ing, and it is only the daily struggle to the
end with disaster not only to himself but
danger to those about him. He says that
the establishment of special sanitariums to
which the incipient cases can be sent and
special hospitals for the advanced cases is
the solution of the problem.
480
THE CHARLOTTE MEDICAL JOURNAL..
Intestinal Antisepsis in Typhoid Fever.
The season for the annual discussion on
the treatment of typhoid fever is close at
hand and we may expect the current litera-
ture from now until December to be filled
with such names as Woodbridge, salol,
Osier, calomel, cold water, salts, turpentine,
opium and silver, and such like.
The International Medical Magazine for
April leads ofF with a symposium on this
very seasonable subject. The opening ar-
ticle is by James M. Anders, who says that
intestinal antiseptics are valuable in this
condition, but they are by no means a spe-
cific, as he considers the disease one of the
general system and not altogether confined
to the intestinal canal.
The Woodbridge treatment he gives a
black eye in passing and in fact only men-
tions it to condemn it as illogical and un-
scientific, which it undoubtedly is beyond
any peradventure.
He recommends intestinal antiseptics for
a rational purpose that is to control in some
measure the meteorism which is often due
to some undigested matter in the canal and
in such cases a laxative will have a good
effect. Salol he has used for a number of
years with good results.
Intestinal irrigation is recommended in
appropriate cases as where the ulcerative
process is in the colon as well as in the small
intestine.
Obstetric Aphorisms.
C. A. Van Ramdohr in Post Graduate
for April has the following aphorism for
the obstretrician's guidance and compact
enough to be easily remembered.
1. Never rupture membrane unless you
are prepared to finish delivery at once, if
necessary, or unless you intend to confine
the patient artificially within a limited
period of time.
2. External measurement of pelvis has to
be practised to yield trustworthy results.
3. The external (Baudelocque's) dia-
meter is never reliable.
4. The distance between the crests should
be about an inch greater than the distance
between the spines. Equal distances or a
larger inter-spine indicate a deformed
pelvis.
5. Contraction at the outlet is extremely
rare, and if it occurs, is usually the result of
an ankylosed coccyx.
6. If the index finger can touch the
promontory there is always a reduced con-
jugate diameter.
7. If, on the introduction of two fingers,
the middle one does not reach the promon-
tory, the conjugate is normal or more than
normal.
8. Whenever the whole hand can be
passed through the superior strait, there is
a possibility of withdrawing the child
through the natural passages.
9. If the hand cannot be passed, there is
an absolute indication for Cesarean section.
Ocular Complications of Variola.
Before the introduction of vaccination,
35 per cent, of all blindness in France was
due to smallpox, says Geo. F. Keiper in
the Medical and Surgical Monitor for
April, after vacciation only 7 per cent. In
Prussia before compulsory vaccination was
introduced, 35 per cent of all blindness
was due to smallpox ; after its introduction
2 per cent.
In the United States about 1.41 per cent
of all blindness is due to this disease.
According to the table of Landesburg, 57
per cent, of cases of variola have disease of
the conjunctiva, 5.56 per cent, have disease
of the lachrymal apparatus, 30 per cent,
have disease of the cornea and is about 3
per cent, the iris if affected.
Pustules appear on the skin of the eye-
lids in 20 per cent, of all cases.
Careful attention to the condition of the
eyes in all cases of smallpox is evidently a
plain duty of the physician in charge.
Perhaps in many cases the treatment does
not consider the details of the management
at all and we are so concerned about the
possible spread of the disease that we do
not pause to take up all the little points in
connection with the patient himself.
Latency or Cure of Pulmonary Tubercu-
losis.
We are reminded of the difficulty in some
cases of saying whether the patient is cured
or whether the disease is only latent, by
Karl von Ruck, in the Journal of Tuber-
culosis for April.
For example, the patient has lost his
cough and expectoration, no marked dis-
turbance in the body temperature, the lost
weight has been regained and he feels a
satisfactory degree of strength and well
being. Most patients are willing to ac-
cept such results as a cure and the physi-
cian may be satisfied with the result of his
treatment, but the case may be far from en-
tirely well. In all such cases where there
is a doubt as to whether the patient is cured
or the disease is only latent for the time
being, he uses the tuberculin test with posi-
tive results as borne out by the subsequent
history of the case.
THE CHARLOTTE MEDICAL JOURNAL.
481
Harris' Urine Separator.
To catheterize the ureters in the male is
out of the question with most of us, and
to get around this impossibility a urine sep-
arator will be valuable in kidney disease.
As described by H. F. Harris, in the
Medical Age for April loth, the instrument
consists simply of a lever which is intro-
duced into the rectum, and a double cathe-
ter. The beak of the lever, when clamped
to a fork on the catheter, elevates the base
of the bladder in the median line and thus
two lateral pouches are formed, into each
of which empties one of the ureters. The
catheters, being introduced and rotated,
drains each pouch separately into bottles
which have been made partial vacuums.
The urethral part of the instrument is
the size of a No. 25 cathether, French scale
and of course can only be used where the
urethra will admit a probe of this size.
Electricity in Chronic Rheumatism.
According to William J. Morton, in the
Medical Record for April 21st, electricity
is a valuable therapeutic agent in the treat-
ment of chronic rheumatism. He uses the
high potential, high frequency current, in
one of its forms and claims that it aflFects
both the local and the general metabolism,
or metritional exchanges.
The current is obtained from a powerful
influence machine, either the static induced
current or the electric wave current. By
the latter the patient's entire person is sub-
jected to the influence of powerful conden-
ser waves.
His convictions as to the efficacy of this
treatment are based upon dispensary prac-
tice, in which no medicines were added to
the electricity.
Intussusception in a Child of Seven Months.
A case of this kind, in which operation
was followed by recovery, is reported by
F. S. Clark and F. E. Bunts in the Cleve-
land Journal of Medicine for April.
The operation was done 24 hours after
the diagnosis was made, and about seven
inches of gut was invaginated of the ileo-
cecal variety. During the manipulation of
the intestines the little patient became very
weak, but rallied all right after the opera-
tion.
The question of feeding afterwards was
very important. The first 34 hours albu-
men water was given freely and with no
vomiting. Beginning the second day calo-
mel was given, causing the passage of gas
and motion of the bowels.
After this they gave cream, sugar and
water, 4 per cent, fat, 6.5 per cent, sugar.
Three weeks after the operation it was ap-
parently well.
A short while after it was taken with
colic, rapid pulse, some temperature above
the norjnal, and vomiting of clear mucus.
In twenty-four hours the child was dead,
and on autopsy the intestine was found ob-
structed by a band of adhesion.
Operation was not admissable in the last
attack on account of the early extreme
prostration.
Injuries of the Nerves Due to Fracture.
Charles G. Cumston, in Pediatrics for
April 1st, relates a case of paralysis of
the median nerve following fracture of the
humerus just above the condyles.
The fracture was reduced soon after the
injury, put up in splint and healed all right
except that the hand of that side remained
practically powerless.
On operation it was found that the nerve
was pressed upon by callus which was
chiseled away. The function of the hand
slowly returned until eleven weeks after the
operation the motor functions were nearly
perfect.
He concludes that these nerve injuries
due to fracture have a most favorable prog-
nosis provided an operation is done for their
relief as soon as the diagnosis is made.
The Prognosis of Brain Syphilis.
Correct prognosis waits on acurate diag-
nosis, says Charles J. Aldrich, in the
Cleveland Medical Gazette for April, and
by diagnosis he does not mean a simple
naming of the disease, but taking in with
a wide grasp the character, progress, loca-
tion and extent of the disease, giving at
the same time due weight to the personal
factor.
The general laws of prognosis in acute
brain disease holds good in acute specific
lesions to a limited extent onlv and the
reason for this lies in the fact that the phe-
nomena produced by brain syphilis are so
capricious, variable and often incomplete
as to constitute a distinct class.
Since we have the results of an infection
to deal with that has little tendency to self-
limitation, it must follow that both brain
and cord lesions have a great tendency to
relapse.
Age, sex, social status, alcoholism, ca-
chexia, and sexual excesses all have vital
prognostic importance.
Youth is favorable and women are less
liable to diseases of the middle cerebral ar-
teries and therefore less liable to fatal re-
sults.
THE CHARLOTTE MEDICAL JOURNAL.
A life laden with syphilis and given to
excesses of any kind is always in danger.
Alcohol and syphilis are the twin devils of
pathology, which neither fleet footed mer-
cury can overtake nor iodine exorcise.
Syphilis of the nervous system as a
pathological process differs in no way from
syphilis elsewhere except as influenced by its
histological environments. Syphilis apo-
plexies are seldom rapidly fatal and are less
liable to be followed by permanent injury.
The lesion of the nervous system pro-
duced by syphilis in the secondary or blood
stage of the disease are far more remedial
than the late lesions.
To the specific endarteritis, we must look
for the principal cause of syphilis of the
large ganglia.
In syphilis of the convexity and in the
localized seizures which are usually termed
Jacksonian epilepsy, the prognosis is usu-
ally good.
Inoculation with the Malarial Parasite.
A case of probable accidental inoculation
with the malarial parasite is reported by
William H Katzenbach in the Medical
News for April 21st.
On September i8th a surgeon performed
a vaginal hysterectomy on a patient from
a malarious district and during the opera-
tion he pricked his fingers several times with
the needle he was using.
The patient had chills some time before
the operation, but they yielded readily to
quinine.
About two weeks after the operation the
surgeon had a chill at noon, lasting for half
an hour, which was followed by one every
day for awhile. Examination of the blood
showed the malarial parasite in abundance
of the estivo-autumnal variety. The sur-
geon had been a resident of New York for
twenty years and this form of parasite is
not found in the blood of patients infected
in the ordinary way in the vicinity of Man-
hattan
Nephritis of Malaria in Childhood.
After reviewing the literature of nephri-
tis of childhood in general, Moncorvo, in
Pediatrics for April 15th, says that in 35
cases of acute nephritis in young subjects,
recently seen, 26 coexisted with malaria.
The diagnosis of malaria was confirmed by
an examination of the blood.
Calomel, quinine and milk diet was the
basis of the treatment followed with good
results.
He endorses the position of Hutinel who
thinks it possible that the action of the mi-
croorganism of Laveran on the kidneys is
purely and simply ajocal one, which may
be ascribed either to the pressure of the
protozoon in the vessels of the glomeruli or
to its contact with the cellular elements.
It is also possible that this action is exerted
through the medium of the blood, the al
terations in which are undoubted.
Nephroureterectomy.
A case is reported by George H. Noble,
in the American Journal of Obstetrics for
April, in which he removed the kidney and
ureter in one mass through an opening
barely large enough to admit the hand.
The patient was a female and the poste-
rior vaginal vault was opened and the ureter
tied close to the bladder.
The case had developed a large, extra
peritoneal abscess which was opened and
drained, but a sinus persisted leading to the
kidney which was cystic and the ureter tu-
bercular, so the whole was removed in one
piece.
The kidney was the largest;, (16 centi-
meters), and the ureter perhaps the longest
(31 centimeters) ever removed together.
This is the fifth nephroureterectomy and
the second case done by the extra'peritoneal
vaginal method, and the only one of these
two which the ureter and kidney were re-
moved in one piece.
Of the five operations, McKosh had one
Morris one, Kelley 2, Noble one.
Syphilis.
In the Medical Standard for May, Wil-
liam S. Gotthiel begins a series of articles
on syphilis.
Historically this disease can not be cer-
tainly traced back farther than the closing
years of the 15th Century but soon spread
rapidly throughout the civilized world.
The type has gradually changed, severe
forms have become less frequent and mild
tvpes prevail more and more.
No betterment of treatment is responsible
for this change in type, as our remedies to-
day are the same as those employed 300
years ago.
He thinks it is due to the "syphilization"
of mankind, our blood strains are all more
or less infected and protected, and our tis-
sues have gradually become less and less
suitable for the luxuriant growth of the
organism. But in virgin soil it is still
capable of terrible ravages.
He further discusses the general history
of the disease, the virus and its transmis-
sion, primary syphilis and the chancre.
A number of excellent cuts illustrate the
different kinds of chancres.
THE CHARLOTTE MEDICAL JOURNAL.
483
Treatment of Epilepsy at Craig Colony.
According to the Superintendent, Wm.
F. Spratling, in the Medical Standard, the
colonizing of the patient means that he is
placed under such restriction that we can at
all times have entire control of his acts.
This is most essential, for the nature of his
disease causes him too frequently to disre-
gard the laws of health and indulge in many
dissipations.
We treat him as an individual at first,
along broad hygienic lines, for many come
to us in poor general health, and the first
demand is that they be built up, recon-
structed physically.
To do this we employ a diversity of
means : Medicines, systematic occupation,
gymnastic exercises, baths, special feeding,
and the use of such moral agencies as may
be essential.
All the while he is being studied for aura ;
for the presence in the blood, urine, or other
secretions, of noxious substances that may
cause or help to cause the disease.
He must eat only such food and only in
the manner prescribed for him. We regard
this as most essential.
He must not overeat, for by tradition
founded on fact he is apt to gormandize ;
and if he is habituated to the excessive use
of tobacco he should be cautioned to be
moderate in its use.
He is not permitted to use alcoholic stim-
ulants in any form or to any extent. Tea
or coffee, if properly made for him, he may
take in moderation without harm ; but it is
seldom properly made for him.
At the colony every epileptic received is
made to undergo a complete change of life.
If he was of sedentary habits he is put out
in the fields, under the sun and in the air
— not abruptly, but gradually. His entire
life, as far as can be, is thrown into new
channels. If, when received, he is feeble,
as many of them are who have suffered from
long neglect (and I am speaking of the in-
digent classes), he is put into the hospital,
fed on light nutritious foods, and every
effort made to build him up.
If we see at any time that he fails easily
under any mental strain, such as study or
close reading, he is made to quit such pur-
suits and to use his body only.
If his body is big and strong and he is
weak intellectually, then the opposite course
is pursued, the object always being the co-
equal development of the mind and body —
no vitiation of one at the expense of the
other.
If he has any natural bent or inclination
in the way of study or work, it is recog-
nized and encouraged, for mental occupa-
tion in the treatment.
Due heed to the foregoing over a suffi-
cient time will, as we have learned from
experience, cure from six to eight per cent,
of all cases that come under our care.
Splenic Auemia.
The original department of the Boston
Medical and Surgical Journal for April 26
is taken up with the consideration of splenic
anemia by several writers.
R. C. Cabot gives a historical sketch of
splenic pseudoleukemia in which he says
that the first systematic treatment of this
subject was given by Banti in 1882, though
attention had been called to it by H. C.
Wood in 187 1.
In the diagnosis of the disease we have
to distinguish : Cases of idiopathic splenic
enlargement without any anemia or any
other symptoms which are not very uncom-
mon ; pernicious anemia, in which a slight
enlargement of the spleen is almost always
present, and sometimes a very considerable
one ; cirrhosis of the liver ; splenic tumor
associated with chronic malarial poisoning;
leukemia; the anemias of children.
The prognosis varies according to the
different writers. Some of Osier's cases
lasted twelve years or more and were still
in good health.
Splenectomy he considers reasonable
treatment in certain cases.
Said in Yellow Fever.
Surgeon Nunez has great faith in the ef-
ficacy of salol in the treatment of yellow
fever. He claims that it acts as an anti-
septic, rendering the stools absolutely odor-
less, that it calms the irritation of the
stomach and bowels and thereby reduces
the temperature, for the kidney he gives
cream of tartar which also serves to keep
the bowels open.
Bat Smith, in the Texas Medical Journal
for April, says that he has watched the ef-
fect of this treatment very closely in the
yellow fever hospital at Santiago, and he
comes to the conclusion that it is not much
good.
He bases his objection on the fact that salol
is split up in the body into salacylic acid and
carbolic acid and the latter is very injurious
where there is any active inflammation of
the kidneys as is found in severe cases of
yellow fever. He admits that many cases
have recovered under the Nunez plan of
treatment, but contends that they were
mild cases and would likely have got-
ten well without any treatment at all.
484
THE CHARLOTTE MEDICAL JOURNAL.
Mucous Colic.
A case of intestinal catarrh of 20 years
standing, in a woman 60 years of age, is
reported by H, B. Forbes in the Denver
Medical Times for April.
She suffered from attacks of cramps at
intervals with bloody mucous stools.
Mucous casts of the bowels were passed
during these attacks.
The patient was of slender stature, rather
poorly nourished and of evident neurotic
temperament.
She was placed on a free milk diet, bis-
muth, salol and morphine. When the diar-
rhea was checked the above was substituted
by 12 drop doses of tincture of nux vomica.
The duration of the attack under this
treatment was much shorter than usual.
She still passes some casts, but enjoys
fairly good health.
Operation for Typhoid Perforation.
A case of perforated typhoid ulcer oper-
ated on 18 hours after perforation is re-
ported by William E. Lower in the Cleve-
land Medical Gazette for April.
The perforation occurred at the beginning
of the fourth week at 3:15 p. m., and the
operation was done the following morning
at 9:15. The patient was anesthetized and
the abdomen opened by a three-fourths of
an inch incision to the right of the median
line. Considerable fecal matter was found
in the peritoneal cavity.
About 14 inches from the ileocecal valve
the perforation was found which was about
the size of a goosequill. It was turned in
and silk Lembert sutures used. Six hours
after the operation the pulse was 120 and
the respiration 28 ; at the end of twelve
hours the pulse was 1 18 and of good volume.
The patient died 60 hours after the opera-
tion of sepsis.
An earlier operation might have saved
this case.
entire uterus carrying the bladder and rec-
tum, protrudes through the vaginal orifice.
In the severer forms usually three indica-
tions are to be met : the vaginal canal and
vulvar outlet must be restored to its normal
condition, the enlarged or subinvoluted
uterus corrected, and the uterine supports
applied from above.
The Emmet operation is best for restora-
tion of the pelvic floor, then repair of the
cervix and curettment for subinvolution
and ventrofixation above.
In the third variety, where the prolapse
is complete, an anterior or posterior colpor-
rhaphy or both may be necessary in addi-
tion.
Special Treatment of Certain Diseases of
the Eye.
The successful treatment of three impor-
tant cases of the eyes by the combined
method or mercury and iodide of potassium
internally and pilocarpine hypodermically
is reported by G. Herbert Burnham, in the
Canadian Practitioner and Review for
April. One was a cyclo-iritisof both eyes,
of long duration, with the other changes
in the eyes usually associated with contin-
uance of this disease ; a second of iritis of
both eyes, with typical diffuse scleroderma ;
and a third of complete paralysis of the left
third nerve, from acquired specific disease.
In all of these cases the result was all
that could be desired from any plan of
treatment. Under this treatment there are
no relapses, even in those cases in which
under the forms of treatment previously
used they have recurred frequently and
severely. In severe cases it is of course
necessary to give the treatment for some
time.
He says that even in old cases of iritis he
uses this treatment instead of doing an iri-
dectomy with far better results. This plan of
treatment is applicable to nonsyphilitic as
well as syphilitic affections with equally
good results.
Prolapse of the Uterus.
John B. Deaver, in the American Jour-
nal of Obstetrics for April, makes some
very practical remarks in regard to the
operative treatment of this condition.
He calls the hypertrophic form false pro-
lapse, and says that unless it is causing
marked symptoms it had better be left
alone.
The simple or true may be one of three
varieties, according to the degree of pro-
lapse ; first, slight downward displacement ;
second, where the cervix approaches within
one or two inches of the vaginal outlet ;
The Radical Treatment of Follicular Tonsillitis.
As the cause of infection in these cases
may be traced directly to the tonsillar
crypts with their contents of food detritus,
micro-organisms and pus, M. A. Goldstein,
in the Laryngoscope for April, says that
the speediest means of arresting the disease
is to remove the cause by complete evacua-
tion and cleansing of these follicles.
For this purpose he uses two specially
constructed instruments, a slender tonsil
scoop and applicator.
After each follicle is cleaned out with the
third, where the cervix, and frequently the i scoop, a small tuft of cotton saturated with
THE CHARLOTTE MEDICAL JOURNAL.
pure guaiacol is introduced with the appli-
cator.
A gargle of one dram of tincture of iron
to an ounce of glycerine, completes the
local treatment.
In general give a brisk saline purge,
pilocarpine hydrochlorate, and sodium ben-
zoate and sodium salicylate to saturation.
Rachitis.
Some are inclined to doub*- the prevalence
of this disease except among the very poor,
Frank P. Earle in the Chicago Clinic for
April says that the age for this disease is
from six months to tw^o years. Males and
females are alike affected and the disease is
confined to the temperate zone. The ques-
tion of heredity is in dispute but Holt states
that it is apt to occur with parents of a
syphilitic or alcoholic diathesis.
In this country it is most frequent in
Italians and negroes. Tuberculosis is rather
a result than a cause.