. F. Stew-
art in the Medical and Surgical Monitor for
March.
The patient was male, age 52 ; predispo-
sition to tuberculosis ; three years ago he re-
ceived a blow over the hepatic region, which
ever afterwards gave him more or less trou-
ble ; he came for treatment and presented
the following symptoms : Ascites to an
extreme degree, legs and scrotum edema-
tous ; later the arm above the elbow joint
was swollen, chills and sweating were se-
vere and intermittent ; tongue coated ; pulse
120 per minute ; temperature 102^ degrees
F. ; nausea and vomiting ; diarrhea persis-
tant ; leucocytosis throughout his entire ill-
ness. Hiccough was a constant symptom
two weeks before death, hepatic facies and
well marked emaciation. Drew away 20
pints of fluid from the abdomen and 6 pints
from scrotum. Baxidages were applied to
the lower extremities ; the kidneys were in-
active, urinary secretions nearly arrested.
The treatment consisted of cardiac stimu-
lants and diuretics and preparations to sus-
tain the patient ; light nutritious food in
small quantities and often repeated. The
outcome was fatal ; postmortem examina-
tion was held twelve hours after death.
The liver was abnormally large, smooth on
the surface, irregular in outline ; on section
364
THE CHARLOTTE MEDICAL JOURNAL.
there were numerous pocket? which contain-
ed pus. The external surface of the liver
was very dark, The hepatic flexure of the
transverse colon was adhered to the inferior
border of the right lobe of the liver for a
distance of four inches : a large opening in-
to the intestine was found through which
pus had escaped. The capsule of the liver
was very tough and tenacious. The portal
vein showed the results of the violence of
the inflammation, and thrombi were found
in several localities.
The Relative Humidity of our Houses in
Winter.
An interesting report of this subject is
made by Robert DeC. Ward in the Boston
Medical and Surgical Journal for March ist.
Several observations taken daily for twen-
ty days gave the following means, inside
air temperature 69 deg. outside air 36 deg.
inside air humidity 30 per cent., outside air
70 per cent.
After giving the relative humidity of
several very dry and desert places in the
country at large he concludes that these ex-
amples show clearly enough that the atmos-
phere of the room in which the observations
were made was drier than many desert re-
gions. That so dry an atmosphere is not
healthy, especially in our winter climate,
there is no need of an argument to show —
certainly not in a medical journal. This
low relative humidity means excessive evap-
oration from skin, lungs and respiratory
passages. Furthermore, the strain which is
put upon the body in the rapid adjustment
which it has to make when we go out from
the high temperatures and the desert aridity
of our houses in winter into a temperature
it may be 70 deg. , 80 deg. , or 90 deg. , lower,
and a relative humidity of 70 per cent, to
100 per cent., is a greater one than we ought
to repeat day after day, and many times a
day.
The present methods of heating our
houses are wretc hedly inadequate from the
point of view of supplying sufficient moist-
ure. Undoubtedly, the relative humidity of
the air commg from an ordinary furnace
may be somewhat increased by increasing
the size or the number of the evaporating
pans in the furnace, or by placing pans of
water on or. better still, within the regis-
ters.
Suppurative Lesions of the Kidneys.
Most of these conditions arise either from
direct extension of infective bacteria from
the urethra or bladder along the ureters and
pelvis into the calices and medullary sub-
stance or by metastis, hematogenous or
lymphangic from some previously infected
area according to A. Stewart Lobingier in
the Colorado Medical Journal for February.
The bacteria which are most destructive
are the bacterium coli commune, the strep-
tococcus and the staphylococcus pyogenes.
Other bacteria may take part in a mixed in-
fection such as the bacillus tuberculosis,
gonococcus, pneumococcus and bacillus ty-
phosis.
One of the commonest exciting causes of
renal suppuration is uricacidemia resulting
in renal calculus. In nephrolithiasis with
the stone free in the pelvis, pyonephrosis
sooner or later is inevitable.
Hematogenous and ymphangic infections
represent a more acute involvement and
may arise from a septic embolism from an
ulcerative endocarditis pyophlebitis, lym-
phangitis, retro-peritoneal abscess, psoas
abscess or caries of the spine, primary ab-
scess of the liver, osteomyelitis or septic
urethritis. Some cases may be traced to an
appendiceal abscess, septic salpingitis, ab-
scess of the ovary or septic parametritis.
Perinephritic Suppuration may be pri-
mary or by extension. In the primary form
the bacteria have been present some time,
waiting for some traumatism or acute con-
gestion to lower the vitality and resistance
of the tissues before they could begin work.
In calculous pyelitis nephrotomy is the
only remedy. Where there is practically
total destruction of the renal substance ne-
phrectomy is indicated. A perenephric
abscess uncomplicated by renal suppuration
demands a simple incision, washing and
drainage as in any local abscess.
Tuberculosis of Bones and Joints.
A rational line of treatment is outlined
by DeForest Williard in the International
Medical Magazine for March.
First. Assist the repelling powers by
sunshine, fresh air, good food, keeping the
digestion in the best possible order. When
vour medicines disagree change them or the
method of administration.
Second. Rest and mechanical assistance
by placing the patient in bed, applying
rigid splint or some form of extension.
Third. Operative procedures. Iodoform
oil injection he does not think much of, one
per cent, solution of formalin in sterilized
glycerine is better. Remove the local in-
fection if possible especially when in the
region of the foot, ankle, knee, wrist or el-
bow. Repeated erasions are better in chil-
dren than excisions.
The operation of choice is total eradica-
tion of the focus.
THE CHARLOTTE MEDICAL JOORNAL
365
The Operative Treatment of Pulmonary
Tuberculosis.
A case of pulmonary tuberculosis success-
fully treated by drainage and iodoform,
with apparent recovery is reported by Fer-
guson in the Medical News for March 17th. i
Three operations were performed, the
first being for an abscess of large size below the
right clavicle which was found to commu-
nicate with a carious rib.
The intrathoracic and general symptoms
not improving from the first operation, ?
second operation was done three weeks
later and two inches of the 3rd rib removed
and a large, hard, unyielding mass, com-
pletely filling the chest wall was found op-
posite the fourth and fifth ribs. Two and
one-half inches of the 5th rib was removed
directly over the mass. The mass was su-
tured to the parietal pleura and the wound
packed and further operation delayed for a
few days.
After two weeks the diseased lung was
explored with grooved director and artery
forceps but not a drop of pus was found.
A substantial piece of the diseased lung
was removed for examination and into the
cavity left a dram of iodoform was put and
iodoform gauze packed in as a plug.
Within 12 hours, temperature dropped to
97, pulse 80, respiration 30 and said he felt
better than for months. Once or twice a
week, for five and a half months, a dram of
iodoform in powder or emulsion was intro-
duced into the diseased area.
At present the man performs all his func-
tions as well as he ever did and over the
very place where the dulness was greatest
and consolidation thickest, a clear resonant
note is demonstrable and a beautiful vesicu-
lar murmur is present with no evidence of
tuberculosis.
Pernicious Nausea and Vomiting of Pregnancy.
In a considerable number of these cases
the womb is sharply anteflexed and the cer-
vix extraordinarily thickened, says Edward
P. Davis in the American Journal of Ob-
stetrics for March.
The pelvic organs are forced strongly
downward aud forward, and a contracted
condition of the pelvic facia and muscular
tissue is present, which may be termed
"pelvic tenesmus."
In other cases the womb is retroflexed or
retroverted.
These patients are much relieved by rais-
ing the uterus as far as possible in the pelvis
and by stretching the cervix. The latter is
done at the risk of bringing on an abortion,
but is sometimes effective in stopping the
nausea and enabling the patient to go to
term.
In these cases, the salient feature is nausea
and not vomiting. Many of the worse cases
vomit but once or twice in 24 hours, but are
nauseated while awake.
Coupled with this, and resulting from it,
is the profound mental and physical depres-
sion from which these patients suffer.
Especially significant in the symptom-
atology of these cases is the obstinate, bor-
ing, burning pain beneath the sternum, and
the discharge in the vomit or bowels move-
ments of coffee-ground material, which is
recognized as decomposed hemoglobin.
Coffee-ground vomit has been observed
repeatedly in nephritic patients and in those
suffering from extensive degenerative dis-
ease.
In cases of pernicious nausea the patient
is not invariably emaciated. In two fatal
cases under observation emaciation was not
present, nor could any appreciable diminu-
tion in the bulk of the patient's body be
observed.
Death comes to these patients through
exhaustion, and the downward progress of
the patient is marked by the persistence of
the nausea, the occurrence of coffee-ground
vomit, the rapid failure in the metabolism
of the body, as shown by the lessened dis-
charge of solids in the urine, and the occur-
rence of albuminuria. In order, then, to
appreciate the gravity of a case, it must be
viewed in the light of the degree of exhaus-
tion present, the condition of anemia pres-
ent as shown by an examination of the
blood, the degree of excretion maintained
by the patient, and the evidences that the
blood is undergoing rapid disintegration as
shown by coffee-ground discharges.
As regards treatment, no narcotic or
sedative can absolutely control the distres-
sing sense of nausea. If the patient can be
fed, put at absolute rest, and her strength
so recruited that her nausea gradually
ceases, she can go on to recovery. The
replacement of the uterus to a better posi-
tion and the stretching of the pelvic and
cervical tissues is an important aid.
Unless the patient can be promptly sup-
ported and made better by these means,
after careful consideration and consultation,
the pregnancy must be ended.
Prolapsus of the Anus and Rectum.
This condition may occur in very early
life. Geo. J. Munroe, in the Cincinnati
Lancet-Clinic for March loth, reports a
case in a child three months old.
In the treatment the first indication is to
reduce the protrusion and after washing in
THE CHARLOTTE MEDICAL JOURNAL.
a solution of boracic acid the fingers are
greased and the two forefingers are pressed
gently over the mass while the anus is dila-
ted with two fingers of the other hand.
Failing in this the author recommends the
introduction of one finger into the anus and
press the mucous membrane up around the
finger.
The bowels should not be allowed to be-
come constipated and the child should defe-
cate in the recumbent position.
Pinworms, dysentery, phimosis, etc.,
should be attended to. Compress may be
used if the prolapse is frequent.