ABSTRACTS AND EXTRACTS. SURGERY. OPERATION on the BRAIN for the RELIEF OF At che meeting of the PathologiLEFT HEMIPLEGIA. cal and Clinical Society of Glasgow, on January 21st, Dr. Macewen showed a patient whose brain had been operated upon for the relief of left hemiplegia, and who has recovered the power of movement to such an extent as to enable her to walk freely about, though with a paraplegic gait ; to raise her arm to the level of her shoulder, and to grasp with considerable power, though there is a deficiency in co-ordination of movement of the hand. She had a syphilitic history. The hemiplegia was preceded by a tingling sensation and a numbnessof the left arm and leg, which increased until it ended (within six weeks from the commencement) in complete motor paralysis and a deficiency in the perception of touch. The left side of the face was also slightly affected. This was accompanied by mental confusion and of memory. ?
joss
Full anti-syphilitic treatment had been tried along with counter-irritation to the head, previous to her coming into the Royal Infirmary, and while she was in the medical wards of that inTh?se did not seem to have relieved in the slightest stitution. the condition spoken of above.
Trephining was performed over the middle of the ascending Internal table of the disk frontal and parietal convolutions. removed was found softened and thicker than usual, having a series of projections or roughnesses, on its internal surface some protruding for nearly one-eightli of an inch beyond A second level. the general opening was made over the occipital region, and a similar thickening of the internal table was found. Opposite to the first opening the dura mater and somewhat thickened. It was was paler than normal, elevated, and a false membrane of yellcw colour, and about inch in thickness, was removed. one-sixteenth of an An incision was made into the brain in the direction of the paracentral lobule, when a gush of grumous red-coloured fluid escaped Its quantity was not measured, as it could out of the opening. been collected. not have Aproximately, there would be The brain pulsations previously about a couple of drachms. were not discernible, but, after the escape of this collection of fluid, it was thought that very feeble pulsations were seen. Some of the surgeons standing by doubted the presence of The disks of bone were carefully the cerebral pulsation. divided into segments and replanted, and are now quite firm. Wounds treated without pus production. The day after the operation she expressed herself as very On the third day she moved her toes. Within much better. a week she lifted her leg from the bed and stated that she was so much better that she could turn in bed, and believed she could walk. The fingers were moved within a week. Her mind greatly changed for the better, her memory improving and her intelligence becoming much brighter. She can now walk freely about, and does a considerable amount of domestic duty in the ward. She lifts her arm to the level of her shoulders, and can grasp with considerable force. Dr. FlNLAYSON said that he had lately had the opportunity of seeing this case, at Dr. Macewen's request, in private, and he thought that there could be no possible doubt that the improvement which had taken place was due to the operation. It is known that in such cases as this, remarkable improvements do take place as the result cf purely medical treatment but in this case it is certain that the improvement was due to the operation. This method was quite a new one, and depended greatly upon the advances that had in recent years been made in cerebral localization. It was quite different, too, in its nature from operations on brains injured by violen;e. Although the case shown to-night was a very successful one, yet advance in such a procedure could scarcely be with-
expected
*78
out
a
THE INDIAN MEDICAL GAZETTE. certain number of
February, 1884.
misfortunes.?Glasgow
Medical Journal?
On Dec. ioth the patient again presented herself with a local recurrence of three weeks' duration, but otherwise in good health. This recurrent growth was removed on Dec. 14th, and was found, on reflecting the skin, to occupy the gap between the fifth and seventh ribs, to involve the pleura, and to In tearing down be adherent to the lower lobe of the lung. these adhesions the whole lung collapsed, exposing to view the pericardium and diaphragm. Owing to the dyspnoea which naturally ensued, the chloroform was abandoned. KroNLEIN then observed that there was a secondary nodule, the size of a walnut, projecting from the lung itself. He accordingly brought the organ up to the level of the wound, cut out the nodule with scissors, and arrested the hemorrhage, which was but scanty, by a catgut ligature around the margins of the wound. The pleural cavity was washed out with salicylic solution, the outer wound closed by sutures, a drainage-tube inserted, and iodoform gauze and salicylic bandage appliedAt the end of three weeks, and on the fourth dressing, cicatrisation was complete. He was astonished at the small amount of exudation from the pleura, and the rapidity with which the lung unfolded and the signs of pneumothorax disappeared. The temperature only reached 38'2? C. (1007? F.) on two evenings, being at other times normal. The pulse and respiration rose to 140 and 60 respectively after the operation, but fell to normal in a fortnight, and on her discharge from the hospital physical examination showed normal but weak breath-sound over the lung, and impaired resonance atjthe seat of operation, which also was slightly retracted with inspiration.
intention.
FORCIBLE DILATATION of the ORIFICES of STOMACH : RECOVERY.?On the 15th of March Professor Loheta forcibly dilated the cardiac orifice in the
the
a , Surgical Clinique of Bologna. The patient, E. L. young woman aged twenty, had for four years manifested all rational and the symptoms, direct, of ulcer of the stomach. For the last twelve months constriction had steadily increased ; at first solids, and then liquids, entered the stomach with difficulty, so much so that only a few drops of broth could be swallowed at a time. Regurgitation of substances swallowThe body wasted rapidly, and life could ed became the rule. only be maintained with nutritive enemata. Having diagnosed stenosis of the cardiac orifice, Professor Loreta proceeded to dilate it. He opened the abdomen in the linea alba, and found the stomach thick, small, and contracted. He incised it freely, "and passed an elastic sound through the cardiac orifice to make way for his dilating instrument. This the obstacle, in spite of efforts to vomit, and soon overcame the oesophagus was found much dilated. The apertures in the stomach and in the abdominal wall were sutured separately. The operation was performed under chloroform in thirty minutes ; and the patient, so soon as she had recovered from the narcosis, to the great surprise of the onlookers, swallowed three spoonfuls of water with perfect ease. Professor Loreta has favoured us with an obliging note, of ninth this his case, stating that the patient has completely recovered (" ora trovasi completamente guarita.")?Lancet,
We quote this case in detail because it indicates a line along which surgery may perhaps advance, for it shows that tumours of the ribs may be excised, and even pulmonary growths also, with impunity. Whether Dr. Kronlein has succeeded in removing the whole disease is another matter. It is more than likely that he has not ; but there can be little doubt that by his boldness he has prolonged life. Cases such as this are 'probably the only ones in which resection of the lung is justifiable ; yet, in spite of this success, we doubt if surgeons in general will care to extend their operations upon this organ beyond the limits afforded by incision of suppurating cavities.?Lancet, March 8.
April.
*
????
Bimanual
Detection and Removal of Stone in Children.?Mr. Hugh Smith, in the Brit. Med. Jour., July 21, p. 126, reports a case under Mr. Churchill, at the Victoria Hosptial for Children, of a child, aged 9 years, who was suspected to be suffering from a vesical calculus. The patient being under chloroform, it was decided to determine the shape of the calculus by rectal examination. This being done, Mr. Churchill proceeded to remove the stone by the usual operation of lateral lithotomy, binding difficulty in extraction with the forceps, and also with the scoop, Mr. Churchill decided to extract the stone by manipulation. The left index finger was introduced into the bladder, and the calculus (a conglomerate mulberry one?weight, 280 grains) was hooked by the finger straight from the fundus to the neck of the bladder. Mr. Churchill then introduced the right index finger into the rectum, and, by cautiously removing the left index finger, which fixed the stone, the calculus was tilted up and pressed through the opening into the bladder, and then through the external
swelling would
SUTURE OF ULNAR NERVE Six: Months after Division.?Mr. H. Page, in the Brit. Med. Jour., June 18S3, p. 1223, reports a case of a man, aged 25, who received a severe wound from glass on his left wrist, which took a long time to heal, and left a very painful cicatrix, as well as loss of power in the ring and little fingers, with wasting of the thenar and hypothenar eminences, and the interossei muscles. The patient was anxious for relief, and accordingly Mr. Page cut down on the site of the ulnar nerve, discovering the separated ends after The upper end was not enlarged, and a transsome difficulty. verse section of it, when freed from the cicatrix, showed the of healthy nerve. The lower end of the upper appearance portion was swollen to about three times its natural size, and ended in a firm bulbous nodule, which was bound in cicatricial tissue. From this it was dissected, and a third of an inch had to be removed before the section looked natural. The ends of the nerve were joined together eventually by three fine catgut sutures, and the wound healed by first intention. Within three weeks sensation had decidedly improved, the cicatrix was free from pain, and some power of extension had returned. The patient, however, was treated with galvanism and the faradic current for about eighteen months, and eventually recovered perfect strength and use of his hand. A very large series of cases in which suture of the divided nerves was followed by cure may be consulted by reference to sect. 1248 : 2 of the Medical Digest.?Loud Med. Reed. its
incision.
ELEPHANTIASIS, ARABUM Cured isy Ligature of the Femoral Artery.? In view of the fact that the successful operations, both in this country and in Europe, for the cure of this most obstinate disease of the lower extremity, by ligation of the femoral artery, are few, and because of the apparent propriety of resorting to this last method before amputation becomes an imperious necessity to save the life of the patient, the successful case operated upon by Dr. G. C. E. Weber, and reported in the January number of The American Journal of the Medical Sciences, has considerable interest. Thirty days after the operation the limb had diminished in circumference nearly one-half, and at the end of six months the patient reported that he suffered no inconvenience whatever from his limb, save that upon unusual exertion a slight cedematous
[June, 1884.
.
supervene.
SURGERY?Partial Resection of Kronlein of Zurich, in a paper in the Bet liner Wochenschrift of March 3rd. upon this subject, rightly judges that surgery goes too far in extending her operations to the phthisical lung ; but he shows in the case upon which he did resect a portion of lung what is possible in another form of disease. The case was one of a sarcomatous tumour of the rib in a young woman. The growth sprang from the sixth rib on the left side, and was about the size of a child s head, and on was periosteal, June 26th, 1883, he removed the tumour, which and afterwards resected a portion (nine centimetres) of the rib. The wound was dressed antiseptically, and healed by first
PULMONARY
Lung. Klini
'ker
Dr.
PARTIAL RESECTION OF THE PHARYNX and (EsoCancer.?At the meeting of the Royal Academy of Medicine of Turin held on the 8th of February, Professor Novaro presented a woman, aged forty-five, from whom he had removed, for carcinoma, the upper part of the oesophagus and the lower part of the pharynx, to the extent of two inches and three quarters. At the date of operation (Sept. 3rd, 1883) phagus for
the
patient
could
only
swallow
liquids
with
difficulty.
She
able, when presented to the Academy, after the lapse of five months, to swallow solids. She was then in good health, was
and
presented
no
traces of recurrence.?Lancet,
April
19.
ABSTRACTS AND EXTRACTS.
June, 1884.] THERAPEUTICS
& PHARMACOLOGY.
The Action of SALINE CATHARTICS.?Dr. Mathew Hay concludes a report of his investigation regarding saline cathartics (in the Journal of Anatomy and Physiology) with certain
statements, intelligent
a regard for which would conduce to the more It will he exhibition of this class of cathartics. seen from these conclusions which we subjoin that there is no property in saline cathartics which warrants their administration for other than the temporary effect of cleaning out the alimentary canal. They all tolerably closely agree in the ultimate effect which they have on the alimentary canal and the body generally. They cause no irritation or inflammation of the canal; stimulate, but in the smallest degree, the secretion of the more important digestive juices as the gastric, the pancreatic and the biliary: have, under ordinary circumstances, little action on the blood ; and mainly act by increasing the intestinal secretion and by hindering the absorption of the intestinal fluid. Their purgative action is, therefore, extremely simple. They sweep out the contents of the alimentary canal with the least possible disturbance of the digestive system, and of the other systems of the organism. Few other purgatives, if any, have so simple an action. The value, therefore, which has ever been assigned to them in the treatment of the occasional disturbances of digestion, to which almost every one of us is at times subject, and where the indications seem to be simply "to empty the canal," is quite justified by the results of this inves-
tigation.
Alum in H/ematuria.?A case of severe haemorrhage from the kidney, successfully treated by an unusual remedy, is re-
S. Radcliffe, in the Philadelphia Medical The cause of the hematuria is left It is stated that the patient, a open question. lady, aged twenty-five, had suffered from malarial disorders, and that there was a family history of heart disease and rheumatic fever. At the time of the attack, however, the temperature was but slightly raised, and the heart sounds were normal. Although the hematuria came on suddenly, wi h paroxysmal pain in the right lumbar region and with nausea, it is curious to note that the urine remained bloody for nearly three weeks. During this time almost all the astringents were tried with no beneficial effect. The patient was first given gallic acid alone, then in various combinations, the acid with quinine, with ergot, She also took tannic acid, with sulphuric acid, with opium sugar of lead and opium, fluid extract of ergot, infusion of buchu and matico, muriated tincture of iron, and with this quinine; extract of logwood, and extract of hamamelis. Ice was employed internally and externally, and counterirritation by sinapisms and blisters, was used. The hamamelis appeared to lessen the hemorrhage slightly, but for the rest, Dr. Radcliffe says : " It appeared as if I might as well have given her so much cold water." Rockbridge water was then used on theoretical grounds, champagne-glassful draughts being taken every three hours. Beneficial effects were manifested with the third dose, and on the fourth day the urine was free from blood corpuscles, and on the sixth day it was normal in colour, quantity and quality. It merely remains to add that the Rockbridge alum water appears, from an analysis appended to this paper, to be remarkably rich in alluminium sulphate, and to contain very appreciable quantities of calcium and magnesium sulphates, free sulphuric acid and cilicic acid. It is said to have been employed with benefit in chronic discharges, such as diarrhoea and bronchorrha:a. corded
by
Dr.
J.
News for January 12, 1884.
179
price of quinine, it is certainly desirable that some other substance could be found to replace it. Several experiments with kairin have been made in Italy and Germany, and according to the reports published this new substance is the most efficacious, trustworthy, and safest antipyretic that could be employed. It is said to be more powerful and rapid in action than even quinine or salicylic acid. Notwithstanding these advantages, kairin has not yet found much favor in France, and Professor Rikgel reports most unsatisfactory results in the treatment of pneumonia by kairine (Allgemeine Medicinische Central-Zeitung, July 28, 1883). He was unable to obtain any notable reduction of temperature by four hourly doses of seven and a-half grains each, and even larger amounts were often powerless to produce Even when he succeeded in reducing the the desired effect. temperature nearly to the norma', it often rose again in spite of repeated doses of the remedy. As regards the pulse, it was by no means reduced in frequency as the temperature fell, and, furthermore, it was much weakened. An improvement in the subjective sensations of the patient, as described by Filehne, was not met with, but, on the contrary, there was repeatedly observed such a depression, amounting almost to collapse, that it was necessary to discontinue the kairine The same effect has been noticed and resort to stimulants. by Seifert. Professor Riegel concludes that kairine is a dangerous remedy, in pneumonia at least, chiefly because of its depressing action upon the heart, and he cautions against its use in asthenic forms of the disease. It is evident that further trials are necessary before the exact value of this it is doubtnew substitute for quinine can be determined, and ful whether it will be able to maintain the high character as a safe and certain antipyretic which the early experimenters claimed for it. Therapeutic Gazette.
continued high
an
PARALDEHYDE
as a Narcotic compared with ChloMorphia.?I)r. Dujardin-Beaumetz publishes in the Bulletin de Therapeutique (January 30th),the results of numerous trials which he has made of paraldehyde, according to M. Yvon's fo. mula, viz., paraldehyde, twenty parts by weight, alcoOf this hol at 93? 100, syrup 75, and tincture of vanilla 5 parts. solution twenty to thirty grammes (i. e., two or three of paraldehyde) are given at a dose. All patients agree as to its having a less disagreeable taste than chloral, while a calm and refreshing sleep of from four to eight hours is soon produced, preceded in some cases, and especially in females, by a few minutes On awaking there is no headache or heaviof excitement. There is, however, an extremely strong odour of ness. aldehyde exhaled by the breath, especially when three grammes have been taken. Asa hypnotic, it has proved itself superior to morphia and chloral ; the sleep produced being more calm, waking being also more easy, and unaccompanied by the pains in the hea l, attendant upon opium. But while chloral, and especially morphia, will allay pain without causing sleep, this is not the case with paraldehyde, which under these cirIt is, however, an excellent remedy cumstances is powerless. in insomnia, and that even in cases of morphiomania ; its use in such a case, in the hands of Dr. Constantin Paul, having broIt has yet to be determined ken through the morphia-habit. whether the prolonged use of this substance may not induce disorders in the economy, analogous to those produced by alcohol, and further the stability of a substance which is an intermediate between alcohol and acetic acid, with a tendency to return to one or other of these bodies, has to be enquired ral akd
into.?Medical Times, April 19th.
Camphor.?Dr. Dymock, in the recently concluded "Vegetable Materia Medica of Western India," points out the curious fact that camphor is resublimed in India, not so much with
view to its purification as to increase its weight by getting In order as much interstitial water as possible into the cake. not to lose the profit thus obtained, the camphor is sold as soon as possible after sublimation at the same price as the crude article, the profit being thus drawn out of the water. a
KAIRIN?the latest rival of Quinine.?This new was discovered about a year ago by from Dr. Fischer of Munich, It is extracted coal-tar, and as it chemically resembles quinine, M. Fischer imagined that its therapeutic properties would be analogous to the time-honored antipyretic par excellence. Considering the
antipyretic agent
Convallaria Majalis {Lily of the Valley).? Dr. Marag* liano, Director of the Clinical Institute, Genoa (Centralbl. ftir die Med. IViss.), says that the remedy which, the author states, was much valued in the early half of this century, has again recently been recommended in heart disease. Experiments by Dr. Lowrie show that intra-arterial pressure is not materially increased by its administration. The systolic pulse-curve is the while the of and remarkably raised, pulse frequency respiraThe secretion of urine is augmented. tion remain unaltered. Its action resembles that of digitalis, but is safer, inasmuch cumulative. No ill effects have been as its effects are not known to follow its administration.?Lotul. Med. A'ec. Tonsillitis and fourth International
Bicarbonate of Soda.?At the of Hygiene, held at Geneva
Congress
mWW
THE INDIAN MEDICAL GAZETTE,
igo
1882, Dr. Jean Give Partagas Prophylaxis and Treatment of Simple
read a paper on the Tonsillitis by means is stated that in the initial stage of Bicarbonate of Soda." It of tonsillitis characterised by pain during the act of deglutition the effects of the application of bicarbonate of soda are as certain as they are rapid. The medicament ought to be employed in substance, and may be applied with the index finger Fresh applications are made every five minutes of the sufferer. for five or six periods. After this time attempts at swallowing may be made, and the inflammation is said to be aborted. The nausea and salivation-which result from the treitment, far from being bad, are powerful auxiliaries, because the violent contractions of the palatal muscles favour the evacuation of the muciparous follicles. The complete abortion of the tonsillitis can only be effected when the malady is taken at its very commencement. After the onset of fever and the appearance of tonsillar swelling, the remedy can only exert a favourable influence over the inflammation. Two or three applications a day for one or two months is said to bring about a gradual resolution of hypertrophic tonsils. The remedy seems so simple, and tonsillitis is so common, that the real value of such assertions should soon be decided.?Lancet, April 19th. in "
Bichloride of Mercury in Ringworm.?In the February number of the Journal of Cutaneous and Venereal Diseases, Dr. R. W. Taylor recommends a solution of corrosive sublimate in the treatment of the various forms of ringworm. He found that the efficacy of the mercury was much enhanced by of it in tincture The of the solution myrrh. dissolving strength was four grains to the ounce. Eczema marginatum, and ringworm in general, was readily cured by thoroughly painting the It was applied affected parts with this parasiticide solution. He believes that the tinctures of the gum-resins twice daily. make excellent vehicles for various agents in the treatment of skin diseases.
Salicylic
in Acid Thickened Epidermis.?A new for salicylic acid is coming to the front, Dr. J. C. Ogilvie Will {But. Med. Joum., Marc 1 29,) describes a case of thickened epidermis of foot, in which the whole anter or of the foot had become in two months like hippopotamus' hide, but was completely cured in three weeks by the use of salicylic acid plaster. The advantages of salicylic acid in curing corns are well known. Dr. Will thinks that there is a very wide field of usefulness for this agent in some morbid conditions of the skin, the treatment of which has hitherto proved ex'remely difficult. use
OBSTETRICS. Strychnia
in
Uterine
Inertia.?The
Medical
and
Surgical Reporter quotes from a report in the Journal de Med. de Paris, in which strychnia is recommended as a substitute for ergot in parturition. When the cervix is dilated and there is uterine inertia, a dose of the (-130 of a grain of the sulphate of strychnia is to be given every ten minutes, the interval
Dr. bet ween the doses being increased as the head descends. who contributes this report, gives strychnia thus administered the preference to the forceps, the expulsive pains being very effective, and hemorrhage being less likely to supervene than when the instruments are employed.
Deghilage,
Soda in Phlegmasia Dolens.?D. Miguel says that of four cases of he has had occasion to treat, in phlegmasia alba dolens which the first with the topical remedies usually employed he obtained no result attributable to the medication, since the patient remained in bed two months ; and that jn the other three having employed the salicylate of soda, in the dose tff 4 grammes (60 grains! a day, he noticed in all from the first day of taking the Neither medicine notable diminution of the fever and oedema. of these patients passed more than twenty-one days in bed and no oedema, nodosities, or thickening of the lower limb remained.?Lond. M.d. Rcc.
Salicylate
of
Vigar (La Correspondencia Medica)
Boil's Resuscitation of Stillborn Infants ?//?? Met hod.? In the Vracheb. Vcdomosty, 1883, No. 560, p. 3856, Dr. H. I. RODZEWICZ, of Niznt-Novgorod, relates the case of a primipara, in which he delivered, by podal version, an infant without pulsation in the umbilical cord, or any other signs of life. Schultze's method having proved unsuccessful, the
author took
[June, 1884-
large ba=in,
a
filled
it
with hot water from the
(Russian tea-machine), added cold water until the temperature of about 350 R. had been reached, and placed the infant in the basin, leaving free only her head. In a minute or so the child began to breathe and lustily cry. Identical cases may be found in the London Med. Kec. May, 1882, p. 199 samovar
(Rusanofsky'sj Influence
;
and
July,
p. 286
^Greult's).?Ibid.
Ovaries in the Determination of Sex ?Dr. Richard Neale writes to the British Medical Journal: ?" Among the many theories regarding the determination of sex, is one broached or supported by Mr. Thomas Tuckey, that the right ovary is for males, and the left for females. On the 5th instant I delivered a lady, upon whom left ovariotomy was performed, in January, 1883, of a male child. Dr. Hamilton, in the Lancet, page 191, records a case where two males were born after the removal of the right ovary, the patient having borne two female children previous to the operation. Those cases refute the ovular theory. of the
Vicarious Amenorrhea.?Dr. Menstruation and Samuel Wilks, senior physician to Guy's Hospital, writes to the Medical Times (February 9th) commending a recent paper by Dr. Matthews Duncan on Vicaiious Menstruation and Amenorrhoea, and protesting against the belief in vicarious menstruation as an "'old-wives' fable." He has never seen a case, and considers that the references to the subject in the He text-books are a mere repetition of groundless traditions. also declares against the use of the term amenorrhoea as referring "to a substantive complaint. "For my own part," says he, I know nothing of such a disorder, nor of such remedies as emrnenagogues. I believe myself that amenorrhcea, like many other complaints, is the remnant of a popular delusion, and if so it should be eradicated, like the other disorder, from the medical minds."
joss
Full anti-syphilitic treatment had been tried along with counter-irritation to the head, previous to her coming into the Royal Infirmary, and while she was in the medical wards of that inTh?se did not seem to have relieved in the slightest stitution. the condition spoken of above.
Trephining was performed over the middle of the ascending Internal table of the disk frontal and parietal convolutions. removed was found softened and thicker than usual, having a series of projections or roughnesses, on its internal surface some protruding for nearly one-eightli of an inch beyond A second level. the general opening was made over the occipital region, and a similar thickening of the internal table was found. Opposite to the first opening the dura mater and somewhat thickened. It was was paler than normal, elevated, and a false membrane of yellcw colour, and about inch in thickness, was removed. one-sixteenth of an An incision was made into the brain in the direction of the paracentral lobule, when a gush of grumous red-coloured fluid escaped Its quantity was not measured, as it could out of the opening. been collected. not have Aproximately, there would be The brain pulsations previously about a couple of drachms. were not discernible, but, after the escape of this collection of fluid, it was thought that very feeble pulsations were seen. Some of the surgeons standing by doubted the presence of The disks of bone were carefully the cerebral pulsation. divided into segments and replanted, and are now quite firm. Wounds treated without pus production. The day after the operation she expressed herself as very On the third day she moved her toes. Within much better. a week she lifted her leg from the bed and stated that she was so much better that she could turn in bed, and believed she could walk. The fingers were moved within a week. Her mind greatly changed for the better, her memory improving and her intelligence becoming much brighter. She can now walk freely about, and does a considerable amount of domestic duty in the ward. She lifts her arm to the level of her shoulders, and can grasp with considerable force. Dr. FlNLAYSON said that he had lately had the opportunity of seeing this case, at Dr. Macewen's request, in private, and he thought that there could be no possible doubt that the improvement which had taken place was due to the operation. It is known that in such cases as this, remarkable improvements do take place as the result cf purely medical treatment but in this case it is certain that the improvement was due to the operation. This method was quite a new one, and depended greatly upon the advances that had in recent years been made in cerebral localization. It was quite different, too, in its nature from operations on brains injured by violen;e. Although the case shown to-night was a very successful one, yet advance in such a procedure could scarcely be with-
expected
*78
out
a
THE INDIAN MEDICAL GAZETTE. certain number of
February, 1884.
misfortunes.?Glasgow
Medical Journal?
On Dec. ioth the patient again presented herself with a local recurrence of three weeks' duration, but otherwise in good health. This recurrent growth was removed on Dec. 14th, and was found, on reflecting the skin, to occupy the gap between the fifth and seventh ribs, to involve the pleura, and to In tearing down be adherent to the lower lobe of the lung. these adhesions the whole lung collapsed, exposing to view the pericardium and diaphragm. Owing to the dyspnoea which naturally ensued, the chloroform was abandoned. KroNLEIN then observed that there was a secondary nodule, the size of a walnut, projecting from the lung itself. He accordingly brought the organ up to the level of the wound, cut out the nodule with scissors, and arrested the hemorrhage, which was but scanty, by a catgut ligature around the margins of the wound. The pleural cavity was washed out with salicylic solution, the outer wound closed by sutures, a drainage-tube inserted, and iodoform gauze and salicylic bandage appliedAt the end of three weeks, and on the fourth dressing, cicatrisation was complete. He was astonished at the small amount of exudation from the pleura, and the rapidity with which the lung unfolded and the signs of pneumothorax disappeared. The temperature only reached 38'2? C. (1007? F.) on two evenings, being at other times normal. The pulse and respiration rose to 140 and 60 respectively after the operation, but fell to normal in a fortnight, and on her discharge from the hospital physical examination showed normal but weak breath-sound over the lung, and impaired resonance atjthe seat of operation, which also was slightly retracted with inspiration.
intention.
FORCIBLE DILATATION of the ORIFICES of STOMACH : RECOVERY.?On the 15th of March Professor Loheta forcibly dilated the cardiac orifice in the
the
a , Surgical Clinique of Bologna. The patient, E. L. young woman aged twenty, had for four years manifested all rational and the symptoms, direct, of ulcer of the stomach. For the last twelve months constriction had steadily increased ; at first solids, and then liquids, entered the stomach with difficulty, so much so that only a few drops of broth could be swallowed at a time. Regurgitation of substances swallowThe body wasted rapidly, and life could ed became the rule. only be maintained with nutritive enemata. Having diagnosed stenosis of the cardiac orifice, Professor Loreta proceeded to dilate it. He opened the abdomen in the linea alba, and found the stomach thick, small, and contracted. He incised it freely, "and passed an elastic sound through the cardiac orifice to make way for his dilating instrument. This the obstacle, in spite of efforts to vomit, and soon overcame the oesophagus was found much dilated. The apertures in the stomach and in the abdominal wall were sutured separately. The operation was performed under chloroform in thirty minutes ; and the patient, so soon as she had recovered from the narcosis, to the great surprise of the onlookers, swallowed three spoonfuls of water with perfect ease. Professor Loreta has favoured us with an obliging note, of ninth this his case, stating that the patient has completely recovered (" ora trovasi completamente guarita.")?Lancet,
We quote this case in detail because it indicates a line along which surgery may perhaps advance, for it shows that tumours of the ribs may be excised, and even pulmonary growths also, with impunity. Whether Dr. Kronlein has succeeded in removing the whole disease is another matter. It is more than likely that he has not ; but there can be little doubt that by his boldness he has prolonged life. Cases such as this are 'probably the only ones in which resection of the lung is justifiable ; yet, in spite of this success, we doubt if surgeons in general will care to extend their operations upon this organ beyond the limits afforded by incision of suppurating cavities.?Lancet, March 8.
April.
*
????
Bimanual
Detection and Removal of Stone in Children.?Mr. Hugh Smith, in the Brit. Med. Jour., July 21, p. 126, reports a case under Mr. Churchill, at the Victoria Hosptial for Children, of a child, aged 9 years, who was suspected to be suffering from a vesical calculus. The patient being under chloroform, it was decided to determine the shape of the calculus by rectal examination. This being done, Mr. Churchill proceeded to remove the stone by the usual operation of lateral lithotomy, binding difficulty in extraction with the forceps, and also with the scoop, Mr. Churchill decided to extract the stone by manipulation. The left index finger was introduced into the bladder, and the calculus (a conglomerate mulberry one?weight, 280 grains) was hooked by the finger straight from the fundus to the neck of the bladder. Mr. Churchill then introduced the right index finger into the rectum, and, by cautiously removing the left index finger, which fixed the stone, the calculus was tilted up and pressed through the opening into the bladder, and then through the external
swelling would
SUTURE OF ULNAR NERVE Six: Months after Division.?Mr. H. Page, in the Brit. Med. Jour., June 18S3, p. 1223, reports a case of a man, aged 25, who received a severe wound from glass on his left wrist, which took a long time to heal, and left a very painful cicatrix, as well as loss of power in the ring and little fingers, with wasting of the thenar and hypothenar eminences, and the interossei muscles. The patient was anxious for relief, and accordingly Mr. Page cut down on the site of the ulnar nerve, discovering the separated ends after The upper end was not enlarged, and a transsome difficulty. verse section of it, when freed from the cicatrix, showed the of healthy nerve. The lower end of the upper appearance portion was swollen to about three times its natural size, and ended in a firm bulbous nodule, which was bound in cicatricial tissue. From this it was dissected, and a third of an inch had to be removed before the section looked natural. The ends of the nerve were joined together eventually by three fine catgut sutures, and the wound healed by first intention. Within three weeks sensation had decidedly improved, the cicatrix was free from pain, and some power of extension had returned. The patient, however, was treated with galvanism and the faradic current for about eighteen months, and eventually recovered perfect strength and use of his hand. A very large series of cases in which suture of the divided nerves was followed by cure may be consulted by reference to sect. 1248 : 2 of the Medical Digest.?Loud Med. Reed. its
incision.
ELEPHANTIASIS, ARABUM Cured isy Ligature of the Femoral Artery.? In view of the fact that the successful operations, both in this country and in Europe, for the cure of this most obstinate disease of the lower extremity, by ligation of the femoral artery, are few, and because of the apparent propriety of resorting to this last method before amputation becomes an imperious necessity to save the life of the patient, the successful case operated upon by Dr. G. C. E. Weber, and reported in the January number of The American Journal of the Medical Sciences, has considerable interest. Thirty days after the operation the limb had diminished in circumference nearly one-half, and at the end of six months the patient reported that he suffered no inconvenience whatever from his limb, save that upon unusual exertion a slight cedematous
[June, 1884.
.
supervene.
SURGERY?Partial Resection of Kronlein of Zurich, in a paper in the Bet liner Wochenschrift of March 3rd. upon this subject, rightly judges that surgery goes too far in extending her operations to the phthisical lung ; but he shows in the case upon which he did resect a portion of lung what is possible in another form of disease. The case was one of a sarcomatous tumour of the rib in a young woman. The growth sprang from the sixth rib on the left side, and was about the size of a child s head, and on was periosteal, June 26th, 1883, he removed the tumour, which and afterwards resected a portion (nine centimetres) of the rib. The wound was dressed antiseptically, and healed by first
PULMONARY
Lung. Klini
'ker
Dr.
PARTIAL RESECTION OF THE PHARYNX and (EsoCancer.?At the meeting of the Royal Academy of Medicine of Turin held on the 8th of February, Professor Novaro presented a woman, aged forty-five, from whom he had removed, for carcinoma, the upper part of the oesophagus and the lower part of the pharynx, to the extent of two inches and three quarters. At the date of operation (Sept. 3rd, 1883) phagus for
the
patient
could
only
swallow
liquids
with
difficulty.
She
able, when presented to the Academy, after the lapse of five months, to swallow solids. She was then in good health, was
and
presented
no
traces of recurrence.?Lancet,
April
19.
ABSTRACTS AND EXTRACTS.
June, 1884.] THERAPEUTICS
& PHARMACOLOGY.
The Action of SALINE CATHARTICS.?Dr. Mathew Hay concludes a report of his investigation regarding saline cathartics (in the Journal of Anatomy and Physiology) with certain
statements, intelligent
a regard for which would conduce to the more It will he exhibition of this class of cathartics. seen from these conclusions which we subjoin that there is no property in saline cathartics which warrants their administration for other than the temporary effect of cleaning out the alimentary canal. They all tolerably closely agree in the ultimate effect which they have on the alimentary canal and the body generally. They cause no irritation or inflammation of the canal; stimulate, but in the smallest degree, the secretion of the more important digestive juices as the gastric, the pancreatic and the biliary: have, under ordinary circumstances, little action on the blood ; and mainly act by increasing the intestinal secretion and by hindering the absorption of the intestinal fluid. Their purgative action is, therefore, extremely simple. They sweep out the contents of the alimentary canal with the least possible disturbance of the digestive system, and of the other systems of the organism. Few other purgatives, if any, have so simple an action. The value, therefore, which has ever been assigned to them in the treatment of the occasional disturbances of digestion, to which almost every one of us is at times subject, and where the indications seem to be simply "to empty the canal," is quite justified by the results of this inves-
tigation.
Alum in H/ematuria.?A case of severe haemorrhage from the kidney, successfully treated by an unusual remedy, is re-
S. Radcliffe, in the Philadelphia Medical The cause of the hematuria is left It is stated that the patient, a open question. lady, aged twenty-five, had suffered from malarial disorders, and that there was a family history of heart disease and rheumatic fever. At the time of the attack, however, the temperature was but slightly raised, and the heart sounds were normal. Although the hematuria came on suddenly, wi h paroxysmal pain in the right lumbar region and with nausea, it is curious to note that the urine remained bloody for nearly three weeks. During this time almost all the astringents were tried with no beneficial effect. The patient was first given gallic acid alone, then in various combinations, the acid with quinine, with ergot, She also took tannic acid, with sulphuric acid, with opium sugar of lead and opium, fluid extract of ergot, infusion of buchu and matico, muriated tincture of iron, and with this quinine; extract of logwood, and extract of hamamelis. Ice was employed internally and externally, and counterirritation by sinapisms and blisters, was used. The hamamelis appeared to lessen the hemorrhage slightly, but for the rest, Dr. Radcliffe says : " It appeared as if I might as well have given her so much cold water." Rockbridge water was then used on theoretical grounds, champagne-glassful draughts being taken every three hours. Beneficial effects were manifested with the third dose, and on the fourth day the urine was free from blood corpuscles, and on the sixth day it was normal in colour, quantity and quality. It merely remains to add that the Rockbridge alum water appears, from an analysis appended to this paper, to be remarkably rich in alluminium sulphate, and to contain very appreciable quantities of calcium and magnesium sulphates, free sulphuric acid and cilicic acid. It is said to have been employed with benefit in chronic discharges, such as diarrhoea and bronchorrha:a. corded
by
Dr.
J.
News for January 12, 1884.
179
price of quinine, it is certainly desirable that some other substance could be found to replace it. Several experiments with kairin have been made in Italy and Germany, and according to the reports published this new substance is the most efficacious, trustworthy, and safest antipyretic that could be employed. It is said to be more powerful and rapid in action than even quinine or salicylic acid. Notwithstanding these advantages, kairin has not yet found much favor in France, and Professor Rikgel reports most unsatisfactory results in the treatment of pneumonia by kairine (Allgemeine Medicinische Central-Zeitung, July 28, 1883). He was unable to obtain any notable reduction of temperature by four hourly doses of seven and a-half grains each, and even larger amounts were often powerless to produce Even when he succeeded in reducing the the desired effect. temperature nearly to the norma', it often rose again in spite of repeated doses of the remedy. As regards the pulse, it was by no means reduced in frequency as the temperature fell, and, furthermore, it was much weakened. An improvement in the subjective sensations of the patient, as described by Filehne, was not met with, but, on the contrary, there was repeatedly observed such a depression, amounting almost to collapse, that it was necessary to discontinue the kairine The same effect has been noticed and resort to stimulants. by Seifert. Professor Riegel concludes that kairine is a dangerous remedy, in pneumonia at least, chiefly because of its depressing action upon the heart, and he cautions against its use in asthenic forms of the disease. It is evident that further trials are necessary before the exact value of this it is doubtnew substitute for quinine can be determined, and ful whether it will be able to maintain the high character as a safe and certain antipyretic which the early experimenters claimed for it. Therapeutic Gazette.
continued high
an
PARALDEHYDE
as a Narcotic compared with ChloMorphia.?I)r. Dujardin-Beaumetz publishes in the Bulletin de Therapeutique (January 30th),the results of numerous trials which he has made of paraldehyde, according to M. Yvon's fo. mula, viz., paraldehyde, twenty parts by weight, alcoOf this hol at 93? 100, syrup 75, and tincture of vanilla 5 parts. solution twenty to thirty grammes (i. e., two or three of paraldehyde) are given at a dose. All patients agree as to its having a less disagreeable taste than chloral, while a calm and refreshing sleep of from four to eight hours is soon produced, preceded in some cases, and especially in females, by a few minutes On awaking there is no headache or heaviof excitement. There is, however, an extremely strong odour of ness. aldehyde exhaled by the breath, especially when three grammes have been taken. Asa hypnotic, it has proved itself superior to morphia and chloral ; the sleep produced being more calm, waking being also more easy, and unaccompanied by the pains in the hea l, attendant upon opium. But while chloral, and especially morphia, will allay pain without causing sleep, this is not the case with paraldehyde, which under these cirIt is, however, an excellent remedy cumstances is powerless. in insomnia, and that even in cases of morphiomania ; its use in such a case, in the hands of Dr. Constantin Paul, having broIt has yet to be determined ken through the morphia-habit. whether the prolonged use of this substance may not induce disorders in the economy, analogous to those produced by alcohol, and further the stability of a substance which is an intermediate between alcohol and acetic acid, with a tendency to return to one or other of these bodies, has to be enquired ral akd
into.?Medical Times, April 19th.
Camphor.?Dr. Dymock, in the recently concluded "Vegetable Materia Medica of Western India," points out the curious fact that camphor is resublimed in India, not so much with
view to its purification as to increase its weight by getting In order as much interstitial water as possible into the cake. not to lose the profit thus obtained, the camphor is sold as soon as possible after sublimation at the same price as the crude article, the profit being thus drawn out of the water. a
KAIRIN?the latest rival of Quinine.?This new was discovered about a year ago by from Dr. Fischer of Munich, It is extracted coal-tar, and as it chemically resembles quinine, M. Fischer imagined that its therapeutic properties would be analogous to the time-honored antipyretic par excellence. Considering the
antipyretic agent
Convallaria Majalis {Lily of the Valley).? Dr. Marag* liano, Director of the Clinical Institute, Genoa (Centralbl. ftir die Med. IViss.), says that the remedy which, the author states, was much valued in the early half of this century, has again recently been recommended in heart disease. Experiments by Dr. Lowrie show that intra-arterial pressure is not materially increased by its administration. The systolic pulse-curve is the while the of and remarkably raised, pulse frequency respiraThe secretion of urine is augmented. tion remain unaltered. Its action resembles that of digitalis, but is safer, inasmuch cumulative. No ill effects have been as its effects are not known to follow its administration.?Lotul. Med. A'ec. Tonsillitis and fourth International
Bicarbonate of Soda.?At the of Hygiene, held at Geneva
Congress
mWW
THE INDIAN MEDICAL GAZETTE,
igo
1882, Dr. Jean Give Partagas Prophylaxis and Treatment of Simple
read a paper on the Tonsillitis by means is stated that in the initial stage of Bicarbonate of Soda." It of tonsillitis characterised by pain during the act of deglutition the effects of the application of bicarbonate of soda are as certain as they are rapid. The medicament ought to be employed in substance, and may be applied with the index finger Fresh applications are made every five minutes of the sufferer. for five or six periods. After this time attempts at swallowing may be made, and the inflammation is said to be aborted. The nausea and salivation-which result from the treitment, far from being bad, are powerful auxiliaries, because the violent contractions of the palatal muscles favour the evacuation of the muciparous follicles. The complete abortion of the tonsillitis can only be effected when the malady is taken at its very commencement. After the onset of fever and the appearance of tonsillar swelling, the remedy can only exert a favourable influence over the inflammation. Two or three applications a day for one or two months is said to bring about a gradual resolution of hypertrophic tonsils. The remedy seems so simple, and tonsillitis is so common, that the real value of such assertions should soon be decided.?Lancet, April 19th. in "
Bichloride of Mercury in Ringworm.?In the February number of the Journal of Cutaneous and Venereal Diseases, Dr. R. W. Taylor recommends a solution of corrosive sublimate in the treatment of the various forms of ringworm. He found that the efficacy of the mercury was much enhanced by of it in tincture The of the solution myrrh. dissolving strength was four grains to the ounce. Eczema marginatum, and ringworm in general, was readily cured by thoroughly painting the It was applied affected parts with this parasiticide solution. He believes that the tinctures of the gum-resins twice daily. make excellent vehicles for various agents in the treatment of skin diseases.
Salicylic
in Acid Thickened Epidermis.?A new for salicylic acid is coming to the front, Dr. J. C. Ogilvie Will {But. Med. Joum., Marc 1 29,) describes a case of thickened epidermis of foot, in which the whole anter or of the foot had become in two months like hippopotamus' hide, but was completely cured in three weeks by the use of salicylic acid plaster. The advantages of salicylic acid in curing corns are well known. Dr. Will thinks that there is a very wide field of usefulness for this agent in some morbid conditions of the skin, the treatment of which has hitherto proved ex'remely difficult. use
OBSTETRICS. Strychnia
in
Uterine
Inertia.?The
Medical
and
Surgical Reporter quotes from a report in the Journal de Med. de Paris, in which strychnia is recommended as a substitute for ergot in parturition. When the cervix is dilated and there is uterine inertia, a dose of the (-130 of a grain of the sulphate of strychnia is to be given every ten minutes, the interval
Dr. bet ween the doses being increased as the head descends. who contributes this report, gives strychnia thus administered the preference to the forceps, the expulsive pains being very effective, and hemorrhage being less likely to supervene than when the instruments are employed.
Deghilage,
Soda in Phlegmasia Dolens.?D. Miguel says that of four cases of he has had occasion to treat, in phlegmasia alba dolens which the first with the topical remedies usually employed he obtained no result attributable to the medication, since the patient remained in bed two months ; and that jn the other three having employed the salicylate of soda, in the dose tff 4 grammes (60 grains! a day, he noticed in all from the first day of taking the Neither medicine notable diminution of the fever and oedema. of these patients passed more than twenty-one days in bed and no oedema, nodosities, or thickening of the lower limb remained.?Lond. M.d. Rcc.
Salicylate
of
Vigar (La Correspondencia Medica)
Boil's Resuscitation of Stillborn Infants ?//?? Met hod.? In the Vracheb. Vcdomosty, 1883, No. 560, p. 3856, Dr. H. I. RODZEWICZ, of Niznt-Novgorod, relates the case of a primipara, in which he delivered, by podal version, an infant without pulsation in the umbilical cord, or any other signs of life. Schultze's method having proved unsuccessful, the
author took
[June, 1884-
large ba=in,
a
filled
it
with hot water from the
(Russian tea-machine), added cold water until the temperature of about 350 R. had been reached, and placed the infant in the basin, leaving free only her head. In a minute or so the child began to breathe and lustily cry. Identical cases may be found in the London Med. Kec. May, 1882, p. 199 samovar
(Rusanofsky'sj Influence
;
and
July,
p. 286
^Greult's).?Ibid.
Ovaries in the Determination of Sex ?Dr. Richard Neale writes to the British Medical Journal: ?" Among the many theories regarding the determination of sex, is one broached or supported by Mr. Thomas Tuckey, that the right ovary is for males, and the left for females. On the 5th instant I delivered a lady, upon whom left ovariotomy was performed, in January, 1883, of a male child. Dr. Hamilton, in the Lancet, page 191, records a case where two males were born after the removal of the right ovary, the patient having borne two female children previous to the operation. Those cases refute the ovular theory. of the
Vicarious Amenorrhea.?Dr. Menstruation and Samuel Wilks, senior physician to Guy's Hospital, writes to the Medical Times (February 9th) commending a recent paper by Dr. Matthews Duncan on Vicaiious Menstruation and Amenorrhoea, and protesting against the belief in vicarious menstruation as an "'old-wives' fable." He has never seen a case, and considers that the references to the subject in the He text-books are a mere repetition of groundless traditions. also declares against the use of the term amenorrhoea as referring "to a substantive complaint. "For my own part," says he, I know nothing of such a disorder, nor of such remedies as emrnenagogues. I believe myself that amenorrhcea, like many other complaints, is the remnant of a popular delusion, and if so it should be eradicated, like the other disorder, from the medical minds."
