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The American practitioner online

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quickly separated off the muco-purulent coat, cleaned the tonsils and
pharynx thoroughly, and applied with cotton mop the methylene blue



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7 he American Practitioner and News. 407

soltition, same strength as Case i. Gave } grain of morphia sulph.^
\\% gtain of atropia sulph., and had him wait around the clinic for an
faour. At the end of that time the pain had almost disappeared, and
the hjrpersecretion of mucns very much decreased.

t gave him compound cathartic pills to open the bowels, ako gave
him internally two grains of methylene blue three times a day in cap-
^mles, not forgetting to tell him that it would color his urine. I gave
llim the methylene blue internally for its anti-rheumatic effect.

I kept up this treatment for about a week, keeping the bowels open
^th salines, and applying the solution of blue to the tonsils every
morning.

At the end of one week all symptoms entirely disappeared. I then
tedttced the internal dose of methylene to two grains once a day, and
toM him to keep up this treatment for several weeks. I did not see
liim again until November 16, 1899, when he told me that he had no
further trouble with his throat, and that all symptoms of rheumatism
had entirely disappeared. I examined his throat on the date of his last
visit and found the tonsils slightly hypertrophied but otherwise
normal.

Case 3. Howard C, age nineteen ; occupation, houseboy. Presented
himself at the college clinic September 5, 1899, complaining of nasal
catarrh and frontal headache. Examination showed that the nasal
passages were very much obstructed by the turbinated bodies, mucous
membrane very pale and patulous and covered with dry crusts, very
foul odor ; hearing slightly impaired ; patient very anemic, sense of
smell almost gone; no specific history. Patient is a typical mouth-
breather.

Treatment. I thoroughly cleansed both nasal passages with
peroxide hydrogen, full strength, removed all crusts, and applied to the
nasal surfaces four-per-cent solution of methylene blue ; ordered gen-
^eral tonic containing arsenic and strychnia, and told the patient to
teport back the next morning. He did so, and I found that there was
a slight formation of crusts. I again cleansed with peroxide hydrogen^
implied the blue solution, and gave him the following powder :

B Pulv. borax. 31;

Pulv. camphor, * Rt. W ;

Pulv. cubebs, gr. iii.

II. ft chat i. Sig : Use aa snuff three or four times a day.

I isaw him again the next day, when the odor had almost entirely
disappeared. I kept up the above treatment, and at the end of two



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.408 The American Practitioner and News.

weeks t|ie patient was discharged, apparently well. I saw him on the
street two weeks ago, and he told me that he had had no further trouble.

I report the above cases, believing that the pus-destroying proper-
ties of methylene blue are equal, if not superior, to any drug we have.
It is non-irritating in one to five-per-cent solutions, and need not be
used stronger than that.

I know that there are objections to its use in some cases on account
of its staining qualities, as, if not carefully applied, it will stain any
part of the tissues with which it comes in contact; but to overcome this
objection I always coat over the surfaces (that I do not want it to
come in contact with) with oil or vaseline.

As an internal remedy I have gotten good results in rheumatism and
malaria. Prof. M. F. Coomes, who has had a large experience with
methylene blue, belieyes it to be one of the best of all pus-destroying
agents.

LOUISVII«LB.



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Kcports of Societies.



THE LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.*

Stated Meeting, October ao, 1899, the President, WiUiam Cheatham, M. D.,

in the Chair.

A Device for Preventing Mouth- Breathing. Dr. Wm. Cheatham:
The little device I show you was gotten up by Dr. Hooper, of this city^
for the use of mouth-breathers. He has some very favorable reports
from its use. It is made from rubber, and of such shape that it will fit
in between the lips and gums and effectually prevent mouth-breathing.
I have used the device in several instances with most excellent results.
Of course, if any obstruction to nasal breathing exists, it must be
removed ; but the majority of children who have had nasal obstruction^
when this obstruction is removed, still breathe through the month.
This little device also acts well with adults ; it will stop mouth-breath-
ing, snoring, etc. It seems to be an excellent thing.

Uterine Polpy, Dr. Turner Anderson : This specimen is a small
uterine polyp that I removed to-day. I made the diagnosis of intra-

* Stenographically reported for this journal by C. C. Mapes, trOuisville, Ky.



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The American Practitioner and News. 409

cervical polyp a few days ago, and this morning, in the course of my
rounds, I concluded I would remove it. I had little or no trouble in
getting a snare on and removing it in this way. There followed quite
an active hemorrhage. I merely mention the case to show that in
operations of this kind it is a good plan to prepare for every thing.
Ordinarily we would not expect any hemorrhage from such an opera-
tion. This polyp had going into it quite a good-sized blood-vessel, j^ncl
I had to control the hemorrhage by applying a clamp. This is the first
case where I have seen any hemorrhage following such an operation.

Discussion, Dr. A. M. Cartledge : It has been my custom for years
to twist off pure mucous polypi ; but where there is any considerable
connective tissue in them, I make a V-sha>ped incision and remove
them in this way. This is of importance in preventing a recurrence^
and the danger of hemorrhage is less. I split the cervix where neces-
sary, and take out a V-shaped piece. I operated upon a case eight
months ago where a polyp had recurred three or four times, and at each
of the previous operations there had been considerable hemorrhage. In
making a V-shaped incision to remove a cervical polyp, I always get
into the contraptile tissue, which does not bleed as readily.

Dr. Turner Anderson : I recognize that cervical polypi are rare.
Uterine polypi do not ordinarily gfrow from the cervix, and in my
experience I have never seen a uterine polyp recur after being snared.

Meningeal Lipoma, Dr. Louis Frank: On Wednesday of this
week I first saw the child from whom this specimen was removed-
The history was about as follows : This child is one of two in the
family, about six months old, of healthy parents. At the time of birth
there was noticed at the sacro-lumbar juncture this tumor. It was
described to me as being at that time a sac with a pedicle, only par-
tially covered with skin, the entire tumor being not quite the size of
the head of a newborn infant, not covered by integument, apparently
translucent, glistening in appearance, fluctuating. The physician who
delivered the woman advised removal of the tumor at once. The
mother would not consent to the operation, and a little later moved
from the place where the child was born to Frankfort, Ky., where I
?aw it. . . ^

I examined the child carefully and found this tumor, and could feel
an opening in the spine at the point where the tumor arose. It, i^rqs^



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Tht American Practitioner and News.

\y pedicle about one inch in diameter. That portion of the
lich is not Covered with skin, when I saw it presented a yellow
ppearance, and the tumor had a very fetid odor. The child,
showed no symptoms of any kind ; the fontanelle was fairly
ed ; there was no evidence of hydrocephalus ; the child had
1 any spasms m^ other symptoms expected with such a condi-
re was nothing except the presence of the tumor, and Bot-
ling its condition, septic, the child had a regular, even pulse.
y indicated, there was nothing but the presence of the tumor
ich was a nasty, stinking mass, presenting the appearance I
bribed.

ight, as did the other physicians who had seen the case, that
spina bifida ; it sprang directly from the median line at the
3f the sacral and lumbar vertebrae. The consensus of opinion
the child would die shortly, and I was asked to remove the

nt the child to an infirmary in Frankfort, and the tumor was
ay by cutting in probably one inch from its base. In remov-
imor it was the intention to make two semi-circular flaps, and
hat I had gone within three quarters of an inch of the point
of the tumor itself. In removing it I did not go into the
aal, and after removal, upon opening the tumor, I found there
ivity, or any thing which would lead one to believe that it was
)ifida, cyst, or meningocele. I believe that the tumor is a
uch as we sometimes find with bifid spines, and that this child
had a true meningocele which did not extend the entire
the tumor. Whether this is true or not I do not know,
xternal wound was closed, and the child apparently did well.
pared, had I opened the spinal canal, to closed it with sutures.
1 body of the tumor had undergone gangrenous degeneration,
as an incision was made into the tumor, a lot of mud-colored
ped.

the future of the case will be I do not know. In a tumor of
the diagnosis would be very difficult, as in an examination
mt a spina bifida would suggest itself.

^sion. Dr. A. M. Vance : I had a case some time ago, a boy

ars old, from the mountains, who had an old case of infantile

with several sores upon his body which had commenced t9



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The American Practiizoner ^md News. 411

slough. I curetted these thoroughly and sent the boy back to the
tnonntnins. He returned subsequently with the condition practically
unimproved.

I concluded, upon investigating this case thoroughly, that the
paralysis was probably due to a condition similar to that in the case
reported by Dr. Frank, except that the tumor in my case was covered
by skin. There was a tumor upon the boy's back that appeared to be
an ordinary lipoma, as far as we could make out. I am sure it was a
case like the one reported, a tumor made up principally of lipomatous
tissue, with a meningocele in it ; that the paralysis of the lower extrem-
ity was due to the presence of this meningocele interfering with th^
nerves on that side. I did not undertake to remove the tumor. I
amputated the boy's foot because of the gangrene when he returned
the second time, and the amputation wound healed primarily.

I have never removed a meningocele by radical operation, and think
statistics show that it is not a very satisfactory operation.

Dr. Turner Anderson : I do not see how it would have been possi-
ble, judging from the appearance of this tumor, to have made an
accurate diagnosis. It looks more like a spina bifida than any thing
rfse. Dr. Frank deserves much credit for attacking it in an off-hand
way, and was very lucky to find that it did not communicate with thts
chord. He was probably induced to operate on account of the general
symptoms present, the development of the fontanelles having gone on
satisfactorily, the absence of paralysis of the extremities, etc.

I have a case under observation at present, that I was called to see
in consultation some time ago, which presents a condition somewhat
similar, but in this case there is absence of development of the cranial
sutures, and I am sure that it is a case of true spina bifida. I congratu-
late the doctor upon his success in the treatment of his case.

Dr. A. M. Cartledge : I take it that this tumor is practically the
only one that causes any difficulty in making the diagnosis of spina
bifida. There is a remarkable thing about lipoma that occurs in this
connection in its simulation of spina bifida, also in its histological
structure. I find that the researches of Senn and others show that this
tumor, while coming under the head of fatty tumor, is characterized by
a remarkable development of connective tissue ; that the trabeculse are
t€ry numerous. It is a congenital arrangement, and hence is some^
times associated with spina bifida, and has a true meningocele present^
ing in the base of the tumor.



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le best article that I have seen on the subject, I think, is in
s' Recent System of Surgery, and this very tumor is described ;
is about the only tumor that has any similarity to a meningocele
s spina bifida,
ad occasion some time ago, when Dr. Rodman presented a case

this Society, to look up the literature of the subject. This is
\y tumor which occurs here in which there can be any difficulty
erentiating from a true spina bifida.

e point Dr. Anderson makes about the fontanelles and the ques-
f paralysis from interference of the nerves by pressure tend to

the diagnosis. Such tumors frequently slough and become
ic.

. Louis Frank : I have searched hurriedly what little literature I
at my command on this subject, and it would seem from the

thus far that I have been very fortunate. Had I known then
[ now know, I might not have operated upon this case. The clear-
J best description that I have been able to find is given by Sutton
work on tumors. Senn, Dennis, and others have copied largely
the original description given by Sutton, and their conclusions
to be the same as those stated by Sutton. Sutton also reports a
ike this occurring in a child eight months of age. Other cases
)een reported where the base of the tumor was made up of lipo-
s tissue, a sac extending into the tumor proper which contains
5 — the so-called meningo-myelocele, but not a true meningocele,
ter — Further examination seems to show this tumor to be a true
geal lipoma.

looking up the subject of lipoma, the only description I found of
na occurring in this connection was the lipoma associated with
gocele. These tumors are described clearly ; they occur in the
n line at the base of the spine, either about the lumbar vertebrae
lumbo-sacral juncture; the description tallies almost perfectly
he case reported; they are all said to be complicated with spina

with a distribution of nerves in the sac itself. I think this case
le of that variety. It is a true spina bifida, but associated with it
is a congenital lipoma, springing from -what structures I can not
I was perhaps lucky in not going any deeper with my dissection.
Dved the entire tumor, cutting through it about one inch from its



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The American Practitioner and News. 413

The child presented no evidence of any defect, although he was
carefully examined. There was no clubfoot, no paralysis, no cleft pal-
ate, no hernia — nothing that we would expect to find in such a case.
Upon manipulation of the tumor there was no tendency toward con-
vulsions or coma, as we often find in such cases. The only thing
which would strike one as occurring with such a condition was a failure
of the fontanelles to close firmly. They were still somewhat soft^
much more so than we would expect to find in a child of this age.

A striking thing about the tumor is that the skin proper extends
over only a portion of it. Why the tumor should have undergone
sloughing or become gangrenous I do not know. The blood-supply
was quite extensive. There was considerable hemorrhage during the
operation ; five or six small vessels spurted quite sharply. The tissue
a:t the base of the tumor was fibrous, dense, hard ; it could hardly be
cdught up with a hemostat in controlling the hemorrhage. It was nec-
essary to pass a ligature down and transfix the two main vessels that
supplied the tumor.

In operations upon these cases, statistics show recoveries in from
fifteen to twenty-six per cent; and I believe one German authority
reports forty per cent of recoveries in the cases he has operated upon.
I do not believe there have been a great many cases of this kind
operated upon.

Removal of a Foreign Body From the Eye, Dr. T. C. Evans : About
the first of September a young man came to me with the history of an
injury (accident) to the eye. On examination I found that a small
piece of steel had passed entirely through the cornea and lodged in the
iris. The way the accident occurred, he said, was that he was a fore-
man in a machine shop, and was standing by while a workman was
attempting to remove a die from a casing ; that he took a sledge ham-
mer and hit this hardened steel die, and a small piece of the steel froraf
the die struck him in the eye. It pained him for a few minutes only •
he went to see a general practitioner in the neighborhood where the
accident occurred, who told him there was a piece of steel in the eye;
and advised him to consult an oculist at once, and he came to see me.
The particle of steel was a very sharp, needle-like piece, and had
caused no loss of the aqueous. The wound had immediately closed
after it passed through the cornea. I told him it would be necessary
to do an operation in order to remove the piece of steel, and made an



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The American Practitioner and News.

t the next day. I operated by making an incision
terior part of the cornea, then passed a majj^et into the
er and removed the particle of steel in this way. The
vas about half an inch in length and probably 1*3^
iameter. The wound healed without trouble, the pupil
lar, vision normal. It had not gone far enough to make
lens.

of the most satisfactory cases that I have seen where a
Kras renloved from the eye with a magnet. Had I
emove it with forceps, the operation would have been
and there would probably have been considerable hem-^

mry to the Eye from an Explosion of Nitrite of Am^
xt accident is rather an unusual one. An old lady, a
; western part of the city, undertook to heat a tube of
[ over a gas flame ; the tube as a matter of course
^s of the fragments passed through the cornea into the
I traumatic cataract. Whether a piece of the glass
I lens or not I am unable to say. One or two pieces of
into the lips and remained there for ten days. It seems
that a woman in the drug business did not know better
;ube of nitrite of amyl, therefore I say the accident was

ctdent in Remoznug an Intubatum Tube, The next case
dent, but of a different character. Two weeks ago I
emove an intubation tube from the throat of a child
is of age. It was the child of a doctor, and with the
)lding the child, and its father (the doctor) holding the
very ably assisted. I had used the modified O'Dwyer
IS a smaller head on it than the old-fashioned O'Dwyer
ipting removal of the tube I was afraid to push very
\ extractor, and because of this fact an insecure hold on
ed, but I thought it was sufficient to withdraw it from
St about the time I was extracting the tube the father
1 because he saw a little blood in the child's mouth, and
;uming the child over; the tube was thus thrown from
id was swallowed. I did not feel any unea.siness about
that I knew the mother, grandmother, father, and other
be greatly worried for twenty-four to forty-eight hours»



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The American Practitioner and News. 415

Strange to say, the father consulted several of bis^ surgical friends. about
the case, the majority of whom told him that nothing was necessaary ;
that the child would come out all right. One surgeon, however,^ said
he would do a gastrostomy and remove the tube before it left the stom-
ach. This was not done, and the tube passed by the rectum in about
forty-eight hours.

Discussion. Dr. Wm. Cheatham : Doctor Evans' case of foceign
body in the eye reminds me of two cases that I have seen. The first
was in the Manhattan Hospital. A piece of iron entered the eye of a
man, who did not know it until he began to become blind. He came
to the hospital with an incipient cataract, and we could see the foreign
body in the lens. I have seen one other case like this. It is some-
times remarkable how much trauma may be inflicted upon the eye
without the patient really knowing any thing about it at the time.

The tube presented by Doctor Evans has an enormous caliber, and
it seems to me the extractor would have some trouble in engaging it
for this reason. I have gone back to the old-fashioned O'Dwyer tubes
without the bulbous extremity. There is less danger in their use, they
are inserted more easily, and there is also less trauma than with the
tubes having the bulbous extremity.

I have been very much interested, and I think Doctor Evans has
also had some correspondence with the same individual, in the subject
of intubation recently. A gentleman in Munich, Bavaria, has written
me several times on the subject. He is getting up some statistics on
intubations, and also the serum treatment of diphtheria. I will read a
portion of one of his letters giving facts he has collected, which may be
interesting in this connection. It will be observed where the death-
rate in intubation for laryngeal diphtheria was about 60 per cent
before the introduction of serum, it is now only 10 per cent.

Cyanosis. Report of a Case : Dr. F. C. Wilson : I saw an exceed-
ingly interesting case recently in a child two and a half years old, sent
to me from the country, who shortly after birth had manifested some
evidences of a patent foramen ovale. The child had also a decided
cleft palate, and it had been the subject of paroxysmal blueness ever
since birth. It was slow in development, slow in teething; it did not
have any teeth until it was fifteen months old, and then they came in
the reverse order ; it cut the back teeth first and the incisor teeth last



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The American Practitioner and News.

finished teething when I saw it a few days ago, but it was the
of intense paroxysms of cyanosis, which occurred almost daily,
ver the child would become at all excited it would become blue ;
re fingers and finger-nails would become cyanosed ; face livid ;
ue ; the whole surface of the body more or less livid and blue,
remains sometimes for several hours ; then when the child goes
) these symptoms pass off

\ question arises as to what condition there is which gives rise to
iether there is still a patent foramen ovale, or what can give
this intense cyanosis, which comes on with considerable regu-
nd persistency. The child is developed normally so far as its
id upper extremities are concerned, but the lower extremities
y partially developed. The child has never walked, and the
consulted me to know whether any thing could be done looking
relief.

IS satisfied from my examination, taking the condition found in
tion with the cleft palate, that there might have been some
jf development in the formation of the heart itself; possibly a
/e development of the valve which ought to close the foramen
itid with that idea I could give them little hope for relief except
ature might bring about in development and improvement of the
)n of the child.

\ child is fairly well nourished, and the lower extremities, the
1 say, are becoming better developed as the baby attains greater
>o the only ray of hope I could suggest to them was that nature
bring about relief in development. Any thing like a surgical
3n was out of the question, and the only advice I could give
ras to seek to improve the child's nutrition in every possible
> improve the development of the lower extremities by massage;
e the general condition of the child by the administration of
nutritious foods, reconstructives, etc.

s has been an exceedingly interesting case to me, and one which
follow closely to determine what the future results will be.

msston. Dr. H. A. Cottell : I would like to ask Dr. Wilson if
1 any association between cleft palate and an open foramen ovale,
istics show that there is any relationship between the two con-
} My reasbn for asking this question is, that the last case of
>ramen ovale I saw, and I have seen but three in my entire



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The American Practitioner and News. 4 17

practice, had also a cleft palate. <Fortunately the children all died
within a few hours after they were born. The last one I saw, I noticed •
when the child was born that it was blue. I did not like its appearance.
I had turned it upon the right side, and gave orders for it to be kept in
that position. I went on about my business, and in the course of perhaps
two hours I was called to come back. When I reached the house they
said the child was dead. They told me that it had shown some symp-
toms of strangling; that the physician whom they called in the emer-
gency had made a great discovery ; he had found that the child's throat
was in a terrible condition. Looking into the throat I found there was



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 101 of 109)