(3) The irritation of abraded or fissured nipples. (4) When constant attempts at suckling are made, and either the gland itself secretes feebly from its own imperfect development, or the mother's blood is deficient in milk-forming materials, localized hyperemia is apt to be induced, and eventually end in deep ab scesses. Surgery. SPEEDY CURE FOR NASAL POLYPI.-Dr. solutely irregular in arrangement The a writing desk, etc. valvular system of the lymphatics differs according to the calibre of the vessels. In the most minute there are but complete or partial constrictions not projecting into the lumen, and only serving to slacken the lymph current. In the largest vessels perfect valves are found, all opening in one direction; some are placed at the extremity of a dilatation; some across a dilatation; some few in an undilated segment of a vessel. But the constrictions are far more common than the valves, even in the large lymphat- Caro (Med. Record), says that the injection ics, where they are often oblique, giving into a nasal polyp of five or six drops of the tube an appearance as though it was spi- pure acetic acid, by means of a hypodermic rally twisted on its axis. The constrictions syringe, is followed by the sloughing of the are sometimes double and sometimes close same, and entire removal within from three to to a true valve. Between the endothelial five days. The offensive odor arising from the cells of these vessels he often found small decaying mass is readily corrected by a carspaces. These were outgrowths from the bolic or other disinfecting wash. Dr. R. cells which had pushed in the borders of neighboring cells. The invaded borders had gradually met round these outgrowths, cutting them off from their parent cells. The subserous lymphatic vessels communicate with those in the muscular layer, from which, and never from the sub-serous vessels directly, the main trunks collect and run into the broad ligaments. Into these trunks the sub-mucous uterine lymphatic vessels also empty themselves. Hence the communication between the sub-mucous and the sub-serous lymphatic plexus is very indirect. Harrison reports in the Brit. Med. Jour. excellent results in the removal of polypi by applying rectified spirit as a spray. Dr. Miller, in the same journal, reports similar success by the same method. A preliminary puncture of the polyp seems to render the treatment more effective. VALUE OF THE DEPENDENT POSITION OF THE HEAD IN OPERATIONS ON THE MOUTH AND THROAT.-Dr. Thos. Annandale (Lond. Lancet), calls special attention to the above. Eighteen months since, when removing the greater part of the lower jaw, including its MAMMARY ABSCESS-ITS CAUSES.-Dr. W. symphysis, he allowed the patient's head to A. Jamieson (Lond. Obstet. Jour., Nov., fall over the edge of the table. Although 1879) gives the following as the usual causes the tongue immediately fell back towards of mammary abscess occurring a few weeks the posterior wall of the pharynx after the succeeding parturition: (1) Distention of attachments of the tongue to the jaw had the milk ducts due to some obstruction to been freely divided, the man's breathing was the free secretion of milk deeper than the perfectly easy-much more so than when nipple. This is often produced by exposure the head was raised or lay level with the to cold ere the system has become accus- trunk. In his next operation for thyrotomy, tomed to the new demands made on it for he placed the head in the same position, the performance of lactation. (2) Imperfect with like satisfactory results. Operations development of the nipple itself, the nipple for tumor, cleft palate, etc., have likewise being retracted or malformed, or either demonstrated the advantanges of wholly or partially impervious to the milk method. formed in the gland. This atrophic state may be due to (a) abscess of the mammæ in early infancy, the subsequent condensa EXTRAORDINARY TENACITY TO LIFE.-The tion having choked up the nipple.; (b) long- Boston Med Jour., reports the following: A continued moderate pressure upon the nipple boy about fourteen years of age had his craduring early womanhood by hard, ill-fitting, nium almost cut in two by a circular saw, and, or tight stays, or dresses too narrow across although the brain was nearly severed to the the breast; (c) pressure of the nipple against base, he still lives. The wound commenced this He has the head hang over the edge of the table and supported by the hands of an assistant. Puerperal fever set in, accompanied by peritonitis. From the 27th of June, the patient's condition began to improve. July 17th, she commenced to menstruate and July 20th she was dismissed, well. near the right nostril and extended upward as it attained the inner surface of the abdomand backward for a distance of eight inches inal parietes on that side. The child was a through the head. While the patient was female. being carried to the hospital a comatose condition came on, which was however of short duration, but which was followed by partial paralysis of the left arm and left side of the face. Since then the patient has been at times perfectly conscious and at times delirious, while he has sometimes suffered a good deal of pain and again has been apparently free from it. On the second night after the injury the paralysis extended to the left lower extremity, the pulse began to fail and he seemed to be sinking rapidly, but afterwards he again rallied and at last accounts was still living. GUNSHOT WOUND OF UTERUS: BULLET TRAVERSES A SIX MONTHS' FŒTUS; RECOvERY OF PATIENT IN FOUR WEEKS.-Dr. G. A. B. Hayes, (N. O. Med. and Surg. Jour., Oct., 1879). The doctor was hurriedly summoned June 20th, 1879, to Magnolia Plantation, six miles distant, to see Mary Wash ington, colored, aged 18, married, six months' pregnant, primipara, suffering from a gunshot wound of abdomen received that morning. The overseer had fired a pistol shot at some hogs in the corn field; the ball had ricochetted from the hard, dry field road and, wounded the woman who was standing concealed behind a clump of tall alder bushes sixty yards distant. The ball (weight, 136 grains), had entered the abdominal cavity on the left side, about two inches diagonally in front and above the ant. sup. spinous process of the ilium, ranging upwards and had lodged within the abdominal cavity. CONGENITAL ABSENCE OF RECTUM.-Dr. A. L. Carroll (Med. Record, Dec. 13, 1879), from a consideration of the above topic, concludes: (1) In congenital malformations of the rectum, exploration from the perineum should always be first essayed, and by preference, with the trocar. If occlusion consists of a simple membranous septum, it need only be incised crucially with a probepointed bistoury. If the intestinal pouch be sufficiently near to the surface, the track of the trocar should be enlarged by the knife and an endeavor made to bring the mucous lining down to the external wound. If, how ever, the interruption of continuity be too great for this proceeding, we should be content with dilatation of the fistulous passage, although with small chance of prolonging life beyond a few weeks. (2) In case of failure to find the bowel with the trocar, a forlorn hope may be sought in colotomy. And here, in view of the probability that the arrest of development has occurred at an early stage, I should choose the right lumbar region as the site of operation. (3) Where the deficiency of the rectum involves a considerable part of its course, the prognosis is almost hopeless, whatever method of operation be adopted. TREATMENT OF WOUNDS.-C. B. Miller, M. D., (Cincinnati Lancet and Clinic, Nov. 29th, 1879), says: Almost the only examples. of immediate union are those (of cuts) more or less exposed to the air. To what, then, is the success which has attended Mr. Lister's method due? I have no doubt that it Well-marked labor pains came on about sunrise, June 21st, and shortly after 11 A. M., the fœtus, placenta and membranes were expelled simultaneously with a very slight gush of waters when the membranes were ruptured. Uterus contracted well, not more than two ounces of blood being lost. Examining is principally "to keeping it dry, protecting, the fœtus for the pistol ball, the doctor found and disturbing as seldom as possible." that it had penetrated beneath the left scap- Without heat and moisture there can be no ula, ranged diagonally through the trunk, a such thing as decomposition. While we distance of about three inches, and made its have been enjoined to guard against septic exit in the right hip. Careful search could germs in the air, we have been instructed to not find the ball either in the placenta or flood our wounds with water-much more among the coagula, and hence the doctor con- likely to contain them. It is not, however, cluded that it had traversed the uterus, and on this latter probability that we base our as it could not be felt externally on the right objections so much as on another, that by its side, that its course had been arrested just use the plastic material for their healing is diluted, washed off, or destroyed, and an ele- when it is due to congestion of the vessels, ment indispensable to decomposition sup- and then only when the circulation is not plied. If this be true, we can, by treating completely arrested. (d) Opium, which by the dry method-heretofore advocated acts indirectly in paralyzing the abdominal by myself, though somewhat earlier by Mr. muscles. (e) Emetics act probably by upGamgee, Surgeon to Queen's Hospital, ward traction. (f) Purgatives, like emetics, Birmingham-dispense with the extensive do harm when unsuccessful; they act probparaphernalia for destroying imaginary ably by producing anti-peristalsis. (g) Togerms in the atmosphere and carrying out the antiseptic treatment. To carry out this plan of the dry treatment of wounds it is imperative that water be rigidly excluded from the wound during an operation and throughout the treatment. When operating, if soft, dry cloths cannot be had to absorb the fluids, the sponges should be washed in carbolized water and squeezed as dry as possible. Dry lint or cotton, only, should be used for cleaning the wound afterwards, while the dressings should be made as seldom as practicable, the parts kept at rest, and a firm, equable, but gentle pressure maintained. bacco and other enemata cause general muscular paralysis. (h) Postures in which the viscera are dragged towards the upper portion of the abdominal cavity are directly useful. INDICATIONS AND COUNTER-INDICATIONS FOR OPERATIONS IN INDIVIDUALS SUFFERING FROM CONSTITUTIONAL DISEASES.-Prof. Ver neuil (Brit. Med. Jour.), in an address be fore the International Medical Congress, developed the following points: (1) Surgical operations are not formally counter-indicated tutional diseases. They may be performed in individuals who are affected with consti under such circumstances as often to render POSTURE AS A MEANS OF RELIEF IN them useful, and even in some cases very STRANGULATED AND INCARCERATED HERNIA. necessary. (2) Their prognosis is much more -Dr. F. H. Hamilton (Hospit. Gazette) con- serious than in healthy individuals. It is cludes an interesting paper upon the above less certain and more difficult to make, for subject as follows: (1) Hernial apertures we have no clue whatever as to the favorcan seldom be relaxed or opened by any able or deleterious effect that the traumatic measure other than a surgical procedure. lesion may have on the general health of the The apertures do not but with rare excep- patient; neither can we judge in what way tions actively compress the protruding vis- the disease will affect the local process of cera; the viscera, however, become con- healing. (3) The prognosis varies according stricted by pressure against the apertures. to the different constitutional diseases, and Relaxation of these apertures is not, there- for each of them considered individually. It fore, ordinarily a part of the mechanism of the varies also according to the degree of the alrelease of a strangulation and of the return terations that have taken place in different of the viscera. (2) Taxis or pressure from parts of the body. (4) The danger attached without, judiciously applied, is first in to the diathesis is not great as long as it is point of importance as a means of reducing still confined within the boundaries of dysstrangulated hernia. Inward traction, judi- crasia. It increases considerably with the ciously employed, is only second in import- manifestation of chemical and histological ance to taxis. It is affected indirectly by lesions. It becomes alarming when the prinparalysis of the abdominal muscles, through cipal viscera-such as the liver, kidneys, the agency of posture or of general mus- spleen, heart, lungs are extensively affected cular relaxants, and by emptying the bladder by sclerosis, steatosis, amyloid degeneration, and lower gut. It is effected directly by phlogosis, or when they present pathological peristalsis, anti-peristalsis and gravitation products that belong specially to certain diathrough the agency of posture. As to the thetic conditions-e. g. tubercles, gummata, means employed, the following are given: carcinomata and various neoplasms. (5) (a) Emptying the bladder and rectum and We are not justified in depriving diathetic. distracting the attention of the patient. (b) individuals of the benefit of surgical interChloroform, bleeding to syncope, or the hot vention, even in cases where it might be bath to syncope. (c) Ice as a local applica- dangerous. It must be the aim of the praction can only relieve the button holding titioner to render the prognosis less serious The ized eye-ball, the result of an old injury. and to assure the success of the operation. DEATH FROM CHLOROFORM.-Mr.H.H.RobHe will succeed in doing this if he be very inson (Brit. Med. Jour.) reports a death careful about choosing the best method for from chloroform at the Hull General Infirmperforming it and applying the most efficient ary. The patient, a powerfully-built coundressing. He will also do well in putting try laborer, was admitted with a disorganthe patient under a hygienic, dietetic, pharmaceutic treatment--in a word, under a medical treatment which is well adapted to the constitutional disease. (6) The practitioner must be thoroughly well acquainted with the etiology, pathology, development, the end and the medical treatment of constitutional diseases in order to make sure of the indications or counter-indications for the op. erations. In this way he will be better able to judge whether he had better perform the operation or not, and to calculate with more or less precision what the chances may be. judged, the patient had not inhaled any of the A knowledge of these conditions, which, vapor for three or four minutes previous to perhaps, all surgeons do not possess to a the cessation of respiration. When the adsufficient degree, would tend rather to pre- ministration ceased the pulse was a fairly vent surgical operations than to encourage good one. Post mortem examination them, and would inspire the operator with a threw no light on the cause of death. higher degree of confidence in the efforts of nature, supported by a comparatively mild therapeutic treatment. (7) A conscientious Ophthalmology. SCLEROTOMY.-This is a term applied by examination of the immediate or future effect Wecker to an operation for the relief of of operations performed on individuals under some constitutional diathesis, will tend to land Med. Society, 1879) describes it thus: glaucoma. Dr. A. J. White (Trans. Marydestroy many of our illusions respecting the It is nothing more nor less than the usual power of surgical art. It is sad to say that puncture and counter puncture made in catcomplete and lasting favorable results are aract extraction with Graefe's knife without very rare. There may be many successful finishing the section. This puncture and operations, but the therapeutic results may counter puncture should be made at the upper and lower part of the cornea parallel to the horizontal diameter and as far back in be far from successful. A manifestation of the diathesis or some intercurrent affection may be suppressed, but frequently the con- the irido-corneal angle as possible, so as to stitutional disease increases in force and rapidity. Many patients suffering from penetrate deeply into the trabecular tissue of this angle, and thus open the closed cancer and scrofula would live longer if they canals. For this purpose Wecker has prehad remained under medical treatment inpared a modification of Graefe's knife, with stead of passing through the hands of the blades from two to four millimetres broad surgeon. (8) It is only just to add that al- and having lance-shaped points. He always though the aforesaid operations are more frequently attended by palliative than by eserine before and after the operation, uses a one per cent. solution of sulphate of curative results, nevertheless they are some- Special indications are claimed for this opertimes extremely useful. In extreme cases ation when we are dealing with a hæmorthey may prolong life, render it less hard to bear, and give the patient at least a gleam of hope. In less serious cases and where the constitutional disease may be successfully treated, the operation has a good effect upon the treatment by allowing the medical man to gain time, suppressing an immediate cause of danger and giving the therapeutic treat ment greater scope. rhagic glaucoma, or with absolute glaucoma. In the former case we avoid danger of hæm orrhage, and in the latter diminish recurrence and Manthuer endorse and recommend this of pain, without mutilation. Kniess, Weber operation as a substitute for iridectomy. KERATITIS TREATED BY NITRATE OF SIL VER.-Dr. Geo. A. Berry (Edinburgh Med. Otology. VALUE OF ATROPIA IN THE TREATMENT OF ACUTE INFLAMMATIONS OF THE MIDDLE EAR. Jour., November, 1879) gives us an account center of a circumscribed abscess or infilof the results obtained at the Copenhagen trated ulcer, the eye being meantime fixed Clinic in treating keratitis with nitrate of to insure its correct application. The imsilver. The two methods employed are (a) provement which takes place in all of these the application directly to the cornea of a cases is, as a rule, exceedingly rapid and apstrong solution of nitrate of silver (grs. x to parent, and the pain, during the cauteriza3j) and (b) the actual cautery. Many cases of tion insignificant and afterwards nil. suppurative keratitis, which have resisted the ordinary means of treatment, improve rapidly after the application of a two per cent. solution applied quickly over the cornea with a camel's hair brush once daily for Dr. Theobald (Amer. Jour. Otology) says two or three days. But there is one class of that he has found the use of atropia very cases in which this treatment is invaluable, valuable in allaying the pain dependent viz., in incipient suppurative infiltration of upon furuncular and diffused inflammation the corneal wound after cataract extraction. of the external auditory canal, and possibly Dr. Hansen says that, whilst with compres- in shortening the inflammation itself. It sion, alternating with poulticing, local appli- has, however, proved most efficacious in the cation of quinine, etc., he has scarcely ever cutting short of acute otitis media, especially succeeded in arresting such a suppuration when resulting from colds in young chiland preventing its transition into panoph- dren, or following the exanthematous fevers. thalmitis, he has very frequently successfully He uses the medicine in solution, four grains combatted this danger by the use of nitrate of silver in solution. Such suppurative infiltrations, which undoubtedly imply infection of the wound, begin generally thirty-six to forty-eight hours after the operation, the first sign being a milky appearance in the neighborhood of the incision; otherwise everything appears as yet perfectly normal, but the upper eyelid soon becomes the seat of an edematous swelling, giving rise at the same time to a thin secretion, which escapes on opening the eye. Then follows dimness of the aqueous humor. If immediately after the to an ounce of distilled water. Eight to ten drops of this are warmed, dropped in the ear and allowed to remain simply by position of the head from ten to fifteen minutes, and repeated every three or four hours, according to the severity of the symptoms. It seems, from the clinical evidence, that the drug both relieves the pain and cuts short the disease. GENERAL PATHOLOGY OF EAR DISEASES. Dr. P. Field (Lond. Med. Record) points out the analogies between diseases of the ear and those of similar tissues in other parts of the body. The tissues of the external ear are composed of skin, sub-cutaneous cellular tissue, fat, muscle, yellow elastic fibro cartil age, and some fibrous tissue. Of the diseases of the skin of the external ear, we have erythema, eczema, psoriasis, pemphigus lupus, ichthyosis and purpura. Here, as elsewhere, we must look for a local or con commencement of this abnormal secretion we boldly brush the nitrate of silver solution over the wound, the secretion, as a rule, dimin ishes at once; generally, it is necessary to apply the solution twice daily as the secretion, after the lapse of a few hours, begins again to increase. This treatment does not prevent the infiltration, but it spreads slowly, and generally ceases after a few days. Often one cannot prevent the extension from the corneal infiltration of a mass of exudation over the pupil, which seldom becomes so completely absorbed as to render an after operation unnecessary; but the eye is saved, and there remains the possibility of attain ing vision by a second operation, which may In the externa] even be sufficiently acute to permit of the meatus we have condylomata and epitheliopossibility of reading. The actual cautery is mata as about the lips. The skin of the used in the form of a knitting-needle heat- meatus is subject to the same diseases as ed to redness in a spirit lamp, applied to the that of the auricle. The outer half of the stitutional cause, or both. The sub-cutaneous cellular tissue may become inflamed from injury or erysipelatous poison. Of new growths of external ear we have from the sub-cutaneous fatty tissue, fatty tumors; from fibrous tissue, fibrous tumors; from the blood vessels, large nævi; from the cartil ages, hæmatoma auris. |