The Medical Herald

Incorporating the

Kansas City Medical Inder-Lancet

Under the Editorial Direction of

Chas. Wood Fassett and S. Grover Burnett

OUR SLOGAN:

"Fewer and Better Medical Journals."

EMERSON'S FAMOUS EPIGRAM

"If a man can write a better book, preach a better termon, or make a better mouse-trap than his neighbor, though he builds his house in the woods, the world will make a beaten path to his door."-Ralph Waldo Emerson.

"THE OPEN DOOR."

We have no latch-string; our door is always open to those who would add aught of scientific interest to our readers, and the pathway to the door of The Medical Herald is not difficult to find.

Subscription, $1.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including Newfoundland, 50 cents a year additional.

The Medical Herald aims to reflect the progress in the sciences of medicine and surgery, especially throughout the Missouri Valley and Southwest, the territory of its greatest distribution.

Concise and practical articles, news and reports of interesting cases invited, and should be type-written.

The privilege of rejecting any communication is reserved, and all papers accepted must be for exclusive publication in this magazine, unless otherwise arranged.

To contributors of original articles a liberal number of copies of the Herald will be given (or mailed free of expense if addresses are furnished) and the publishers will furnish reprints at printers' cost, application for same to be made when proof is returned.

The editors are not responsible for the utterances of contributors or correspondents.

Illustrations will be furnished at reasonable rates, if drawings or photos are furnished.

Address all remittances, correspondence, articles for publication, books for review and exchanges to the Managing Editor.

Subscribers changing their addresses, will please notify us promptly, as magazines cannot be forwarded without adding postage.

Advertising forms close on the 20th of each month. Time should be allowed for correction of proof.

Advertising rates on application to the Managing

Editor.

Cracked nipples are promptly relieved by painting three times a day with tincture benzoin comp. Or five per cent solution of silver nitrate.

Wanted.-Partnership, to do eye and ear work exclusively; or with a general surgeon. Address, Oculist, care Medical Herald, St. Joseph, Mo.

Partnership Wanted. -A physician of experience, specializing in gynecology and obstetrics, would buy a partnership with some well established general practician in Kansas City. Can give best of references as to ethical standing. Address W. A. G., care of Medical Herald.

For Sale.-Instruments, books, and office equipment. Address "Retired," care of Medical Herald, St. Joseph, Mo.

For Sale.-Hospital equipment for 50 patients for sale at a bargain. Includes beds, mattress, linen, operating furniture, high pressure sterilizer, combination range, dining room furniture. For particulars address, 501 Sharp Bldg., Kansas City, Mo.

A Familiar Form of Cystitis.-There is a form of cystitis quite familiar to the general practitioner. It occurs in females, old and young, with apparently normal pelvic organs, generally after a chilling. There is an abrupt onset with frequent micturition, tenesmus. and perhaps dysuria. The acid urine contains the infecting organism, usually a colon bacillus, pus, and often blood, Rest in bed, local warmth, light diet, free catharsis and sanmetto are the measures employed, and in a few days the severity of the attack subsides, and generally in two or three weeks the patients are as well as ever.

CAUTION! Whenever the true merit of

a preparation is authoritatively established, imitation is sure to make its pernicious appearance. To counteract the injurious results of another of these fraudulent proceedings-in this instance affecting firm name and reputation-Sander & Sons have been compelled to appeal to law, and in the action tried before the Supreme Court of Victoria, the testimony of a sworn witness revealed the fact that this witness suffered intense irritation from the application to an ulcer of the defendant's product, which was palmed off as "just as good as Sander's Eucalyptol." Sander & Sons had the satisfaction to obtain a verdict with costs against this imitator, who is perpetually restrained from continuing his malpractice. Dr. Owen, in a report to the Medical Society of Victoria, and Dr. J. Benjamin, in the Lancet, London, both denounced, as others did before, on the strength of negative results, the application of unspecified eucalyptus products.

This forms convincing proof that only an authoritatively sanctioned article can be relied on.

SANDER & SONS' EUCALYPTOL
(Ecalypti Extract)

1. Has stood the test of Government investigation.

2. It was proved at the Supreme Court of Victoria by experts to be an absolutely pure and scientifically standardized preparation.

3. It is honored by royal patronage. 4. It always produces definite therapeutic results.

Therefore, to safegaurd the physicians' interest and to protect their patients, we earnestly request you to specify "Sander's Eucalyptol" when prescribing eucalyptus.

The Meyer Bros. Drug Co., St. Louis, Mo., agents, will forward one original package (1 oz.) on receipt on One Dollar.

Vol. XXXIII

No. 2

MEDICAL

OFFICERS.

FLAVEL B. TIFFANY...

President.

Cysts of bone have been so seldom recognized in the past that one might think the subject had been settled and needed no more attention. But now that the X-ray enables us to study living bone pathology we find cysts of bone more frequently. Indeed it has been my good fortune to see several of these cases during the past few months. So little do I find in literature about this condition that I do not think it out of place to report these cases and to discuss their causation and pathology.

Etiology Many formerly held that cysts of bone were part of a degenerative process taking place in osteomata, chondromata and sarcomata osteomalacia and osteitis deformans. Indeed in the American Text-book of Pathology of a few years ago the statement is made that cysts of bone seldom occur from any other cause. The ability to find these cysts in the living subject by means of the X-ray has shown

Read before the Medical Society of the Missouri Valley at Omaha, September 18, 1913.

that they are much more frequent than was formerly supposed and that cysts of bone do exist in no way connected with any other kind of bone pathology. Simple cysts are found in the long bones quite often. Cysts of the lower jaw, where they form about an unerupted tooth, or about the root of an old useless tooth, are most frequent of all. Those cases of multiple cysts in bone are thought to be part of a chronic inflammatory process where the bone softens in a manner similar to osteomalacia.

Pathology. It is in this latter class that spontaneous fractures occur. The portion of the bone involved becomes porous and very fragile being filled with many small cysts. These cyst cavities have a distinct lining membrane or sac (Fig. III). and are filled with a viscid substance similar to the white of egg. The specimen shown was one of several cysts removed during resection of a femur for spontaneous fracture due to osteitis cystica fibrosa. In this dried specimen you will notice the

shiny membrane lining the cavity while the one surrounding the cavity is thinned out having a coarse, dead appearance.

In none of the patients who have come under my observation has pathological fracture occurred where a single cyst was present. On the contrary, I shall report one case where fracture of the femur occurred through healthy bone in the vicinity of a cyst but not through the cyst. In these cases it would appear that a degenerative process begins in the bone, the bone substance undergoing a local osteoporosis then the animal matter in this area liquefies, a membranous wall forms and a cyst results. This sac may have slight secretory power similar to that of a serous membrane so that the fluid gradually increases in amount, the surrounding bone atrophies and thus the cyst enlarges. One can scarcely explain why these cysts enlarge equally in all directions when the medulla is involved as well as the cortical portion, for we naturally think of such extensions following the path of least resistance. The medulla being less compact than the cortex would argue for extension along the medullary canal, but this does not necessarily follow. In one case cited in this paper the cyst occupied the medulla of the femur and

Fig. II Lateral view of femur showing multiple cysts (c), fracture (F). Illustrating Case I.

thinned the cortical substance on all sides almost to the thinness of paper, yet had not pushed back the medulla beyond the absorption of the cortex.

In another case of this series a single cyst had ruptured through the cortex of the bone into the soft tissues, but no fracture had occurred. On the contrary, the bone was much thickened in the immediate vicinity. This particular case was complicated by malignancy diagnosed as carcinoma, but I am inclined to think the microscopical findings were those of an old inflammatory process.

Symptoms. In the simple type of cyst the presence of pain brings the patient to the physician. There may be a history of attacks of pain and lameness with intervals of practical freedom. In another the enlargement of the bone at the site of the lesion brings him for examination.

In the cases of osteitis cystica fibrosa pathological fracture calls for attention first. Even at this time the condition will be overlooked unless one employs the X-ray as a routine in all fracture work. A second spontaneous fracture in the same region, together with the enlargement of the bone calls for X-ray examination and the true condition is discovered.