Electrical treatment of exophthalmic goitre.

Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Electrical treatment of exophthalmic goitre. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    any accident, thanks to antiseptic pre- cautions ; 5 induced labours and 3 craniotomies and cephalotripsies were performed without any consequent com- plication. Aron goes so far as to assert that involution is more perfect and puerperal fever less to be feared after instrumental and artificial than after spontaneous delivery. Charpentier strongly combated this theory and insisted that the application of the forceps only an hour and a-half after complete dilatation and turning, com- menced when the cervix is still re- tracted, are hasty, meddlesome pro- ceedings. 4358) Excretion of Earthy Salts in Mollifies. Neumann (Archiv f. Gyndk., vol. xlvii, Part II, 1894) examined the urine and faeces of a woman, aged 37, who was at- tacked with mollities ossium, which as usual made progress during pregnancy, though the child was delivered without instruments. After labour the patient was well fed and well housed ; for two weeks she was kept on a milk diet in order to allow of a free supply of calcium and phosphoric acid. The bone disease, it appears, was in consequence arrested, the bones of the extremities becoming firm again. Neumann discovered that the excretion of calcium by the kidneys in the progressive stage of mollities was much the same as in health. During the second stage, that of osseous regenera- tion and recovery, less calcium escaped through the kidneys, but rather more in the fasces. A slight relative loss of magnesium occurred during the pro- gressive stage ; on the other hand, that salt was eliminated in less than the normal amount during the second stage. The normal relation of calcium to mag- nesium in the excreta (1 to 3) was al- tered, the latter earth diminishing in amount. The loss of phosphoric acid during the progressive stage was found to be marked and continuous, and that compound was as evidently retained during recovery. <339) Bacteriological Examination during Abdominal Section, C. B. Penrose (International Med. Mag., August, 1894) has adopted this practice with success. Cover-glass examina- tions of the suspected material are made, and are fixed in the flame of a spirit lamp, and then stained with carbol- fuchsin. The microscopic examination is made with a Leitz oil immersion lens. Penrose neither irrigates nor uses the drainage tube, unless the microscope shows these contents to be septic. The presence of gonococci in small numbers does not necessitate drainage. Penrose recently operated in two cases of tubo-ovarian abscess, caused by sepsis at labour. In each case the abscess was ruptured during removal, and the pelvis filled with pus. In the first the pus was found to be sterile, and the abdomen was closed without irriga- tion or drainage. In the second the pus contained streptococcus, staphylococcus, and bacillus coli communis. The pelvis, in consequence, was well washed out and drained. Both patients recovered without peritonitis or sepsis, though the convalescence of the first was very much easier than that of the second. <360) Torsion of Pedicle in Clironic Disease of Uterine Appendages. Hartmann and Reymond (Annales de Gynec. et d'Obstet., September, 1894) add a case of this kind to the two recorded by Bland Sutton and Delbet. In the cases already published, however, the tube alone was twisted; in Hartmann and Reymond’s the ovary was involved. The patient was a mnltipara, subject to pelvic pains for six months, with dys- uria and painful defaeeation. A tumour was detected rising above the pubes. The authors diagnosed double sal- pingitis, and, a few weeks later, the pains suddenly increased in intensity and the swelling in size. Abdominal section was performed. A big red tumour was exposed, adherent to omentum and to small intestine and to the sigmoid flexure. The pedicle was twisted three times, according to the drawing in the paper. It sprang from the left side of the uterus; that organ was itself rotated half a turn. The opposite, or right appendages, were cystic, and Hartmann removed them. The left appendages consisted of a tubo- ovarian cyst full of blood. The patient made a good recovery. <3G1) Disadvantage of Ovariotomy In Childbed. Grassow (Centralbl. f. Gyndk., No. 43, 1894) recently exhibited at a German medical society a parovarian cyst which had contained 25 pints of fluid. The patient had gone to the end of her eleventh pregnancy. The tumour caused a marked distortion of the child’s skull. Fourteen days after de- livery ovariotomy was performed. The bulky uterus, in imperfect involution, gave great trouble to the operator. The base of the cyst, being sessile, was with difficulty detached ; the pedicle required very careful ligature, or rather suture. Grassow concludes that, what- ever may be said for ovariotomy during pregnancy, it is not right, save when urgent symptoms appear, to perform that operation after delivery till involu- tion is complete. THERAPEUTICS. (362) The Antitoxin Treatment of Diphtheria. Schippers (Weekblad vanhet Nedtrlandsch Tydschrift voor Geneeskunde, October 27th) records a case of acute diphtheria cured by a single injection of Behring’s serum No. ii. The patient was a boy, aged 5years, and the symptoms were very severe. The tonsils, the uvula, and the entire surface of the posterior wall of the pharynx, were covered with membranes. The voice was entirely lost; stridor was so loud that it could be heard outside the front door. The lungs were un- affected. Temperature 100° F., the pulse full, somewhat accelerated. An operation seemed to be the last re- source, but, as the author a few days before had obtained from Ber- lin a single dose of serum, the in- jection was decided upon, although the case seemed hopeless for the experiment. The serum was injected in the right hypochondrium. The treatment which was being pursued be- fore the injection (quinine and sesqui- chloride of iron, the application of ice, and inhalation of steam) was continued. The following morning a decided im- provement was observable. The false membranes had nearly entirely disap- peared. The voice was still hoarse, but the stridor was greatly diminished. By the third day after the injection the alarming symptoms had entirely sub- sided, the temperature was normal, and the appetite had returned. In the case of another child of the same family, for whom no serum was available at the date of report, the membranes were ex- tending with alarming rapidity over all the organs of respiration. <363) Local Treatment of Faucial Diphtheria. Loeffi.er (Deut. med. Woch., October 18th, 1894) emphasises the importance of local treatment based on a bacterio- logical study such as he has followed out in a large number of cases. Many antiseptic solutions kill diphtheria bacilli in a few seconds. Equal parts of turpentine and alcohol were found much more efficient when carbolic acid (2 per cent.) was added to them. Ferric perchloride kills the diphtheria bacillus very rapidly. The author uses the fol- lowing application : Alcohol (60), toluol (36), and liq. ferri perchlor. (4). Fully developed diphtheria cultures were killed in five seconds. If a dose of virulent diphtheria bacilli was intro- duced beneath the skin of a guinea-pig, and followed by TVc.cm. of the above mixture, the animal did not become ill, and even after an interval of one to four hours it was saved. This remedy was used in an epidemic of diphtheria. Among 71 patients treated out of hos- pital, not 1 died. Of 30 hospital patients, 5 died; in 4 of these the disease had already extended into the larynx and nose, and the fifth died of gangrenous pneumonia. The general condition of the patients soon improved. Complica- tions were rare. As long as any mem- brane remains a further application is made. The remedy should be vigorously used at least every four hours. When decomposition processes are present in the throat the chloride is converted into sulphate, and is inefficient. Menthol was found a useful addition (10 g. to 100 g. of the remedy). Creolin (2 to 3 per- cent.) and cresol were found useful sub- stitutes for the iron, but they are in- ferior in bactericidal properties. The author has also tried the addition of pyoktanin with good effect. In all cases of genuine diphtheria the iron mixture should be used, but where decomposi- tion processes are going on the other solution, specially that containing cresol, should be tried.—Goldschmidt {Rev. deMed., October, 1894) speaks very highly of the internal use of the per- chloride of iron in small and frequent lOoU c