sick headache in the family, no matter how
healthy the individual might be.

I have had over thirty years of experience
and as Grand Rapids is noted for its special-
ists jevery class of eye strain has been first
excluded; our specialists are especially good
diagnosticians, and, as you may imagine, every-
thing has been brought to bear to ascertain
the real cause of the disease, but I have found
recently a better way which has not yet been



Digitized by



Google



22



HEADACHE— SOLIS.



Jour. M.S. M.S.



emphasized but which was given by your
essayist and that is the static electricity. I
can quote one case in the time limit, perhaps,
that will show you what is accomplished in
many cases. I have in mind a patient who is<
thirty-two years old, whom I have known
from a child; she was married at twenty and
had one child; she has had severe headaches
since her menstrual life began; her child was
two years old, and it was decided that the
headaches were the rei^ult of some disease of
the ovary; both ovaries were removed. She
has been under the best physicians of the city
from that time on for ten years. She canut
to me the first of last September saying that
the longest time she had been free from a
severe headache was nine days; she had just
returned from one of the northern resorts,
where she had spent the last two months.
Being a woman of means, everything was done
that could be done to relieve her; she had
no eye strain; no special rheumatic tendency
could be discovered; the urine was normal;
the temperature normal; she was treated daily
for twenty applications and had only one at-
tack of headache, after that every other day
for another month and from that time on she
has not had a headache; this after ten years —
yes, fifteen years — of the best treatment that
she could have from a variety of physicians.
The only way I have treated her was with
the static electricity. I might quote dozens of
cases which have been relieved by static electricity
as Dr. Sol is has recommended.

A. W. Ives, Detroit: I have had patients
come to my office who have been treated by
me and by others for headaches so severe
they pould scarcely stand. These patients after
taking the static breeze for fifteen minutes to
one-half hour go away relieved and practic-
ally cured for the time being.

C. W. Hitchcock, Detroit: It is rather pre-
sumptive in one who has not heard the paper
to enter into this discussion. I simply rise
for a few words upon this general subject of
headaches, and although it was not my priv-
ilege to hear the paper, I will follow the ex-
ample of others.

It seems to me that this is worth observing,
that while it is well known that the static
breeze in some cases seems to relieve a head-
ache, it is also well known that galvanism in many
cases will do the same, and while gynecolo-
gists by treating the ovaries or the uterus or
investigating rectal conditions will relieve



headaches due to reflex disturbances, we must
not lose sight of the fact that headache is not
a disease; it has, like epilepsy, a diseased con-
dition producing it. We know but little
about it. When the gynecologist and rectolo-
gist and all the other 'ologists have finished
describing all the possible disturbances which
by reflex influences may produce headaches,
there will be left a large class of headaches
no less persistent but seemingly amenable to
no treatment that yet come to us for treat-
ment. One trouble is, we know but little
about what the cerebral circulatory condi-
tions are at these times. Some very com-
mendable investigation has been going on,
and I think a Cincinnati man has called at-
tention to the close relation between migraine
and epilepsy and he has made some very in-
teresting examinations of the urine at the
time of the headache and at the time of the
convulsion and he advances the theory that
these disturbances are caused by paraxanthin
in the urine. And so there will be numerous
other claims made. We as yet know but little
about the diseased conditions and let us hope
that future investigations will give us more
light, but we should remember alj the time
that it is only a symptom that we are talking
about and not a disease.

C. B. Stockwell, Port Huron: Twenty-three
years ago I abandoned the use of mydriatics
in testing eyes and got better results without
it in the relief of headaches. Lately, while in
New York city, I learned that the use of
mydriatics was being abandoned, because a
greater number of headaches were relieved
without than with the use of mydriatics.

J. J. Mercen, Holland: An enlarged lower
and middle turbinate is sometimes a cause of
headaches. There are a great many cases of
headaches, especially those over the eyes, and
running to the back of the head, that I think
are due to this enlargement. A cauterization
will very often relieve this condition alto-
gether.

Willis S. Anderson, Detroit: I would like
to call attention to obstructive lesions of the
nose, and to sinus disease as a cause of head-
ache. Involvement of the sinuses often gives
rise to very severe and persistent headaches.
The pain may be orbital, frontal or referred
to the center of the head and described as
severe and boring in character. These cases
are difficult to diagnose. Where one has a
muco-purulent discharge from the nose, espe-



Digitized by



Google



January, 1904. I.ACERATIONS OF THE CERVIX— MORSE.



23



ciajly if it be unilateral and accompanied by
obstruction and pain, it is well to think of
nasal or sinus disease as the cause of the pain.

F. S. Conovcr, Flint: Just a word regard-
ing the use of the cycloplegic and mydriatic.
Examine your patient carefully under mydria-
tic or cycloplegic and a physician who has
not done this has failed in his full duty. I
state this from personal experience. For six
years I was a terrible sufferer from sick head-
ache, so much so that three days in the week
I went to bed. I consulted oculists in this
state and they passed me up. I went on; I
met Dr. Colborn of Chicago in 1900. He used
the mydriatic; gave me proper correction, and
my headache disappeared. I want to say that
I believe it is the duty of every physician to
use the mydriatic in these cases.

D. E. Welsh, Grand Rapids: I think that
headaches are simply an expression and not
a disease of itself, and I do believe that 80%
of all the cases of headache would be relieved
by taking care *of eye strain or some refrac-
tive error. We must bear in mind there are
two conditions of refractive error: First, that
which is always ascertainable and that which
is brought out under the influence of mydria-
tic. It is the small errors that give the most
trouble and especially those that are associated
with lack of muscle balance. If we take into
consideration all these causes associated with
lack of muscle balance however small and cor-
rect them in connection with the amount of
latent difficulty, and bring our patients under
the use of a lens which corrects the latent
difficulty either at once or gradually to their
full correction, I think we can remedy all
these headaches. I do believe that in cases of
children from eight years up to eighteen or
twenty, barring myopic conditions, if refracted
properly on account of headaches, that within
a year or a year and a half, they will get
along without any glasses whatever.



PATHOLOGICAL CHANGES FOL-
LOWING LACERATIONS OF
THE CERVIX.*

R. L. MORSE,
Ann Arbor.

From the time of Emmet's first com-
munication on the "Surgery of the Cervix

*Read before Section on Gynecology and
Obstetrics at the annual meeting of the Mich-
igan State Medical Society at Detroit, June,
1903, and approved for publication by the Com-
mittee on Publication of the Council.



Uteri" in 1869 to the present, the changes
following lacerations of the cervix have
been carefully studied by numerous inves-
tigators with the result that our knowl-
edge of the minute anatomy of the lacer-
ated cervix has been greatly increased. In
the present paper, I shall confine myself
chiefly to the histological changes in the
mucosa of the cervix and their relation to
malignancy.

For convenience, the mucosa of the
cervix may be divided into two parts, the
cervical canal and the vaginal portion.
The cervical canal extends from the in-
ternal to the external os. It is lined by
a single layer of tall columnar epithelium
with basal lying nuclei. Beneath these
and opening into the canal, are numerous
acinous glands, — the cervical glands. The
vaginal portion is covered by stratified
squamous epithelium. Beneath the epi-
thelium of both the cervical canal and
the vaginal portion is a well-defined layer
of yellow elastic tissue.

The junction of the columnar epithe-
lium of the canal and the squamous epi-
thelium of the vaginal portion, which oc-
curs normally at the external os, may vary
through anomalies in development :

1. Congenital ectropion, where the co-
lumnar epithelium extends outward be-
yond the external os, over the anterior and
posterior lips as two tongue-shaped
streaks.

2. Congenital erosion, where the canal
near the uterine body is constricted and
expands outward toward the external os;
the funnel shaped cavity being lined by
columnar epithelium.

3. Where the lower part of the canal is
covered By squamous epithelium and in
the upper part changes directly into cylin-
drical.

These variations in the mucosa are im-



Digitized by



Google —



24



I^ACERATIONS OF THE CERVIX— MORSE. Jour. M. S. M. S.



portant in that later, through inflamma-
tion and irritation, they may undergo
changes similar to those conditions aris-
ing from laceration.

Through laceration of the cervix there
is a loss of continuity at one or more
points in the cervical ring. In the spon-
taneous healing, unless it be anterior or
posterior, there is more or less deformity
resulting. In the case of bilateral lacera-
tion, the anterior and posterior lips are
forced from each other in the direction
of least resistance, the integrity of the ex-
ternal OS destroyed and the cervical struc-
tures rolled outward, giving rise to ectro-
pion. As a result, the circulation in the
cervix is impaired and the tissues become
engorged and swollen. The columnar
epithelium of the cervix, with the under-
lying glands, being thus rolled out into
the vagina, are subject to further inflam-
matory changes by virtue of their unna-
tural position.

Instead of being in the alkaline and
practically sterile condition of the cervi-
cal canal, these same structures are now
in the acid and infected secretions of the
vagina. Sooner or later, through irrita-
tion, congestion and infection, there is set
up an endocervicitis, which exaggerates
the existing condition. Very frequently
the process extends upward, giving rise to
infective endometritis, metritis, salpingi-
tis, parametritis, and oophoritis. As a re-
sult of one or more of these conditions,
the size and weight of the uterus is in-
creased, thus forcing the cervix lower in
the vagina. The normal excursions of the
uterus during respiration and walking fur-
ther irritate the inflamed cervical struc-
tures. The endocervicitis, endometritis
and irritation give rise to tlie so-called
"erosions" of the cervix.



By erosion is meant the extension of
the cervical columnar epithelium and
glands beyond the external os, its normal
limit, or beyond that point which is first
occupied as a result of ectropion.

This extension is produced in three
ways :

1. By a shelving off of the upper lay-
ers of the squamous epithelium down to
the basal layer, through maceration, and
a rotation of the axis of mitotic division
from perpendicular to parallel to the sur-
face, thus afterwards producing a simple
instead of a stratified epithelium, — a me-
taplasia.

2. By a gradual shoving back of the
squamous epithelium by the advancing co-
lumnar.

3. By a complete desquamation of the
squamous epithelium and a replacement
by the columnar.

The columnar epithelium having re-
plac.ed the squamous by one or more of
these processes, forms glands by invagi-
nation, using the papillary depressions as
starting points.

The eroded surface appears redder than
the normal cervix because the single layer
of columnar epithelium permits the blood
in the capillaries of the stroma to be seen
through it more readily than through th^
many layers of the stratified squamous.

There are three types of erosion:

1. Simple, in which the columnar cells
replace the squamous with no important
participation of the glandular apparatus.

2. Papillary, in which there is an in-
crease in the size and number of the
cervical glands and a proliferation of the
stroma between the glands, giving rise to
papillary excrescences.

3. Follicular, in which the underlying
glands are distended by their secretions,
forming cysts.



Digitized by



Google



January, 1904. LACERATIONS OF THE CERVIX— MORSE.



25



As a result of ectropion and erosion
there may be a desquamation of the epi-
thelium, either columnar or squamous,
with but little inflammation, or the pro-
cess may be accompanied by marked in-
flammatory reaction, necrosis of the sur-
face, small cell infiltration, new. blood
vessels, and exudate, in fact, in all re-
spects an ulcerative process.

When the immediate causes of the ero-
sion, desquamation or ulcerat,ion have sub-
sided, i. e., the irritation, endocervicitis
and endometritis, there is a tendency for
l3ie part to heal. The final result of the
healing is either complete, the eroded sur-
face being again covered by squamous
epithelium and the glands effaced, or the
healing is incomplete, the gland cells re-
maining in the deeper parts of the former
glands.

During the healing process there may
be seen in the advancing squamous epithe-
lial border numerous mitotic figures. This
border moves forward, replacing the co-
lumnar cells, sometimes arching over, the
columnar cells disappearing underneath,
or by shoving under and lifting the colum-
nar up, giving the picture of columnar
epithelium resting upon squamous. When
the squamous epithelium reaches a gland
it may dip down into the gland, replac-
ing the columnar cells completely, or it
may only replace them in part. Again,
the .squamous cells may not descend into
the gland at all, but growing over the
mouth occlude it completely or leave an
opening through which the contents may
escape. It is the occlusion of the gland
mouths by squamous epithelium and the
consequent distention that gives rise to
many of the so-called Nabothian follicles.

Through acute excaberation of the
causes leading to erosion, and through ir-



ritation, the cervical epithelium may un-
dergo further proliferative changes. The
squamous epithelium is thickened, the
papillae lengthened and the masses of cells
filling the former gland increased. The
simple columnar epithelium may change
to stratified and the glandular invagina-
tions become deeper. In these cases we
note irregularity in the size and shape
of the cells, and their nuclei are larger
and hyperchromatic. This is usually
spoken of as atypical proliferation and is
suggestive of milignancy.

In beginning malignancy we have the
above picture. of atypical proliferation ex-
-aggerated. The masses of epithelial cells
extend deeper into the underlying tissues,
breaking through the yellow elastic layer,
and show strands and fibres of it among
the invading cells. As the process ad-
vances there is usually some evidence of
cornification as shown by the beginning
formation of epithelial pearls. There is
more or less small cell infiltration along
the advancing border and capillary
changes, showing reaction on the part of
the normal tissue to the invading cells.
The diagnosis of malignancy at this time
is usually plain.

Looking at the sequelae of laceration
from another point of view, we find that
carcinoma of the cervix is far more fre-
quent in multipara than in nullipara, while
carcinoma of the body of the uterus is of
about equal frequency in both. And
among multiparous women those with
carcinoma of the cervix have had more
children than those not affected, showing
that labor predisposes to carcinoma. Now,
the common result of labor is trauma and
its most frequent effect upon the cervix is
laceration. Thus we arrive at the same
conclusion from another point of view.



Digitized by



Google



26 INTERMEDIATE GROUP OF ORGANISMS— CONNOR. Jour. M. S. M. S.



CERTAIN FACTS IN REGARD TO

THE INTERMEDIATE GROUP

OF ORGANISMS.*

GUY L. CONNOR,
Detroit.

I regret that the paper I am about to
present is not of a more practical nature.
It does not pretend to touch on more
than certain points. As you will see when
I am through/ there is nothing original
in it. Nevertheless the literature on the
subject is so scattered and the subject
itself is of such recent origin that I
thought that those who heard this paper
might possibly be interested in it.

There is a group of organisms which
for convenience sake and for other good
reasons are called by some the "Interme-
diates." They resemble the Bacillus Ty-
phosus in certain respects and the Bacillus
Coli Communis in others.

It was not until the Gruber-Widal re-
action was applied, that the various mem-
bers of this group could be separated
much if any.

1888 — Gartner discovered that the Bacil-
lus Enteritidis was associated with
epidemic meat poisoning.
1892 — Nocard's work on the Bacillus

Psittacosis appeared.
1893 — Gilbert introduced the terms Par-
acolon and Paratyphoid.
1896 — Achard and Bensaude were the
first to apply the term Paratyphoid
in a clinical sense.
Not, however, until 1901, after Schott-
miiller reported several cases did the term
Paratyphoid acquire a very general use.
The intermediate group embraces the
following organisms :

I. Bacillus Enteritidis of Gartner.

♦Read before Detroit Academy of Medicine,
Sept. 8, 1903.



2. Bacillus Psittacosis of Nocard.

3. Gas producing "Typhoid" of vari-
ous observers.

4. Bacillus Cholerae Suis.

5. Bacillus Typhi Murine.

. 6. Bacillus Icteroides of SanarelH.

7. Bacillus Calf Septicemia of Thom-
assen.

8. Bacillus Paracolon.

9. Bacillus Paratyphoid.

This group can be distinguished from
bacilli coli communis and bacilli typhosus
without much difficulty.



INTERMEDIATRS.

Gas in glucose.
No gas in lactose.
No gas in saccharose.
Coagulates milk — No.
Indol — No.



TYPHOID.

No gas in glucose.
No gas in lactose.
No gas in saccharose.
Coagulates milk — No.
Indol — No.



Paracolon Bacillus



COLI COMMUNIS.

Gas in glucose.
Gas in lactose.
Gas in saccharose.
Coagulates milk — Yes.
Indol — Yes.

In this country the two most frequently
found organisms of the above group are
the bacillus paratyphoid and bacillus para-
colon. The main differential points are
the following:

Milk,alkaline,after initial
acidity, terminal alkali-
nity in I to 2 weeks.

Gas formed freely in
glucose.

Milk, initial acidity, little
or no subsequent alka-
Paratyphoid Bacillus / linity.

/ Gas production is much
\ less than in the above.

Paracolon Bacilli — Turns neutral red agar
yellow in 24-48 hours and the culture
remains yellow.

Paratyphoid Bacilli — Also turns neutral
red agar yellow in 24-48 hours but it
does not remain so. After 4-5 days
it becomes red again. This redness



Digitized by



Google



January, 1904. INTERMEDIATE GROUP OF ORGANISMS— CONNOR. 27



starts at the top of the tube and ex-
tends downward. The redness i s
complete in 2-3 weeks.

The paracolons constitute several dis-
tinct species while the paratyphoids con-
stitute one distinct species. All the para-
typhoids give typhoids states in man, but
only a certain few of the paracolons pro-
duce typhoidal symptoms in the human
being.

The agglutinative tests have taught us
that the paracolon group is made up of
several distinct species because they all
do not show mutual reactions. The para-
typhoids, on the other hand, interact with-
out exception.

Dr. Warren Coleman, Professor of
Medicine in Cornell University Medical
School, gives us a very interesting classi-
fication for the several distinct forms of
disease caused by the "Intermediates."

I. Epidemic meat-poisoning type —

Etiology —

(a) Bacillus botulinus (Von Er-

minghem). This organism
is a saprophite. The infec-
tion of the meat takes place

IT

after the animal is killed. ^^'
The meat itself is off color,
has a bad odor and one can
readily tell it is unfit to eat.

(b) Bacillus enteritidis (Gart-

ner). Dr. Buxton puts
this with paracolons. The
animal is diseased before
death. There is nothing in
the sight or the taste of the
meat which will tell one
that the animal had this
disease. Cooking the meat
will not always kill this or-
ganism, as the temperature



in the. center of.tlie meat
may not be sufficiently
high.

Transmission to man —

1. Eating infected meat (com-

monest) .

2. Man to man.

Forms —

1. Gastro-enteric type (common

form).
Vomiting.

Griping abdominal pain.
Purging.

Fever loo-ioi. , }

Duration —

Mild — 1-5 days. '

Severe — ^months.

2. Typhoidal type —

Very difficult to distinguish
clinically from bacillus ty-
phosus infection.

3. Choleraic type —

Vomiting. *

Diarrhcea.
Rice-water stools.
Muscular cramps.
Sub-normal temperature.

Psittacosis type —
Originally an infectious disease of

parrots.
Durham believes bac. psittacosis is a

variety of Gartner's organism.
Modes of infection —

1. Direct from parrots.

2. From inanimate things, as

cages, etc.

3. Man to man.

Period of invasion, 5-7 days.
Stationary period — Beginning with

sudden rise and terminating with

sudden fall of fever.
Convalescence is apt to be prolonged.

Digitized by VjOOQIC



28 INTERMEDIATE GROUP OF ORGANISMS— CONNOR. Jour. M. S. M. S.



From Typhoid Fever



From LaGrippe



Mortality in man is 28-37%.
Bronchial complications are common
and dangerous.

Diagnosis— 7

Abrupt rise and fall of

fever,
Intensity of respiratory

trouble,
Absence of eruption, all

favor Psittacosis disease.
Extremely difficult,
Source of infection may
( help one.

III. Typhoid type—

Dr. Coleman thinks it would be bet-
ter to broaden the scope of etiology
of typhoid fever to include the fol-
lowing organisms —

(a) Bacillus alcaligenes of Pe-

truschky.

(b) Bacillus typhosus.

i (c) Bacillus paratyphoid.

(d) Bacillus paracolon (certain
members which have been
called by some beta para-
typhoids).

I would now like to say a few words
concerning paratyphoid and paracolon in-
fections.
Etiology —

Paracolon Bacillus and Paratyphoid
Bacillus.

Geographic location counts nothing in
this class of cases, as they have a
very general distribution. Cases
have been reported on the continent,
in this country, in the islands of the
Pacific, etc.

Age — Among the cases reported the
youngest patient who had paraty-
phoid or paracolon fever was a baby
of 7 months ; the oldest a man of 60
years. The majority are in young
adults.



Morbid Anatomy —

There are on record three deaths with
autopsies. The only ulcer found in
the intestines of any of these three
cases was one in the ileum. Whether
it was an ulcerated follicle the ac-
count didn't say. In the other two
cases the solitary follicles and Pey-
ers' patches showed no lesions. In
Strong's case there was a moderate
catarrh of tlie intestines and a few
superficial hemorrhages in the large
and small bowel. The mesenteric
lymphatics and some smaller lym-
phatics along small intestine were
hemorrhagic. The spleen was en-
larged in all three cases. The other
pathological changes which were
foimd were those which occur in any
febrile condition.
Symptoms —

These are practically the same as those
found in genuine typhoid fever.
Complications —

Intestinal hemorrhage.

Furunculosis.

Initial broncho-pneumonia.

Venous thrombosis.
Relapses —

These occurred in several cases.

Duration —

12-84 days.

Average, 20-36 days.
Diagnosis of Paratyphoid Fever —

1. Absence of Widal (not less than

1-40'),

plus

2. Positive reaction against a known

paratyphoid bacillus,
or
Recovery of a paratyphoid organism
from the blood, urine, stools or
complicating inflammatory pro-



cess.



Digitized by



Google



January, J904. PATHOLOGY OF CYCLICAL ALBUMIN ARIA.



29



It must be remembered that you can
have a mixed infection of typhoid and