Post-mortem examination as J. W., twenty-eight years, barber. far as permission has been given: Body: Emaciated, abdomen distended. Thorax Right pleural cavity filled with clear serum; right lung. collapsed; left lung normal. Heart normal, slight adhesion of aorta. Abdomen Filled with clear serum, parietal peritoneum congested, thickened, covered with small translucent nodules, size of a pin's head. A large nodular mass occupying the position of the omentum extended along the middle of the abdomen; this mass was hard, congested, coarsely nodular, and was attached above to the transverse colon. The peritoneum of the posterior portion of the abdomen was also studded with small nodules. Liver Markedly cirrhotic, hob-nail, very hard and dense, and of a yellowish and white mottled color. Spleen Of large size. Kidneys: No marked change. Stomach: Normal. Spinal cord: Membranes somewhat thickened, cord slightly congested; no lesions visible to the naked eye. The cord, median, ulnar and posterior tibial nerves were reserved for microscopical examination. The gastrocnemius muscle was of a light yellow color, and did not look at all like muscular tissue, the arrangement of the fibre could not be seen, and oil oozed from the cut surface. Microscopical Examination.-Gastrocnemius muscle: The muscular fibres are almost completely replaced by fat, a few scattered fibres can be seen here and there, and have for the most part lost their striated appearance, and are infiltrated with and degenerated into adipose tissue. Peripheral nerves: Median and ulnar nerves show to a moderate degree the lesions of peripheral neuritis, the myelin is broken up into blocks and contains fat globules. The posterior tibial nerve shows to a very marked degree the lesions of peripheral neuritis; the myelin stains in small particles, like a row of beads, and contains many small globules. Axis cylinder intact. Spinal cord: Not yet examined. The heart was normal. The dyspnoea appeared to be caused by oedema of the lung and by ascites. I diagnosed the case as one of alcoholic paresis, and thought the ascites due to cirrhosis of the liver, also thought there was peripheral neuritis. Neurosis of the pneumogastric nerve is apt to cause fainting spells. The carcinomatous growths found might have helped to produce the ascites, but the real cause was probably the cirrhotic condition of the liver. His intense pallor would suggest lead poisoning, but there was found no lead line. There being no further business, the Society adjourned. FREDERIC J. SHOOP, Secretary. BROOKLYN DENTAL SOCIETY. The annual meeting of the above Society was held at the rooms of the Kings County Medical Society on the evening of the 23d of June. The following officers were elected for the ensuing year: President-E. T. Rippier. Vice-President-B. A. R. Ottolingui. Rec. Sec'y-Louis Shaw. Cor. Sec'y-F. W. Moore. F. C. Walker. Librarian-J. A. Meara. Treasurer The newly-elected President was escorted to the chair, and in an address thanked the Society for the honor conferred upon him. He also appointed the following committees for the year: Executive Committee.-Wm. Jarvie, Jr.; O. E. Hill; W. A. Campbell. Ethics.-J. P. Geran; M. E. Elmendorf; M. L. Thompson. Subjects.-Will H. Johnston; A. H. Brockway; L. G. Wilder. Membership.-H. G. Mirick; C. D. Cook; C. B. Parker. Clinics.-B. A. R. Ottolingui; J. J. Pitts; S. F. Cook; R. C. Brewster; R. T. Holly. PROGRESS IN MEDICINE. SURGERY. BY GEO. RYERSON FOWLER, M. D., Surgeon to St. Mary's Hospital, and to the Methodist Episcopal Hospital, Brooklyn. STERCORAL INTOXICATION. Verneuil (Gaz. des Hôpitaux, 1889, No. 133; Centralblatt f. Chirurgie, No. 13, 1890, p. 237). In the course of a lecture delivered to the students upon the occasion of his installation to the professorship of surgery at the Hôtel-Dieu, V. pointed to the advantages which surgery had derived from modern bacteriology, and in the course of his remarks took occasion to refer to what he deemed his recently-discovered intoxicating influence of retained fæcal accumulations. Observations made by Velpeau called attention to the fact that the fluid contained in the sac of an incarcerated or strangulated hernia produced an irritating effect upon the hands of the operator. Others have observed that the entrance of fluid from such a sac into the abdominal cavity gives rise to peritonitis without there having necessarily been an injury to the intestine. Clado discovered bacteria in such fluids, and inoculation of animals with the same produced rapid death with symptoms of violent intoxication. This is called by V. "stercoral intoxication," and he claims that the bacteria of Clado give rise to the disease. FRACTURE OF THE PATELLA. Lucas Champronière (Gaz. des Hôpitaux, No. 19, 1890). The author is an unqualified advocate of the operation of suture of the patella following fracture. He follows Lister and Cameron in advocating free opening of the point and suture by means of silver wire. Of 14 cases thus treated, 4 were old fractures, 9 were recent fractures, and I was a refracture in which the original fracture was treated by bandaging. In the 9 recent cases the operation was done between the first and 12th day; the author asserting that the earlier the operation is performed the better. The author drains the parts during the first eight days, and places the limb in a splint. Thereafter any source of mobilization is removed, and slight movements of the limb are encouraged. The patient is allowed to step upon the limb three weeks after the operation. (In view of the recent researches and experiences of Riedel in rupture of the upper recess of the synovial cavity of the knee-joint and extravasation of synovia and blood in the intermuscular spaces, complicating fracture of the patella, some caution could be profitably employed in following the advice involved in the observation that "the earlier the suturing is done the better."-G. R. F.) THE TREATMENT OF SOFT GOITRE BY MEANS OF PARENCHYMATOUS V. Morsetig-Moorhof (Wiener med. Presse, 1890, No. 1; Centralblatt f. Chirurgie, 1890, No. 21). The author recommends injections of iodoform. He has treated every case of this variety of the disease coming under his notice by this means during ten years, and without exception favorable results have followed its employment. The injections should be made under the strictest antiseptic precautions. From I to 2, and at the most 4 grammes of the following solution should be employed at each sitting: The solution should be freshly prepared, of a light yellow color, and transparent. The injections should be made at intervals of from three to eight days, from five to ten injections being required according to the size of the tumors. But slight reaction is said to follow each injection, as a rule. The ultimate result of the case is not reached with the final injection, but the resorbent influence of the iodoform remains active for a long time; the primary reduction continues after discontinuance of the treatment until a cure results. SUTURE OF CLEFT-PALATE WITHOUT DIVISION OF THE MUSCLES. In Julius Wolff, Berlin (Centralblatt f. Chirurgie, No. 25, 1890). operations upon the soft palate it has heretofore been deemed of the greatest importance to provide against tension upon the parts by myotomy of the lateral palatine muscular structures. Contrary to the teachings of Dieffenbach, Fergusson and Langenbeck, W. declares that the structures comprising the soft palate are the most elastic in the entire organism, and by virtue of these qualities section of the muscles may be dispensed with. He operates as follows: Incisions are made in the usual manner in the hard palate along the alveolar border, to the posterior boundary of the latter. The muco-periosteal structures of the hard palate are now carefully loosened, first from the surface of the mouth and from the edges of the cleft in the hard palate, then from the posterior edge of the horizontal portion of the bony palate and from the neighboring pyramidal processes of the latter, in so far as may be required in order to approximate properly and easily the edges of the cleft in the median line, where they are sutured in the usual manner. Since October, 1889 (less than a year), W. has operated ten times in this manner, and with uniformly favorable results. In not a single instance was there performed section of the muscles. In these cases there occurred an improvement in the speech considerably in advance of that which follows ordinarily, and this is attributed by the author to the fact that the muscular structures were not interfered with. Even in Billroth's procedure (chiselling off of the pterygoid process) there is some interference with the muscular attachments, which, according to W., may be avoided by the method herein suggested. A NEW METHOD OF TREATMENT OF PNEUMOTHORAX FOLLOWING PENETRATING WOUNDS OF THE CHEST WALL. O. Witzel, Bonn (Centralblatt f. Chirurgie, No. 28, 1890). tion is called to the extreme dangers arising from attempts to remove the air from the cavity of the chest in this class of cases on the one hand, and the risks of setting up suppurative inflammation, should it be permitted to remain, on the other. W. recommends the following course: A large male rubber catheter is passed into the wound and the latter firmly sutured about the same until the opening is both air and water tight, with the exception of a point left open for the escape of the air. The catheter is connected with the nozzle of an irrigator, and the cavity of the chest slowly filled with a weak boric acid solution, of the temperature of the body, the air escaping from the point of opening above mentioned. By lowering the irrigator, after the chest is filled and the air cases to escape, the fluid is siphoned out, the air exit being at the same time held tightly closed and the catheter removed, while a number of temporary sutures, previously placed upon either side of the catheter, are drawn tightly together and tied. OLD FRACTURES OF THE PATELLA. M. Chaput (Thèse de Paris, 1889; Centralblatt f. Chirurgie, No. 18, 1890). The author makes five divisions of this class of cases : 1. Consolidation of the fragments by bone or a short fibrous tissue connecting band. 2. Consolidation by bone or a short fibrous connection, and considerable lengthening of the patella. a short but easily stretched fibrous connecting band. fibrous connecting band from two to four cm. long. fibrous connecting band from five cm. long and upwards. 3. Cure, with 4. Cure with a 5. Cure with a The treatment of these various types will depend not so much upon the particular anatomical conditions found as upon the amount and kind of functional disturbance present. Durin the first year following the injury, the author insists upon the use of baths, douches, massage and electricity, to the exclusion of operative measures. Should the extension be interfered with, bony suture should be employed. In case of interference with flexion the treatment must be directed according to the particular injury which governs the functional disturbance. In the fourth division, according to C, the removal of the upper fragment will be a rational procedure, as well also as in those cases in the second division in which fibrous union has occurred. In cases in which bony union has taken place, and in which also extension is interfered with, removal of the entire patella is recommended. In the third division only extension is interfered with, and the question of bony suture will only arise. That the extirpation of the entire patella does not interfere materially with the function of the limb has been shown by C. by a series of experiments upon dogs. |