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ter of the clear fluid withdrawn. Several other cases are on record where tapping had been attended with success, although it is not easy to see exactly why this was so.
Mr. Bernard Pitts mentioned the case of a girl who had been run over by a hansom cab. There appeared to have been some hæmaturia; and six weeks later a tumor was found, which was tapped and about thirty-one ounces of clear fluid withdrawn. The sac rapidly refilled, and massage was then resorted to, with the result of procuring ultimate arrest and diminution in the size of the tumor.
Mr. Walter Pye quoted the case of a man who had been wounded by a spear thrust, involving the kidney. About a fortnight later hydronephrosis developed, and was tapped; sixty ounces of a clear albuminous fluid being evacuated. There has been no recurrence. It was probably caused by plugging of the ureter with blood-clot, the result of the injury to the kidney.
Mr. Davies Colley recalled an incomplete but interesting case of hydronephrosis, attributed by the patient to the shock of a rail way accident. An action was brought against the railway company, and some division of opinion was elicited as to the influence of the shock in the production of the tumor. His own opinion was that a calculus had probably become displaced, and so caused the blockage.
Dr. Samuel West said that, to his mind, the evidence was inconclusive as to diagnosis of hydronephrosis, and suggested that some of the symptoms pointed rather to chronic peritonitis with effusion.
Dr. Lowe, in reply, said that plugging by means of blood-clot was a very probable cause, and that injuries to the kidneys, involving hæmaturia, were more common than might be supposed.
The case of “Narrowing of the Small Intestines," which Dr. Davidson reports in the Med. Press, was one of a boy, aet. 5, the constriction being organic, and the passage less than half an inch in diameter. The situation was barely an inch from the ileocæcal valve. It was probably caused by the appendix lying across the small intestine at this point, and so leading to a gradual narrowing of the bowel.
The child had no symptoms of obstruction till ten days before admission into the Infirmary, when constipation and vomiting commenced. On admission the abdomen was much distended, and tympanitic, pulse 120, temp. normal. He was treated with tinct. bellad., five minims every four hours, and small quantities of beef tea and barley water. The vomiting ceased soon after admission, and bowels acted the same evening. The child continued to improve, but suddenly, a fortnight after admission, was seized with symptoms of acute peritonitis, without any apparent cause, and died the same night. At the post-mortem a perforation of the bowel was found close to the stricture. In this case the cause of the obstruction could not have been diagnosed during life, nor could any operation have relieved a stricture so close to the cæcum.
The Med. Record says that Dr. Assaki states that it is possible to replace a portion of a tendon an inch or more in length by a similar piece taken from another animal. When this operation is performed under antiseptic precautions union takes place in about a week, without any impairment of function of the tendon, which glides in its sheath normally, unrestricted by adhesions. He has made successful transplantations, not only from one animal to another of the same species, but also from dogs to rabbits, and the reverse, and even from birds to mammals. Subsequent examination of the animals operated upon showed complete union of the sutured tendons, the only trace of the operation being an increased vascularization of the tendon sheath. The author argues that the operation ought to be equally successful in the human subject. In his experiments the transplanted portions were united to the divided tendons by catgut sutures, and strict antisepsis was maintained.
The question of the propriety of (Esophagotomy for foreign bodies lodged in the tube is ably discussed by Dr. T. M. Markoe in the New York Med. Journal (May 1), who concludes from the premises given that he would deduce the following surgical rule : To attempt the removal of foreign bodies impacted in the csophagus as soon as proper instruments can be procured, and failing, after a fair and sufficient trial, to proceed at cnce to the operation of esophagotomy.
With reference to the treatment of intestinal obstruction Dr. H. Illoway, of Cincinnati, in a paper in the January nuniber of the American Journal of the Medical Sciences, advocates the employment of enemata administered with sufficient penetrating power to pass beyond the ileo-cæcal valve and into the small intestines, and to produce peristaltic action. He advocates the use of the force pump, and claims, first, that enemata thus administered are superior to every other method of treatment in the rapidity with which they either relieve the symptoms or clearly indicate the necessity of surgical interference; second, that they are entirely free from all danger, and in no way prejudice the case should a surgical operation become necessary.
During the past year I have used the force pump in complete intestinal obstruction in three cases where I had been called in by the medical attendants for the purpose of performing laparotomy as a last resort, effecting complete relief in each case.
The tube of a stomach pump after being well oiled was cautiously introduced into the bowel about thirty inches and the intestines moderately distended with a solution of carbonate of soda. A concentrated solution of tartaric acid was then injected, the pump disconnected and the thumb placed over the end of the tube to be used as a safety valve if the pressure from the gas generated should endanger the walls of the intestines.
The obstructions were almost immediately removed but convalescence was slow in consequence of the local inflamation which existed at the place of obstruction.
At a recent meeting of the New York Surgical Society, Dr. A. D. Stimson exhibited a patella which, having had occasion to divide he had subsequently united by a catgut suture, but whether one more he was unable to say. Union ensued without suppuration. About four months latter, however, it was found necessary to excise the same knee-joint, and this afforded an opportunity of examining the patella, which was also removed. The line at which the bone was originally divided was practically invisible, and the specimen clearly demonstrated the capacity of catgut to retain the fragments of a divided patella in such apposition that firm body union may result. In this case, however, the circumstances were immediately favorable to union; the fracture was clean and new, and was quickly united, whereas in ordinary examples of the injury encountered by surgeons neither of these conditions is likely to exist. In Dr. Stimson's case it is not unlikely that any method adopted for keeping the fragments closely applied might have been followed with precisely similar successful union, the wound being really united by first intention, and organization proceeding to the extent of
osteogenesis. The author of the account expresses much regret for his omission to make special note of the number of catgut sutures employed—whether one or more—but it really would seem that this is of little importance, for the same general result would be obtained whenever a fractured patella is forthwith placed under the conditions mentioned, whether by suture or otherwise.
Goitre is discussed, as the writer saw it in the Himalayas, in the March number of the Dublin Journal of Medical Science. Beginning with a glance at its geographical distribution, which includes not alone large portions of these mountains, but also Thibet and Bhootan, and such remote religions as Yarkand and Kashgar-in other words, all the table lands of Central Asia,- Dr. Curran describes the treatment that is resorted to for it on the spot, and shows that this consists mainly, if not exclusively, in a very free use of the moxa. Illustrations in point are given, and our author asserts that the people are firm believers in its efficiency. He then discusses the etiology of the complaint, and setting aside as improbable or unproven the ice-water hypothesis as well as the weight-on-the-head carrying theory, as he calls it, he ascribes it to the secluded lives and impoverished surroundings of these poor people. He ascribes it, in a word, to heredity, breeding in-and-in, and especially to the “poor monotonous vegetable dietary” to which their “poverty rather than their will consents." Whatever we may think of this hypothesis, it has the undoubted merit of meeting all the requirements of the case, as these are seen or can be studied on the spot, and the paper will otherwise raise the repute of its author. We strongly commend the perusal of it to our readers, as well as to all who take an interest in the pathology or diffusion of this obscure malady.
In a meeting of the Petersburg Medical Society, Dr. B. M. Schapiro, recently delivered a lecture on tne treatment of neuralgia by subcutaneous injections of osmium acid (St. Petersburg Medical Weekly Journal, 26, 27, 1885). He first mentioned the observation of Frænkel, that the acid exerts a disturbing influence on the substance of the nerves and muscles, and greatly diminishes their activity. In nerves an epineuritis develops, which compresses the fibres, while in muscles an interstitial inflammation soon leads to atrophy of the muscular tissue. Living nerve-fibres assume under the influence of the drug a black tint, while the neighboring tissue becomes denser, and motor nerves situated near occasionally suffer decidedly in consequence of these injections, a fact to be well noted.
Dr. Schapiro studied the eftect of the acid in eight cases of neuralgia of the fifth nerve. The pains attacked all branches of the nerve, and all cases were obstinate and of long duration. The result was a complete cure in five cases (62-5 per cent.), in two cases a decided improvement, and in one case no effect whatever. The two greatly improved cases were of the most violent and obstinate nature, and the want of success of the most severe therapeutical procedures warranted the belief that the nerves had undergone an incurable morbid change at their origin.
The following solution was employed by Schapiro for the purposes of the hypodermic medication: R Acidi osmici, 12 3 grains.
Aquæ destill, 113 fluid drachms.
Glycerin. pur., 1 fluid drachm.
This solution, according to Schapiro can be kept in a good condition for two or three weeks, a fact of importance if one takes into consideration the high price of the drug, while the simple watery solution is decomposed within a day or two. The number of injections in each individual case varied from one to twelve: in the beginning five drops, and later a slightly increased quantity was employed. In every case where the injection was made into the tissues directly over the seat of the pain perfect analgesia developed, but the pain occasionally. then attacked neighboring branches of the same nerve, which before had not been painful. Other deleterious effects were never observed by Schapiro, but one lady, highly nervous and subject to epileptic fits, fainted immediately after the injection.
In cases where all other therapeutical procedures seem to be without effect, or where the intensity of the pain necessitates immediate relief, the hypodermic application of osmium acid may, therefore, well be worth a trial.
Neisser (German Medical Congress in Strasburg) investigated 143 cases of gonorrhea, which had existed for more than a year, in respect to their contagiousness. In more than half of these, the urethra had been irritated by repeated injections of 1:20,000 sublimate solutions. Quadrate heaps of gonococci were found in the