per part of the milk undisturbed in the bot-
tle. This may be easily done with a small
glass syphon or rubber tubing, previously
filled with water to start the siphonage.
Pinch one end of the rubber tube and hold
it firmly, while the other is thrust throujj'h
the cream and to the bottom of the bottle.
Lower the outer end into the inner vessel
of an ordinary double boiler, and release it,
when the skim-milk will run out, provided
the latter vessel is kept lower than the milk
in the bottle. To the milk thus drawn off
add a teaspoon and a half of a good Es-
sence of Pepsin, and warm slowly in the
double boiler to blood heat, and keep at
that temperature until thoroughly curdled.
Now heat, with constant stirring, until
a thermometer dipped into the milk shows
a temperature of 155 deg. F., and remove
from the fire. Strain, while hot, through
clean wire strainer and dissolve in the whey
a heaping teaspoon of sugar of milk and
the white of one egg. When cold, pour the
sweetened whey back into the milk bottle



and mix thoroughly with the cream and top
milk. Pasteurize the mixture in a Free-
man's pasteurizer.

NoTK. — Should this food prove too laxa-
tive, reduce the quantity of milk sugar. It
is well to add, at the time of feeding, from
one to two teaspoonfuls of lime water to
each meal. As the child increases in age
and strength the amount of bottom milk
siphoned off may be diminished."



Cystitis in the Female.

Abram Brothers, before the New York
Obstetrical Society, discussed some points
in the diagnosis and management of cystitis
in the female.

According to the Annals of Gynecology
and Pediatry for April, he related the vari-
ous visible changes in the bladder in dis-
ease and accepted Casper's classification :
I. Change in color and lustre ; 2. increased
capillary circulation; 3. swelling; 4.
changed secretion. The inspection of the
bladder is positively contraindicated m
acute inflammations, but is allowed in all
forms of sub-acute and chronic inflamma-
tions. Dr. Brothers narrated in detail the
treatment of the various forms of vesical
inflammation, insisting upon as early an
examination of the bladder cavity as is per-
missible for the establishment of the exact
diagnosis. He then showed the Nitze in-
strument comparing it as he exhibited
with the instruments devised by Kelly,
claimed simplicity and greater ease
manipulation for the Nitze cystocope.



It,

He

of



Mastitis.



According to the Medical Standard for
May, Fenger, in speaking of this disease,
says it may occur in (i) the new born in
which it comes on three to five days after
birth and disappears soon, rarely suppur-
ating, (2) at puberty, the inflammation dis-
appearing in a few weeks to three or months
and may have simple treatment with com-
pression, rarely terminates in suppuration,
(3) at the menopause, usually localized, not
very acute, rarely terminates in pus forma-
tion, but ends in resolution with shrinkage
of the gland from formation within the
gland of cicatricial tissue. Differential
diagnosis from carcinoma best determined
by examination of indurated tissue rather
than to wait for possible development of car-
cinoma. The mastitis occurring (4) dur-
ing lactation, due to invasion almost always
of staphylococcus albus or aureus, is more
common on the right side. In operating
always make incision in a radial direction,
the nipple as the center.



THE CHARLOTTE MEDICAL JOURNAL,



491



Electrocautery in Throat Diseases.

According to S. G. Dabney, in Medi-
cine for May, the conditions in the throat
which are most often helped by the
electrocautery are: (i) Deep-seated fol-
licular inflammation of the tonsils, espe-
cially in the shrunken tonsil hidden within
its folds. (3) Enlarged lymph follicles on
the posterior pharyngeal wall — the so-called
granular sore throat — a common cause of
clearing the throat and a little hacking
cough, and an occasional cause of pain.
(3) Mycosis of the fauces. Here the small
spear-like projections grow from the faucial
and lingual tonsils. They are difficult to
remove and tend to recur. Electrocautery
is the best treatment. (4) Enlargement of
the veins at the base of the tongue. This
condition may cause the sensation of a
foreign body in the throat, and quite fre-
quently causes a small amount of blood to
be spit up, especially in the early morning,
(5) Enlargment of the adenoid tissue be-
tween the base of the tongue and the epi-
glottis — the so-called lingual tonsil. This
is a frequent cause of the tendency to swal-
low when there is nothing to be swallow-
ed — known as "empty swallowing" — and
of a feeling of fulness in the throat and
some disturbance of the voice, with or with-
out laryngitis.



Suppurative Pericarditis.

The surgical treatment of this condi-
tion is discussed by John A, Ouchterlong,
in the American Practitioner and News for
April 1st.

In order that the incision for suppurative
pericarditis shall be satisfactory, it ought
to comply with certain requirements.

The opening into the heart-sac ought to
be sufficiently roomy to permit examina-
tion of the condition of things within and
to permit drainage with two drainage-tubes
of sufficiently large caliber, and to enable
the operator to effect removal of fibrinous
masses that may exist.

The incision ought to be so made as to
afford the most easy discharge of pus, and
so that even the posterior portion of the
pericardium may be drained without there-
by embarrassing the movements of the
heart.

Its situation should be such that after
contraction of the pericardium has taken
place, it may not be outside the pericardial
area.

On cutting through the thoracic wall,
the pleural canity should be protected
against infection from pus in the heart-sac.

The incision should be made within the



area of absolute dullness, so as to avoid in-
juring the lung.

The mammary vessels should be avoided,
or, if the incision is in their vicinity it should
be so made that they may be easily ligated.

Great attention should be given to avoid
injury to the heart.

The operation should be as simple and
uncomplicated as possible; at all events,
when the patient is much depressed, when
also general narcosis must be avoided.



Membranous Croup.

Fifty cases of membranous croup, treated
by the same method, with 38 recoveries
and 13 deaths are reported by O. A. Flies-
burg in the Northwestern Lancet (Ar-
chives of Pediatrics for April).

In the series none but true cases with
membrane were included ; of the series 13
cases were instrumental with 3 recoveries ;
the balance, 37 cases, were treated exclu-
sively by the mathod here detailed with 35
recoveries, or in all 50 cases with 38 recov-
eries. These cases were seen over a period
of 14 years and all were membranous.

The treatment consists in the administra-
tion of powders composed of the hydro-
chlorate of apomorphia gr. 1. 100- 1-40, cal-
omel gr. I, bicarbonate of sodium gr. 2.
These powders are given dry on the tongue,
one every hour. It is claimed that the usual
doses of apomorphia are too large, but this
in a small dose and combined with the cal-
omel and soda there is a stimulating, anti-
septic effect from the whole powder not to
be had when one ingredient is administered
alone.



Rupture of tlie Liver and Gall Bladder.

Two cases are reported by Carl V, Vischer
in the International Journal of Surgery for
May, and after a careful consideration of
such cases he concludes as follows :

That injuries of the liver, followed by a
greater or less hemorrhage, are accompa-
nied by shock, which is largely in propor-
tion to the amount of the bleeding, and
which has a tendency to grow progressively
worse, terminating in collapse in a relative-
ly short time.

Inasmuch as such injuries are usually
fatal, operative interference, if at all under-
taken, must be done at the earliest possible
moment, for even after the hemorrhage
ceases, peritonitis is most prone to develop
in these cases.

That in injuries to the gall-bladder, the
shock is not so pronounced, and reaction
usually sets in. The prognosis is, therefore,
more favorable.

The escape of bile into the abdominal



492



THE CHARLOTTE MEDICAL JOURNAL.



cavity, from a ruptured gall-bladder or
ducts, is not necessarily fatal. Were it
possible to recognize such an injury as a
certainty, we would almost be justified in
giving a favorable prognosis, and even in
postponing operative interference until
complete reaction from the shock has taken
place.

That the mere drainage of the abdominal
cavity after rupture of the gall-bladder will
often suffice as an operative procedure. In
late interference we are apt to find adhe-
sions of the viscera to such an extent as to
make anatomical land-marks and visceral
relationships unrecognizable, and inasmuch
as they prevent the dissemination of any
septic matter that may be present, it is ad-
visable not to disturb them.



Acute Diabetes in a Boy Aged Five Years.

Pediatrics for May ist says that W. A.
Milligan, in the Lancet, gives the history
of a case of this kind. •

On admission, the boy was very weak
and wasted, and complained of an intense
thirst. He was very restless^ and his res-
piration was 40 per minute. Pulse 140,
temperature 97.4 deg. F. Tongue coated,
but breath had distinct, sweet smell. Ten
days before admission the patient was very
constipated, and received enemata which
relieved the trouble. Five days later there
was severe vomiting and great thirst.
During the next three days, these symp-
toms got steadily worse, and the boy lost
flesh rapidly. Two nights before admis-
sion he had incontinence of urine. On ad-
mission, the urine contained a considerable
quantity of sugar, and some albumin. Co-
deine pills and an antidiabetic diet were
prescribed, but the temperature continued
subnormal, the pulse and respirations in-
creased in frequency, until the patient be-
came comatose. He died after a few hours
of coma. The writer states that the case
was remarkable for its extreme acuteness.
Incontinence of urine, when it occurs sud-
denly, is a symptom which should make us
suspect diabetes. The occurrence of albu-
min with sugar is a bad prognostic sign.
Heredity plays no part in this case. The
peculiar sweet smell of the breath is a sign
of impending coma.



Carcinoma of Uterus and Vagina.

A case of total extirpation of the vagina
and uterus for cancer is reported by A.
Sippel in Centralb. f. Gyn. (Post-Graduate
for April).

The case was one of primary vaginal car-
cinoma in which the vaginal lumen was



completely obliterated by the new growth ;
the author dissected out the entire length
of the vagina from its surroundings and
then proceeded and tied off the uterus from
its connections with the broad ligament.
He succeeded in removing vagina and uterus
in one mass, from the periphery without
invading the diseased vagina. The patient
recovered.



Medicines by the Nasal Cavities and the

Feeding of Patients by the same

Method.

Salomon, in Progres Medical, reported
in Pediatrics for May ist, states that he has
used this method '.n his practice for twenty
years, in cases where it was impossible to
use the stomach tube without violence.
His method simply consists in pouring the
medicine, or food, in solution, directly into
the patient's nostrils. The patient is placed
on his back, the head is bent backward, and
held in this position, if necessary. It is
useful, in some cases, to swab out the nos-
trils with a weak solution of cocaine. One
nostril is then plugged with cotton, and the
liquid poured into the other by means of a
spoon. One must be careful to wait for the
beginning of an inspiration, and to pour
just at the moment when it begins. There
is never any asphyxia, as the fluid drops
down directly into the pharynx, and never
into larynx. The procedure is indicated
whenever other means of artificial feeding
are insufficient, difficult of performance, or
dangerous. It is especially valuable in the
country, where no other paraphernalia are
at hand. The only objection to it is that it
is slow, but this may be compensated by the
concentration of the food used.



New Treatment for Eczema.

Radcliffe Crocker, in Health, quoted by
Va. Med, Semi-Monthly for April 13th,
has proposed a new way of treating obstin-
ately recurring eczema, which is well
worthy of attention, as it does not interfere
with other treatment. The method con-
sists in the application of a counter irritant,
not to the part affected, but to the other
parts of the body which have some connec-
tion with the nerve centers. The counter
irritant used is an ordinary mustard leaf,
but when that is not sufficiently strong a
blister is produced with liquor epispasticus.
For the face alone the mustard leaf (or
blister, as the case may be) is applied be-
hind the ear ; for the face and forearms,
apply it to the nape, and for the leg the
counter irritant should be applied on the
hip over the large sciatic nerve. In most



THE CHARLOTTE MEDICAL JOURNAL.



493



cases this treatment has been followed by
removal of the itching, and the relief lasts
from one to several nights. The redness
and swelling are also relieved.



Nerve Injury from Fracture.

George R. Fowler presented the follow-
ing case before the Brooklyn Surgical So-
ciety as reported in the Brooklyn Medical
Journal :

L. E., aet. 22, suffered a fracture of the
left humerus about 4 inches above the elbow.
Five weeks later, when the splints were re-
moved, the hand was stiff, and it was not
until two months later that he realized that
paralysis existed. He was treated by elec-
tricity until he applied at Dr. Fowler's ser-
vice at the New York Polyclinic, where he
presented a typical wrist drop. The divided
musculo-spiral nerve was identified and su-
tured by the Brun's method with kangaroo-
tendon. The club-shaped upper end was
found with considerable difficulty. The
arm was put up in strong flexion to avoid
tension upon the sutured nerve-ends.

Prompt healing followed. The operation
has been of too recent date to expect evi-
dences of restoration of function at this
time.



Ovarian Cyst.

In the Annals of Gynecology and Pedia-
try for April, Clement Cleveland reports a
case of ruptured ovarian cyst, which he re-
moved.

The patient gave a history of a fall. At
the operation a great deal of fluid was found
in the abdomen and a tense cyst at the side
of which another ruptured cyst or possibly
part of a multilocular cyst. There was a
peritonitis present, so drainage through the
cul-de-sac was established. Dr. Skene's
clamp was used satisfactorily in the removal
of the tumor. Despite all efforts, the pa-
tient's bowels could not be made to move,
and pain and nausea became continuous.
Finally, forty-eight hours after the opera-
tion, the lower bowel was distended by
oxygen gas up to the point of pain. After
this, the twist or obstruction evidently be-
ing relieved, the patient passed gas, the
distention disappeared and the abdomen
became flat. The patient is now in stupor
and the prognosis is bad. The reason for
reporting the case is to speak of the method
of distending the lower collapsed bowel in
the hope of relieving the obstruction higher
up, which must be useful in other cases.

In reply to questions by Dr. Boldt, Dr.
Cleveland said that he had used oxygen in
preference to carbonic acid gas because it
was present.



Functional Dysphonia in the Course of
Sypliilis.

In the Rev. Hebdom. de Laryn., reported
in the Medical Bulletin for April, Chauveau
writes, not of laryngeal paralyses of syphi-
litic origin studied by authors, but of cer-
tain functional disturbances, the relations
of which with syphilis seem to have es-
caped observations. He leports the case of
a singer who contracted syphilis and who
was troubled by certain vocal disorders.
There were no appreciable anatomical le-
sions in the pharynx or larynx, but the right
vocal cord was sluggish. There seemed to
be insufficient action of the thyro-arytenoid
and the ary-arytenoid. Four injections,
made with eight days' interval, produced a
cure as far as the power and endurance of
the organ were concerned.



Foreign Bodies Left in the Abdomen after
Celiotomy.

One hundred cases in which foreign
bodies were left in the abdomen after celio-
tomy are reported by Neugebauer in Cen-
tralblat fur Chir., as stated in the Thera-
peutic Gazette for April.

Fifty-eight patients recovered, forty-two
died. Twenty-nine times a sponge was
lost, twenty-eight times a tampon or gauze
compress, four times a drainage tube, and
nineteen times artery forceps. In a num-
ber of instances two foreign bodies were
left in. The sponges were generally re-
covered by second section. It is note-
worthy that the majority of tampons and
compresses were discharged spontaneously
through the rectum.



Treatment of the Consumptive Poor.

There is no doubt that such cases can be
treated better than they are at present, and
the fact that they should be is beginning to
dawn upon the people, if only as a matter
of self-protection.

John F. Russell, in the New York Med-
ical Journal for May 5th, thinks that the
dispensary treatment may do much for such
cases if properly carried out.

He gives the following instructions :

1. That they must come to the dispensary
twice each day, Sundays and holidays in-
cluded, without regard to weather.

2. That they must eat regularly and all
they can of what they have, being guided
in their selection of food as far as possible
by our suggestions. Tea and coffee are
allowed but once a day, and all alcoholics
are forbidden.

3. That they must keep their feet dry



494



THE CHARLOTTE MEDICAL JOURNAL.



and warm and avoid overclothing. Corsets
are forbidden.

4. That they must sleep with windows
wide open in all weather ; that they are to
keep in the open air, avoiding overexertion
or exercise as much as possible ; that they
must not go to places of amusement, keep
late hours at night, etc.

5. That they are to have a satisfactory
movement of the bowels each day. No
medicines except cathartics are used.

He shows in his paper :

That a large number of poor people suf-
fering with pulmonary tuberculosis in a
curable condition can not go to sanatoria
for treatment.

That dispensary treatment is practicable,
successful, and comparatively inexpensive.

That curable pulmonary tuberculosis by
dispensary treatment is confined to the early
stage.

That without organized effort such cases
are difficult to attract for treatment, owing
largely to ignorance of the disease and a
belief that it is incurable.

That the treatment covers a long period
and patients require daily supervision.

That the majority of dispensaries at pre-
sent make no adequate provision for such
treatment.

That it is the duty of such dispensaries
to organize classes for this purpose.

The advantages to be derived from the
general adoption of the plan of treatment
outlined are as follows :

Many are cured.

All are benefited.

All are educated and made capable of
protecting and teaching others.

All, laboring and idle alike, can come for
treatment.

In the end it will break down the deep-
rooted belief that pulmonary tuberculosis
in all stages or any stage is incurable and
lead to the application for relief early in
the disease.



Sterilization of Cat Gut.

Charles A. Elsbery, in the Medical Re-
cord for May 5th, gives a preliminary re-
port on a new and simple method of steril-
izing catgut.

1. Catgut, freed from fat, is tightly
wound in single layers on suitable spools.

2. The spools are boiled for from ten to
thirty minutes in a hot saturated solution of
ammonium sulphate in water, made by ad-
ding chemically pure ammonium sulphate
to boiling water until no more will dissolve.

3. Two per cent, carbolic acid solution
may be substituted for the water if a quicker
sterilization (three to ten minutes) is de-



sired ; or I :i,ooo chromic acid solution, if
the catgut is to be chromicized.

4. The spools are thoroughly washed by
agitation for from one to two minutes in
cold or better warm sterile water, carbolic
acid, or bichloride solution of any strength.

5. The catgut spools are preserved in
strong alcohol.

6. For resterilization the catgut spools
are boiled for from five to fifteen minutes
in any of the solutions, and washed in the
same manner as described under 4.



Suppurative Pancreatitis.

The Therapeutic Gazette for April says
that Guinard (Revue de Chirurgie) found
in his hospital service a woman twenty-two
years old, suffering from fever and violent
pains in the epigastric region. She was
shocked, and the abdomen was tender and
slightly tympanitic. The patient was
watched for several days, during which
period the diagnosis fluctuated from perfor-
ating gastric ulcer to appendicitis, and
finally to hematocele. The patient sud-
denly becoming much worse, an immediate
incision was made in the epigastric region.
The lower border of the liver was adherent
to the anterior surface of the stomach. On
freeing these adhesions and tearing through
the more inflammatory material, a large
sac, filled with brownish pus, was found in
which were floating necrotic particles of
tissue. This cavity was drained, and the
patient recovered with a fistula, from which
there flowed a small quantity of pancreatic
fluid.



Tuberculosis of the Middle Ear.

A case of acute tuberculosis of the middle
ear is reported by Gaudier in the Gaz. des
Mai. Infant., according to the Archives of
Pediatrics for April.

A boy of five years had an otitis media
following an angina. There was a large
fungoid mass in the auditory canal, and an
operation showed the bone to be soft, friable
and filled with large fungosities, a mass of
which later burst through the wound and
attained the size of an orange. Guinea-pigs
inoculated with portions of this mass died
of general tuberculosis. The boy died with
symptoms of meningitis and pulmonary
tuberculosis.

Among 21 cases of fungoid otorrhea the
author has only seen two tuberculous cases,
which seem to be rare and difficult to diag-
nose. Stress is laid upon the rapidity of
the development of the fungosities and the
persistency with which they return after
removal.



THE CHARLOTTE MEDICAL JOURNAL.



495



Significance of Albuminuria.

For a long time it was thought that albu-
min in the urine was always indicative of
Bright's Disease, in fact albuminuria was
a synonym of this disease until about the
J. ear 1840.

Now we know that this condition is only
a symptom of a number of disease manifes-
tations.

According to Orville A. Kennedy, in
Medicine for May, albuminuria may be as-
sociated with coarse organic lesions of the
kidneys, which includes chronic parenchy-
matous nephritis, chronic interstitial ne-
phritis and acute diffuse nephritis. We
may have in addition to these, functional
albuminuria or albuminuria with no evident
renal lesions, extra-renal albuminuria, or
albuminuria derived from the genito-urinary
tract.

The conditions which give rise to func-
tional albuminuria are numerous. Good-
hart gives as the most important forms :

The lithemic, which may occur at all
ages, the result, especially in children, of
too heavy feeding on solids without suffi-
cient liquid being taken with the food.

The hemoglobinuric, in which, instead of
the urine of hemoglobinuria, albumin is
passed. This form is sometimes caused by
a cold bath, and it is the paroxysmal albu-
minuria of other writers.

The neurotic, which, according to Good-
hart's theory, is caused by the exhaustion
of the higher brain centers from work or
worry.

In the extra-renal form the albumin is
found only in traces, and is derived from
the genito-urinary passages, accompanying
leucorrhea, or other venereal discharges,
and cystitis. It may also be due to the
natural seminal fluid or prostatic secretion.
Oxaluria may give rise to albumin in the
urine by the sharp edges of the crystals of
calcium oxalate scratching the mucous mem-
brane of the urinary passages.



Traumatic Pneumonia.

Medicine for May says that A. Sonquez,
in La Presse Medicale , gives a study of a
certain variety of pneumonia known as
pneumonie contusive. By this he under-
stands a pneumonia developing after a blow
on the walls of the chest, in which there is
no solution of continuity in the lung tissue
such as would come from a fractured rib or
the penetration of a foreign body. He has
studied forty-nine cases of this type and