Syyhilis has perhaps little bearing but
deficient food, bad hygiene, dampness and
squalor are powerful abettors though not
the real cause of the disease.
The real caxse is malassimilation or foods
deficient in fats and proteids.
As to treatment he recommends, cream
and butter, lime either as limewater or the
lactophosphate, phosphorus, cod liver oil,
iron, arsenic and strychnia, cod liver oil he
considers nearer a specific than anything
else he has tried.
In advanced cases where the deformity is
marked they must be referred to a surgeon.
The Treatment of Croupous Pneumonia.
W. G. Ewing, in the Aledical and Sur-
gical Bulletin for March, gives his plan of
treatment for this condition.
Dover's powder for the pain, with strap-
ping and proper position.
He does not consider high fever as es-
pecially dangerous unless long continued.
When necessary he uses cold applications
locally.
For the cardiac depression, alcohol,
strychnine and digitalis. Strong, black,
hot coflfee is also recommended as a good
stimulant.
For the restlessness which may develop
into sleeplessness and delirium he uses cold
sponging to the head with a hot mustard
bath to the feet. Veratrum viride he con-
siders better than bleeding when this is in-
dicated.
Pneumonia cannot be aborted and the
cases in which it is supposed to have been
cut short, to six, five or four days, by this
or that line of treatment can be matched
by other cases of equally short duration,
without the use of the so-called abortive
measures.
The heavy doses of calomel recommended
by some he thinks injurious, though in dose
sufficient to clear out the alimentary tract
at the commencement of an attack, its use
is admissable.
Urticaria.
Several varieties of this disease are men-
tioned by David Walsh in Gaillard's Medi-
cal Journal for April.
He states that the treatment may tax all
the resources of the physician, and in all
cases we should search diligently for the
cause.
Disorders of digestion, certain articles of
diet, certain drugs, the underclothing, cold
and other things may be at the bottom of
the attack, So the treatment may vary
from salines to curretting the uterus.
Atropine subcutaneously in i-ioo grain
doses, cautiously increased is worth a trial.
Locally warm alkaline baths are useful.
In general, antiseptic, astringent and
evaporant lotions and baths are preferable
to ointments.
The Use of the Angiotribe.
After using the instruments of Thuniin
and Bissell, J. Riddle Goffe, in the Boston
Medical and Surgical Journal for April
1 2th, says that he prefers the angiotribe
of Tuffier to either of the others. He used
it in sixteen gynecological cases with the
very best results.
He claims the following advantages :
The superiority of this method of con-
trolling the blood vessels over the former
of applying forceps becomes apparent at
once. By the former method forceps had
to be left in place as they were applied, one
after the offer, in the progress of the oper-
ation. These filled the vagina more or less
and impeded the progress of work. In the
use of the angiotribe, on the contrary, more
and more room is gained with each appli-
cation.
The handles of the forceps protruding
from the vagina were a great source of an-
noyance and discomfort to the patient.
Moreover, the forceps had to be removed
at the end of thirty-six to forty-eight hours.
This was a great annoyance to the patient,
and in a certain proportion of cases hemor-
rhage occurred from the tissue adhering to
the forceps and being torn away as they
were withdrawn. After the use of the
angiotribe none of these disturbances arise ;
convalenence is smooth and comfortable.
Indeed, his experience is that there is very
THE CHARLOTTE MEDICAL JOURNAL.
much less pain 'after using the angiotribe
than by either the old forceps application
or in the use of ligatures.
It is superior to ligatures in two respects :
it is more easily and quickly applied and it
is attended by less discharge during conva-
lescence, whether the ligature used is catgut
or silk.
In his opinion, the angiotribe has a field
of application in dealing with hemorrhoids,
and while he has had no actual experience
in this line of work, he believes it will
prove to be superior to the ordinary clamp
and cautery.
Tertiary Syphilis.
Three cases of this form of syphilis are
reported by John V. Shoemaker in the
Medical Bulletin for April.
The first was a woman, 53 years of age,
with tubercular syphilide on the left side of
the chest, which resembled herpes zoster.
She was put upon mercury with chalk on
account of the weakness of her digestive
organs, three grains four times daily. Lo-
cally the following ointment was ordered :
Ung. hydrarg. nitrat., 3ss.
Acetanilid, gr. x.
Ung. zinci oxid, venzoat, Jss.
The amount of acetanilid to be gradually
increased to 20 grains.
The second case was a man, 30 years of
age, who had the pustulocrustaceous form
of skin syphilis upon the cheeks and neck.
He had a chancre five months before. He
was given
Potass, iodid, Jss.
Syr. sarsaparilla co., gvi.
Dessertspoonful four times a day.
The third case was a woman, 38 years of
age, with a well marked lesion upon the
forehead and another on the right side of
the chest. This was a typical case of rupia
and she was gives 15 grains of potassium
iodide four times daily. Externally an oint-
ment containing 10 grains of calomel and
15 grains of carbolic acid to an ounce of
oxide of zinc ointment.
Restoration of the Base of the Bladder and
Urethra.
A case is reported in the Post-Graduate
for April, by Bache McE. Emmet, in which
he restored the base of the bladder and ure-
thra by plastic surgery.
Following instrumental delivery the va-
ginal vault was destroyed, carrying the base
of the bladder and the urethra entire.
This was remedied by using the posterior
wall of the vagina which necessitated the
temporary closure of the vagina.
The time of treatment covered about one
year, but the result was satisfactory in every
way.
Pathology and Treatment of Typhoid Fever.
That typhoid fever is a specific disease
has not yet been fully proven, according to
George Dock in the Physician and Surgeon
for March.
Neither the results of bacterial cultures
nor the Widal test are at present sufficient
to establish this fact. He calls attention to
the fact that it is not a local disease, but a
general one. From this he knocks the
props from under the specific intestinal
treatment of this condition. Of course
antiseptics do good, but he is inclined to
believe that simple cathartic? will accom-
plish all that should be expected from in-
testinal medication. The germs are in the
system and it would be as sensible to try to
kill them by pouring antiseptics on the
patient's hands as to attempt it by the lumen
of the bowel.
The infection takes place usually in the
lymphoid tissue of the ileum, then the mes-
enteric glands, spleen, gall bladder, liver,
blood and kidneys.
The value of the cold bath in the treat-
ment is indisputable, not for its antipyretic
effect but for its stimulant effect on nutri-
tion, secretion and excretion, the nervous
system and, only incidentally, the tempera-
ture is reduced. One very good effect of
the bath is its diuretic effect, because the
intoxication is more important than the
high temperature. Not only is more water
excreted, but the total solids are distinctly
increased.
He advocates more liberal diet than milk
but cautions us to watch the stools, temper-
ature and the patient closely.
As for medicines he uses none except for
special symptoms. For stimulants he uses
coffee and strychnia, depending on the
urgency. Alcohol as a routine drug has
been entirely abandoned, the doses before
and after the bath being entirely unneces-
sary. Hot milk internally or hot water
bags externally more than replace the spirits.
Etiology of Malarial Fever.
William S. Thayer read a paper on this
subject before the Congress of American
Physicians and Surgeons, reported in the
Medical News for May 5th.
He was of the opinion that the disease
was acquired through the gastro-intestinal
tract, especially by drinking water ; through
inhaled air ; and by the bite of insects.
The experiments of Celli, Marino, Zeri,
Grassi and Filetti were strong evidence
THE CHARLOTTE MEDICAL JOURNAL.
487
against the idea that the disease might be
acquired through the gastro-intestinal tract ;
whiel a careful study of the literature as
well set forth by Norton revealed the utter
lacik of ^^idence in support of such an idea
With regard to the theory that the disease
was acquired by inhaled air, it could only
be said that while such general facts spoke
in its favor, no positive evidence in its sup-
porthad ever been adduced. That the dis-
ease might be acquired through the bites of
insects, aspecially of mosquitoes, had be-
come an attractive hypothesis. It then
may be considered as proven, that the ma-
larial parasite possesses an extra-corporeal
cycle, which is completed in the stomach
wall of mosquitoes of the genus Anopheles,
and that members of the genus Anopheles
are capable of transmitting malarial from
infected to non-infected individuals. The
author then went over the bites of insects
indigenous to certain localities in relation
to the patholegical eflfects, and especially
referred to the cassof mosquitoes which
infect the suburbsof Balltimore.
Hour-Qla5s Contraction of the Stomach.
F. S. Watson, before the American Sur-
gical Association, reported in the Medical
News for May 5th, said that this lesion has
a surgical history of only ten years — and
the principle of anastomosing the two por-
tions of the stomach was first carried out
by Wolfler in 1894. Since then anastomo-
sis has been carried out in one form or an-
other many times. Altogther thirty-five
operations upon an hour-glass stomach have
been published. The speaker described a
case on which he had successfully operated.
His plan was to suture together the parts to
be anastomosed, before the stomach was
opened. Communicating incisions were
then made, which of necessity exactly co-
incided, and were sutured internally. The
extra incision in the stomach was then
closed. The choice of method must de-
pend on the conditions found. In some in-
stances gastro-anastomosis is not practica-
ble because it would bring too great a ten-
son on the parts. Gastro-enterostomy fails
to utilize the digestive capabilities of the
pyloric half of the stomach, and if the car-
diac portion of the stomach is atrophied,
this loss of the pyloric portion will be se-
rious — a plastic operation is in many cases
technically inadvisable while a resection of
the constricted portion is too dangerous for
practical use. Whatever operation is chosen
the surgeon should not forget the advant-
age of freeing adhesions — as this of itself has
been known to cure many annoying symp-
toms.
Diagnosis of Malarial Fever.
Albert Waldert in Medicine for May
gives in detail the method of examining
the blood in the diagnosis of malarial fever.
The necessary apparatus consists of a one-
twelfth oil immersion lens and warm stage,
large clear cover glasses and slides.
The cover glass and slide should be
thoroughly cleaned with alcohol and wiped
dry without touching them with the bare
fingers. The lobe of the ear or end of
finger from which the blood is to be taken
should also be perfectly clean.
The warm stage should be so adjusted as
to keep the specimen at 98.2 F., too great
heat or cold will crenate the corpuscles.
Do not take the first drop of blood but
allow several to escape, then touch the
summit of a drop with the coverglass in
the blades of the forceps without touching
the skin.
The blood should spread out smoothly as
the coverglass is allowed to fall by its own
weight on to the slide. If it does not do
so there in some fault in the technique and
a new specimen must be selected. It is
time wasted to try to examine a bad speci-
men.
The microscope should be taken to the
bedside of the patient and the specimen
examined immediately after it has been
withdrawn from the circulation.
Several specimens should be collected at
diflferent periods of the fever, because the
parasites are not always found. During
the period of apyrexia they may be absent
from the peripheral circulation.
As a rule only a limited number of malarial
parasites are discovered in each specimen of
blood obtained, and frequently ten to fifteen
minutes must be consumed before one good
specimen is found.
The small hyalin segmenting bodies are
seldom found free in the plasma. As soon
as sporulation occurs they at once enter the
red corpuscles.
It should be remembered that the plasm-
odium malarise has a turning, twisting,
rotary, or flattening-out movement, and in
the later stages containing fine pigment
granules in active motion.
As the specimen of blood becomes cold,
the movements of the organism become
slower and slower, and finally cease al-
together.
It is very common to meet with foreign
material and "blood dust'' in the plasma,
which at times may be mistaken for the
non-pigmented hyalin parasites of malarial
fever. The bodies may have an active
Brownian movement.
In begining this study one should confine
his attention to the parasites within the red
488
THE CHARLOTTE MEDICAL JOURNAL.
cells. In looking for the tertian parasite
any enlarged and decolorized red corpuscle
should at once arrest the attention.
If there be a double or triple infection,
the organisms will be of different sizes.
Except in the estivo-autumnal type of
fever a few doses of quinine will cause all
organisms to disappear from the blood.
Medical School of the Future.
The medical student is coming in for his
share of attention in this progressive time.
H, P. Bowditch, in his presidential ad-
dress before the Congress of American
Physicians and Surgeons, reported in the
Medical News for May 5th, says that the
medical schools of the first rank will, in the
near future, be organized and administered
as follows :
It will be connected with a University,
but will be so far independent of university
control that the faculty will practically de-
cide all questions relating to methods of
instruction and the personnel of the teach-
ing body.
It will offer advanced instruction in every
department of medicine and will therefore
necessarily adopt the elective system of
some sort, since the amount of instruction
provided will be far more than any one
student can follow.
The laboratory method of instruction will
be greatly extended and students will be
trained to get their knowledge, as far as
possible, by the direct study of nature, but
the didactic lecture, though reduced in im-
portance, will not be displaced from its
position as an educational agency.
The work of students will probably be
so arranged that their attention will be con-
centrated upon one principal subject at a
time and these subjects will follow each
other in a natural order.
Examinations will be so conducted as to
afford a test of both the faithfulness with
which a student performs his daily work
and of his permanent acquisition of medi-
cal knowledge fitting him to practice his
profession.
Nephropexy .
This method of kidney fixation without
sutures is described by Nicholas Senn in
the Medical Standard for May.
The following is a stenographic report
of the clinic at which the patient was ex-
hibited.
We performed a fixation of the kidney
without suturing, i. e., nephropexy, a pro-
cedure with which we have become amply
familiar during the last two semesters. The
kidney can be anchored safely and perma-
nently, without subjecting it to the least
possible injury with suturing. We per-
formed this operation, first making a long
Semon incision, cutting down upon the
adipose capsule of the kidney and freely
excising it. The beginning of the incision
of the fatty capsule should be on the spinal
side, because a little recklessness in this
spot might possibly lead to damage of the
peritoneal cavity and its contents. After
the free incision of the fatty capsule the
kidney is brought well forward into the
wound so as to change its position, render-
ing it oblique, thus correcting the flexure of
the ureter, a condition which is so con-
stantly present in advanced malposition of
the kidney. The kidney is liberated of fat
down as far as its hilus, the capsule is freely
but carefully scarified with cambric needles
and the organ imbedded in iodoform gauze
or plain sterile gauze, making a new position
of the k?dney. We create a condition in
which we rely on exciting active tissue
repair, after which we find it lined through-
out by a pavement of fine, healthy tissue,
anchoring the kidney in its normal position.
Those of you who have not seen our
method of after-treatment may be interest-
ed in knowing how we treat the wound.
It is left widely open after the tumor is
removed and is packed with gauze. By
this simple procedure we invariable secure
beautiful primary wound healing, which
compares favorably with the healing of the
wound after suturing. This operation was
performed several weeks ago and not a
single suture was employed either for the
fixation of the kidney or to unite the wound.
We simply bring the granulating Surfaces
together, a small absorbent compress holds
the wound surfaces together. A pad, con-
sisting of a folded towel, is placed in the
hypochondriac region, thus reenforcing the
gauze packing of the kidney. This is in-
corporated in a bandage which passes
around the waist and holds the dressings
and compress in place.
You know that this wound is a linear
one, and what we always like to see about
a wound, particularly after operations for
tubercular affection, there is a tendency of
the scar to contract. There are no exuberant
granulations to be found here and the pro-
cess of repair is about complete. We shall
advise that this towel support remain in
place in order to support the delicate scar
and to prevent undue stretching. We shall
also supply the pat'ent with an abdominal
bandage which she will wear for the next
four or six weeks. I have now the greatest
difficulty to palpate even the lower pole of
the kidney by abdominal palpation. The
THE CHARLOTTE MEDICAL JOURNAL.
kidney is now fixed permanently in its
normal position by firm connected tissue
adhesions. The position of the kidney now
is not a vertical one, but an oblique position,
which you know is as it ought to be under
normal conditions.
Sarcoma of the Pericardium.
A case of this very rare disease is report-
ed by J. C. Williams and A. L, Miller in
the New York Medical Journal for April
14th.
The case was one of primary diffuse small
celled sarcoma of the parietal pericardium
in a boy about thirteen years of age. Both
of the boy's grandfathers had died of carci-
noma of the stomach, and an aunt with car-
cinoma of the breast. He died after being
under observation for three months. There
was enormous uniform thickening of the
pericardium, no involvement of the epicar-
dium, slight enlargement of the peribron-
chial and mediastinal glands but no glandu-
lar enlargement was found elsewhere.
The neoplasm was large, irregularly
rounded and lobulated, of a yellowish-white
color and of fairly hard consistency, though
it tore apart very easily. The anterior sur-
face was rather flat and had the appearance
of having been attached to the under sur-
face of the sternum and costal cartilages.
The lower surface was firmly attached to
and involved the diaphram ; the sides show-
ed a distinctly lobulated appearance. It
weighed together with the heart and both
lungs, six pounds and a quarter.
Treatment of Puerperal Sepsis.
The clinical value of the newer methods
in the treatment of puerperal sepsis is dis-
cussed by John O. Polak in the Post Grad-
uate for April.
He emphasizes the following points :
That puerperal sepsis usually begins in
one of two forms of endometritis, /'- e., pu-
trid or septic. Except, when the infection
has been direct through the inoculation of
lacerations and abrasions by the streptococ-
cus or by the tetanus or diphtheria bacillus.
That while the curette is indispensable to
the successful management of putrid endo-
metritis, it is harmful in an empty uterus,
iuch as is commonly found in the septic
form.
That all forms of septic infection are bene-
fited by general stimulation and supportive
treatment.
That, of the antitoxins used, ungt. crede
has proven its superiority over the anti-
streptococcic serum.
That blood-washing and the artificial
production of a hyperleukocytosis are valu-
sble adjuncts to the routine treatment.
Finally, that hysterectomy post-partum
should be limited to those cases in which
the sepsis is localized, as a metritis with
pyosalp'inx, or tubo-ovarian abscess, after
the acute symptoms have somewhat subsid-
ed, and that most parametric pus collections
can be more safely handled by vaginal
section.
The Widal Test.
According to William Ophuls in the Oc-
cidental Medical Times for April, the Wid-
al test is a valuable measure in the positive
diagnosis of typhoid fever.
He says that a certain dilution is not so
important as the use of an appropriate time
limit with the dilution chosen.
Only an absolutely perfect reaction, that
is, complete immobilization and uniform,
clumping should count in making a diagno-
sis.
By adhering to this rule Widal claims not
to have made any mistakes in 390 controls,
although he still adheres to the old fashioned
dilution of i to 10.
After examining the objections to the
method he comes to the following conclu-
sions, which do not diflfer materially from
those originally formulated by Widal.
The test ought to be made with a fixed
dilution and a proper time limit.
When it is possible to exclude the possi-
bility of a former attack, the presence of
the reaction is positive evidence of an in-
fection with typhoid fever bacilli, e. g., in
999 out of 1,000 cases of the presence of ty-
phoid fever. A negative reaction does not
exclude typhoid fever, but the presence of
the dssease becomes the less likely, the later
in the course of the disease the test remains
negative. It is therefore advisable to make
repeated examinations in all suspicious
cases.
Perforating Ulcer of the Stomach.
J. M. T. Finney discussed this subject
before the American Surgical Association
and, as reported in the Medical Record for
May 5th, stated that the severity of the
symptoms and the prognosis depended on :
(i) the size of perforation; (2) whether,
at the time of perforation, the stomach was
empty or full; (3) the position of the pa-
tient (unimportant) ; (4) the nature of the
infection, character and number of bac-
teria being of the utmost importance. Ex-
periments with a case of duodenal fistula
at Johns Hopkins Hospital showed that in-
fected milk was discharged with the infec-
490
THE CHARLOTTE MEDICAL JOURNAL.
tious organibms still active. Hence the
speaker urged the necessity of using steri-
lized food, and of sterilizing the mouth for
two days prior to operation. Hyperacidity
seemed, under certain conditions, to favor
development of germs. (5) As in typhoid,
leucocytosis was of great importance when
present. An important question was :
Shall we use opium, and how much? The
answer was, most emphatically, to use only
as much opium as was absolutely neces-
sary to ease the pain. Another ques-
tion was: Shall we await shock.'' Equally
emphatic was the answer, /. c, to operate
immediately. This was particularly true
if the symptoms were growing more pro-
nounced. Local anaesthesia, combined with
a few whiffs of chloroform, if necessary,
was of great importance in operating for
diagnosis. Indeed, in this manner the en-
tire operation was best done. The steps
were as follows : the cardia should first be
examined; second, the pylorus; third, the
lesser curvature, and last, the posterior sur-
face. He closed by speaking of the hope-
ful results of surgical intervention.
Infant Food from Cow's Milk.
A safe and simple method of preparing
infant food from cow's milk is needed by
mothers, especially at this season of the
year.
E. H. Bartley, in the Brooklyn Medical
Journal for May, gives the following di-
rections for making a safe food :
"Siphon off from the bottom of a bottle
of fresh milk of good quality three-fourths
of its contents, leaving the cream and up-