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tion that the constipation was more severe, the ascending and transverse colon was especially tender to the touch; a few hours preceding an evacuation of the bowel, especially when the contraction of the bowel was such as to dislodge a large quantity of mucous, patient would experience a sinking period with intense nausea, cold extremites, cold sweats and subnormal temperature. I may say the cold sweats and cold extremities were present to some extent most of the time. One peculiar feature during this attack, which was related by those in attendance as nurse, that what appeared to them as large as a good sized orange was noticed to travel from and across the transverse colon and disappear, to be soou followed by an evacuation of a large mass mostly mucous of the darker character described.

Patient suffered with "cramps of the stomach," especially during the convalescent period. She is affected also with multiple fibroid of the uterus, and this may have added to the gravity of the case. During extreme distention these tumors would beome prominent, and to apparently disappear so soon as relieved by an evacuation of the bowel.

Her temperature ranged from 97 to 103.3; pulse ranged from 86 to 140. At only one time, early in the attack, did the temperature reach the highest mark stated, 103.3.

Treatment was supportive, narcotics, antiseptics, and meeting depressed conditions with stimulants as indicated.

COMPOUND FRACTURE DISLOCATION OF THE ULNA.-L. B. Henkel, Annapolis, Md. (Jour. A. M. A., Dec. 23), reports the case of a workman who fell from a ladder a distance of about fifteen feet, landing on the palm of his right hand, left wrist, knees and face. He suffered a lacerated injury of his right hand, requiring six sutures, contusions of the knees and face and a dislocation of the ulna, the free end being splintered and penetrating the soft tissues and skin of the wrist so that the wound had to be enlarged about three inches to reduce the dislocation. This was done, the wound sutured and a plaster bandage applied with a window over the wound, which was dressed with 10 per cent iodoform gauze after bichlorid irrigation. The plaster was removed in three weeks and anterior and posterior splints applied for ten days longer. The sutures were removed after four weeks, the wound having healed by third intention. After removal of the splints, massage and passive movenients were employed and the patient discharged at the end of the seventh week with fairly good movement.

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Observations in the Far East.

In

AT the meeting of the St. Louis Medical Society, December 23d. 1905, Dr. Mary McLean, in a paper, "Medical Observations in the Far East," discussed. conditions as she found them in the several cities of China and Japan in the order in which she visited them. At Shanghai there are two flourishing hospitals, Dr. Boone's hospital for men and boys, and the Woman's Hospital. The Chinese hare contributed some $65,000 to the support of Dr. Boone's hospital, and this physician never charges a fee, finding it pays better to trust to the liberality of his patients. The essayist concludes that the Chinese character is on a much more generous plan than the American. the Woman's Hospital there is a daily clinic of 100 to 300 women and girls. Some of the cases in this hospital are so desperate that in this country early death could be safely predicted. There they recover with but little attention, owing to their pcwer of recuperation. Dr. McLean saw but little of the Chinese methods, but she did see a kit of surgical instruments in Korea. These instruments were merely a number of needles varying in size. The afflicted person is supposed to be possessed of an evil spirit and one of these needles is inserted into that part of the body nearest the pain in the hope of releasing this evil spirit. Even the heart is sometimes pierced in this way. Dr. McLean referred to one case in which a piece of flesh from a woman's arm was cooked and given to her sick child. There is no such thing as sanitation among the Chinese. In illustration of this the doctor cited one instance that came to her notice. In a little pond, the water greenish-black, a woman was soaking her vegetables, a coolie near by was washing his

feet, while not far away a pig wallowed and a woman was washing her clothes. The people are very poor, many of them, in the interior, subsisting chiefly on grass seeds, roots and pounded corn, rice being too costly for daily food. These people believe chicken deadly to consumptives, also eggs, none of them drink milk or eat butter, both being disgust. ing to them.

In Hang Chow, Dr. Main, of Scotland, has had charge of the medical work for twenty-five years. An immense amount of charitable work is done here and the several institutions are almost entirely supported by the Chinese. In the general hospital of 200 beds every patient upon admission is required to have a thorough bath and change of clothes, to keep out the vermin so plentiful in China. Dr. Main uses a ton of carbolic soap in one year. In addition to this hospital he has one partly for men and partly for women, besides an institution for lepers, a school for leprous children and a very fine tuberculosis sanitarium, for both Chinese and mission workers.

In Kiu Kiang is a hospital conducted by a young Chinese woman, a graduate of an American university. She has trained her own assistants, and is conducting the institution most successfully in every particular. Dr. McLean spoke very highly of the medical educational work being done in Pekin, where the representatives of the four denominations have united in the work. The hospitals here are well equipped. Here, too, she saw the Northern Chinese bed, or kang, a raised platform of cement and brick, with an opening underneath for a charcoal fire.

She found the Japanese surgeons skilful and painstaking and she stated, apparently in all sincerity, that they were always good natured and did not even swear.

The discussion was opened by Dr. George Gellhorn who related some of his experiences during a visit to China several years ago. He also showed the society two Chinese textbooks on gynecology.

Dr. Robert M. Funkhouser and Dr. Robert Barclay, in connection with these people's quiet endurance of pain, discussed the religion and philosophy of the orientals and the value of suggestion in its relation to sur

gery.

The President, Dr. Henderson, agreed with Dr. McLean that the Chinese must be more generous than the Americans. In proof of this he stated that but three patients had ever paid him more than the amount of his bill; a German who could speak no English, a Hebrew and a Chinaman.

The paper was further discussed by Drs. Fleming, Goodloe, Stauffer and Hopkins.

THE annual banquet given by the Medical
Society of City Hospital Alumni at the be-

The Hospital
Society
Banquet.

The

ginning of each new administration has come to be recognized as one of the more important social events of the season in which medical men alone are interested. The banquet this year was given at the Washington Hotel on the evening of January 4th, and was an occasion of more than Of the military hospitals in Japan, the usual pleasure to all in attendance. essayist had nothing but praise for everything president for 1905, Dr. John Green, Jr., preand everybody in connection with them, in- sided during the feast, and when cigars were cluding the patients. The Red Cross and lighted, in a inost felicitous address gave a Toyama hospitals each have a capacity of resume of the work accomplished during the about 7000. The wards are one-story, long, year and work under way and introduced frame structures, with windows on either the president-elect, Dr. Louis H. Behrens. side, a hall running down the middle, with President Behrens spoke of the past and fua bath-room at each end. The soldiers were ture of the society, dwelling on its accomplishbountifully provided with good nourishing ments and the duties which lie before it and food, many receiving the richest sterilized for the future, the responsibility of each memmilk in addition to their regular diet. In her to be a factor in the accomplishment of rethe diet kitchen everything was exceedingly forms and improvements which must be clean, and the milk sterilizing plant wonder- effected in St. Louis in the near future. fully complete. In the operating rooms the nursing was far superior to that seen in St. Louis, there were never less than five nurses in the room, each attending strictly to her duty. In the surgical dressing rooms often as many as twenty soldiers were being attended to or waiting their turn, yet during the two months over which her observations extended, Dr. McLean never heard one of them utter a complaint, not even a groan.

Following Dr. Behrens, Dr. Geo. Gellhorn spoke on Medicine in Europe; Dr. M. G. Seelig, on Medicine in the East; Dr. Walter B. Dorsett, on Medicine at Home, and the Old City Hospital; Health Commissioner Snodgrass, on The New Pathologic Laboratory of the City Hospital; Irvin V. Barth, Esq., on Quackery in Medicine; and Dr. Merrell and Superintendent Elbrecht (of the Female Hospital) on unassigned subjects.

The attendance at this banquet was better than 100, and the enthusiasm aroused presages well for the work of the society during 1906.

ST.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

HARE'S THERAPEUTICS. A Text-book of Practical Therapeutics, with Especial Reference to the Application of Remedial Measures to Disease and their Employment Upon a Rational Basis. By Hobart Amory Hare, M.D., B. Sc., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. New (11th) edicighth decennial revision of the U. S. Pharmacopoeia, 1905. In one octavo volume of 910 pages, with 113 engravings and four colored plates. Philadelphia and New York: Lea Brothers & Co., 1905. (Cloth, $4.00, net; leather, $5.00, net; half morocco, $5.500 net.)

WORKING ORGANIZATION OF THE LOUIS MEDICAL SOCIETY FOR 1906. President Homan has appointed the following tion, enlarged and thoroughly revised to accord with the standing committees to assist him in his administration of the affairs of the St. Louis Medical Society for the current year: Elections-Thomas A. Hopkins, chairman; Walter Baumgarten, Julius H. Gross. Executive-John C. Morfit, chairman; C. Morfit, chairman; Davis Forster, John Green, Jr.

Publication and Debate-Geo. M. Tuttle, chairman; Hudson Talbott, Albert E. Taussig.

Library-James M. Ball, chairman; M. W. Hoge, Mary H. McLean.

Microscopy and Pathology-Albert E. Meisenbach, chairman; Wm. W. Graves, E. F. Tiedemann, Wm. H.Mook, L. M. Warfield. Public Health and Legislation-Clarence M. Nicholson, chairman; Hugo W.Bartcher, Robert Luedeking.

Ethics (elected)-Paul Y. Tupper, chairman; Benj. M. Hypes, Frank L. Henderson. Contested Elections (three Junior ExPresidents)-Frank L. Henderson ('05), B. M. Hypes ('04), A. R. Kieffer ('03).

CALCIUM OXALATE CALCULI.-As prophylaxis Bruce advises regular daily exercise in the open air-change to bracing, hill or coast region; cold or tepid baths with friction; exclusion of rhubarb, tomatoes and onions from diet and using cabbage, farinaceous puddings and all kinds of sweets sparingly; an alkaline stomachic tonic just before meals, or acid stomachic tonic after meals.

BRAIN TUMOR.-J. Grinker, Chicago (Jour. A.M.A, Dec. 23), reports a case of brain tumor, locally diagnosed antemortem as occupying the subcortical region under the lower two-thirds of the anterior central convolution of the left side, but not involving the base of the brain. The autopsy revealed a large subcortical glioma involving the region indicated and not clearly defined from the surrounding brain tissue. The author remarks on the absence of local cortical symptoms in the case, the probable limitation of the motor area to the region anterior to the Rolandic fissure in man, the impossibility of making an exact anatomic diagnosis of the nature of the growth and the general inoperability of glioma because of its tendency to infiltrate and its usual deep situation in the white substance of the hemisphere.

Since the appearance of the 1905 edition of the U. S. Pharmacopoeia many new preparations have been introduced, some official drugs have been excluded, and the dosage and strength of many tinctures, extracts and fluid extracts, have been altered, all of which are included in Hare's new book on Therapeutics. The physiological action, therapeutics and administration of drugs are clearly outlined, and particular stress is put on the indications and reasons when during the course of a disease certain drugs are indicated or contra-indicated. The chapter devoted to the treatment of diseases will be of great aid to the physician until he finds time to consult special books on this subject.

DISORDER OF METABOLISM AND NUTRITION, DIABETES MELLITUS. By Prof. D. Carl von Noorden. New York: E. B. Treat & Co., 19.5. (Price, $1.50.)

The author's extensive knowledge of the pathology, chemistry and physiology of diabetes mellitus enables him to give us valuable information in the dietetic, hygienic and The inmedicinal treatment of this disease. discriminate use of fixed diet lists or of drugs does more harm than good, but the author advises us to study and treat each case individually.

SALINE THERAPY. By Prof. D. Carl von Noorden. New York: E. B. Treat & Co., 1904.

The author reports a number of cases, suffering from an acidity, subacidity and hyperacidity of the gastric juice who received saline mineral waters, some of which were much benefited while others grew worse, depending on the cause of this symptom and the diet instituted. The chapter devoted to the effect on absorption of food, especially on the digestion of fat is very thorough, and proves that the use of mineral waters and a diet rich in fat are permissible, at times being highly beneficial to the patient. The same is true of fruits and vegetables. The diet must be regulated according to the diseased condition and the effect which certain articles of food have on the patient. This little book will be found useful to any one who is interested in the various mineral springs.

PATHOGENIC MICRO-ORGANISMS, INCLUDING BACTERIA AND PROTOZOA. A Practical Manual for Students, Physicians and Health Officers. By William Hallock Park, M.D., Professor of Bacteriology and Hygiene, University and Bellevue Hospital Medical College, etc.. assisted by Anna W. Williams, M.D, Assistant Director of the Research Laboratory. Second Edition, Enlarged and Thoroughly Revised, with 165 Engravings and 4 full-Page Plates. Philadelphia and New York: Lea Brothers & Co., 1905. (Cloth $3.75 net.)

This well-known work appearing in its second edition certainly represents a working manual of excellence in bacteriology for any one interested and working along these lines, whether he be student, physician or laboratory bacteriologist. The part devoted strictly to the pathogenic bacteria has been revised and brought up-to-date, facts submitted and conclusions drawn in the bright, concise and thorough manner so characteristic of that indefatigable and able worker and writer, Dr. Wm. Park, the author of this work. Park needs no introduction to our readers. To those of us who have seen his work in the New York Department of Health, as was the good fortune of the reviewer, the work in hand is a speaking and written likeness of its author. For those who have not had the pleasure of Dr. Park's acquaintance, a careful study of his work will give one an idea of his ability in this new-found science of bacteriology. The chapters on the Protozoa are of invaluable aid to those who have not had time or occasion to follow the recent litera

ture on this line. The study of the protozoa has received a new impetus in the last few years, particularly by the work of those on this side the Atlantic. The chapters on protozoa written by the able assistant director of the Health Department Laboratory teem with these new facts and discoveries. The work of Mallory and his followers on the protozooan-like bodies found in scarlet fever; the work by Theobald Smith on the tick of Texas fever; the study of trypanosomes in man, particularly the work of Schaudin on the spirochaeta pallida found in syphilitic lesions is given in extenso.

We cannot commend the work too highly; certainly it is the best that has yet appeared in our language, and compares equally wlll with any that has appeared in any language. R.B.H.G.

POST-NASAL ADENOIDS.-These growths are characterized by open mouth and vacant expression, a peculiar muffled voice; and by the appearance of a reddish-gray mass hanging down from the vault and obscuring the upper part of the nasal septum. The only treatment worth consideration is operative removal with curette and finger under cocaine or general anesthesia.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

PATHOLOGY AND BACTERIOLOGY.

goats.

R. B. H. GRADWOHL, M. D.

Intestinal Origin of Pulmonary Tuberculosis. A. Calmette and C. Gurein (Annales de l'Institut Pasteur, No. 10 Tome XIX, October 25, 1905) call attention to the fact that Behring claims that all cases of pulmonary tuberculosis seen in the adult are not infected through the respiratory tract, but are due to infection in early life through the intestinal canal. The writers determined to attempt a solution of this problem and consequently selected for their experimentation the kid as an animal easily susceptible both in young and adult life to the tubercle infection. Advantage in these experiments was taken of the work of Nocard, Rabieau and Schroeder who proved that it is easy to produce a tuberculous mammitis by injection tubercle bacilli directly into the mammary glands of As a preliminary measure, Calmette and Guerin injected goats with cultures of human, bovine, aviary and pseudo-tubercle bacilli. It was found that the injection of glands produced a rapidly fatal local mambovine tubercle bacilli into the mammary mitis tuberculosa, without extension of the lesions into other parts; that the human tubercle bacillus produced similar effects, not so pronounced however (many animals surviving the infection for a while); that the cultures of the pseudo-tubercle bacillus and the avian tubercle bacillus were comparatively inoffensive. Finally, these preliminary tests demonstrated that the differentiation between the human and the bovine bacillus could be made by comparison of the effects on these goats. The tests were then carried out by infecting pregnant goats and these tuberculous-infected mammary glands. allowing their young to be suckled from At the same time living cultures of the different varieties of the tubercle bacillus were introduced into the intestinal canals of fullgrown goats by means of esophageal hollow tubes. Typical tuberculosis was developed. The conclusions of the two writers were that in the immense majority of cases tuberculosis pulmonalis is not contracted by inhalation, but by ingestion, as has been so long contended by Behring. They reject the theory of Behring's that adult tuberculosis is the result of a latent and tardy intestinal tuberculosis developed in early infancy. They believe that adults are more easily infected through the intestinal canal than are infants,

better protected and yet milk from such animals may fairly swarm with virulent tubercle bacilli.

are

i.e., that the young are better protected through their early life by their ganglionic (mesenteric glandular) system than adults. They believe that it is easier for infection to travel from the intestinal canal through the blood and lymphatic systems of adults than of children. They believe also that the swallowing of sputum holding tubercle bacilli in adults means re-infection after re-infection, with absorption through the lymph stream, causing new foci to form in different parts of the lungs. For this reason they advocate that tuberculosis patients. should never swallow sputum, and that there should be a strenuous attempt made to keep the mouth clean and free from these bacilli after expectoration, particularly before eating.

INTERNAL MEDICINE.

O. E. LADEMANN, M. D.

Pavy's Test for the Percentage Estimation of Sugar in the Urine.-Sahli (Deutsche Med. Wochenschrift, No. 36, 1905) upholds the muchly disfavored Pavy method of sugar titration with the ammoniacal copper solution and proposes a modification which overcomes the technical difficulties heretofore entailed, namely: (1) The exclusion of air during the process of titration, necessitating an air tight fastening of the buret to the flask in order to prevent an oxidation of the colorless solution; (2) as a consequence of the gradual addition of the urine cuprous oxide will be precipitated by the removal of ammonium occasioned by the too prolonged boiling of the solution. The author discusses its application in the clinic, and for general practice, highly commending it as a simple, rapid and reliable method for the quantitative estimation of sugar in the urine, giving it preference to the methods of Sox hlet-Allihn, Lehmann's iodometrio titration, the areometric fermentation test, the polarimetric estimation or Lohnstein accurate fermentation saccharometer. Sabli prepares the ammoniacal copper solution as follows: No. 1.

The Pulmonary Lesion of Tuberculosis.M. H. Vallee (Annales de l'Institut Pasteur, No. 10, Tome XIX, Oct. 25, 1905) in a paper read before the International Congress of Tuberculosis, discusses the lesions and the methods of infection in pulmonary tuberculosis. He narrates a number of experiments made upon calves with bovine tuberculosis. Calves were treated with tubercle bacilli by direct injection into the trachea. It was found at autopsy on these animals that while local tuberculosis of the mucosa was brought about in every case by such injections, that the tuberculous process did not spread to the lungs, even though the secretion from the tuberculous areas in the trachea was carried down the bronchial tree and deposited in all accessible parts of the lungs. It was also determined by means of pulverizations of Crystalized copper sulphate... 4.158 grams

living virulent cultures of tubercle bacilli
into the naso-pharynx that while immense
caseous tuberculous lesions were produced in
the retro-pharyngeal glands, all other organs,
lungs, liver, etc., remained free from tuber-
culosis. Another series of experiments
wherein young calves were allowed to feed
upon the milk from a cow with tuberculous
mammitis showed that these animals con-
tracted tuberculosis of the lungs and peri-
bronchial lymph nodes, said infection taking
place through the intestinal canal. The mes-
enteric glands however, showed but very min.
ute changes. These experiments proved that
infection can take place through the intes-
tinal canal, afterwards reaching the lungs,
without producing any marked changes in
the intestinal mucosa or in the mesenteric
lymph nodes. The writer believes that adult
cases of tuberculosis are due to a tuberculous
infection through the intestinal canal.
points to the work of Rabinowitch, Mohler
and Moussu who showed that cows may have
tuberculosis of internal organs without any
manifestations of tuberculosis of the udder,

He

Distilled water...

...500 0.0.

20.4 grams 20.4 grams

No. 2.
Sodium potassium tartrate......
Potassium hydrate, C.P..
Aq. ammonia (S. G. 0.88)......300.0 c.c.
Distilled water, ad.....
...500.0 c.c.

Ten cc. of the combined solutions (5 cc. each), which exactly reduce 0.005 grams of sugar, are put into a flask of 75-100 cc. capacity to which is added 30 cc. of water, the addition of the latter being to prevent an early escape of the ammonia. The flask is gradually heated until it simmers on an asbestos gauze. Violent boiling is to be avoided. The urine, before placing in the buret for titration, is diluted fifty times its volume with distilled water. In diluting the urine it is better to use 10 cc. to 500 cc. of water than in the proportion of 1 to 50. tration is practiced until the simmering am. moniac copper solution is completely oxydized and the percentage of sugar estimated by the usual mathematical calculation. Sahli also emphasizes the necessity of the practi

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